Zorgtraject verworven spraak en taal –
logopedisch deel
Prof. Maaike Vandermosten – 2024-2025
DEEL 1: AFASIE ...................................................................................................................................5
Introductie .............................................................................................................................................5
Definitie ..........................................................................................................................................5
Prevalentie en incidentie ..................................................................................................................5
Oorzaken afasie ..............................................................................................................................5
Evidence based practice ..................................................................................................................6
Geschiedenis van afasie ..................................................................................................................7
Broca, Wernicke Lichtheim ..............................................................................................................7
Samenvatting ..................................................................................................................................8
Taxonomieën van subtypes .....................................................................................................................9
Terminologie ...................................................................................................................................9
Classificatie van voornaamste afasietypes ...................................................................................... 10
Kritiek classificatie afasietypes ...................................................................................................... 10
Types afasie .................................................................................................................................. 11
Samenvatting ................................................................................................................................ 14
Neurolinguïsch model .......................................................................................................................... 16
Structuur ...................................................................................................................................... 16
Taalverwerkingsmodellen .............................................................................................................. 16
Dubbele dissociaties ..................................................................................................................... 16
Taalverwerking op woordniveau...................................................................................................... 17
A: Symptomen afasie ................................................................................................................. 17
B: Begrip gesproken woorden...................................................................................................... 17
C: Woordproductie .................................................................................................................... 21
D: Model gesproken woordproductie en -begrip ........................................................................... 24
E: Lezen .................................................................................................................................... 24
F. Schrijven................................................................................................................................ 27
G. Gehele model ........................................................................................................................ 29
Taalverwerking op zinsniveau ......................................................................................................... 31
A. Symptomen afasie ................................................................................................................. 31
B. Representatie van werkwoorden ............................................................................................. 31
C. Stoornis in de representaties werkwoorden ............................................................................. 31
D. Auditief zinsbegrip ................................................................................................................. 31
E. Stoornissen in zinsbegrip ........................................................................................................ 32
1
, F. Mondelings zinsproductie ....................................................................................................... 32
G. Stoornissen in produceren van zinnen ..................................................................................... 33
H. Model ................................................................................................................................... 33
Assessment ......................................................................................................................................... 34
Afasie assessment ............................................................................................................................ 34
Psychometrie formele test ............................................................................................................. 34
Do and don’t: assessment ............................................................................................................. 35
Assessment: concrete toepassingen .................................................................................................. 35
Structuur: ..................................................................................................................................... 35
1. Screening .............................................................................................................................. 35
2.1 Stoornisgericht onderzoek .................................................................................................... 38
2.2 Stoornisgericht onderzoek .................................................................................................... 43
2.3 Functionele communicatietests ............................................................................................ 44
Analyses van Spontane Taal bij Afasie (ASTA) ...................................................................................... 46
Functionele communicatietest .......................................................................................................... 46
Quality of Life (QoL) .......................................................................................................................... 47
Welke testen in versch herstelfasen? ................................................................................................. 48
Therapie .............................................................................................................................................. 50
Rol van logopedist ............................................................................................................................ 50
Voorlichten en begeleiden omgeving .................................................................................................. 51
Gerichte therapie .............................................................................................................................. 52
Therapeutische opties ................................................................................................................... 52
Fasen in de therapie (Springer) ....................................................................................................... 52
Therapie in acute fase .................................................................................................................... 53
Algemene benaderingen binnen de afasietherapie .............................................................................. 54
Auditief begrip ............................................................................................................................... 54
Low-level auditief-fonologische training .......................................................................................... 56
Fonologisch systeem: FIKS ............................................................................................................ 57
Semantisch systeem ..................................................................................................................... 58
Woordvindingsproblemen .............................................................................................................. 59
Woordvindingsproblemen – semantisch ......................................................................................... 60
Woordvindingsproblemen – fonologisch ......................................................................................... 61
Woordvindingsproblemen – fonologische vs semantische therapie? ................................................. 63
Speech entrainment ...................................................................................................................... 65
Verb Network Strengtening Treatment (VNeST) en morfo-syntaxis ..................................................... 66
