Communication after a Stroke Aphasia and Apraxia of Speech

Topics to cover Aphasia Apraxia Definition Incidence/Prevalence Characteristics Assessment Measures Treatment Support Definition Causes Characteristics Assessment Measures Treatment Support

What is Aphasia? Aphasia is an acquired neurogenic language disorder resulting from an injury to the brain, most typically the left hemisphere, that affects all language modalities (ASHA, 2015). Stroke is the most common cause of aphasia and apraxia; however, it can also be diagnosed after a lesions or trauma to the brain.

Incidence and Prevalence- Aphasia Approx 35-40% of patients who suffer a stroke are diagnosed with some form of aphasia. (Dickey et al., 2010; Pedersen, Jorgensen, Raaschou, & Olsen, 1995). It is estimated that there are 80,000 new cases of aphasia per year in the United States (National Stroke Association, 2008). The National Institute of Neurological Disorders and Stroke (NINDS) estimates that approximately 1 million people, or 1 in 250 in the United States today, suffer from aphasia (NINDS, n.d.).

Aphasia A language disorder resulting in the difficulty to communicate and understand language. The four modalities of language Listening comprehension Reading comprehension Verbal expression Writing expression Affects on language, not on intellect

Language centers Arcuate fasiculus (language loop)

Types of Aphasia Wernicke’s Broca’s Decreased auditory comprehension Fluent Aphasia Most associated with Apraxia Decreased verbal expression Non-Fluent Aphasia Slow, halting, effortful speech

Wernike – Geshwind Model (The Brain from Top to Bottom) A word is heard processed in your auditory cortex Wernike’s area (links with a word in your memory) word is now associated with a meaning A word is read processed by your visual cortex sent to Wernike’s and again is linked with memory A word is read aloud originates from the “dictionary” in Wernike’s gets looped to Broca’s area in order to be pronounced planning articulators motor cortex for speech movement A word is spoken

Characteristics of Aphasia Listening Comprehension Decreased understanding Unreliable Y/N Reading Comprehension Alexia: loss in ability to recognize letters, words, etc. Writing Expression Agraphia: loss in the ability to communicate by writing Verbal Expression Word finding: Anomia Paraphasias perseverative, phonemic, verbal, neologistic etc. Phonemic: “speep” for “speech” Verbal: “garbage” for “garage”

Assessment Measures - Aphasia Screening versus Comprehensive assessment Standardized Testing BDAE (Boston Diagnostic Aphasia Examination) WAB (Western Aphasia Battery Non-Standardized Testing Observational methods

Treatment (ASHA, 2015)

Aphasia support For information on organizations, research and clinical trials St. Luke’s Stroke club Academy of Neurologic Communication Science and Disorders Aphasia Hope National Aphasia Association Stroke Association Emotional aspects of a stroke, and loss of communication

What is Apraxia of Speech? - Adults Apraxia of speech is a motor disorder that is a result of vascular lesion in the left subcortical region. The inability for volitional movement of the speech articulators. It is not muscle weakness.

Apraxia Disconnect between the words in the brain, and how to form the movements of those speech sounds. Limited research on prevalence and incidence. Often co-morbidities such as dysarthria (muscle weakness) or aphasia (language disorder).

Characteristics of Apraxia Groping – most often with initiation Slowed pace Limited or no usable speech Difficulty performing “non-speech” tasks upon request Awareness and frustration Inconsistent errors

Causes of Apraxia Acquired versus Developmental Adult is acquired

Assessment Measures - Apraxia Diagnosed by a speech-language pathologist after informal and formal testing procedures Speech sample in conversation Oral mechanical examination Motor speech evaluation Apraxia vs Dysarthria

Treatment for Apraxia Three steps Planning Sequencing Muscle coordination (slow rate, pacing) Retraining the brain. Make new connections. Repetitive practice. Gestures Guess my communicative intent Writing AAC Alphabet boards Picture boards Speech isn’t just speech

Treatment of Apraxia Melodic Intonation Therapy (MIT) PROMPT – involving tactile cues for articulators Minimal pairs imitation Key word approach Phonetic placement Practice, practice, practice

Apraxia support For information on organizations, research and clinical trials St. Luke’s Stroke club National Institute of Neurological Disorders and Stroke National Institute of Deafness and other Communication Disorders

References Aphasia and the Brain (2015). Wernike and Broca History. Image retrieved January 11, 2015 from http://aphasia-and-brain.tumblr.com/post/45124007874/wernicke-and-broca-history The Brain from Top to Bottom (2015). Broca’s Area, Wernike’s Area, and other Language-Processing Areas in the Brain. Retrieved January 11, 2015 from http://thebrain.mcgill.ca/flash/d/d_10/d_10_cr/d_10_cr_lan/d_10_cr_lan.html National Institute on Deafness and Other Communication Disorders (2015). Apraxia of Speech. Retrieved January 11, 2015 from http://www.nidcd.nih.gov/health/voice/pages/apraxia.aspx National Institute of Neurological Disorders and Stroke (2015). Apraxia Information Page. Retrieved January 11, 2015 from http://www.ninds.nih.gov/disorders/apraxia/apraxia.htmhttp:// The Stroke Comeback Center, VA. Williamson, Darlene M.S., CCC-SLP. Adult Acquired Apraxia of Speech: Principles, Practice and Technology. Retrieved January 11, 2015 from www.ohioslha.org/pdf/Convention/2012%20Handouts/NeuroSC18F.pdf

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