Cognitive Communication Disorders (Final Exam Review) Flashcards
The 2 main types of cells in the nervous system are the ___ and the ___
Glial cells (support cell function, Neurons (communication)
What do Sensory Neurons do?
(Receptors) Transmit sensory information to Nervous System
Name 3 types of sensory neurons (receptors):
Chemoreceptors (chemicals), Thermoreceptors (temperature), Mechanoreceptors (force/pressure), Photoreceptors (light during vision), Baroreceptors (changes in blood pressure), Proprioceptors (position)
connections between sensory and motor neurons are called ____________
Interneurons
What do Motor neurons (effectors) do?
Receive excitation from other cells and send impulses (signal transmission)
• E.g. instructs muscles to contract or glands to
secrete
At the cellular level, information is transmitted in the nervous system (NS) by the conversion of what kinds of energy (E)?
electrical energy
–> chemical energy —-> (back into) electrical
energy
Electrical energy moves within the neuron from the ___ to the ___.
(cell) body to the axon
Chemical cellular communication happens at the____ _____
synaptic cleft
Neurotransmitter function?
Chemical messenger; transmits message from Nerve Cell (across synapse) —-> target cell
Change in electrical value is known as _____ _____
Action Potential
The divisions of the nervous system are the ___ nervous system and the ___ nervous system
Central (CNS), Peripheral (PNS)
What two structures make up the CNS? ___ and ____
brain, spinal cord
The PNS is divided into the Autonomic & Somatic NS. It consists of ___ and ____ that are outside the CNS.
Nerves and ganglia (cell bodies) outside the CNS
The divisions of the PNS are the ___ and the ____
Autonomic NS, somatic NS
The outer coverings of the brain include the ___ , ___ , and the ___ .
Dura Mater, (outer coverings), Arachnoid Mater/ Membrane, Pia Mater (inner, near brain)
Between the arachnoid & pia mater is the ____ ____ which contains blood vessels and CSF
subarachnoid
space [which contains blood vessels and cerebrospinal fluid
(CSF)]
What is the function of CSF?
Cleans & protects the brain & spinal cord by circulating throughout the ventricles.
Major ventricles in brain___, ___, ____
2 lateral ventricles, 3rd ventricle, 4th ventricle
Neurology is the branch of medicine that deals with the _____, ______, and____ of the ____ _____ (..)
the anatomy,
physiology (function), and disorders of the nervous
system (N.S.)
Why do SLPs need to be well versed in Neurology?
To be effective
Dendrites are the ___ ___ of cell bodies.
Receptor Branches (of cell bodies)
Ganglia are….
Clusters of cell bodies in the PNS.
Nuclei are…
Clusters of cell bodies in the CNS.
What do Axons do?
Transmit electrical impulses (action potential) AWAY from cell body/ nucleus to terminal buttons
Axons are covered in a ___ ____
Myelin sheath
A tract is a bundle of _____ in the _____ ________ ________ (_ _ _)
Axons in the central nervous system (CNS)
A NERVE is a bundle of _____ in the _____ ________ ________(_ _ _)
A bundle of axons in the PNS-peripheral nervous system
The Nodes of Ranvier are gaps in _____ along the ___
gaps in MYELINATION along the AXON
What contains synaptic vesicles (stores the neurotransmitter for release at the synapse)? The ___ ____.
Terminal button (aka Axon Terminal)
Main components/ structures in the brain include the ____ (__), the ____, the ___, and the ___
Cerebrum (lobes), Cerebellum, Subcortical Structures, Brainstem
The cerebrum consists of ___ matter
gray matter
Gray matter is grey because it consists of ………
Somas, densely packed cell bodies
3 Regions with gray matter include _____, _____, and ____ _____
Cerebrum, Thalamus, Spinal Cord.
White matter appears white because …..
the majority of axons are wrapped in myelin, giving a whitish appearance
Name the 5 lobes of the brain
frontal, parietal, temporal, occipital, insula
When a function is controlled by 1 hemisphere (1 side), it is said to be _______(ed).
lateralized
Speech and language are thought to be controlled by the ____ hemisphere
in about __% of people
left, 95%
When certain brain regions serve distinct functions it’s referred to as “_____”.
