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Block 8 week 4 > After the Stroke - Brancamp > Flashcards

After the Stroke - Brancamp Flashcards

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1
Q

What is cerebral plasticity?

A

The brain’s potential for reassigning to a different brain region functions that are lost when brain tissue is damaged. This diminishes with age.

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2
Q

Why is the severity of the persisting consequences of brain injury increased with age?

A

Because cerebral plasticity decreases with age.

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3
Q

Describe some characteristics of aphasia.

A
  1. is neurogenic
  2. is acquired
  3. involves language problems
  4. is not a problem of sensation, motor function or intellect
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4
Q

What is Aphasia?

A

An impairment of the ability to comprehend and formulate language; a multi modality disorder represented by a variety of impairments in auditory comprehension, visual and reading comprehension, oral-expressive language and writing.

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5
Q

Aphasia is not…….?

A
  1. a disturbance of articulation
  2. a product of mutism
  3. a product of aphonia
  4. language disorder experienced in altered states of awareness
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6
Q

What is aphonia?

A

Lack of ability to phonate sound at the level of the vocal cord or larynx.

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7
Q

What is dysarthria?

A

A collective name for a group of speech disorders resulting from disturbances in muscular control over the speech mechanism due to damage of the CNS or PNS. It designates problems in oral communication due to paralysis, weakness or incoordination of speech musculature.

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8
Q

What is apraxia?

A

A neurogenic speech disorder resulting from impairment of the capacity to program sensorimotor commands for positing and movement of muscles of the volitional production of speech. It can occur without significant weakness or neuromuscular slowness and in the absence of disturbances of conscious thought or language.

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9
Q

What is agnosia?

A

lack of knowing

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10
Q

What is dyscalculia?

A

Impaired ability to do math.

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11
Q

What is alexia/dyslexia?

A

Impairment in reading.

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12
Q

What is agraphia?

A

Impairment in writing.

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13
Q

Where is Broca’s area (area 44)?

A

Inferior frontal lobe.

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14
Q

Describe the pathway when someone hears something spoken and then formulates a reply.

A

Info comes into Wernickes area (mostly on the left side) and then it goes through the arcuate fascicles to broca’s.

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15
Q

Condiction aphasia is a problem with what structures?

A

The arcuate fasciculus.

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16
Q

What is the function of Broca’s area?

A

Motor programming for articualtion.

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17
Q

What is the function of the pre central gyrus for language?

A

Activation of muscles for articulation.

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18
Q

What is the function of the arcuate fasciculus in language?

A

Transmission of linguistic info to anterior areas from posterior areas.

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19
Q

What is the function of Wernickes area for language?

A

Comprehension of oral language.

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20
Q

What is the function of the angular gyrus in language?

A

Integrates visual, auditory, and tactile info and carries out symbolic integration for reading. Located in the left parietal lobe.

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21
Q

What is the function of the supra marginal gyrus in language?

A

Symbolic integration for writing.

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22
Q

What is the function of the corpus callosum in language?

A

Transmission of information between the hemispheres.

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23
Q

What is PWA and what are some characteristics of it?

A

Posterior Wernicke’s Aphasia.
A person with aphasia (PWA) produces some speech, or even abundant speech, which does not conform to the grammatical rules of the language being used
Errors include omission of words, erroneous choice of words, errors in word order.
During the first hours or days of onset, the aphasic person may not produce speech, but most will attempt to communicate by gesture or facial expression.

24
Q

A person with PWA has difficulty with what?

A

A PWA often has difficulty comprehending a purely verbal command.
Verbal messages through auditory or visual means without gestures, facial expressions or emotional intonation.
Errors range from almost complete inability to comprehend a simple command to mild deficits with complex sentences.

25
Q

Does a person with PWA have awareness of their environment?

A

A PWA is aware of self and environment (they are not confused, demented or psychotic), has an appropriate level of awareness.
He/she is intent on communicating thoughts regarding his/her condition and environment.
Exceptions are possible during the first few hours after acute infarcts and late in the chronic stages for a few.

26
Q

General characteristics of speech fall into what two general categories?

