CD0658- CH10

Description:	Exam #2
Category:	Speech Therapy
Created by:	Melanie.Stutler on 2009-05-12

Question	Answer
Definitions and Etiologies of Acquired Aphasia: Definition	 Language disorder stemming from disease or accident that alters neurological functioning after a period of normal language development
Definitions and Etiologies of Acquired Aphasia: Etiologies	 Focal lesions: Confined to specific areas of brain resulting from penetrating injuries such as gunshot, stroke, hemorrhage, tumors  Diffuse lesions: Spread throughout brain resulting from traumatic brain injuries or poisoning
Characteristics of Traumatic Brain Injury	Diminished or altered state of consciousness Impaired cognition Impaired physical functioning Disturbance of emotional and behavioral functioning Temporary or permanent impairments Partial or total functional and/or psychosocial maladjustment
Causes and Incidence of Traumatic Brain Injury	 Infants and Toddlers: falls and abuse  Preschoolers: falls  School-aged children: sports, accidents (bikes, MVA)  Adolescents: accidents (MVA)  Incidence  K – 12th grade: 4%  Special Education: 8% – 20%
Glascow Coma Scale	Eye opening Motor responses Verbal responses Severity ratings 13 – 15 mild brain injury 9 – 12 moderate brain injury Predictive of death/poor outcome but doesn’t correlate with level of future difficulties
Acquired aphasia: Strokes, Tumors	 Uncommon in children vs. adults  1/3 occur during birth to 2 years  Cerebral hemorrhages create risk for reoccurrence
Acquired aphasia: LKS	 Landau-Kleffner Syndrome  Low incidence  Convulsive disorder (seizures)  Indicated by abnormal EEG
TBI, Landau-Kleffner Syndrome & CVA Characteristics	Fine/gross motor skills: TBI impacted, LKS not affected, CVA with hemiparesis. Cognitive skills: TBI impacted, LKS not affected, CVA with lower verbal vs. performance scores
TBI, Landau-Kleffner Syndrome & CVA Characteristics (2)	Perceptual motor skills: Visual disturbances for all etiologies but worse for TBI Behavior skills: Impacted in all etiologies; CVA least impacted Social skills: Impacted in all etiologies; TBI most impacted
Language development and recovery	Recovery rates 75% show dramatic recovery of language unrelated to recovery of motor function Associated seizure disorders reduce rate of recovery 25% + show residual aphasia and deficits in IQ & academic achievement testing one year post onset
Acquired aphasia: recovery	Toddlers/young children: best recovery Older children: TBI recovery similar to adults Aphasia secondary to seizures: better recovery at older ages Fluent aphasia: worse prognosis vs. non-fluent aphasia
Acute Recovery: Initial Three Months to One Year Post Onset-Comprehension	 Corresponds to severity of injury  Corresponds to complexity of information  Worse in KLS vs. TBI and CVA
Acute Recovery: Initial Three Months to One Year Post Onset-Word retrieval	 TBI: improves but persists 1 year post TBI  KLS: similar to language based LD
Acute Recovery: Initial Three Months to One Year Post Onset-Syntax	 TBI & CVA: reduced number of utterances, shorter MLU, fewer complex sentences, writing more impaired than speaking KLS: nearly mute
Acute Recovery: Initial Three Months to One Year Post Onset-Speech production	 TBI & CVA: dysarthria and dyspraxia  KLS: similar to children who are deaf
Later Recovery and Residual Language Impairments: TBI	 Higher level language deficits for narratives, verbal disorganization, difficulty with inferences and nonliteral meanings  Similar to adolescents with language impairment
Later Recovery and Residual Language Impairments: CVA	 Less elaborate language production; slower word retrieval but similar to typically developing children
Academic Achievement of Children with Acquired Aphasia: Academic problems	 May be placed in regular classroom settings  Achievement testing reveals difficulties for reading recognition (20%), reading comprehension (33%), spelling (55%), and arithmetic (85%)  Writing problematic for children with more severe TBI
Academic Achievement of Children with Acquired Aphasia: Metacognitive & metalinguistic problems	Limited self-awareness of comm. problems Poor planning of narratives Difficulty initiating conversation Problems inhibiting inappropriate remarks Failure to self-monitor conversations General self-evaluations Lack of flexibility for problem solving
Differences between Developmental and Acquired Language Disorders in Children	Reaccess premorbid abilits, compensate for lost abilits, acquiring new skills Differ in attitude, prof. of abilits. Prior: social/academic success concept of normality Problems with generalization, structuring, integration
Assessment of Children with Acquired Language Disorders : Hospital based	 Neurologist, physiatrist, pediatrician, neuropsychologist, SLP, OT, PT, MSW, RT, parent