Lezen en schrijven ......................................................................................................................... 68
Trainen van specifieke modules...................................................................................................... 69
Algemene benaderingen binnen de afasietherapie .............................................................................. 70
2
, Verbale conversatietraining ........................................................................................................... 70
Muziek/ritme georiënteerde benadering .......................................................................................... 70
Psycho-sociale/ functionele behandelingen .................................................................................... 71
Effect van afasietherapie (niet echt in detail kennen) ........................................................................... 72
Effectmetingen.............................................................................................................................. 72
Therapie in acute fase .................................................................................................................... 74
Het einde van de therapie .............................................................................................................. 74
Beëindigen van afasiebehandeling .................................................................................................. 74
Onbeantwoorde vragen ................................................................................................................. 74
Aanbevelingen NVAT en NVLF ........................................................................................................ 74
Informeren van kinderen ................................................................................................................ 74
DEEL 2: DYSARTRIE ........................................................................................................................... 75
Karakteristieken ................................................................................................................................... 75
Prevalentie ................................................................................................................................... 75
Definitie ........................................................................................................................................ 75
Neurale basis spraakproductie....................................................................................................... 76
Classificatie en types ........................................................................................................................ 81
Slappe (flaccid) dysartrie ............................................................................................................... 83
Spastische dysartrie ...................................................................................................................... 84
Atactische dysartrie....................................................................................................................... 85
Hypokinetische dysartrie (te weinig aan bewegingen) ....................................................................... 85
Hyperkinetische dysartrie (te veel aan bewegingen) ......................................................................... 86
Unilateral Upper Motor Neuron dysartrie (UUMN) ............................................................................ 86
Gemengde dysartrie ...................................................................................................................... 87
Anartrie: locked-in syndroom ......................................................................................................... 88
Samenvatting ................................................................................................................................ 88
Assesment .......................................................................................................................................... 89
Protocol dysartrie ............................................................................................................................. 89
Doelstellingen .................................................................................................................................. 89
Gegevensverzameling ....................................................................................................................... 90
Therapie .............................................................................................................................................. 96
Behandeling dysartrie ....................................................................................................................... 96
Opstellen behandelplan .................................................................................................................... 96
Behandeling dysartrie ....................................................................................................................... 96
Principes motorisch leren .................................................................................................................. 96
Behandeling dysartrie ....................................................................................................................... 98
Instrumentele aanpak (protheses en hulpmiddelen) ............................................................................ 98
Gedragsmatige logopedische interventie ........................................................................................ 98
3
, Behandeling ademhaling ............................................................................................................ 98
Behandeling fonatie ................................................................................................................... 99
Behandeling resonantie ............................................................................................................ 100
Behandeling articulatiestoornissen ........................................................................................... 102
Behandeling spreeksnelheid (‘rate’) .......................................................................................... 103
Evidence-based practice ................................................................................................................. 103
Gebruik van non-spraak taken?........................................................................................................ 104
Behandeling dysartrie ..................................................................................................................... 104
Verbeteren vd verstaanbaarheid ............................................................................................... 104
Verbeteren vd begrijpbaarheid .................................................................................................. 105
Communicatie georiënteerde therapie ............................................................................................. 105
Spraakondersteunende technieken ................................................................................................. 105
Gebruik van ondersteunende communicatie (AAC) ........................................................................... 108
Coaching rol v logopedist ................................................................................................................ 108
DEEL 3: APRAXIE ............................................................................................................................. 109
Karakteristieken ................................................................................................................................. 109
Spraakapraxie ................................................................................................................................ 109
Definitie en symptomen .................................................................................................................. 109
Normale spraakproductie ......................................................................................................... 109
Definitie spraakapraxie ............................................................................................................. 110
Ernstgraden ............................................................................................................................. 111
Prevalentie en etiologie ............................................................................................................ 111
Neuro-anatomische locatie ...................................................................................................... 111
Andere vormen v apraxie .......................................................................................................... 112
Assesment ........................................................................................................................................ 113
Spraakapraxie ................................................................................................................................ 113
Beschrijvende diagnostiek ........................................................................................................ 113
Differentiële diagnostiek........................................................................................................... 114
4