“Specialization” (e.g. Frontal lobe is specialized for
executive function)
The main lobe involved with cognition? ___ lobe
frontal
3 main structures/ areas of the frontal lobe: 1. _______ _____, 2. ____ _____ ____3. _____ ____ ____
- Prefrontal cortex, 2. Supplementary Motor Area, 3. Primary Motor Cortex
Frontal Lobe Main Functions (9 of them)
(1) control for movement, (2) planning, (3) initiation,
(4) judgement, (5) reasoning, (6) concentration, (7) disinhibition of behaviors, (8) adaption to change, (9) emotional response
Primary Motor Cortex (Frontal Lobe) contains ____ neurons that send signals to execute movement.
motor neurons that send signals to execute movement
____ neurons are arranged in a somatotopic fashion
Motor
Broca’s area is included in the ___ ____ (___ side of the Frontal Lobe)
Premotor Cortex (left, frontal)
Function of Premotor cortex?
Plans movement
_____ (Efferent/ Afferent) nerves travel from the CNS to the body.
Efferent (exit the CNS)
_____ (Efferent/ Afferent) nerves travel from the body to the CNS.
Afferent (arrive in the CNS)
If the central point is the brain, then sensory neurons are ____ (afferent/efferent) because they send information to the brain, while motor neurons are ____ (afferent/efferent)because they carry information from the brain to organs, like muscles or glands.
For example, if the central point in question is the brain, sensory neurons are afferent because they send information to the brain (arrive in brain), while motor neurons are efferent because they carry information from the brain (exiting brain) to effector organs like muscles or glands. It is crucial to keep in mind exactly which structure is the current focus of the discussion since the terms “afferent” and “efferent” are relative to the direction of information transmission.
Although there may be involvement across multiple lobes of the brain for cognition, the main lobe is believed to be the ___ ____.
frontal lobe
Which cortex of the frontal lobe is typically associated with executive function? The ___ cortex
prefrontal
If you were to experience agnosia, or inability to recognize objects, this would likely be due to damage of the __ lobe of the brain.
parietal
Visual processing is believed to be involved with the __ lobe of the brain
occipital
Balance is typically associated with this part of the brain: the__.
cerebellum
The brain’s subcortical structures include the: thalamus, hypothalamus, pituitary gland, hippocampus, ___ ____ , and the ____.
substantia nigra; midbrain
The subcortical structure believed to form and store memories associated with emotional events is the ___
amygdala
The 3 parts of the brainstem from superior to inferior are the __, __, __.
midbrain, pons, medulla
The portion of the midbrain that produces the neurotransmitter dopamine is the ___
Substantia nigra
Which type of tracts in the CNS provide intrahemispheric connection? The ___ tracts
Association (tracts)
The 2 arterial systems in the brain are the____ arteries, which provide posterior blood circulation, and the ___ arteries which provide anterior circulation
Vertebral (posterior); Carotid (anterior)
What areas (lobes) of the brain are most likely impacted when there is attention impairment?
Frontal lobe, parietal, temporal
What area within the frontal lobe believed to be most involved with executive function?
prefrontal cortex
Which brain area is believed to be important for the storage of new memories?
Temporal lobe or Hippocampus (if destroyed, incapable of creating new memories)
The memory retrieval process is believed to be mediated by the __ lobe and subcortical structures
Frontal
CAPACITY LIMITATION is the principle that says ___is a limited-capacity resource, whereas SELECTION asserts that __ involves the selection of relevant stimuli while others are ignored/ filtered
attention; attention
Cognition is an umbrella term for all higher mental processes, including: ___, ___, ____, ___
attention, memory, executive function, language
Neuropsychologists are similar to SLPs in terms of assessing and treating cognition. However, they differ from SLPs in that they treat _____disturbances and ______ functioning
mood; emotional
The two general types of treatment are ___ and ___
rehabilitative; compensatory
According to Sohlberg and Mateer (1987, 2001, 2010), the two broad types of attention are __ and __
Sustained Attention; Executive control of attention
A screen is used to identify presence of impairment and is usually pass/ fail (T/F)
True
The 4 types of attention UNDER EXECUTIVE CONTROL are
Suppression, Selective, Alternating,
Working memory
Listening to a spoken passage in the presence of background noise requires intact attention of what kind?
Selective
(aka divided) ability to shift focus between tasks or stimuli is called __________attention
Alternating attention
ability to control impulsive responding is ________ ____ _________
Suppression of Attention (define)
ability to hold and manipulate information is called ________ _________
Working Memory
Selective Attention
selectively process information while inhibiting responses to nontarget information
Mental flexibility
(EF) ability to change a course of action based on shifting demands of a situation
Planning
Involves setting objectives and determining a course of action to achieve those objectives
being able to discern the good and harmful aspects of a situation is known as ________
Judgment
ability to select appropriate responses and suppress unwanted actions is called_______
Inhibition
Attention is always defined in relation to a __
Stimulus, external stimulus, internal stimulus
As an SLP, your evaluation should include these 4 parts:
Case history, Background, Physical examination, Assessment
Katie has an appointment at 3:00 pm. It’s now 2:30 and she knows she should leave but she can’t seem to get going. THis is an example of a deficit in which executive function component?
