Cognitive-Communication Disorders

Question 1

Types of Attention

Answer 1

Sustained
Selective
Divided
Attentional Shifting

Question 2

Working memory

Answer 2

Ability to hold and manipulate several items of info at any one time

Question 3

Speed of processing

Answer 3

how quickly we process any kind of info

• motor speed/reation time
  eg. reading a passage quickly/adding up as quickly as possible

Question 4

Visuoperceptual abilities

Answer 4

Ability to discriminate, integrate and process visual info

colour, shape, form, size

Question 5

Visuospatial abilities

Answer 5

Ability to conceptualize visual and spatial relationships

Question 6

Visuomotor/visuoconstructional abilities

Answer 6

Ability to manipulate and construct objects

Question 7

Types of memory

Answer 7

verbal memory, visual memory, immediate recall, delayed recall

Question 8

Immediate recall

Answer 8

Ability to recall info a short time after it has been presented
Includes verbal and visual info

Question 9

Delayed recall

Answer 9

Recalling info that has been stored for a period of longer than a few minutes
Both verbal and visual info

Question 10

Executive functions

Answer 10

High level abilities that guide and control behaviour 
Mental flexibility 
Inhibitory control 
Generativity 
Planning and organisation
Decision making 
Self-monitoring

Question 11

Indicators of Cognitive-Communication Disorders

Answer 11

Immediate recall, delayed recall, episodic memory

- affected in Alzheimers

Question 12

Prospective memory

Answer 12

Planning for the future

Question 13

Disorders of the Conceptualiser

Answer 13

Cognitive-Communication Disorders
High Level Language Difficulties
Right Hemisphere Language Disorder

Question 14

Neurological conditions associated with Cognitive-Communication Disorder

Answer 14

TBI
Dementia (Alzheimer’s Disease, Frontotemporal Dementia)
Stroke (R. Hem Stroke, prefrontal cortex)
Autism

Question 15

TBI

Answer 15

Insult to the brain caused by an external force

• head being struck/striking an object
• acceleration/deceleration without external trauma
• foreign body penetrating the brain
• Forces from blast/explosion

Question 16

Incidence of TBI

Answer 16

More common in males vs females
Assoc. with lower socioeconomic status, history of risk taking behaviour, poor academic/vocational achievement, use of alcohol and recreational drugs
Falls in the older population

Question 17

Forms of TBI - Closed Head Injury

Answer 17

Blunt blow/violent shaking

- Symptoms depend on the location, intensity and direction of blow, whether the head was still or in motion

Question 18

Forms of TBI - Penetrating Head Injury

Answer 18

Object penetrates skull, may carry debris into the brain

- type/severity of symptoms depend on location of penetration and trajectory of object

Question 19

Primary Damage from TBI

Answer 19

Coup and contrecoup damage 
Contusion, laceration and shearing of axons 
- diffuse axonal injury 
- bruising and swelling of brain tissue
Shearing of blood vessels 
- subdural and intracerebral haemorrhage

Question 20

Coup and Contrecoup injury

Answer 20

Skull strikes a stationary object - brain moves within the cranium 
Causes coup (site of contact) and contrecoup (opposite side) brain injury

Question 21

Common Sites of Primary Damage

Answer 21

Anterior and inferior frontal and temporal lobes
Explains common presentation of:
- depressed executive control over cognitive/communicative functions
- impaired social perception/social reactivity
- Reduced behavioural self regulation
Diffuse neuronal shearing concentrated in subcortical white matter, brain stem and corpus collosum
- contributes to initial loss of consciousness, arousal/attentional deficits, reduced processing speed

Question 22

Secondary Damage

Answer 22

Haemorrhage - slowly developing and localised
Cerebral oedema - widespread swelling
Intracranial pressure - compression/displacement of brain tissue due to pressure build up
Seizures - post traumatic seizures complicate recovery, may persist
Hypoxic Ischaemic Injury - stroke

