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Neurologic PT > Cognition and Communication > Flashcards

Cognition and Communication Flashcards

1
Q

Which professionals are typically responsible for assessing communication?

A

Speech Therapist

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2
Q

List 7 professionals equipped to assess patient cognition.

A
  1. Neuropsychologist
  2. Neurologist
  3. Physiatrist
  4. Occupational Therapist
  5. Speech Pathologist
  6. PT
  7. Nursing Staff
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3
Q

What is sensation?

A

COLLECTION of visual, somatosensory, vestibular, auditory, gustatory, olfactory info

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4
Q

What is perception?

A

Selection, integration, and INTERPRETATION of stimuli from body and environment

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5
Q

What is cognition?

A

Knowing, understanding, awareness, judgment, and decision making

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6
Q

List the 4 components of the cognition pyramid from the bottom up.

A
  1. Arousal
  2. Attention
  3. Memory
  4. Executive function
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7
Q

What system mediates arousal and consciousness?

A

Reticular Activating System (RAS)

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8
Q

List the 5 levels of consciousness/arousal.

A
  1. Coma
  2. Semi-coma
  3. Obtunded
  4. Lethargic
  5. Alert
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9
Q

What should be documented when examining a patients arousal?

A

Document time alertness is maintained and the stimuli necessary to maintain it.

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10
Q

List 4 intervention CONSIDERATIONS that should be taken into account with regards to arousal.

A
  1. Time of day / treatment schedule
  2. Stimuli noxious v. non-noxious
  3. Personnel
  4. Posture
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11
Q

What is attention? How can it be classified?

A
  1. A constellation of processes that includes: alertness, arousal, ability to select stimuli, ability to span attention
  2. Can be classified by the modality that is used for processing, such as visual and auditory
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12
Q

List and describe the 4 McDowd attention behaviors.

A
  1. Selective Attention: focus on one set of stimuli
  2. Sustained Attention: maintain attention for prolonged period of time
  3. Divided Attention: ability to attend to multiple stimuli at once
  4. Attention Switching : ability to switch attention from different stimuli without a lag
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13
Q

What 4 attention related deficits that interfere with memory and learning?

A
  1. Distractibility: ability for extraneous stimuli to pull patients attention away from task at hand
  2. Preservation: inability to switch attention from one stimuli to another
  3. Decreased concentration
  4. Slowness of information processing: secondary to lag in preparation for movement and heightened distractibility
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14
Q

Preservation can be defined as having heightened ______.

A

Selective attention

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15
Q

What are 2 techniques used to examine attention?

A
  1. Serial subtraction

2. Addition tracking

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16
Q

List 4 things a patient with impaired attention may have difficulty with (clinical observations).

A
  1. Difficulty in busy environments
  2. Difficulty with complex tasks
  3. Difficulty with dual tasks
  4. Difficulty with maintaining performance over time or multiple repetitions
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17
Q

List 5 intervention considerations used to treat attention disorders.

A
  1. Change environment and/or tasks frequently
  2. Low stimulation environment
  3. Speak only when you have eye contact
  4. Paced with speech
  5. Keep sessions short
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18
Q

What is orientation?

A

Integration of attention, memory and perception

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19
Q

What 4 things should be asked about in the patient interview to assess orientation?

A
  1. Person: awareness of self and social role
  2. Place: where you are
  3. Time: includes public time (clocks, calendars) cued time (time of day, seasons) and personal time (passage of time and ordering time)
  4. Situation: what happened to you, what’s going to happen to you
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20
Q

What 3 interventions can be used when treating patients with impaired orientation?

A
  1. (Orient them) using verbal and visual reminders
  2. Calendars, seasonal clues, clocks, lights off at night, windows (enriched environment)
  3. Emphasize structure and schedule
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21
Q

What is memory?

A

Ability to store and retrieve information, learn new information, retrieve previously learned information

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22
Q

What 3 lobes of the brain primarily mediate memory?

A
  1. Temporal
  2. Parietal
  3. Occipital
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23
Q

List and describe the 6 types of memory.

A
  1. Short term: or working memory (small amount of info. retained for a short period of time) such as a phone number
  2. Long term: or remote, ability to remember for a long time; not capacity-limited
  3. Procedural (Implicit): for sequences and processes, retrieval is demonstrated (skilled memory)
  4. Declarative (Explicit): for facts and events, retrieval is expressed
  5. Semantic: encompassing rules, meanings and context
  6. Sensory: visual, auditory, and kinesthetic
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24
Q

Standardized assessments of cognition include a ____ component.

A

Memory

25
Q

Describe the clinical assessment used to examine memory.

A

Clinical assessment can be combined with orientation questions, recall of personal information, recall of what was done previously in therapy

26
Q

List 3 interventions used to treat patients with impaired memory.

A
  1. Identify and use the most competent system for memory
  2. (Visual memory: use pictures for instruction, verbal memory use writing for instruction)
  3. Reduce the memory load: break task into manageable components (part task practice)
27
Q

What is dementia?

A

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
28
Q

List 2 reversible causes of dementia.

A
  1. Delirium

2. Depression

29
Q

List 7 irreversible causes of dementia.

A
  1. Alzheimer’s
  2. Vascular Dementia(multiple small infarcts)
  3. Lewy Body Dementia
  4. Frontotemporal dementia
  5. Parkinson’s
  6. Huntington’s
  7. Korsakoff’s Syndrome (related to long term exposure to alcohol)
30
Q

List 5 REMAINING strengths of individuals with dementia.

