Chapter 3 - Cortical Symptoms Flashcards
1. Dysphagia 2. Aphasia 3. Dysarthria 4. Apraxia 5. Neglect
List 5 ways of communications / 5 main language skills ๐
Define aphasia. ๐๐
- Reading
- Writing
- Listening
- Speaking (verbal)
- 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
Paraphasia. Location, Definition & types ๐๐
PARAPHASIA
- Incorrect substitution of words or parts of words
- Seen in: Conduction aphasia, CCC-Conduction โTargeting wordsโ
TYPES
Literal or phonemic paraphasias ุฃุตูุงุช ุดุจููู
Similar sounds (e.g., โsoundโ for โfoundโ or โfenโ for โpenโ)
Verbal or semantic paraphasias ุฃุณุงู ู ุดุจููู
Word substituted for another from same semantic class (e.g., โforkโ for โspoonโ)
Cuccurollo 4th Edition Chapter 1 Stroke pg43-45
Stroke Rehabilitation Clinician Handbook 2020 Model 1 pg12
Anomia - Echolalia - Neologis
Define and mention where they are seen. ๐๐
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 (โechoingโ) of words or vocalizations made by another person
- Seen in: Transcortical sensory aphasia because itโs non-comprehensive talk
NEOLOGISM
- A โnew wordโ that is well articulated but has meaning only to the speaker
- Seen in: Transcortical sensory aphasia because itโs non-comprehensive talk
Cuccurollo 4th Edition Chapter 1 Stroke pg43-45
Define Circumlocution - Telegraphic speech - Jargon
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
What is Primary progressive aphasia (PPA)? ๐๐ EXAM
Type of neurological syndrome in which language capabilities slowly and progressively become impaired. caused by neurodegenerative diseases, such as Alzheimerโs Disease.
Leading to slowly lose the ability to speak, write, read, and generally comprehend language. Eventually, becomes aphasic.
Outcome measure or tools to assess language ๐๐ EXAM
- Boston Diagnostic Aphasia Examination
- Western Aphasia Battery
- Porch Index of Communication Ability
- Communications Activities of Daily Living (ADLs)
- Aachen Aphasia Test
- Aphasia Severity Rating Scale
DeLisa 6th Edition Chapter 23.8 Stroke pg564 Table 23.8
Types of Aphasia. 4 Fluent and 4 Non-Fluent & Their Blood Supply ๐๐
FLUENT
- Transcortical sensory โ Left PCA
- Wernickeโs โ Left MCA, superior temporal lobe
- Conduction โ Left MCA, temporoparetial lobe
- Anomia โ Left MCA, temporoparetial lobe
NON-FLUENT
- Brocaโs โ Left MCA, frontal lobe
- Transcortical motor โ Left ACA, frontal lobe
- Global
- Mixed transcortical
Cuccurollo 4th Editoin Chapter 1 Stroke pg42 Table 1-13 Types of Aphasias
Label 7 marks ๐
Transcortical motor aphasia.
Location & list 3 features ๐๐
Brocaโs aphasia. Location & list 4 features ๐๐ A patient is having a Brocaโs aphasia. ๐๐ 1) Where is the lesion? 2) And explain the language impairments that he will get?
๐กParaphasias and articulatory errors or struggle
Conduction aphasia.
Location & list 4 features ๐๐
๐กLiteral paraphasias with โtargetingโ โ of words (until getting the right one)
Wernickeโs aphasia.
Location & list 4 features ๐๐
๐ก Marked paraphasias and neologisms
Transcortical sensory aphasia.
Location & list 3 features ๐๐
Anomic aphasia.
Location & List 4 features๐๐
๐ก 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
List 4 Non-Pharmacological Interventions for Aphasia ๐
- Speech Language Therapy
- Computer-Based Treatmentุ Augmentative and alternative communication (AAC)
- Training Conversation / Communication Partners
- Group Therapy
- Word-Retrieval Interventions
- Constraint-Induced (CI) Aphasia Therapy
Stroke Rehabilitation Clinician Handbook 2020 Model 5
Pharmacological Interventions for Aphasia
Cholinesterase inhibitors: Donepezil (Aricept) and rivastigmine
Braddom 6th Edition Chapter 44 Stroke pg965
How can apraxia of speech be distinguished from dysarthria?๐๐
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 โreachingโ for the correct word while speaking. Dysarthria occurs when a patientโs muscles do not coordinate together to produce speech.
