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PassPMR - 01 Stroke > Chapter 3 - Cortical Symptoms > Flashcards

Chapter 3 - Cortical Symptoms Flashcards

1. Dysphagia 2. Aphasia 3. Dysarthria 4. Apraxia 5. Neglect

1
Q

List 5 ways of communications / 5 main language skills ๐Ÿ”‘
Define aphasia. ๐Ÿ”‘๐Ÿ”‘

A
  1. Reading
  2. Writing
  3. Listening
  4. Speaking (verbal)
  5. Gesture (non-verbal)

Acquired disorder of all language modalities, including verbal expression, auditory comprehension, written expression, and reading comprehension.

DeLisa 5th Edition Chapter 15 pg420

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2
Q

Paraphasia. Location, Definition & types ๐Ÿ”‘๐Ÿ”‘

A

PARAPHASIA

  • Incorrect substitution of words or parts of words
  • Seen in: Conduction aphasia, CCC-Conduction โ€œTargeting wordsโ€

TYPES

Literal or phonemic paraphasias ุฃุตูˆุงุช ุดุจูŠู‡ู‡

Similar sounds (e.g., โ€œsoundโ€ for โ€œfoundโ€ or โ€œfenโ€ for โ€œpenโ€)

Verbal or semantic paraphasias ุฃุณุงู…ูŠ ุดุจูŠู‡ู‡

Word substituted for another from same semantic class (e.g., โ€œforkโ€ for โ€œspoonโ€)

Cuccurollo 4th Edition Chapter 1 Stroke pg43-45

Stroke Rehabilitation Clinician Handbook 2020 Model 1 pg12

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3
Q

Anomia - Echolalia - Neologis
Define and mention where they are seen. ๐Ÿ”‘๐Ÿ”‘

A

ANOMIA/VERBAL AXPRAXIA

  • Word-finding difficulties with mild articulatory errors
  • Alexia and agraphia
  • Seen in: Anomic Aphasia, Temporo-parietal injury, Angular gyrus (Angry patient)

ECHOLALIA

  • Repetition (โ€œechoingโ€) of words or vocalizations made by another person
  • Seen in: Transcortical sensory aphasia because itโ€™s non-comprehensive talk

NEOLOGISM

  • A โ€œnew wordโ€ that is well articulated but has meaning only to the speaker
  • Seen in: Transcortical sensory aphasia because itโ€™s non-comprehensive talk

Cuccurollo 4th Edition Chapter 1 Stroke pg43-45

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4
Q

Define Circumlocution - Telegraphic speech - Jargon

A

CIRCULUMOTION

  • Attempts at word retrieval end in descriptions or associations related to the word

TELEGRAPHIC SPEECH

  • Language similar to a telegram, mostly nouns and verbs

JARGON

  • Well- articulated language but mostly incomprehensible to the other person

DeLisa 5th Edition Chapter 15 pg420 Tabke 15.2

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5
Q

What is Primary progressive aphasia (PPA)? ๐Ÿ”‘๐Ÿ”‘ EXAM

A

Type of neurological syndrome in which language capabilities slowly and progressively become impaired. caused by neurodegenerative diseases, such as Alzheimerโ€™s Disease.

Leading to slowly lose the ability to speak, write, read, and generally comprehend language. Eventually, becomes aphasic.

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6
Q

Outcome measure or tools to assess language ๐Ÿ”‘๐Ÿ”‘ EXAM

A
  1. Boston Diagnostic Aphasia Examination
  2. Western Aphasia Battery
  3. Porch Index of Communication Ability
  4. Communications Activities of Daily Living (ADLs)
  5. Aachen Aphasia Test
  6. Aphasia Severity Rating Scale

DeLisa 6th Edition Chapter 23.8 Stroke pg564 Table 23.8

http://www.ebrsr.com/sites/default/files/EBRSR%20Handbook%20Chapter%205_Rehab%20of%20Cognitive%20Impairment.pdf

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7
Q

Types of Aphasia. 4 Fluent and 4 Non-Fluent & Their Blood Supply ๐Ÿ”‘๐Ÿ”‘

A

FLUENT

  1. Transcortical sensory โ†’ Left PCA
  2. Wernickeโ€™s โ†’ Left MCA, superior temporal lobe
  3. Conduction โ†’ Left MCA, temporoparetial lobe
  4. Anomia โ†’ Left MCA, temporoparetial lobe

NON-FLUENT

  1. Brocaโ€™s โ†’ Left MCA, frontal lobe
  2. Transcortical motor โ†’ Left ACA, frontal lobe
  3. Global
  4. Mixed transcortical

Cuccurollo 4th Editoin Chapter 1 Stroke pg42 Table 1-13 Types of Aphasias

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8
Q

Label 7 marks ๐Ÿ”‘

A
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9
Q

Transcortical motor aphasia.