A
  1. Attention
  2. Procedural Memory
  3. Reading/Language
  4. Left/Right Orientation
  5. Emotional Memory
31
Q

List 3 treatment approaches used to treat individuals with dementia.

A
  1. Errorless learning (as opposed to trial and error)
  2. Modelling (show them how to do it)
  3. External memory aids (i.e. pictures and written instructions)
32
Q

What is executive function?

A

Processes involved in the ability to organize information, identify problems (self-monitor), solve problems, anticipate problems, generalize, generate plans, and predict future performance

33
Q

______ is critical to true independence.

A

Executive function

34
Q

What area of the brain is responsible for mediating executive function?

A

Pre-frontal cortex

35
Q

Executive function can be confounded by _____ and _____ impairments.

A
  1. Memory

2. Attention

36
Q

List 4 types of awareness.

A
  1. Anosagnosia
  2. Intellectual
  3. Emergent (how urgent or serious is the situation at hand?)
  4. Anticipatory
37
Q

What are the 3 steps of executive function?

A
  1. Organize: sequence and plan steps
  2. Problem Solve: recognize error and generate solutions, select and implement a solution and assess if that was the correct choice
  3. Judgment: anticipate consequences by planning, problem solving and reasoning
38
Q

List 6 possible ways of examining executive function.

A
  1. Clinical Exam using Observation
  2. Have patient plan a multi-step task (talk through the steps/process)
  3. Have patient predict their performance
  4. Have patient perform a multi-step task
  5. Have a patient rate their performance
  6. Have patient generate strategies for improvement
39
Q

What 2 things can be combined to treat executive function impairments?

A

Combine motor skill with cognitive tasks that require following multi-step commands, learning and applying rules (games), going out in the community

40
Q

What is apraxia?

A

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
41
Q

What is the difference between ideational and ideomotor apraxia?

A

Ideational: Cannot perform mov’t on command or automatically

Ideomotor: Cannot perform mov’t on command however can automatically perform

42
Q

List examples of ways to examine oral, UE and LE apraxia. What should be observed during the examination?

A
  1. Oral: Smile, whistle a tune
  2. UE: Mime making a sandwich, shake hands, wave goodbye
  3. LE: Kick this ball, make a figure eight with your foot

Observe for inconsistencies in function

43
Q

What are the 2 roles of a PT in managing patients with communication disorders?

A
  1. Physiologic support (positioning, control of respiration, muscle strengthening arousal facilitation)
  2. Stimulating and facilitating communication through successful interaction with the patient
44
Q

What is dysarthria? Identify the 5 types.

A

Impairment of speech production resulting from damage to the CNS that causes weakness, paralysis or in coordination of the motor system

  1. Spastic
  2. Flaccid
  3. Ataxic
  4. Hypokinetic
  5. Hyperkinetic
45
Q

What is dysphagia? List 5 patient populations where this is typically seen.

A

Swallowing deficits

  1. PD
  2. ALS
  3. MS
  4. Huntington’s
  5. Stroke
46
Q

What is dysphonia? (2)

A
  1. Inadequate breath support

2. Ineffective laryngeal function

47
Q

What is aphasia? Where is the brain damage seen?

A
  1. Acquired communication disorder

2. Typically, non-dominant hemisphere damage

48
Q

What are 3 types of aphasia?

A
  1. Non-fluent
  2. Fluent
  3. Global
49
Q

List 6 characteristics of non-fluent aphasia.

A
  1. Restricted vocabulary (can produce words but the words are garbled or the wrong word is being used)
  2. Awkward articulation
  3. Word substitutions; nonsense words
  4. Most commonly linked to left hemispheric damage (precentral gyrus, Broca’s Area)
  5. Auditory comprehension intact (can understand but difficulty responding)
  6. Reading less impaired than speech or writing; writing mirrors speech
50
Q

List 4 characteristics of fluent aphasia.

A
  1. Impaired auditory comprehension
  2. Lesion in posterior/temporal gyrus/left hemisphere (Wernicke’s area)
  3. Reading and writing impaired
  4. Verbal output often nonsensical, but flows as though speech is normal
51
Q

List 4 characteristics of global aphasia.

A
  1. A combination of fluent and non-fluent aphasia
  2. Not a designation of severity
  3. Extensive damage
  4. Left hemisphere; often Bilateral
52
Q

____ aphasia has the poorest prognosis.

A

GLOBAL

53
Q

List 3 factors that do not affect recovery from aphasia.

A
  1. Age
  2. Gender
  3. Handedness
54
Q

True or False: Aphasia due to a vascular lesion has better prognosis than post traumatic aphasia.

A

FALSE

Post-traumatic aphasia (i.e. TBI) has better prognosis (spontaneous recovery) than vascular lesion

55
Q

What is agnosia?

A

Inability to make sense of incoming information; intact sensory

56
Q

List 7 types of agnosia.

A
  1. Anosognosia- lack of awareness of one’s paralysis
  2. Somatoagnosia- lack of awareness of body parts to one another
  3. Right-Left Discrimination disorder
  4. Finger/Facial agnosia
  5. VISUAL(Visual Object/ Prosopagnosia/ Color Agnosia)
  6. Auditory
  7. Tactile (Astereognosis)
57
Q

Finger agnosia can lead to ______.

A

Agraphia: loss of ability to communicate through writing

58
Q

Communicating with a person with dementia

A

Refer to slides cause the list is looooong

Neurologic PT (11 decks)

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