List 4 types of dysarthria ๐๐ EXAM
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
Mention 4 causes of abductor vocal cord paralysis ๐๐
๐ก Vocal cords are muscles, think of UMN & LMN Neuro disorders + Musclular (NMJ).
- Cerebrovascular accident
- Parkinsonโs disease
- Multiple sclerosis
- Poliomyelitis
- Guillain-Barrรฉ syndrome
- Neoplasms
https://pubmed.ncbi.nlm.nih.gov/949150/
- Myasthenia gravis
- Recurrent laryngeal nerve (RLN) injury
Definition of apraxia ๐๐
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
List 5 types of apraxia๐๐
LEFT MCA
- Motor or Limb-kinetic apraxia
- Ideomotor
- Ideational
- Buccofacial or orofacial apraxia
- Apraxia of speech
RIGHT MCA
- Constructional
- Dressing
ACA
- Gait
Ideomotor vs Ideational apraxia.
Definition & Site of lesion ๐๐
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
Constructional vs Dressing apraxia.
Definition & Site of lesion.๐๐
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
Verbal vs Oromotor apraxia.
Definition & Site of lesion. ๐๐
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 Brocaโs 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
Gait apraxia.
Definition & Site of lesion. ๐๐
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
List 2 neuroanatomical locations involved in apraxia. ๐๐
๐ก Another way to ask โType of apraxia in each brain lobeโ Donโt be tricked by simple Q.
- Frontal lobe
- Bilateral ACA: giat apraxia
- Unilateral ACA: hand apraxia, speech and oromotor apraxia
- Parietal lobe (MCA)
- Dominant: Ideomotor apraxia
- Non-dominant: Constructional and dressing apraxia
Which area is commonly associated with Orobuccal apraxia?
Area: Left inferior frontal lesion
Blood supply: Left MCA
Define Neglect.
Location & Blood Supply ๐๐
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
Define Anosognosia.
Location & Blood Supply ๐๐
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
Anosognosia vs Agnosia
ANOSOGNOSIA
Patient is unaware of their own mental health condition or that they canโt perceive their condition accurately.
AGNOSIA
Patient is unable to recognize and identify objects, persons, or sounds despite normally functioning senses.
Why is Left Sided Neglect More Common than Right Sided Neglect? ๐๐
๐ก 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
Types of Unilateral Spatial Neglect ๐๐
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
- Peripersonal space refers to space within the patientโs normal reach.
- Extrapersonal refers to object /environment beyond the patientโs normal reach.
Stroke Rehabilitation Clinician Handbook 2020
List 4 Tests for neglect ๐๐
- Object Cancelation
- Line Crossing
- Clock drawing
- Scene Copy
Stroke Rehabilitation Clinician Handbook
List 4 Treatments in Unilateral Spatial Neglect ๐๐ EXAM
- Visual Scanning
- Computer-Based Scanning
- Sensory Feedback Strategies
- Prisms adaptation
- Limb activation therapy
- Trunk rotation
- Eyepatching and Hemispatial Glasses
- Feedback training
- Neck muscle vibration
- Virtual Reality Therapy
Stroke Rehabilitation Clinician Handbook 2020 Model 5 pg48
Expected coarse of neglect in rehabilitation? ๐
Recovery of Unilateral Spatial Neglect is common; most recovery occurs in the first 6 months
Stroke Rehabilitation Clinician Handbook 2020 Model 1 pg10
2-months history of expressive aphasia. No weakness but with memory and cognitive problem. Word finding difficulty. Parietal lobe is normal.
Anomic Aphasia
What is Primary progressive aphasia (PPA)? ๐๐
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.
Dysarthria. Mention 3 upper neural structures and 3 lower neural structures???๐๐