Location & list 3 features ๐Ÿ”‘๐Ÿ”‘

A
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10
Q

Brocaโ€™s aphasia. Location & list 4 features ๐Ÿ”‘๐Ÿ”‘ A patient is having a Brocaโ€™s aphasia. ๐Ÿ”‘๐Ÿ”‘ 1) Where is the lesion? 2) And explain the language impairments that he will get?

A

๐Ÿ’กParaphasias and articulatory errors or struggle

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11
Q

Conduction aphasia.

Location & list 4 features ๐Ÿ”‘๐Ÿ”‘

A

๐Ÿ’กLiteral paraphasias with โ€œtargetingโ€ โ€˜ of words (until getting the right one)

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12
Q

Wernickeโ€™s aphasia.

Location & list 4 features ๐Ÿ”‘๐Ÿ”‘

A

๐Ÿ’ก Marked paraphasias and neologisms

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13
Q

Transcortical sensory aphasia.

Location & list 3 features ๐Ÿ”‘๐Ÿ”‘

A
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14
Q

Anomic aphasia.

Location & List 4 features๐Ÿ”‘๐Ÿ”‘

A

๐Ÿ’ก Anomic aphasia is frustrating to the patient, thats why they get angry from difficulty findings word (ANGULAR- ANGRY GYRUS)

  • Alexia and agraphia may be present
  • Word-finding difficulties
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15
Q

List 4 Non-Pharmacological Interventions for Aphasia ๐Ÿ”‘

A
  1. Speech Language Therapy
  2. Computer-Based TreatmentุŒ Augmentative and alternative communication (AAC)
  3. Training Conversation / Communication Partners
  4. Group Therapy
  5. Word-Retrieval Interventions
  6. Constraint-Induced (CI) Aphasia Therapy

Stroke Rehabilitation Clinician Handbook 2020 Model 5

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16
Q

Pharmacological Interventions for Aphasia

A

Cholinesterase inhibitors: Donepezil (Aricept) and rivastigmine

Braddom 6th Edition Chapter 44 Stroke pg965

17
Q

How can apraxia of speech be distinguished from dysarthria?๐Ÿ”‘๐Ÿ”‘

A

SPEECH APRAXIA

  • Inconsistent errors due to preserved articulation
  • Disorder of language: word retrieval, comprehension of verbal and written language

DYSARTHRIA

  • Consistent errors due to impaired articulation
  • Disorder of speech system: respiration, phonation, resonation, and articulation

DeLisa 5th Edition Chapter 15 pg415

Google Notes:

  • The difference between the two is that dysarthria is a speech impairment while aphasia is a language impairment.
  • People who live with apraxia have difficulty putting words together in the correct order or โ€˜reachingโ€™ for the correct word while speaking. Dysarthria occurs when a patientโ€™s muscles do not coordinate together to produce speech.
18
Q

List 4 types of dysarthria ๐Ÿ”‘๐Ÿ”‘ EXAM

A

FLACCID LMN DYSARHTIRA

Muscular weakness; hypotonia

SPASTIC BL UMN DYSARHTIRA

Reduced range, force, speed; hypertonia

ATAXIC CEREBELLAR DYSARTHRIA

Hypotonia; reduced speed; inaccurate range, timing, direction

HYPOKINETIC EXTRAPYRAMIDAL DYSARHTIRA

Markedly reduced range; variable speed of repetitive movements; movement arresting rigidity

HYPERKINETIC EXTRAPYRAMIDAL DYSARHTIRA

Quick: Quick. unsustained, random, involuntary movements

Slow: Sustained, distorted movements and postures; slowness; variable, Hypertonus

MIXED DYSARHTIRA

Variable combination of above.

