1. CODI 508: Aphasia in Adults
Hope to help you differentiate efficacious from poor practice.

2. Questions?

3. What is Aphasia?

4. Etiological Aspects of Brain Damage resulting most often in Focal Lesions
Cerebrovascular Accidents
Intracranial Aneurysm
Arterio-Venous Malformation
Neoplasms
Infections
Poisons
Anoxia
Cerebral Edema
Trauma

5. Etiological Aspects of Brain Damage resulting most often in Focal Lesions
Cerebrovascular Accidents (CVAs)
Cerebral Thrombosis
Cerebral Embolism
Cerebral Hemorrhage
Subarachnoid Hemorrhage
Transient Ischemic Attack (TIA)

6. Cerebrovascular Accidents (CVAs) Thromboembolic Lesion
Cerebral Thrombosis – obstruction at the site
Cerebral Embolism – sudden blocking brought to site via blood stream

7. Cerebrovascular Accidents (CVAs) Hemorrhage
Cerebral Hemorrhage – Rupture of one of the Cerebral vessels
Subarachnoid Hemorrhage – Vessel rupture in subarachnoid space

8. Cerebrovascular Accidents (CVAs) Intracranial Aneurysm
Dilation of the wall of the artery
Variable in size Hematoma
May be pulsing tumor or may burst

9. Hemorrhage Cranial Dura Mater

10. Several Hemorrhagic Effects
Often due to arteriosclerotic tissue
May Cause Hematoma
Destroys and displaces tissue
Often tracks along white matter pathways
Cause severe compression and distortion of brain tissue
Acute Subdural Hematoma
Intracranial Hematoma
Herniation is Problem
Subfalcine
Lateral Transtentorial
Central Transtentorial
Tonsillar

11. Arterio-Venous Malformation
Venous and arterial systems are gnarled and malformed
Tend to leak
Usually superficial
Congenital

12. Neoplasms Identified by tissue origin
Glial Tumors (Glioblastoma, Astrocytoma, Oligodendroglioma)
Meningeal Tumors (Meningioma)
Nerve Sheath Tumors (Schwannoma, Neurofibroma)

13. Infections Abcess due to Infection Streptococcus Fungal Infection
Pneumoniae
Numerous causes
Result in fever above 104o – typically deprives brain of oxygen (adults)
May cause anoxia

14. Poisons
Result in metabolic Problems
May result in Anoxia

15. Anoxia Lack of oxygen…can cause generalized cortical loss
Strangulation
Electric Shock
Hanging
Drowning
Cardiac Arrest
Drug Overdose
Alcohol Overdose

16. Social and Psychological Aspects of Aphasia

17. Social and Psychological Aspects of Aphasia
Issues for IWA & Family:
Anxiety
Depression
Emotional Lability
Inadequate Judgment
Under-estimation of Ability
Development of Self-limiting belief system

18. Lezak’s “Coping Hypothesis”
Perplexity Distractibility Fatigue
BIG 3

19. Lezak’s “Coping Hypothesis”
Secondary Five
Irritability
Tendency to Obsessive
/Compulsive Traits
Social Withdrawal
Depression
Anxiety

20. Impact on Families: Overall Observations
Burden does not seem to improve may even grow worse over time
Key is family cohesion and available perceived support
High correlation between depression and family coping
Severe financial hardship
Poor social life
More depression/anxiety in female spouses
Feeling of Burden & Alienation
Often results in troubled family interactions

21. Impact on Children: Observations
Greatly impacts relationship with parents
Complex adaptive problems due to sequelae such as:
Communicative Difficulty
Depression
Social Withdrawal
Irritability
Children may experience behavioral change:
Poor & Eroding Relationship w/ IWA
Acting out behavior
Emotional Problems

22. What do we have to do? Assist Family with:
Acceptance of Changing Expectations
Acquiring Information
Maintaining Hope
Dealing with Social Isolation

23. RECOVERY

24. Recovery Pattern A Restricted View
Spontaneous Recovery
Decelerating Curve
Steepest During first month post-onset
Flattening out 2nd & 3rd months
Still rising 6 to 9 months
Months Post Onset (MPO)

25. Recovery Pattern Expanded View
From social perspective change can/will continue since we are looking at social dyad
Compensations from IWA
Compensations from Partner

26. What we have Learned as Possible Solutions