Cognition and Communication Flashcards
Which professionals are typically responsible for assessing communication?
Speech Therapist
List 7 professionals equipped to assess patient cognition.
- Neuropsychologist
- Neurologist
- Physiatrist
- Occupational Therapist
- Speech Pathologist
- PT
- Nursing Staff
What is sensation?
COLLECTION of visual, somatosensory, vestibular, auditory, gustatory, olfactory info
What is perception?
Selection, integration, and INTERPRETATION of stimuli from body and environment
What is cognition?
Knowing, understanding, awareness, judgment, and decision making
List the 4 components of the cognition pyramid from the bottom up.
- Arousal
- Attention
- Memory
- Executive function
What system mediates arousal and consciousness?
Reticular Activating System (RAS)
List the 5 levels of consciousness/arousal.
- Coma
- Semi-coma
- Obtunded
- Lethargic
- Alert
What should be documented when examining a patients arousal?
Document time alertness is maintained and the stimuli necessary to maintain it.
List 4 intervention CONSIDERATIONS that should be taken into account with regards to arousal.
- Time of day / treatment schedule
- Stimuli noxious v. non-noxious
- Personnel
- Posture
What is attention? How can it be classified?
- A constellation of processes that includes: alertness, arousal, ability to select stimuli, ability to span attention
- Can be classified by the modality that is used for processing, such as visual and auditory
List and describe the 4 McDowd attention behaviors.
- Selective Attention: focus on one set of stimuli
- Sustained Attention: maintain attention for prolonged period of time
- Divided Attention: ability to attend to multiple stimuli at once
- Attention Switching : ability to switch attention from different stimuli without a lag
What 4 attention related deficits that interfere with memory and learning?
- Distractibility: ability for extraneous stimuli to pull patients attention away from task at hand
- Preservation: inability to switch attention from one stimuli to another
- Decreased concentration
- Slowness of information processing: secondary to lag in preparation for movement and heightened distractibility
Preservation can be defined as having heightened ______.
Selective attention
What are 2 techniques used to examine attention?
- Serial subtraction
2. Addition tracking
List 4 things a patient with impaired attention may have difficulty with (clinical observations).
- Difficulty in busy environments
- Difficulty with complex tasks
- Difficulty with dual tasks
- Difficulty with maintaining performance over time or multiple repetitions
List 5 intervention considerations used to treat attention disorders.
- Change environment and/or tasks frequently
- Low stimulation environment
- Speak only when you have eye contact
- Paced with speech
- Keep sessions short
What is orientation?
Integration of attention, memory and perception
What 4 things should be asked about in the patient interview to assess orientation?
- Person: awareness of self and social role
- Place: where you are
- Time: includes public time (clocks, calendars) cued time (time of day, seasons) and personal time (passage of time and ordering time)
- Situation: what happened to you, what’s going to happen to you
What 3 interventions can be used when treating patients with impaired orientation?
- (Orient them) using verbal and visual reminders
- Calendars, seasonal clues, clocks, lights off at night, windows (enriched environment)
- Emphasize structure and schedule
What is memory?
Ability to store and retrieve information, learn new information, retrieve previously learned information
What 3 lobes of the brain primarily mediate memory?
- Temporal
- Parietal
- Occipital
List and describe the 6 types of memory.
- Short term: or working memory (small amount of info. retained for a short period of time) such as a phone number
- Long term: or remote, ability to remember for a long time; not capacity-limited
- Procedural (Implicit): for sequences and processes, retrieval is demonstrated (skilled memory)
- Declarative (Explicit): for facts and events, retrieval is expressed
- Semantic: encompassing rules, meanings and context
- Sensory: visual, auditory, and kinesthetic
Standardized assessments of cognition include a ____ component.
Memory
Describe the clinical assessment used to examine memory.
Clinical assessment can be combined with orientation questions, recall of personal information, recall of what was done previously in therapy
List 3 interventions used to treat patients with impaired memory.
- Identify and use the most competent system for memory
- (Visual memory: use pictures for instruction, verbal memory use writing for instruction)
- Reduce the memory load: break task into manageable components (part task practice)
What is dementia?
Impaired memory and orientation in a person that is alert combined with impairments in at least one of the following:
- Abstract thinking
- Judgment
- Problem solving
- Language
- Personality
List 2 reversible causes of dementia.
- Delirium
2. Depression
List 7 irreversible causes of dementia.
- Alzheimer’s
- Vascular Dementia(multiple small infarcts)
- Lewy Body Dementia
- Frontotemporal dementia
- Parkinson’s
- Huntington’s
- Korsakoff’s Syndrome (related to long term exposure to alcohol)
List 5 REMAINING strengths of individuals with dementia.