Delisa 5th Edition Chapter 15 pg415 Table 15.1

19
Q

Mention 4 causes of abductor vocal cord paralysis ๐Ÿ”‘๐Ÿ”‘

A

๐Ÿ’ก Vocal cords are muscles, think of UMN & LMN Neuro disorders + Musclular (NMJ).

  1. Cerebrovascular accident
  2. Parkinsonโ€™s disease
  3. Multiple sclerosis
  4. Poliomyelitis
  5. Guillain-Barrรฉ syndrome
  6. Neoplasms

https://pubmed.ncbi.nlm.nih.gov/949150/

  1. Myasthenia gravis
  2. Recurrent laryngeal nerve (RLN) injury
20
Q

Definition of apraxia ๐Ÿ”‘๐Ÿ”‘

A

Apraxia is a disorder of voluntary movement wherein one cannot execute willed, purposeful activity despite the presence of adequate mobility, strength, sensation, co-ordination and comprehension.

Stroke Rehabilitation Clinician Handbook 2020 Model 1 pg15 & Model 5 pg88

21
Q

List 5 types of apraxia๐Ÿ”‘๐Ÿ”‘

A

LEFT MCA

  • Motor or Limb-kinetic apraxia
  • Ideomotor
  • Ideational
  • Buccofacial or orofacial apraxia
  • Apraxia of speech

RIGHT MCA

  • Constructional
  • Dressing

ACA

  • Gait
22
Q

Ideomotor vs Ideational apraxia.
Definition & Site of lesion ๐Ÿ”‘๐Ÿ”‘

A

IDEOMOTOR OR MOTOR

Can automatically perform a movement but cannot carry it out on command

Left Hemisphere

IDEATIONAL

Can perform separate movements but cannot coordinate all steps into an integrated sequence

Bilateral Parietal

Stroke Rehabilitation Clinician Handbook 2020 Model 1 pg15

23
Q

Constructional vs Dressing apraxia.

Definition & Site of lesion.๐Ÿ”‘๐Ÿ”‘

A

CONSTRUCTIONAL APRAXIA

Inability or difficulty to build, assemble, or draw objects.

Either parietal lobe, right > left

DRESSING APRAXIA

Inability to dress oneself despite adequate motor ability.

Right > left hemisphere

Stroke Rehabilitation Clinician Handbook 2020 Model 1 pg15

24
Q

Verbal vs Oromotor apraxia.

Definition & Site of lesion. ๐Ÿ”‘๐Ÿ”‘

A

VERBAL APRAXIA

Mispronunciation with letter substitution, effortful output and impaired melody of speech.

Tested by asking the patient to repeat words with an increasing number of syllables

Left Inferior Frontal Lobe (Associated with Brocaโ€™s aphasia)

OROMOTOR APRAXIA

Difficulty organizing non-speech oral motor activity

Tested by asking patients to stick out their tongue, show their teeth, blow out their cheeks, or pretend to blow out a match

Left Inferior Frontal Lobe

Stroke Rehabilitation Clinician Handbook 2020 Model 1 pg15

Braddom 6th Edition Chapter 1 Physical History & Examination pg9

25
Q

Gait apraxia.

Definition & Site of lesion. ๐Ÿ”‘๐Ÿ”‘

A

Difficulty initiating and maintaining a normal walking pattern when sensory and motor functions seem otherwise unimpaired

Frontal lobes

Stroke Rehabilitation Clinician Handbook 2020 Model 1 pg15

26
Q

List 2 neuroanatomical locations involved in apraxia. ๐Ÿ”‘๐Ÿ”‘

A

๐Ÿ’ก Another way to ask โ€œType of apraxia in each brain lobeโ€ Donโ€™t be tricked by simple Q.

  1. Frontal lobe
    1. Bilateral ACA: giat apraxia
    2. Unilateral ACA: hand apraxia, speech and oromotor apraxia
  2. Parietal lobe (MCA)
    1. Dominant: Ideomotor apraxia
    2. Non-dominant: Constructional and dressing apraxia
27
Q

Which area is commonly associated with Orobuccal apraxia?

A

Area: Left inferior frontal lesion

Blood supply: Left MCA

28
Q

Define Neglect.