Question 23

TBI Symptoms - Physical

Answer 23

Headache, nausea, vomiting, dizziness, blurred vision, sleep disturbance, weakness, paresis, sensory loss, spasticity, dysarthria, apraxia

Question 24

TBI symptoms - cognitive

Answer 24

Attention, memory, concentration, language, learning, speed of processing, planning, reasoning, judgement, executive control, insight, impulsivity

Question 25

TBI symptoms - behavioural

Answer 25

Depression, anxiety, agitation, irritability, impulsivity, aggression

Question 26

Mild TBI

Answer 26

GCS (Glasgow Coma Scale) between 13-15 | Duration of PTA (Post Traumatic Amnesia) of <1 hour

Question 27

Moderate TBI

Answer 27

GCS (Glasgow Coma Scale) between 9-12 | Duration of PTA (Post Traumatic Amnesia) of between 30 mins - 24 hours

Question 28

Severe TBI

Answer 28

GCS (Glasgow Coma Scale) of 8 or less | Duration of PTA (Post Traumatic Amnesia) of >24 hours

Question 29

Cognitive Communication Difficulties

Answer 29

Word finding difficulties Difficulty organising and sequencing information Disorganised, poorly controlled and sequenced discourse Inefficient comprehension Difficulty processing lengthy, complex information Difficulty understanding and expressive abstract language Difficulty reading social cues, interpreting speaker intent, adjusting interaction styles to meet contextual demands Difficulty adhering to conversational rules Inappropriate social interaction Self-awareness of problems is limited with poor planning and self monitoring ability Short-term/working memory difficulties Difficulty executing cognitive plans, managing time and self-regulation

Question 30

Delayed Consequences of TBI

Answer 30

Neurological Development Increasing failure Restrictions Growing academic/vocational/family demands

Question 31

Recovery from TBI

Answer 31

Bulk of recovery takes place in first 6-9 months following injury Continues for 2-3 years - Recovery of memory functions appears to be somewhat slower than recovery of general intelligence - Greater optimism for recovery of cognitive functions vs social abilities

Question 32

Social-emotional impacts of TBI/Cognitive Communication Impairment

Answer 32

55% of people with TBI had social relationship problems 23 years post injury Sense of self development through interaction with others Evidence linking social relationships is as important to health as smoking, obesity, BP and physical activity Therapy goals need to focus on social relationships and identity

Question 33

Dementia

Answer 33

Results in progressive, global deterioration in intellect - memory, learning, orientation, language, comprehension, judgement Memory impairment - most evident symptom of dementia

Question 34

Priorities for Demenita Care

Answer 34

Early Diagnosis Optimising physical health, cognition, activity and wellbeing Detecting and treating behaviour and psychological symptoms Providing info and long term support to carers

Question 35

Alzheimer's Disease

Answer 35

Earliest sign = subtle memory change Medial Temporal Lobe pathology - episodic memory loss - Ability to retain new info after delay - loss of memory for recent events - poor encoding and rapid forgetting of info Begins in cortical pathways (temporal lobes, hippocampus), spreads outwards

Question 36

Stages of Dementia

Answer 36

Early/mild Middle/moderate Late/Terminal

Question 37

Speech Path Focus in Dementia

Answer 37

``` Maximise function Maintain sense of identity Reduce carer stress Manage family/carer expectations Adapt intervention as dementia progresses ```

Question 38

Strategies to Support Conceptualisation and Communication

Answer 38

- Don't ask lots of questions that rely on good memory - Stimulate opinions, feelings, thoughts vs recalling facts/knowledge - Don't change topics suddenly - Allow time for important conversations - Turn down background noise and remove distractions - Encourage and support them to join convo where possible

Question 39

Reminiscence Therapy

Answer 39

Involves discussion of past activities, events and experiences Can distract and calm, strengthen memories and stimulate communication Taps into preserved store of long term memories, helps the individual to feel worthwhile and connected Uses multiple communication channels and tangible prompts to draw attention to past (photos etc)