Академический Документы
Профессиональный Документы
Культура Документы
and other
Communication Disorders
by:
Mary V. Andrianopoulos, Ph.D.
Summary of Motor Speech
Disorders
• Problems w motor programming and
planning:
– Apraxia of Speech
• Problems with motor execution
– Dysarthrias
– (categories of dysarthrias pending location of
lesion + associated symptoms)
Apraxia of Speech
• Motor programming, planning problem of
voluntary speech acts
• Dominant hemisphere for language
– Apraxia of speech
• Not due to weakness or paralysis
• Left triangularis + opercularis area usu
involved
– Frontal lobe
Other types of apraxias…
• Inability to carry out voluntary motor acts
for certain tasks in the absence of weakness,
paralysis, or sensory loss
– Dressing
– Construction
– Ideomotor
– Ideational
– Limb
Summary of Dysarthrias
• Supratentorial Problems or Dysarthrias
– Spastic: Bilateral UMN
– Unilateral UMN: unil UMN Æ contralateral
– Hypokinetic Æ BG
– Hyperkinetic Æ BG
• Rhythmic vs. arythmic involuntary movements
• Fast vs. slow movements
– Mixed DysarthriaÆ multifocal
Summary of Dysarthrias
• Infratentorial Problems
– Ataxic: Cerebellar
– Flaccid: FCP-LMN (ipsilateral symptoms)
• Cranial Nerve specific
• Cr. VÆ motor Jaw (sensory mouth)
• Cr. VIIÆ motor face (sensory tongue + face)
• Cr. IXÆ motor pharynx, (Senosry gag + pharynx)
• Cr. X Æ motor VFs, larynx (sensory VFs + larynx)
• Cr. XIÆ motor shoulders (sensory)
• Cr. XIIÆ motor tongue
Aphasias
• Acquired language impairment
• Categorized by location of lesion
• Types of errors:
– Fluent vs. non-fluent
– Grammatic vs. agrammatic
– Problems with expression vs. comprehension
Differential Diagnosis of the Aphasias
• Broca’s: agrammatic
– (pars triangularis Æ ~L-Frontal)
• Transcortical motor: (~L-subcortical/frontal)
– Broca’s like with preserved repetition
• Global: (~L-perisylvian area)
– poor comprehension with minimal expression
Classification of Aphasia: Fluent
• Wernicke’s: poor comprehension (~L-superior temporal)
– neologisms (jargon)
– semantic + phonemic paraphasias
• Transcortical sensory: (~L-frontal + parietal)
– Wernicke’s-like with preserved repetition
• Conduction: (~L-supramarginal gyrus)
– Impaired repetition
• Anomic: word-finding deficit (~L-angular gyrus)
• Transcortical Mixed: Global-like, good repetition
– (~L-Frontal + parietal)
The Agnosias
• Impairment to recognize a stimulus
– Visual agnosia:
• sees object, but can’t recognize it
– Auditory agnosia:
• hears sound, but can’t recognize it
– Tactile agnosia (astereoagnosia),
• feels, but can’t recognize by touch
Agnosias:
usually due to bilateral cortical lesions
Disorders of recognition involving a sensory
modality (with no loss of sensory function).
– Prosopagnosia: can’t recognize people
– Anosoagnosia: can’t recognize one’s own illness
– etc.
Other neurological cognitive-linguistic
based problems
• alexia: reading problems
• agraphia: writing problems
– Alexia with agraphia: L-inferior parietal lobe
– Alexia without agraphia:
• L-medial occipital + medial temporal lobes
• Splenium of corpus callosum
Right Hemisphere Dysfunction
constellation of symptoms
• Peri-linguistic problems
• Verbosity of Speech, tangential responses
• Poor comprehension of idioms, sarcasm, double-meanings,
and relevant vs. non-relevant details
• Aprosodia: expressive + receptive
• Anosoagnosia
• Auditory Agnosia, music agnosia
• Prosopoagnosia
• Visuo-Spatial Disorientation, poor recall non-verbal
material
• Left neglect (not L-homonymous hemianopsia)
• Dressing apraxia
Left neglect sample
Dementia
• Generalized cognitive decline due to
generalized or diffuse disease processes
• Can co-exist with other cognitive-linguistic
and para-linguistic impairments.
• Unremitting deterioration of the following:
– Memory
– Perception
– Language
– Executive functions
– Personality
Forms of Dementia
• Progressive:
– Parkinson’s Disease (PD): subcortical, SN
– Alzheimer’s Disease (AD):
• Hippocampus + bilateral parietal + temporal
– Lewy Body Disease: frontal + temporal, BG
– Frontotemporal Dementia (FTD): Temporal > Frontal
– Huntington’s Disease: subcortical, BG
• Non-Progressive:
– Vascular Disease: multiple infarcts
– Herpes simplex viral encephalitis: bi-temporal
Dementia: cognitive + memory problems
• Cognitive Symptoms:
– Depends on location, etiology, progression
• Memory Problems:
– i.e., Alzheimer’s Disease: persistent + episodic
• Anterograde + retrograde decline
• Yet, procedural relative strength
– i.e., Parkinson’s Disease: procedural memory declines
• Final stages for many dementias:
– Little meaningful output, often mute
• Communication breakdown Æ social isolation +
depression
Impairment of Executive Functions:
“Dysexecutive Syndrome”
• Impairment in one or more of the following:
– Goal-directed behavior
– Inability to initiate or stop action
– Anticipate outcomes
– Adaptation to changing environments
– Form concepts + think abstractly
• Executive functions are high level:
– Influence other basics: attention, memory,
motor skills
Executive Functions of Speech + Language
and associated breakdowns
• Inhibition:
– ability to suppress a habitual response
• Intentionality:
– creation + maintenance of goal directed behavior +
insight of concept
• Executive memory:
– recalling events in correct order
• Positive + negative affect:
– behaviors related to emotion and personality
(Alderman et al., 1998)
Breakdown in Inhibition
– Suppressing problems
– Impulsivity
– No concern for other’s feelings
– No concern for social rules
– Disinhibition
– Impaired abstract reasoning
– Restlessness
Breakdowns in Intentionality:
• Planning problems
• Poor decision making
• Lack of insight
• Distractability
• Dissociation of knowing + doing
Breakdowns in Memory
• Variable motivation
• Aggression
• Euphoria
• Shallow affect
• Apathy
Examples of Disorders affecting
Executive Functions (Elliot, 2003)
• Alzheimer’s Disease
• AIDs-dementia complex
• Subcortical vascular disease
• Psychiatric + antisocial disorders
– Depression, schizophrenia
• TBI
• Korsakoff Syndrome
• Obsessive-Compulsive Disorders
• Tourette’s Syndrome
• Attention Deficit/Hyperactivity Disorders
• Autism