Cognitive-Communication Disorders Flashcards
Types of Attention
Sustained
Selective
Divided
Attentional Shifting
Working memory
Ability to hold and manipulate several items of info at any one time
Speed of processing
how quickly we process any kind of info
- motor speed/reation time
eg. reading a passage quickly/adding up as quickly as possible
Visuoperceptual abilities
Ability to discriminate, integrate and process visual info
colour, shape, form, size
Visuospatial abilities
Ability to conceptualize visual and spatial relationships
Visuomotor/visuoconstructional abilities
Ability to manipulate and construct objects
Types of memory
verbal memory, visual memory, immediate recall, delayed recall
Immediate recall
Ability to recall info a short time after it has been presented
Includes verbal and visual info
Delayed recall
Recalling info that has been stored for a period of longer than a few minutes
Both verbal and visual info
Executive functions
High level abilities that guide and control behaviour Mental flexibility Inhibitory control Generativity Planning and organisation Decision making Self-monitoring
Indicators of Cognitive-Communication Disorders
Immediate recall, delayed recall, episodic memory
- affected in Alzheimers
Prospective memory
Planning for the future
Disorders of the Conceptualiser
Cognitive-Communication Disorders
High Level Language Difficulties
Right Hemisphere Language Disorder
Neurological conditions associated with Cognitive-Communication Disorder
TBI
Dementia (Alzheimer’s Disease, Frontotemporal Dementia)
Stroke (R. Hem Stroke, prefrontal cortex)
Autism
TBI
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
Incidence of TBI
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
Forms of TBI - Closed Head Injury
Blunt blow/violent shaking
- Symptoms depend on the location, intensity and direction of blow, whether the head was still or in motion
Forms of TBI - Penetrating Head Injury
Object penetrates skull, may carry debris into the brain
- type/severity of symptoms depend on location of penetration and trajectory of object
Primary Damage from TBI
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
Coup and Contrecoup injury
Skull strikes a stationary object - brain moves within the cranium Causes coup (site of contact) and contrecoup (opposite side) brain injury
Common Sites of Primary Damage
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
Secondary Damage
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
TBI Symptoms - Physical
Headache, nausea, vomiting, dizziness, blurred vision, sleep disturbance, weakness, paresis, sensory loss, spasticity, dysarthria, apraxia
TBI symptoms - cognitive
Attention, memory, concentration, language, learning, speed of processing, planning, reasoning, judgement, executive control, insight, impulsivity
TBI symptoms - behavioural
Depression, anxiety, agitation, irritability, impulsivity, aggression
Mild TBI
GCS (Glasgow Coma Scale) between 13-15
Duration of PTA (Post Traumatic Amnesia) of <1 hour
Moderate TBI
GCS (Glasgow Coma Scale) between 9-12
Duration of PTA (Post Traumatic Amnesia) of between 30 mins - 24 hours
Severe TBI
GCS (Glasgow Coma Scale) of 8 or less
Duration of PTA (Post Traumatic Amnesia) of >24 hours
Cognitive Communication Difficulties
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
Delayed Consequences of TBI
Neurological Development
Increasing failure
Restrictions
Growing academic/vocational/family demands
Recovery from TBI
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
Social-emotional impacts of TBI/Cognitive Communication Impairment
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
Dementia
Results in progressive, global deterioration in intellect
- memory, learning, orientation, language, comprehension, judgement
Memory impairment - most evident symptom of dementia
Priorities for Demenita Care
Early Diagnosis
Optimising physical health, cognition, activity and wellbeing
Detecting and treating behaviour and psychological symptoms
Providing info and long term support to carers
Alzheimer’s Disease
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
Stages of Dementia
Early/mild
Middle/moderate
Late/Terminal
Speech Path Focus in Dementia
Maximise function Maintain sense of identity Reduce carer stress Manage family/carer expectations Adapt intervention as dementia progresses
Strategies to Support Conceptualisation and Communication
- 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
Reminiscence Therapy
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)