Initiation
____, ___, and ___ are the various stages of information processing described by the Stages Model of human memory
encoding, storage, retrieval
Delayed recall is associated with which stage of human memory?
Retrieval
The early processing of material to be learned is associated with which stage of human memory
Encoding
Etiology:
cause, set of causes, or manner of causation of a disease or condition
Pathophysiology
functional changes associated with or resulting from disease or injury
What type of disease is Encephalitis?
Acute Onset
Covid-19 is an example of what type of disease?
Example of a disease of immunocompromise
Lupus is an example of what type of disease?
Example of a relapsing/ remitting disease
Example of a progressive disease
Parkinson’s Disease (PD), ALS
Cerebrovascular accidents associated with cognitive-linguistic deficits are most often the result of the loss of blood flow in the ___ ___ ___ ___.
Left Middle Cerebral Artery (LMCA)
The 2 types of stroke are: __ and ___
Ischemic; Hemorrhagic
Ischemic strokes account for nearly what percentage of all strokes?
90%
The two types of TBIs are ___ brain injury and __ brain injury
penetrating (open) brain injury; closed brain injury
Inflammation in the brain can cause neuronal communication to quicken (T/F)
False, inflammation can cause neuronal communication to slow.
What is an example of a Demyelinating disease?
MS-multiple sclerosis (NOT: FTD, ALS, MSA, AD)
Neuronal communication is __ in demyelinating disease
slowed, slower, or declined
How much of dementia is the result of Alzheimer’s disease (AD) ? (2/3, 1/4, 1/3, or 1/2)
2/3
What is the hallmark cognitive symptom of Alzheimer’s Disease?
Memory Impairment
Parkinson’s disease is caused by a loss of ___ producing nerve cells in the part of the brain called the___ ___
dopamine; substantia nigra
What is the hallmark cognitive symptom in frontotemporal dementia (FTD)?
Executive function impairment
Which of the below types of dementia is typically associated with attention impairment, appearing early in the disease progression?
Lewy body dementia (LBD)
use of decontextualized tasks to train attention in a specific context is ____ ______
Direct training
training cognitive skills in the context of everyday activities is ________ ____ ______ ______
Training in specific skills
Compensatory strategies
intended to minimize impairment while waiting for function to return or if function does not return
There is insufficient evidence that direct training on its own is effective and therefore should be combined with other approaches (T/F)
True
Which type of cognitive impairment is the most common deficit observed in patients with acquired cognitive communication disorders?
Executive Dysfunction
The 3 treatment types under the rehabilitative approach for memory include __, ___, and _____ _____
Rehearsal, Retrieval (cues), Awareness Training (Metamemory)
List one treatment example type for rehearsal
Rehearsing numbers Inference rehearsal Spatial, spatial rehearsal Inference Rehearsing instructions Spaced retrieval
An “alphabet search” is an example of a ______ ____ for the treatment for memory
Retrieval cue, retrieval, retrieval technique
Which type of cognitive impairment is the most enduring following TBI?
Executive Function
Selection of therapy approach in patients with TBI depends on [ ] Patient’s level of awareness, [ ] Time since Injury, [ ] Support available to patient [ ] cause or [ ] location of injury
Patient’s level of awareness, Time since Injury, Support available to patient (NOT: cause or location of injury)
Presence/ absence of impairment can be made using results of a single cognitive communication measure (T/F)
False
Select all protocols below intended to treat executive function impairment [ ] TATE, [ ] TEACH-M, [ ] Spaced Retrieval, [ ] PIE [ ] memory book or [ ] APT
TATE, TEACH-M, Spaced Retrieval, PIE (NOT: memory book or APT)
Time manaagement pressure is a common complaint among patients with dementia (T/F))
False
Environmental supports used to compensate for executive function deficits include: modification of ___ demands, organization of ___ _____, cueing, prompting and manipulation of ____ factors
Task (demands), (organization of )Physical Space, Prompting, (cueing), and (manipulation of ) Physiologic (factors)
Although there may be involvement across multiple lobes of the brain for cognition, the main lobe is believed to be the ___
Frontal Lobe
The two components of attention according to Sohlberg and Mateer are __ attention and ___ of attention
Sustained (attention) and Executive control (of attention)
Compensatory strategies for Memory:
memory notebook, calendar or smartphone, written aids, pill organizers, alarms
Unilateral neglect is a visual deficit (T/F)
False
Left unilateral neglect is more common than right: (T/F)
True
Unilateral visuospatial neglect can be view centered, ___ centered, or both.
object
Although there is a paucity of treatment efficacy for disorders associated with right hemisphere damage, the exception is ___ ___ ____
Unilateral Visuospatial Neglect (UVN)
RHD-CCD can affect both cognition and communication, including ____ ______, ____, ___, ____, and _____
executive function, awareness, prosody, comprehension, production, and pragmatics
RHD most frequently impacts which of the following types of attention?