- Attention
- Procedural Memory
- Reading/Language
- Left/Right Orientation
- Emotional Memory
List 3 treatment approaches used to treat individuals with dementia.
- Errorless learning (as opposed to trial and error)
- Modelling (show them how to do it)
- External memory aids (i.e. pictures and written instructions)
What is executive function?
Processes involved in the ability to organize information, identify problems (self-monitor), solve problems, anticipate problems, generalize, generate plans, and predict future performance
______ is critical to true independence.
Executive function
What area of the brain is responsible for mediating executive function?
Pre-frontal cortex
Executive function can be confounded by _____ and _____ impairments.
- Memory
2. Attention
List 4 types of awareness.
- Anosagnosia
- Intellectual
- Emergent (how urgent or serious is the situation at hand?)
- Anticipatory
What are the 3 steps of executive function?
- Organize: sequence and plan steps
- Problem Solve: recognize error and generate solutions, select and implement a solution and assess if that was the correct choice
- Judgment: anticipate consequences by planning, problem solving and reasoning
List 6 possible ways of examining executive function.
- Clinical Exam using Observation
- Have patient plan a multi-step task (talk through the steps/process)
- Have patient predict their performance
- Have patient perform a multi-step task
- Have a patient rate their performance
- Have patient generate strategies for improvement
What 2 things can be combined to treat executive function impairments?
Combine motor skill with cognitive tasks that require following multi-step commands, learning and applying rules (games), going out in the community
What is apraxia?
Inability to perform purposeful movement that is within a patient’s motor, sensory and perceptual capacity
Can be limited to a body part or activity
- oral
- limb or trunk
- gait or dressing
What is the difference between ideational and ideomotor apraxia?
Ideational: Cannot perform mov’t on command or automatically
Ideomotor: Cannot perform mov’t on command however can automatically perform
List examples of ways to examine oral, UE and LE apraxia. What should be observed during the examination?
- Oral: Smile, whistle a tune
- UE: Mime making a sandwich, shake hands, wave goodbye
- LE: Kick this ball, make a figure eight with your foot
Observe for inconsistencies in function
What are the 2 roles of a PT in managing patients with communication disorders?
- Physiologic support (positioning, control of respiration, muscle strengthening arousal facilitation)
- Stimulating and facilitating communication through successful interaction with the patient
What is dysarthria? Identify the 5 types.
Impairment of speech production resulting from damage to the CNS that causes weakness, paralysis or in coordination of the motor system
- Spastic
- Flaccid
- Ataxic
- Hypokinetic
- Hyperkinetic
What is dysphagia? List 5 patient populations where this is typically seen.
Swallowing deficits
- PD
- ALS
- MS
- Huntington’s
- Stroke
What is dysphonia? (2)
- Inadequate breath support
2. Ineffective laryngeal function
What is aphasia? Where is the brain damage seen?
- Acquired communication disorder
2. Typically, non-dominant hemisphere damage
What are 3 types of aphasia?
- Non-fluent
- Fluent
- Global
List 6 characteristics of non-fluent aphasia.
- Restricted vocabulary (can produce words but the words are garbled or the wrong word is being used)
- Awkward articulation
- Word substitutions; nonsense words
- Most commonly linked to left hemispheric damage (precentral gyrus, Broca’s Area)
- Auditory comprehension intact (can understand but difficulty responding)
- Reading less impaired than speech or writing; writing mirrors speech
List 4 characteristics of fluent aphasia.
- Impaired auditory comprehension
- Lesion in posterior/temporal gyrus/left hemisphere (Wernicke’s area)
- Reading and writing impaired
- Verbal output often nonsensical, but flows as though speech is normal
List 4 characteristics of global aphasia.
- A combination of fluent and non-fluent aphasia
- Not a designation of severity
- Extensive damage
- Left hemisphere; often Bilateral
____ aphasia has the poorest prognosis.
GLOBAL
List 3 factors that do not affect recovery from aphasia.
- Age
- Gender
- Handedness
True or False: Aphasia due to a vascular lesion has better prognosis than post traumatic aphasia.
FALSE
Post-traumatic aphasia (i.e. TBI) has better prognosis (spontaneous recovery) than vascular lesion
What is agnosia?
Inability to make sense of incoming information; intact sensory
List 7 types of agnosia.
- Anosognosia- lack of awareness of one’s paralysis
- Somatoagnosia- lack of awareness of body parts to one another
- Right-Left Discrimination disorder
- Finger/Facial agnosia
- VISUAL(Visual Object/ Prosopagnosia/ Color Agnosia)
- Auditory
- Tactile (Astereognosis)
Finger agnosia can lead to ______.
Agraphia: loss of ability to communicate through writing
Communicating with a person with dementia
Refer to slides cause the list is looooong
