Aphasia Patterns
Fluent speech + poor comprehension suggests what aphasia type?
Wernicke's Aphasia
Most common artery involved in aphasia?
MCA - Middle Cerebral Artery
In RHD, speech may sound normal but communication is impaired. Why?
Pragmatics affected - cognitive communication challenges impact communication
Name ONE participation barrier caused by aphasia.
Avoids conversations, social withdrawal, avoiding friend groups, stops attendance at social gatherings
A 72-year-old woman is 1 month post left MCA stroke with nonfluent aphasia. Her spouse reports she has stopped attending weekly church gatherings because conversations “move too fast.” Name a participation level barrier and why it occurs for her.
Participation barrier: Social withdrawal / Reduced community participation
Reason: Slow speech production / Difficulty keeping pace with conversation
Nonfluent speech + intact comprehension + impaired repetition?
Broca's Aphasia
A patient experiences impaired executive function, decision making, self monitoring, and contralateral leg weakness following a stroke with which artery?
ACA - Anterior Cerebral Artery
What does the GCS measure? What does it tell us in regards to their communication?
Level of consciousness -eye opening, verbal response, and motor.
*Prognosis (more severe worse prognosis)
Why is documentation important for therapy justification?
Shows medical necessity/functional impact as well as progress
A patient demonstrates increasing repetition of questions, getting lost in familiar places, and difficulty managing finances. Speech remains fluent but with occasional word-finding pauses. What is the most likely cause and prognosis?
Alzheimer's Disease - degenerative so poor overall prognosis as it will continue to decline
Severe impairment across fluency, comprehension, and repetition
Global Aphasia
A patient experiences speech and language impairments, reading/writing issues, contralateral face/arm weakness, sensory loss
MCA - Middle Cerebral Artery
What does Ranchos measure? How is this different from GSC?
Measure patterns of cognitive and behavioral recovery following brain injury. Looks at level of awareness, Attention and responsiveness, Ability to follow commands, Behavior and agitation, Insight into deficits, Ability to learn new information.
Name one internal recovery factor.
Motivation, insight to deficits, education level prior to injury, attention, memory, and executive functioning abilities, Emotional regulation, Depression or anxiety status, confidence
A patient presents with gradually worsening word-finding difficulty over two years. Episodic memory remains relatively intact, and the patient continues to independently manage finances and daily routines. What is most likely the cause and prognosis?
Primary Progressive Aphasia - degenerative so poor overall prognosis as it will continue to decline
Fluent speech + intact comprehension + impaired repetition
Conduction Aphasia
A stroke involving which artery may lead to visual field deficits?
PCA - Posterior Cerebral Artery
Why might reduced insight impact therapy success?
Reduced carryover/generalization - reduced engagement
Name one external recovery factor.
Living environment, family support, social support network, Access to therapy services, Transportation access, Cultural or community support, Work or school accommodations
A patient with moderate aphasia lives alone and has limited family involvement following discharge home. Name one prognostic concern.
Reduced practice opportunities, Safety concerns, Poor carryover.
Nonfluent, effortful speech, Intact repetition; Difficulty initiating speech; reduced verbal output; Good comprehension
Transcortical Motor Aphasia
Explain the difference between Fluent and Nonfluent Aphasia - give hallmarks for each
Nonfluent - Speech is effortful and reduced word finding, pausing, halting, short phrases, frustration (aware)
Fluent - smooth and normal prosody, normal phrase length - nonsense words, lacks meaning (unaware usually)
Explain ONE key difference between aphasia and cognitive-communication disorders and give ONE example of how each may appear in conversation.
Aphasia - Language impairment due to LH damage (word finding, compression, reading, writing) ex: word finding, fluency,
Cognitive/comm - Communication impacted by cognition (attention, memory, pragmatics, exec func) ex: loses topic, tangential speech
Why might a patient perform well on structured naming tasks but struggle in conversation?
Executive function/cognitive communication demands
A patient with mild aphasia attempts to communicate during meals, but family members frequently finish sentences for him to “help.” What is a participation level barrier and how may this impact the patient?
Reduced independence, Learned nonuse, Decreased confidence