A

FLUENT – approximates normal speech in terms of the rate of word production, length of sentences, melodic intonation, and ease in speaking [9+ words/utterance]
NONFLUENT-rate is slow, sentence length is short, melodic contour is lost, production is effortful, may be more pauses than actual words. [0-5 words/utterance].

27
Q

What is an utterance?

A

A group of words that is said on one breath.

28
Q

What are some signs of aphasia?

A

Failure to repeat words or sentences is a hallmark of aphasia; ability may be completely lost or characterized by phonemic paraphasias or omissions of sounds/words.
Presence of impaired repetition has localization value – perisylvian region of the dominant hemisphere

29
Q

Give an example of a phonemic paraphasia.

A

A phenome is a sound disruption. For example saying boy when you wanted to say toy.

30
Q

Where is the zone of language in the brain?

A

In the perisylvian region.

31
Q

Describe some disturbances of auditory comprehension that may occur with aphasia.

A

Ability to decode auditory input
Auditory comprehension rarely preserved in aphasia
Deficits can range from inability to understand:
single words
sentences
multiple-step commands
narrative discourse

32
Q

What are some disturbances of grammatical processing that may occur with aphasia?

A

AGRAMMATISM refers to difficulty ordering words and putting them together in a sentence.
Content words are relatively spared
Agrammatic patients have difficulty producing function words and bound morphemes (problems with tense).

33
Q

What are some disturbances of reading and writing that may occur with aphasia?

A

Patients with auditory comprehension deficits usually have some reading impairment
Reading impairment can appear in a pure form without auditory comprehension or writing impairment.
In most cases of aphasia, reading, writing, and auditory comprehension are impaired together, but not to the same degree.

34
Q

What are some characteristics of Broca’s aphasia?

A 
Dysfluent
Increased effort in speaking
Speech is agrammatic, telegraphic, groping
Often accompanied by dysarthria and/or apraxia of speech
Comprehension better than expressive
Repetition abnormal
Naming is poor
Writing reflects spoken output
35
Q

Are patients with Broca’s aphasia aware of their deficit?

A

Yes, they are:
very aware of their communication and physical impairments
easily upset by failed communication attempts
cooperative and task oriented

36
Q

What are some characteristics of Wernicke’s aphasia?

A

Pt. usually appears normal with no dysarthria or limb weakness/paralysis.
Speech is fluent but often presents with paraphasias and jargon
Syntax is normal
Comprehension is poor
Reading is poor
Repetition is poor.
Word-salad

37
Q

What are some characteristics of patient’s with Wernicke’s aphasia?

A

Most patients are alert, attentive and task-oriented
Mild Wernicke’s: aware of errors and generally follow conversational turn taking
Moderate: rarely notice errors or attempt repairs; attentive & cooperative but get off topic easily (verbal tangents)
Severe: attentive, but severe comprehension deficits interfere with all communication tasks; unaware of errors and communication failure

38
Q

Describe global aphasia.

A

Severe impairment in both comprehension and expression
Concrete understanding of symbols; may not fully comprehend abstract or inferential information
May not understand simple words, may only understand icons or pictures
Performance usually enhanced by materials or activities that are automatic or emotionally laden

39
Q

What are some characteristics of patients with global aphasia?

A

Speech is severely limited and often characterized by stereotypical utterances (whatawhy), overlearned phrases (how-de-do), or expletives.
Most are attentive, task-oriented and socially appropriate (which helps to differentiate from the confused or demented patient).
Occasionally comprehend personally relevant questions fairly well
Some reliably answer yes/no questions

40
Q

Describe conduction aphasia.

A

SOL is thought to be arcuate fasciculus or temporal lobe in the auditory association area
Fluent speech; auditory comprehension deficits range from moderate to mild
Hallmark: inability to repeat long sentences - grossly impaired repetition & relatively preserved language comprehension.
Prosody may be affected because of pauses and hesitations
Alert, attentive and task-oriented; aware of errors in speech and writing; attempts repairs (‘Why can’t I say that?’)

41
Q

What is prosody?

A

The ability to have vocal inflection and affect in speech.

