1. 1. Rehabilitation _Speech R
2. 2.
3. 3.
4. 4. 75 (97-1-54) 1. transcortical motor aphasia 2. transcortical sensory aphasia 3. motor aphasia 4. sensory aphasia
5. 5. fluent paraphasia repetition naming (97-2-60) 1. frontal lobe 2. temporal lobe 3. parieto-occipital lobe 4. angular gyrus
6. 6. conduction aphasia (102-1- 57) 1. arcuate fasciculus 2. basal ganglion 3. Broca 4. Wernicke
7. 7. (102-1-69) 1.Wernicke 2. conduction aphasia 3.Broca 4. transcortical aphasia
8. 8. agrammatic expression apraxia aphasia (99-2-70) 1. Brocas aphasia 2. Wernikes aphasia 3. global aphasia 4. anomic aphasia
9. 9. aphasia (98-1-69) 1. preservation 2. effort 3. naming 4. telegraphic speech
10. 10. aphasia (repetition) (102-2-57) 1. Broca 2. Wernicke 3. conduction 4. transcortical
11. 11. 1. middle cerebral artery main stem global aphasia 2. 3. crossed aphasia 4. anomic aphasia
12. 12. Crossed Aphasia lesion in the right hemisphere in a right-handed individual. Occurs in 1-2% of all aphasias, and characterised by confusion, memory and attention defects, and personality change (in addition to the usual language deficits). Agrammatism is common, but comprehension and naming tend to be preserved.
13. 13. dysprosody articulatory inconsistency (101-2-70) 1. Wernickes aphasia 2. Brocas aphasia 3. articulation disorder 4. apraxia of speech
14. 14. apraxia of speech (99-1-69) 1. dominant hemisphere 2. 3. motor planning 4. automatic speech purposeful speech
15. 15. Apraxia of speech(AOS) neurogenic communication disorder affecting the motor programming system for speech production. By the definition of apraxia, AOS only affects volitional(willful or purposeful) movement patterns, however in AOS usually also automatic speech is affected
16. 16. Stroke-associated AOS is the most common form of acquired AOS, making up about 60% of all reported acquired AOS cases. Individuals with acquired AOS demonstrate hallmark characteristics of articulation and prosody (rhythm, stress or intonation) errors.
17. 17. Apraxia of speech the following five speech characteristics that an individual with apraxia of speech may exhibit: Effortful trial and error with groping Self correction of errors Abnormal rhythm, stress and intonation Inconsistent articulation errors on repeated speech productions of the same utterance Difficulty initiating utterances
18. 18. apraxia (103-1-59) 1. 2. 3. 4.
19. 19. Transcortical sensory TS or Wenickes TM or Brocas Brocas Brocas Angular gyrus Arcuate fasciculus
20. 20. Dysphagia
21. 21. Oral phase dysphagia!!
22. 22. heart burn food sticking (101-2-55) oral stage oral preparatory stage pharyngeal stage esophageal stage
23. 23. (102-2-69) 1. oral phase 2. pharyngeal phase 3. esophageal phase 4. nasal phase
24. 24. (100-2-68) 1. 2. swallowing reflex 3. epiglottis 4. cricopharyngeal muscle
25. 25. (99-2-69) 1.Videofluorographic swallowing study 2.Chest X-ray 3.Brain MRI 4.Laryngoscopy
26. 26. dysphagia (96-1-70) 1. fiberoptic endoscopic examination of swallowing 2. videofluorographic swallowing study 3. oropharyngeal reflex test 4. electromyographic examination of laryngeal muscles
27. 27. swallowing reflex test: SaO2 > 90% / 3 / 2 ml 3 2~4ml 5~9ml 10 ml hyoid elevation cough voice gagling
28. 28. : , : ( (thin liquid) (thick liquid) (paste) X : : X
29. 29. : , : : ,
30. 30. dysphagia (95-1-72) 1. 2. 3. 4. brain-stem stroke
31. 31. Dysphagia (difficulty swallowing) has an overall prevalence of 25 65% in stroke patients: 67% of brainstem strokes 28% of all left hemispheric strokes 21% of all right hemispheric strokes More common in bilateral hemisphere lesions than in unilateral hemisphere lesions. More common in large-vessel than in small-vessel strokes. Delayed pharyngeal swallow is the most common cause (Veis, 1985).
32. 32. dysphagia (94-1-94) 1. chin tuck 2. turning the head to the stronger side 3. tilting the head toward the affected side 4. neck extension
33. 33.
34. 34.
35. 35. A. B. C. D.
36. 36. (102-2-68) 1. 2. thoracic dysphagia 3. Mendelsohn maneuver 4. more than 50 muscles sequential excitation and inhibition
37. 37. Compensatory Strategies Chin tuck: provides airway protection by preventing entry of liquid into the larynx Head rotation: Turn the head to the paretic side. Head tilt: uses gravity to guide bolus into ipsilateral pharynx.
38. 38. Compensatory Strategies Supraglottic swallow: concomitant breath holding and swallowing closes the vocal folds to protect the trachea. Super supraglottic swallow: adds Valsalva maneuver to maximize vocal fold closing. Mendelsohn maneuver: patient voluntarily holds the larynx at its maximal height to lengthen duration of cricopharyngeal opening.
39. 39. (93-2-36) 1. 2. 3. 4.
40. 40. (voice disorder)? (103-1-71) 1. (dysphonia) 2. (apraxia) 3. (dysarthria) 4. (aphasia)