logopedisch deel
Prof. Maaike Vandermosten – 2024-2025
DEEL 1: AFASIE ...................................................................................................................................5
Introductie .............................................................................................................................................5
Definitie ..........................................................................................................................................5
Prevalentie en incidentie ..................................................................................................................5
Oorzaken afasie ..............................................................................................................................5
Evidence based practice ..................................................................................................................6
Geschiedenis van afasie ..................................................................................................................7
Broca, Wernicke Lichtheim ..............................................................................................................7
Samenvatting ..................................................................................................................................8
Taxonomieën van subtypes .....................................................................................................................9
Terminologie ...................................................................................................................................9
Classificatie van voornaamste afasietypes ...................................................................................... 10
Kritiek classificatie afasietypes ...................................................................................................... 10
Types afasie .................................................................................................................................. 11
Samenvatting ................................................................................................................................ 14
Neurolinguïsch model .......................................................................................................................... 16
Structuur ...................................................................................................................................... 16
Taalverwerkingsmodellen .............................................................................................................. 16
Dubbele dissociaties ..................................................................................................................... 16
Taalverwerking op woordniveau...................................................................................................... 17
A: Symptomen afasie ................................................................................................................. 17
B: Begrip gesproken woorden...................................................................................................... 17
C: Woordproductie .................................................................................................................... 21
D: Model gesproken woordproductie en -begrip ........................................................................... 24
E: Lezen .................................................................................................................................... 24
F. Schrijven................................................................................................................................ 27
G. Gehele model ........................................................................................................................ 29
Taalverwerking op zinsniveau ......................................................................................................... 31
A. Symptomen afasie ................................................................................................................. 31
B. Representatie van werkwoorden ............................................................................................. 31
C. Stoornis in de representaties werkwoorden ............................................................................. 31
D. Auditief zinsbegrip ................................................................................................................. 31
E. Stoornissen in zinsbegrip ........................................................................................................ 32
1
, F. Mondelings zinsproductie ....................................................................................................... 32
G. Stoornissen in produceren van zinnen ..................................................................................... 33
H. Model ................................................................................................................................... 33
Assessment ......................................................................................................................................... 34
Afasie assessment ............................................................................................................................ 34
Psychometrie formele test ............................................................................................................. 34
Do and don’t: assessment ............................................................................................................. 35
Assessment: concrete toepassingen .................................................................................................. 35
Structuur: ..................................................................................................................................... 35
1. Screening .............................................................................................................................. 35
2.1 Stoornisgericht onderzoek .................................................................................................... 38
2.2 Stoornisgericht onderzoek .................................................................................................... 43
2.3 Functionele communicatietests ............................................................................................ 44
Analyses van Spontane Taal bij Afasie (ASTA) ...................................................................................... 46
Functionele communicatietest .......................................................................................................... 46
Quality of Life (QoL) .......................................................................................................................... 47
Welke testen in versch herstelfasen? ................................................................................................. 48
Therapie .............................................................................................................................................. 50
Rol van logopedist ............................................................................................................................ 50
Voorlichten en begeleiden omgeving .................................................................................................. 51
Gerichte therapie .............................................................................................................................. 52
Therapeutische opties ................................................................................................................... 52
Fasen in de therapie (Springer) ....................................................................................................... 52
Therapie in acute fase .................................................................................................................... 53
Algemene benaderingen binnen de afasietherapie .............................................................................. 54
Auditief begrip ............................................................................................................................... 54
Low-level auditief-fonologische training .......................................................................................... 56
Fonologisch systeem: FIKS ............................................................................................................ 57
Semantisch systeem ..................................................................................................................... 58
Woordvindingsproblemen .............................................................................................................. 59
Woordvindingsproblemen – semantisch ......................................................................................... 60
Woordvindingsproblemen – fonologisch ......................................................................................... 61
Woordvindingsproblemen – fonologische vs semantische therapie? ................................................. 63
Speech entrainment ...................................................................................................................... 65
Verb Network Strengtening Treatment (VNeST) en morfo-syntaxis ..................................................... 66
Lezen en schrijven ......................................................................................................................... 68