42
Q

Describe transcortical aphasia.

A

Preserved repetition is defining characteristic of the transcortical aphasias (Wernicke’s, Broca’s and arcuate fasciculus are spared)
Lesions are outside of the perisylvian zone
Transcortical Motor Aphasia
Transcortical Sensory Aphasia
Mixed Transcortical Aphasia

43
Q

Describe anomic aphasia.

A

Anomia – word finding difficulties; is common in aphasia and other neurologic disorders (dementia, encephalopathy).
Often the residual impairment of a more severe aphasia
Spontaneous speech is fluent and grammatically correct, but marred with frequent word-retrieval failures. Average phrase length WNL
Auditory comprehension & repetition are relatively intact

44
Q

Cardiovascular events are the leading cause of what?

A

Right hemisphere disorders.

45
Q

Will all adults with right hemisphere disorders have cognitive/communication deficits?

A

No.
50% of all patients with RHD
80-90% of patients in rehab
Diagnosis depends on who does the evaluation

46
Q

What are some communication deficits associated with right hemisphere damage?

A
  1. deficits in facial recognition -prosopagnosia
  2. deficits in comprehending facial expressions and expressing using facial expressions
  3. prosodic deficits
  4. inferencing deficits
  5. discourse deficits
47
Q

What are some neuropsychiatric deficits associated with right hemisphere damage?

A
  1. anosognosia - lack of self awareness
  2. depression
  3. capgras delusion - patient believes a loved one or pet has been replaced by an identical imposter
  4. visual hallucinations
  5. paranoid hallucinations
48
Q

What are some other deficits associated with right hemisphere damage?

A
  1. Visuoperceptual deficits include simultagnosia (cannot perceive more than one object at a time) and cerebral achromatopsia (color-blindness due to brain damage)
  2. Attentional deficits include neglect and sustained and selective attention deficits
49
Q

What are some things that patients with right hemisphere disorder do not have trouble with?

A

Few if any problems in comprehending or expressing language syntax (grammar), morphology (eg, word endings), and/or phonology (speech sounds)
Do not have classical aphasia
lexical retrieval (coming up with words they want to say) is like that of age-matched healthy individuals
Trouble with naming pictures/objects may be due to visual-perceptual or visuospatial difficulties not comprehension

50
Q

Describe neglect with respect to brain damage.

A
  1. May be called -Hemispatial, left or visuospatial neglect, hemineglect
  2. Inattention to the left side
  3. Occurs in 13-80% of patients with RHD
  4. Lesion localization:
    Inferior parietal lobe; parieto-temporal juction
    Inferior frontal, underlying white matter, thalamus, basal ganglia
51
Q

What are the 3 types of neglect?

A
  1. Motor Neglect
    Reduced use of left side of body (less than capable)
  2. Tactile Neglect
    Reduced response/recognition of tactile stimulation (greater than sensory deficit)
  3. Auditory Neglect
    Reduced processing of auditory stimuli from left – poorer localization of sounds
52
Q

What is the course of neglect with relation to right hemisphere damage?

A

Variable performance – hour to hour, day to day; within and across neglect types
Often resolves within first few weeks
Usually accompanied by anosognosia
Presence of neglect - more likely to have other cognitive/communicative deficits

53
Q

What is neglect dyslexia?

A

When the person omits letters/words, substitutes letters, parts of words or words on a line.

54
Q

What is neglect dysgraphia?

A

When the person writes only on the lefts side to the page but has preserved letters/words.

55
Q

What is aprosodia?

A
  1. Production: flat, monotone speech, rate sounds fast
  2. Comprehension: problems interpreting prosody
  3. RHD possibly effects emotional prosody more than linguistic prosody
56
Q

Prosody and affective disorders are characterized by what?

A
  1. Impaired emotion & nonverbal communication
  2. Production:
    Use fewer emotionally-charged words
    Reduced facial expressions
    Reduced animation
    Flat affect – reduced animation, reduced prosody/intonation
  3. Comprehension:
    Misinterpretation of emotional cues (e.g., facial expression, body language, intonation)

Block 8 week 4 (5 decks)

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