Aphasia

Aphasia is an acquired communication disorder resulting from damage to the brain, characterized by impairment in the production and/or comprehension of language across spoken, written, and signed modalities. It is not the result of sensory or motor deficits, a general intellectual deficit, confusion, or psychiatric disorder, but those can co-occur.
(Helm-Estabrooks, N. & Albert, M.L., 2004)

SYMPTOMS: possible symptoms include…

Verbal Expression Impairments:

  • difficulty finding words (anomia)
  • nonsense words/jargon
  • paraphasias/word errors
  • grammar errors/agrammatism
  • imprecise language/cirumlocution
  • speaking with effort or haltingly

Auditory Comprehension Impairments:

  • difficulty understanding spoken utterances
  • providing unreliable answer to “yes/no” questions
  • failing to understanding complex grammar (e.g., The dog was chased by the cat.)
  • lacking awareness of errors.

Reading Comprehension Impairments: (Alexia)

  • difficulty comprehending written material
  • difficulty recognizing some words by sight
  • inability to sound out words
  • substituting associated words for a word
  • difficulty reading noncontent words (e.g., function words such as to, from, the).

Written Language Impairments: (Agraphia)

  • difficulty writing or copying letters, words, and sentences
  • writing single words only
  • substituting incorrect letters or words
  • spelling or writing nonsense syllables or words

ASSESSMENT:

Assessment Areas

  • Verbal Expression:
    • articulation agility
    • phrase length/fluency
    • prosody
    • grammatical form (syntax use)
    • substantive/functor word ratio
    • paraphasias (word errors)
      • literal/phonemic [the letters/sounds are wrong or switched around]
      • semantic [saying the wrong word]
        • within category (related words) vs. remote (words that are not related)
      • neologistic [jargon]
    • perseveration
      • stuck-in-set [stuck in a response mode]
      • continuous [inappropriate prolongation of a behavior]
      • recurrent [inappropriate re-occurrence of a previous response]
        • semantic
        • lexical
        • program of action
        • phonemic carryover
  • Auditory Comprehension
    • processing of spoken language
    • understanding at the word, phrase, sentence, and paragraph levels
    • concrete vs. abstract
    • understanding of directions, commands, questions, common objects
  • Graphic Expression
    • assess written words and drawings
    • writing skills of words, phrases, sentences, and paragraphs
    • functional writing skills
    • copying
    • writing to dictation
    • concrete vs. abstract
  • Reading Comprehension
    • what symbols can the client understand?
    • comprehension of letters, words, phrases, sentences, paragraphs, pages, books
    • functional reading
  • Cognition
    • orientation
    • social communication
    • memory
  • Motor Speech
    • apraxia
      • may co-exist with people with Broca’s aphasia
      • oral apraxia
        • groping or visual searching behavior
          • non-speech oral movements
      • apraxia of speech
        • groping, visual searching of speech oral movements
  • Limb Apraxia
    • difficult with producing gestures
    • OTs will focus more specifically on limb apraxia

Interview Questions 

  • Tell me about your stroke/story.
  • How has your stroke affected your daily life?
  • When do you have the most difficulty communicating?
  • What are you able to do well?
  • Are there strategies that you have found most helpful?
  • How do you interact with others on a daily basis?

Formal Tests

  • .Aphasia Diagnostic Profiles (ADP)
  • Aphasia Language Performance Scales (ALPS)
  • Bedside Evaluation and Screening Test of Aphasia- second edition (BEST-2)
  • Boston Assessment of Severe Aphasia (BASA)
  • Boston Diagnostic Aphasia Examination (BDAE)
  • Cognitive Linguistic Quick Test (CLQT)
  • Communication Activities of Daily Living (CADL)
  • Examination for Aphasia: Assessment of Aphasia and Related Impairments- third edition (EFA-3)
  • Minnesota Test for Differential Diagnosis of Aphasia (MTDDA)
  • Multilingual Aphasia Examination- third edition (MAE-3)
  • Porch Index of Communicative Ability (PICA)
  • Reading Comprehension Battery for Aphasia- second edition (RCBA-2)
  • Sklar Aphasia Scale
  • Test of Adolescent/Adult Word Finding (TAWF)
  • Western Aphasia Battery (WAB)
  • Woodcock Reading Mastery Tests- Revised (WRMT-R)