Trainen van specifieke modules...................................................................................................... 69
Algemene benaderingen binnen de afasietherapie .............................................................................. 70
2
, Verbale conversatietraining ........................................................................................................... 70
Muziek/ritme georiënteerde benadering .......................................................................................... 70
Psycho-sociale/ functionele behandelingen .................................................................................... 71
Effect van afasietherapie (niet echt in detail kennen) ........................................................................... 72
Effectmetingen.............................................................................................................................. 72
Therapie in acute fase .................................................................................................................... 74
Het einde van de therapie .............................................................................................................. 74
Beëindigen van afasiebehandeling .................................................................................................. 74
Onbeantwoorde vragen ................................................................................................................. 74
Aanbevelingen NVAT en NVLF ........................................................................................................ 74
Informeren van kinderen ................................................................................................................ 74
DEEL 2: DYSARTRIE ........................................................................................................................... 75
Karakteristieken ................................................................................................................................... 75
Prevalentie ................................................................................................................................... 75
Definitie ........................................................................................................................................ 75
Neurale basis spraakproductie....................................................................................................... 76
Classificatie en types ........................................................................................................................ 81
Slappe (flaccid) dysartrie ............................................................................................................... 83
Spastische dysartrie ...................................................................................................................... 84
Atactische dysartrie....................................................................................................................... 85
Hypokinetische dysartrie (te weinig aan bewegingen) ....................................................................... 85
Hyperkinetische dysartrie (te veel aan bewegingen) ......................................................................... 86
Unilateral Upper Motor Neuron dysartrie (UUMN) ............................................................................ 86
Gemengde dysartrie ...................................................................................................................... 87
Anartrie: locked-in syndroom ......................................................................................................... 88
Samenvatting ................................................................................................................................ 88
Assesment .......................................................................................................................................... 89
Protocol dysartrie ............................................................................................................................. 89
Doelstellingen .................................................................................................................................. 89
Gegevensverzameling ....................................................................................................................... 90
Therapie .............................................................................................................................................. 96
Behandeling dysartrie ....................................................................................................................... 96
Opstellen behandelplan .................................................................................................................... 96
Behandeling dysartrie ....................................................................................................................... 96
Principes motorisch leren .................................................................................................................. 96
Behandeling dysartrie ....................................................................................................................... 98
Instrumentele aanpak (protheses en hulpmiddelen) ............................................................................ 98
Gedragsmatige logopedische interventie ........................................................................................ 98
3
, Behandeling ademhaling ............................................................................................................ 98
Behandeling fonatie ................................................................................................................... 99
Behandeling resonantie ............................................................................................................ 100
Behandeling articulatiestoornissen ........................................................................................... 102
Behandeling spreeksnelheid (‘rate’) .......................................................................................... 103
Evidence-based practice ................................................................................................................. 103
Gebruik van non-spraak taken?........................................................................................................ 104
Behandeling dysartrie ..................................................................................................................... 104
Verbeteren vd verstaanbaarheid ............................................................................................... 104
Verbeteren vd begrijpbaarheid .................................................................................................. 105
Communicatie georiënteerde therapie ............................................................................................. 105
Spraakondersteunende technieken ................................................................................................. 105
Gebruik van ondersteunende communicatie (AAC) ........................................................................... 108
Coaching rol v logopedist ................................................................................................................ 108
DEEL 3: APRAXIE ............................................................................................................................. 109
Karakteristieken ................................................................................................................................. 109
Spraakapraxie ................................................................................................................................ 109
Definitie en symptomen .................................................................................................................. 109
Normale spraakproductie ......................................................................................................... 109
Definitie spraakapraxie ............................................................................................................. 110
Ernstgraden ............................................................................................................................. 111
Prevalentie en etiologie ............................................................................................................ 111
Neuro-anatomische locatie ...................................................................................................... 111
Andere vormen v apraxie .......................................................................................................... 112
Assesment ........................................................................................................................................ 113
Spraakapraxie ................................................................................................................................ 113
Beschrijvende diagnostiek ........................................................................................................ 113
Differentiële diagnostiek........................................................................................................... 114
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