Location & Blood Supply ๐Ÿ”‘๐Ÿ”‘

A

Failure to report, respond, or orient to sensory stimuli presented to the side contralateral to the stroke lesion.

Location: Right non-dominant partial lobe (primary somatosensory area)

Blood supply: Right MCA

Stroke Rehabilitation Clinician Handbook 2020 Model 5 pg39

29
Q

Define Anosognosia.

Location & Blood Supply ๐Ÿ”‘๐Ÿ”‘

A

DEFINITION

Unawareness of the loss of an important bodily function, primarily hemiplegia

Lack of knowledge or awareness of disability.

LOCATION

Parital lobe of non-dominant side (Primary sensory cortex)

BLOOD SUPPLY

Middle cerebral artery, right upper division

Stroke Rehabilitation Clinician Handbook 2020 Model 1 pg10 & Model 5 pg39

30
Q

Anosognosia vs Agnosia

A

ANOSOGNOSIA

Patient is unaware of their own mental health condition or that they canโ€™t perceive their condition accurately.

AGNOSIA

Patient is unable to recognize and identify objects, persons, or sounds despite normally functioning senses.

31
Q

Why is Left Sided Neglect More Common than Right Sided Neglect? ๐Ÿ”‘๐Ÿ”‘

A

๐Ÿ’ก Unilateral spatial neglect is more common in patients with right sided lesions (42%) than left sided lesions (8%) and is more persistent with right sided strokes.

Neuroanatomical findings have identified that the left hemisphere is responsible for modulating arousal and attention for the right visual field, whereas the right hemisphere controls these processes in both right and left visual fields.

This may explain why unilateral spatial neglect is not typical for those with left hemisphere damage (LHD) post-stroke because the intact right hemisphere is capable of compensating for perceptual deficits that result from LHD

Stroke Rehabilitation Clinician Handbook 2020 Model 1 pg9

32
Q

Types of Unilateral Spatial Neglect ๐Ÿ”‘๐Ÿ”‘

A

EGOCENTRIC NEGLECT

  • Interpersonal neglect of the body or personal space, tendency to neglect the opposite side of the lesion, in reference to the midline the body.

ALLOCENTRIC NEGLECT

  1. Peripersonal space refers to space within the patientโ€™s normal reach.
  2. Extrapersonal refers to object /environment beyond the patientโ€™s normal reach.

Stroke Rehabilitation Clinician Handbook 2020

33
Q

List 4 Tests for neglect ๐Ÿ”‘๐Ÿ”‘

A
  1. Object Cancelation
  2. Line Crossing
  3. Clock drawing
  4. Scene Copy

Stroke Rehabilitation Clinician Handbook

34
Q

List 4 Treatments in Unilateral Spatial Neglect ๐Ÿ”‘๐Ÿ”‘ EXAM

A
  1. Visual Scanning
  2. Computer-Based Scanning
  3. Sensory Feedback Strategies
  4. Prisms adaptation
  5. Limb activation therapy
  6. Trunk rotation
  7. Eyepatching and Hemispatial Glasses
  8. Feedback training
  9. Neck muscle vibration
  10. Virtual Reality Therapy

Stroke Rehabilitation Clinician Handbook 2020 Model 5 pg48

35
Q

Expected coarse of neglect in rehabilitation? ๐Ÿ”‘

A

Recovery of Unilateral Spatial Neglect is common; most recovery occurs in the first 6 months

Stroke Rehabilitation Clinician Handbook 2020 Model 1 pg10

36
Q

2-months history of expressive aphasia. No weakness but with memory and cognitive problem. Word finding difficulty. Parietal lobe is normal.

A

Anomic Aphasia

37
Q

What is Primary progressive aphasia (PPA)? ๐Ÿ”‘๐Ÿ”‘

A

Type of neurological syndrome in which language capabilities slowly and progressively become impaired. It results from continuous deterioration in brain tissue

Leading to slowly lose the ability to speak, write, read, and generally comprehend language. Eventually, becomes aphasic.

38
Q

Dysarthria. Mention 3 upper neural structures and 3 lower neural structures???๐Ÿ”‘๐Ÿ”‘

A

PassPMR - 01 Stroke (6 decks)

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