Alternative Assessment Measures

  • Verbal Expression
    • describing a picture
    • conversational language sample
    • confrontation naming task for picture and real objects
  • Auditory comprehension
    • 1-2 step commands
    • series of Yes/No questions
    • identifying objects from a field of two
  • Graphic Expression
    • automatic writing (name, address, etc.)
    • filling out a form
    • copying words
  • Reading Comprehension
    • reading/answering yes/no questions
    • matching sentences with pictures
    • reading commands
  • Repetition
    • words, phrases, sentences

Initial Treatment Goals

  • The client will improve verbal retrieval skills for naming everyday objects and activities with 60% accuracy with minimal clinician cueing.
  • The client will increase her auditory comprehension for moderately complex sentences/ 3-step commands with 70% accuracy and moderate clinician cueing.
  • The client will use interviewing script and other functional scripts with 80% accuracy and no clinician cueing to work towards returning to work.
  • The client will improve his reading comprehension at the paragraph level by retelling paragraphs with 70% accuracy and minimal to no clinician cueing.

CLIENT & FAMILY EDUCATION:

  • http://www.asha.org/public/speech/disorders/FamilyAdjustmentAphasia/
    • This webpage, provided by the American Speech-Language-Hearing Association, provides information for the family of someone who has acquired aphasia. The page includes common worries that come along with having a loved one with aphasia, changes that the family and persons with aphasia may experience, and the common needs of the family. Coping strategies for the family, as well as communication strategies of talking with persons with aphasia are included within the webpage.
  • http://www.strokecenter.org/patients/caregiver-and-patient-resources/aphasia-information/
    • This websites provides information about strokes, including information about aphasia, to patients and their families. The page includes a basic overview of the definition of aphasia, who acquires aphasia, how someone may acquire aphasia, the diagnosis and the treatment of aphasia. It also provides tips for the family members to better communicate with the persons with aphasia.
  • http://patients.aan.com/resources/neurologynow/?event=home.showArticle&id=ovid.com:/bib/ovftdb/01222928-201107030-00016
    • This webpage is for patients and family members to give a basic understanding of strokes and aphasia. It includes typical definitions of aphasia, as well as the importance of speech therapy, the emotional impact that is often associated with aphasia, what caregivers can do to help the persons with aphasia, and tips for the person with aphasia. The website also stresses the importance of staying positive throughout therapy and the whole experience.

PROFESSIONAL MATERIALS & RESOURCES:

  • http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934663&section=Treatment
    • This webpage, provided by the American Speech-Language-Hearing Association, provides information for SLPs regarding aphasia. It includes the definition of aphasia, the incidence and prevalence, signs and symptoms to be aware of, and causes of aphasia. It also addresses the role and responsibility of the SLP, as well as assessing aphasia and treating aphasia.
  • Helms-Estabrooks, N., Albert, M.L. (2004). Manual of aphasia and aphasia therapy  (2nd ed.). Austin: PRO-ED, Inc.
    • This textbook provides information for SLPs about aphasia. The information in the textbook includes anatomy, diagnosis, and treatment for aphasia. The text also provides other sources for further research into the different aspects of aphasia.
  • https://aalfredoardila.files.wordpress.com/2013/07/ardila-a-2014-aphasia-handbook-miami-fl-florida-international-university2.pdf
    • The aphasia handbook provides, in great depth, information about aphasia. The handbook includes basic information about aphasia, including the history, etiologies, and the linguistic analysis of aphasia. IT also describes the different types of aphasias and other disorders that often accompany aphasia, including alexia and agraphia. The handbook describes associated disorders in aphasia, aphasia within different populations, assessing aphasia, and the recovery, prognosis, and rehabilitation of aphasia.

REFERENCES:

Haynes, W. O., & Pindzola, R. H. (2012). Diagnostics and evaluation in speech pathology (8th ed., pp 215-237). Pearson.

(1997–2014) American Speech-Language-Hearing Association (ASHA)

SPAUD 506: Aphasia notes; Heather Koole (Calvin College)

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