Aphasia Final
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| VA Cooperative Study (Wertz, 1981) | -Compared improvement of pts in group tx to improvement of pts in individual tx
-Both groups improved beyond the spontaneous natural covery period
-Both groups made significant improvement in lang skills
-Individual tx --> better improvement w/ PICA
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| Recovery patterns in aphasia by type (Kertesz & McCabe, 1977) | -Anomic aphasias recover fully
-Broca's & conductive aphasias --> best recovery rate
-Wernicke's aphasics --> little recovery w/ jargon; better recover without jargon
-Global aphasics --> poor recovery but evolution into different types
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| Prognostic factors (Basso, 1992) | -Age (young pts may do better than old pts)
-Personality (pleasant & cooperative)
-Initial severity
-Sparing of critical cortical region
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| Extent of recovery (Basso, 1992) | -Good for pts with anomia and conduction aphasia
-Fair for pts with Broca and Wernicke aphasia
-Poor for pts with global aphasia
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| Rate of recovery (Basso, 1992) | -Fast for pts with conduction & Wernicke aphasia
-Intermediate for pts with Broca
-Slow for pts with anomia and global aphasia
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| Overview of factors contributing to recovery (10) | 1. Age; 2. Personality; 3. Motivation; 4. Severity; 5. Handedness; 6. Time post-onset; 7. Social milieu; 8. General health; 9. Lesion size; 10. Lesion nature
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| Bilingual recovery patterns (Paradis, 1977) | -50% of bilingual aphasic recover in a synergetic pattern (i.e., both languages recover; may be PARALLEL or DIFFERENTIAL)
-27% selective recovery
-6% successive recovery
-4% antagonistic recovery
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| Ribot's and Pitre's rules | -Ribot's Rule --> L1 recovers first (rule of primacy)
-Pitre's Rule --> language most used at time of the injury (rule of recency)
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| Purpose of aphasia assessment | To determine what functions are lost and which functions are still there
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| Differences in the assessment tests | Nature of the tests may be research (i.e., extended version of Boston)
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| Three types of validity for standardized tests | -Predictive validity (Does it distinguish between normal and disordered?)
-Construct validity (Does performance on the test correlate with performance on another measure?)
-Content validity (Do the test items test what the assessment claims to test?)
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| Types of rating scales (and related issues) | -Mild/moderate/severe --> Subjective
-Pass/Fail --> Inadequatel not enough info
-Descriptions --> Impractical; too time-intensive
-Multidemensional --> BEST OPTION; but fewer options available
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| Ideal aphasia test attributes | -Minimizes the effects of intelligence/education to measure language
-Discriminates between normals/pts with aphasia/dementia
-Has internal consistency and comparability of scores
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| Severity Rating Scale | -Provides an estimate of the severity of impairment from 0 (No communication) to 5 (Normal comprehension/output)
-Estimated based on interactions w/ pt (prompts: "Tell me about your family", "How did you get here today?", etc.)
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| Rating Scale Profile of Speech Characteristics | 7 aspects of speech are ranked by examiner: 1. articulatory agility; 2. Grammatical form; 3. Paraphasias in running speech; 4. Melodic line; 5. Phrase length; 6. Word-finding; 7. Repetition and auditory comprehension
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| NCCEA Test | Norms for all ages; Includes tactile naming; Uses Scrabble pieces for testing graphic ability; LIMITATION: does not include spontaneous speech
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| Minnesota | Lacks disorder types
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| PICA stands for... | Porch Index of Communicative Ability
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| Pros of PICA (4) | Multidimensional scoring (1-16 scale); Ideal for plotting recovery; Precise (high inter-rater and test-retest reliability); Uses 10 common objects for homogeneity
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| Cons of PICA | Certified training required;
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| 3 areas of PICA | Verbal; Gestural; Graphic
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| Philosophy of PICA | There is a central language processing capability but SEVERAL input/output modalities
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| PICA standardization sample | 280 LH damage; 100 bilateral damage
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| Pros of Token Test | Very short; Very sensitive to auditory comprehension deficits (pts who perform well on other aphasia tests may falter on this test)
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| CADL | Measures functional communicative ability in simulated activities (e.g., receptionist, shipping, doctor's office, driving, making phone calls)
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| Raven's Progressive Matrices | Assesses intelligence/reasoning with lower verbal load (right brain lesions, TBI)
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| Cognitive Linguistic Quick Test (Nancy Helm) | Symbol cancellation, symbol trains (Executive function, attention- ability to pay attention to some symbols and discard others)
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| Issues with aphasia assessment in children | Rapidly increasing skills in children; Language variability at a given age; Plasticity and compensatory adjustment
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| Social worker | In charge of post-discharge planning
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| SLP's role during acute phase | Prevention of regression; Family reorientation
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| SLP's role during chronic phase | Promotion of restitution; Family participation
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| Information processing deficit due to brain damage | Slow rise time, noise buil-up, retention deficit
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| Response delay | Greatest response increment occurs in 3-5 seconds, with most within 10 seconds. More responses with meaningful/novel stimuli and natural contexts
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| Language Teaching vs. Language Facilitation | Aphasia tx is not teaching, only facilitation; Teaching implies that language has been lost but aphasia only impairs the use of language
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| Pros of response charting | Easy; Brief; Visual feedback; Retention of stimuli; % conversion of scores; criteria for termination
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| Ways to promote generalization | MENTAL IMAGERY
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| Propositional density | Amount of info (i.e., proposition count) divided by the # of words; Tells you how meaningful the utterance is; May be able to predict dementia
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| ABA Tx | Treatment; Nontreatment phase (until target behavior is stable); Repeat tx phase
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| Multiple Baseline Tx | A single tx applied sequentially to multiple behaviors
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| Alternating Tx | Two txs given in a single day and repeated in different order for several days
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| Pro-Activation | Exposure to difficult to name objects interferes with the ability to name easy to name items; Easy to name items facilitates naming of difficult to name items (priming effect)
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| Naming Contexts | Open-ended conversation is most effective; Response to pictures is less effective; Naming from verbal description is least effective
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| Compensated activation | Post-stroke right hemisphere activation; but RH-processing is an inadequate processing route; so optimal recovery is right hemisphere giving up activation in favor of the left hemisphere
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| PACE | Promotes opportunities to practice natural communicative behaviors; cl and cln participate equally
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| Melodic Intonation Therapy | Singing uses right hemisphere; 3 different levels
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| Visual Action Therapy | Visual communication system (manipulative objects, drawings, video, etc.); for pts whose early tx has focused on AAC
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