Additional Aphasias

**The following are considered “exceptional aphasias,” as they do not fit neatly within this or other common classification systems. **

Crossed Aphasia- Occurs when a person demonstrates language impairment after suffering damage to the hemisphere on the dominant side of the body, rather than the alternate side. Thus, a right handed person who develops aphasia following a right hemisphere stroke exhibits crossed aphasia. Crossed aphasia can be classified into 2 basic types; one is the “mirror image type” and the other is the “anomalous type”. The former is similar to typical left brain damage aphasic profiles and the latter is similar to typical left brain damage profiles in addition to being crossed.

Subcortical Aphasia- results from damage to subcortical regions of the brain (e.g., thalamus or basal ganglia), and symptoms can mirror those that arise from cortical lesions.

Primary Progressive Aphasia (PPA)—despite its name—is a type of dementia. It is characterized by gradual loss of language function in the context of relatively well-preserved memory, visual processing, and personality until the advanced stages.

Alexia- Reading comprehension difficulties.

Agraphia- Written expression difficulties.

https://www.asha.org/practice-portal/clinical-topics/aphasia/#collapse_2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309387/pdf/arm-35-949.pdf

https://www.asha.org/siteassets/practice-portal/aphasia/common-classifications-of-aphasia.pdf

Assessment Information

Standardized/ Norm-Referenced Tests

ERRORS IN SPOKEN LANGUAGE EXPRESSION

• Having difficulty finding words (anomia)

• Speaking haltingly or with effort

• Speaking in single words (e.g., names of objects)

• Speaking in short, fragmented phrases

• Omitting smaller words like the, of, and was (i.e., telegraphic speech)

• Making grammatical errors

• Putting words in the wrong order

• Substituting sounds or words (e.g., “table” for bed; “wishdasher” for dishwasher)

• Making up words (e.g., jargon)

• Fluently stringing together nonsense words and real words, but leaving out or including an insufficient amount of relevant content

SPOKEN LANGUAGE COMPREHENSION IMPAIRMENTS

• Having difficulty understanding spoken utterances

• Requiring extra time to understand spoken messages

• Providing unreliable answers to “yes/no” questions

• Failing to understand complex grammar (e.g., “The dog was chased by the cat.”)

• Finding it very hard to follow fast speech (e.g., radio or television news)

• Misinterpreting subtleties of language (e.g., taking the literal meaning of figurative speech such as “It's raining cats and dogs.”)

• Lacking awareness of errors

ERRORS IN WRITTEN EXPRESSION -AGRAPHIA

• Having difficulty writing or copying letters, words, and sentences

• Writing single words only

• Substituting incorrect letters or words

• Spelling or writing nonsense syllables or words

• Writing run-on sentences that don't make sense

• Writing sentences with incorrect grammar

ERRORS IN READING COMPREHENSION- ALEXIA

• Having difficulty comprehending written material

• Having difficulty recognizing some words by sight

• Having the inability to sound out words

• Substituting associated words for a word (e.g., “chair” for couch)

• Having difficulty reading noncontent words (e.g., function words such as to, from, the)

ENVIRONMENTAL AND PERSONAL FACTORS

• Affects of impairment on the quality of life

• Social/family support structure

• Patient goals

STRUCTURAL AND FUNCTIONAL IMPAIRMENTS

• Flaccidity / Spasticity

• Co-morbidity

• Hemiparesis/ Anosognosia/ Neglect

Aphasia (asha.org)

IMPORTANTANT FACTORS

• The outcome of aphasia varies significantly from person to person

• The most predictive indicator of of long -term recovery is initial aphasia severity

• Site of the lesion and size

• Factors that may negatively affect improvement include poststroke depression and social isolation after onset of aphasia

STASTISTICS

• 180,000 new cases of aphasia per year in the United States

• Approximately 1 million people, or 1 in 250 in the United States today, are living with aphasia.

• Aphasia after stroke is more common for older adults than younger adults

• Fifteen percent of individuals under the age of 65 experience aphasia after their first ischemic stroke; this percentage increases to 43% for individuals 85 years of age and older

• Wernicke's aphasia and global aphasia occur more commonly in women

• Broca's aphasia occurs more commonly in men

Aphasia (asha.org)

**Narrative Writing in patients with dementia is one of the most common assessment methods for assessing a patients’ writing capabilities. The goal is to have the patient write a sentence, or a description of a picture. These two different methods have been proven to show where patients have the biggest areas of impairment.

**The National Adult Reading Test (NART) is the most commonly used assessment to determine premorbid ability. For the NART, it is an oral reading test that consists of 50 single-words. The words are considered irregular words, such as chord, because they do not follow standard grapheme-phoneme rules. The purpose of using irregular words is to remove the guesswork of creating the correct production because it promotes and forces the patient to tap into previous knowledge.

(Nelson, National Adult Reading Test)

Differential Diagnosis

Treatment

Auditory comprehension impairment treatment

Schuell's STIMULATION APPROACH: Language system not lost/destroyed (it is uncoordinated/reduced efficiency. Idea is to build on what the client has in their disposal and make that work best)

• Mapping Therapy: Address asyntactic comprehension impairments (common in Broca's aphasia and effective for nonfluent/mixed aphasia) Patient struggles with syntantic structures (e.g., subject/object) and semantic structures (agent/theme);

  • • • • Target sentence typically read or spoken

        • Have client ID the action and verb

        • Have client ID the person or the agent

        • Have client ID the person or the theme (ID can include pointing to the word, writing it out or verbally stating)

Work to improve the client's abiltiy to map the syntactic and the sematic to increase comprehension of sentences.

• Pointing Drills: Drill with a field of pictures or objects- have Client hear the word of item then point and repeat.

• Following direction/commands: One-step to multistep; to add complexity use temporal, locative, conditional phrases, descriptive specifics

• y/n Questions: Simple: Personal and general knowledge questions VS. Complex: Semantics discriminatory questions (e.g.,"do you cook with a hammer?") .

• Sentence/phrase completion: "cloze procedure": Verbal demand involving production and lexical retrieval to complete sentence. Use simple common phrase or sentences with predictable answers. Complexity: vary topic, word frequence level, number of words in the sentence.

• Open-ended questions & retelling: Client must have good verbal production with mild - moderate auditory comprehension impairment to use this treatment. (e.g., read paragraph, describe scenario- use personal relevance or interest, then ask open-ended questions to retell the story or ask client to retell the story/information.

Bridges, K. (2021)

Reading and Writing In Aphasia