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Assessment

Wernicke's Aphasia can be difficult to diagnose as the symptoms can be mistaken as a confused state due to stroke or blunt force trauma. In order for Wernicke's Aphasia to be diagnosed a complete language examination, especially of the auditory system, must be done. There are various diagnostic tests and measures done to determine whether a patient should be diagnosed with Wernicke's Aphasia.

Some examples of these assessments can be seen below:

• Formal screening and bedside tests of aphasia are shorter examinations that determine the presence or absence of Aphasia. Some examples of these tests are the: Bedside Evaluation Screening Test, Second Edition (BEST-2; Fitch-West & Sands, 1998), the Aphasia Screening Test (AST; Whurr, 1996), and the Quick Assessment for Aphasia (Tanner & Culbertson, 1999).

• Once a physician determines that aphasia is a possible diagnosis more comprehensive evaluations are done to determine the type of aphasia. These assessments are standardized Aphasia test batteries and include the: Boston Diagnostic Aphasia Examination (BDAE-3; Goodglass et al., 2000), the Porch Index of Communicative Abilities (PICA; Porch, 1981), and the Western Aphasia Battery (WAB; Kertesz, 1982).

• In order to diagnose a patient with Wernicke's Aphasia auditory comprehension should be assessed thoroughly because it is one of the most effected areas. Auditory comprehension can be assessed using the Functional Auditory Comprehension Test (FACT; LaPointe & Horner, 1978), the Revised Token Test (McNeil & Prescott, 1978) and through real-life conversations with patients.

• In addition to the aforementioned tests reading comprehension and written language can be used to indicate the presence of Wernicke's Aphasia, although there are limited standardized assessment devices in this area.

During assessment clinicians evaluate the patient's initial functioning and performance on the above tasks to form a baseline for treatment. This baseline can help them decide what type of treatment they can use and compare client's future progress with their initial abilities.

Treatment

Patients often don't seek treatment due to their Anosognosia and therefore lack of awareness that they could benefit from therapy [9]. This apparent lack of concern surrounding their symptoms needs to be addressed before treatment can be initiated. In order for the treatment to be helpful patients need to be cooperative and engaged in their therapy. Because each case of Wernicke's Aphasia presents itself differently the treatment options are varied and use multiple techniques. Speech-language pathologists work to create therapeutic programs that are functional and effective for Wernicke's Aphasia patients. The patient's likelihood and prognosis of recovery is dependent upon their severity of symptoms and whether they maintained any auditory comprehension abilities. Across Wernicke's patients auditory comprehension deficits and poor self-monitoring must be initially addressed so that the patient can participate in language-based activities.

Comprehension Training

Comprehension deficits as well as issues of pressure of speech can be improved through comprehension training. Comprehension training confronts the issues of Pressure of speech by redirecting patients attention to listening rather than speaking. In this training the clinician will stop the patient from speaking while listening to a stimulus through the use of gestures and reminders. The comprehension tasks used in this training involve the patient listening to short, context-dependent instructions given by a clinician and initially responding by pointing to an object or picture. These tasks become gradually more difficult as therapy continues.and using the clinicians contextual cues (facial expressions and gesture). The main goal of this therapy is to increase enhance patient's attention towards incoming information while simultaneously slowing and monitoring his or her own speech output.

Schuell's Stimulation

Schuell's stimulation is a well known treatment and most effective at the present time. This treatment involves introducing the patient to strong, controlled, and intensive auditory stimulation. This immersion into intensive auditory stimulation is believed to increase neuronal firing causing an increase in neural activation. This neural activation is used as a facilitator to increase brain reorganization and therefore recovery of language in the patient.

Redistribution of brain activation allows uninjured parts of the brain, such as the frontal and right hemisphere to compensate for the injuries found in Wernicke's area. Many studies have found that when doing comprehension tasks the average person shows activation in Broca and Wernicke's areas in the left hemisphere of the brain with little activation in the right hemisphere. In contrast a patient with Wernicke's Aphasia shows activation in the left hemisphere of their brain providing evidence that aphasia patient's neuroplasticity plays a role in the recovery.

Social Approach

The social approach involves clinician's and patient's collaboration to determine goals for therapy and functional outcomes that can improve everyday the patient's everyday life. This therapy takes a conversational approach where conversation is thought to provide patients with opportunities of growth and development for using strategies to overcome barriers to communication.The main goals of this treatment are to improve patient's conversational confidence and skills. In order to reach this goal many approaches are taken to improve including: conversational coaching, supported conversations, and partner training.

1. Conversational coaching involves aphasic patients and their SLPs, who serve as a "coach" discussing strategies to approach various communicative scenarios. The "coach" will help the patient develop a script for a scenario (such as ordering food at a restaurant), and help the patient practice and perform the scenario in and out of the clinic while evaluating the outcome.
2. Supported conversation also involves using a communicative partner who supports the patient's learning by providing contextual cues, slowing their own rate of speech, and increasing their message's redundancy to promote the patient's comprehension.
3. Promoting Aphasics Communicative Effectiveness (PACE) encourage conversation outside the clinic.

Successful treatment incorporates these various treatment programs and approaches to facilitate patient's learning. In order to reduce logorrhea, press and rate of speech, patient's self-monitoring needs to be improved. In order to improve self-monitoring SLPs will slow their own rate of speech, pausing between meaningful segments and encourage patients to do the same, slowing down their own speech, listening to themselves speak and monitoring their speech output.

It is also important to include patient's families in treatment programs so they can have speaking partners where they communicate the most, at home. Clinicians can teach family members how to support one another an adjust their speaking patterns to further facilitate their loved ones treatment and rehabilitation.

2- short and meaningful messages, increasing redundancy, exaggerating gestures, and facial expressions to facilitate auditory compprehension

For this reason, therapists often use a contextual approach which can increase speech comprehension from 2% to 90%.[10]

Causes

Receptive aphasia is traditionally associated with neurological damage to Wernicke’s area in the brain,[6] (Brodmann area 22, in the posterior part of the superior temporal gyrus of the dominant hemisphere). Since Wernicke's area is responsible for "reading, thinking of what to write, and processing information", that is where we see many of the deficits associated with damage to this area. [7] However, the key deficits of receptive aphasia do not come from damage to Wernicke's area;[6] instead, most of the core difficulties are proposed to come from damage to the medial temporal lobe and underlying white matter. Wernicke's aphasia results from damage in the posterior one-third of the superior gyrus of the temporal lobe of the left hemisphere. Damage in this area not only destroys local language regions but also cuts off most of the occipital, temporal, and parietal regions from the core language region.[8]

Edits for Gesture in Language Acquisition

I will be working with Mikailaperrino (talk) and Cait ash (talk) to change this student essay into a Wikipedia page. In order to do this we will be separating this essay into sections. I will be working on the introduction and deictic gestures.

Introduction

I will be creating a proper introduction to this topic introducing why gestures are important to language acquisition as well as defining the different types of gesture using the book Hand and Mind: What Gestures Reveal About Thought by David McNeill.

Deictic Gestures

I will be further defining deictic gestures and their influence on language acquisition looking specifically at joint attention and the acquisition of two word phrases. In order to do this I will be looking at articles by Kovacs et al., Legerstee & Barillas, Iverson, Capirci and Caselli, and Iverson et al.