Assessment of Children with Acquired Language Disorders: School based	SLP, psych, reg.ed., sped, OT, PT/adaptive PE, parent. Obtain info from sources Hospital records for inpatient, acute rehab, home health/out-patient SLP & services, Parent/teacher interviews, classroom observations, form/informal test
Assessment of Children with Acquired Language Disorders Formal Testing	 Cognitive/linguistic tests normed on children and adolescents with acquired aphasia  Assess cognitive issues such as attention span, memory, and executive functioning in addition to language functioning
Assessment of Children with Acquired Language Disorders Formal Testing	 Standardized language tests assess developmental language skills  Not normed on children with acquired aphasia so interpret with extreme caution  Useful to determine eligibility and compare to typically developing peers
Assessment of Children with Acquired Language Disorders Ross Information Processing Assessment – Primary	Normed on 115 children w/TBI, seizures,& LD ages 5;0–12;11 Ages 5–12 subtests: immed. memory, recent memory, spatial orient., recall of info Ages 8–12 subtests: temporal org, org, problem solving, abstract reasoning Standard scores and percentile ranks
Assessment of Children with Acquired Language Disorders Ross Information Processing Assessment (2nd Edition) RIPA-2 (1996)	Normed on 126 individuals with TBI ages 15 - 90 10 subtests: immediate memory, recent memory, temporal orientation for recent/remote mem, spatial orientation, orientation to environ, recall of info, problem solv/abstract reason, org, auditory process/ret
Assessment of Children with Acquired Language Disorders Formal Testing: Comprehensive	Comprehensive language testing CASL CELF-4 TOLD series (TOLD-P:4, TOLD-I:4, TOAL-4)
Assessment of Children with Acquired Language Disorders Formal Testing: Specialized	Specialized language testing LPT – 3 (Language Processing Test – 3) TOPS – A (Test of Problem Solving – Adolescent) TOPS – 3 (Test of Problem Solving – Elementary) TOPL (Test of Pragmatic Language
Assessment of Children with Acquired Language Disorders Informal Testing	Informal Testing  Language sampling and analysis  Narrative sampling and analysis  Performance differences in quiet versus noisy environments
Intervention of Children with Acquired Language Disorders	• TBI is an eligibility category for special education services
Intervention of Children with Acquired Language Disorders:	AC (augmentative and alternative communication) may be needed if the child’s speech is initially unintelligible or the child cannot speak• Recovery from TBI is often associated with aggression, impulsivity, disinhibition, antisocial behavior, withdrawal
Intervention of Children with Acquired Language Disorders: Intelligibility	• Associated dysarthria and apraxia can co-exist with TBI and aphasia.
Intervention of Children with Acquired Language Disorders:Developmental Versus Remedial Intervention	 Preschoolers: developmental model
Intervention of Children with Acquired Language Disorders: Early & middle stages	• Early Stages: modify environment and orient child
Intervention of Children with Acquired Language Disorders: Late stages	• Late Stages: compensatory strategy training, use of memory devices, deductive reasoning and problem solving, identifying major points, self-monitoring
Intervention of Children with Acquired Language Disorders Facilitative Versus Compensatory Intervention	Facilitative Versus Compensatory Intervention Restoration of function  Socialization/emotional support w/peers Instruction w/multi-modality cuing, self-monitoring, use of buddy Assistive devices Modify materials
SLP Cognitive/Linguistic Therapy Goals and Objectives	Goal: Improve memory skills  Immediate memory  Recent memory
Cognitive/Linguistic Therapy Goals and Objectives	) Goal: Improve orientation skills  Spatial  Temporal
SLP Cognitive/Linguistic Therapy Goals and Objectives	Goal: Improve higher level thinking skills  Problem solving  Abstract reasoning  Deductive reasoning
Intervention of Children with Acquired Language Disorders SLP Language Intervention	Goals and Objectives 1) Elementary school-aged child: same as for language and children with learning disabilities 2) Middle/high school aged child: same as for adolescents with language impairment
Intervention of Children with Acquired Language Disorders Transitioning to School	 SLP services initially provided in hospital setting (acute and acute rehabilitation) followed by home setting (home health) which are less demanding in areas of attention, concentration, and socialization
Intervention of Children with Acquired Language Disorders Prerequisites for return to school	 Attend for 10 – 15 minutes  Tolerate 20 – 30 minutes of classroom stimulation  Function in small groups  Engage in meaningful conversation  Follow simple directions  Demonstrate potential for learning new information