Sustained, Selective, Alternating
Define anosognosia in your own words
Anosognosia is the lack of awareness of one’s own deficits. A patient may have left-sided neglect, where they do not see things on the left side of a page or the left side of their body. Anosognosia can include a lack of awareness of this left-sided neglect.
Name one type of treatment for affective aprosodia:
Motoric-imitative treatment
Cognitive affective treatment
Indicate whether the Motoric-imitative & cognitive affective treatment are intended for expressive affective aprosodia or receptive affective aprosodia
Expressive aprosodia-both motoric-imitative treatment & cognitive affective treatment (p.178-180)
__ is a treatment for neglect that can be categorized as “bottom-up” (p. 174)
Adding characters to words (e.g. provide meaningless symbols (e.g. xxx) before words Left side anchors External sensory simulation Border around stimuli Prism adaptation
Bottom-up treatments are designed to _________________
increase attention to left-sided stimuli through manipulation of attentional systems or the stimuli themselves (p. 174)
Treatments that Improve individuals’ performance via cognitive strategies. (p. 174)
Top-down attentional treatments for UN
______ (multiple answers) is a treatment for neglect that can be categorized as “top-down”
Lighthouse strategy
Visuospatial motor treatments
Limb activation training
Visual scanning
Which category of treatments for neglect (UVN) currently has better evidentiary support in the literature?
Top-down
Mild cognitive impairment is a preclinical condition suggesting risk for developing dementia (T/F)
True
Which type of dementia has an onset typically occurring before 65 years of age?
Frontotemporal Dementia
Which type of dementia has accompanying sleep disturbances and hallucinations?
Dementia with Lewy Bodies (DLB) (p.244)
The 2nd most common cause of dementia is
Vascular Dementia
Name one screen for cognitive impairment
Montreal cognitive assessment Cognitive linguistic quick test plus Cognitive linguistic quick test Mini mental state examination Saint louis university mental status exam Clock drawing test
Name one measure to assess dementia across cognitive domains
Arizona Battery for Cognitive Communication Disorders, 2nd edition
Cognitive Linguistic Quick Test
Dementia Rating Scale
Repeatable Battery for the Assessment of Neuropsychological Status
Treatment for cognitive-communication disorders for dementia includes behavioral and __ treatment
Pharmacological
Surgical
medical
Name one feature of successful interventions for persons with dementia:__
Task formats that reduce error likelihood during initial learning
Capitalize on relatively spared sustained attention during intervention
Provide contexts for learning by doing and for practice with generate…??
Errorless learning
Exposure to meaningful sensory stimuli
Learning by doing with multiple opportunities
Opportunities for meaningful social engagement
Write one evidence-based behavioral treatment for cognition for persons with dementia
Reading Roundtable
Memory wallets
Memory books
Spaced retrieval
Patients with dementia undergo treatment
Direct behavioral Treatment
Family members undergo training
Indirect behavioral treatment
Write on SMART Goal that would be beneficial for persons with dementia
My goal: In 12 weeks, the patient will demonstrate the use of a compensatory strategy (e.g. utilize a memory book to rehearse personal information) in 4 out of 5 opportunities during 3 consecutive therapy sessions, as measured by SLP therapy data and observations.
TBI- what are rotational forces?
Rotation of the object around its center of gravity. Because of the structure of the skull and meninges, cortex suffers damage due to shearing strain during rotation
Application of rotational force causes angular acceleration of skull while brain initially remains stationary due to inertia
Then, brain surface catches on bony protuberances on inner surface of skull and is dragged along with movement of the skull
Results in ripping of the cortex with the greatest damage in the frontal and temporal regions
Scales to measure TBI severity
Glasgow Coma Scale
Post-traumatic amnesia
Altered level of consciousness
The ___ ____ ___ is a common scoring system used to describe the level of consciousness in a person following TBI
Simple, reliable, objective. Can be used to assign severity level.
Glasgow Coma Scale (GCS): Measures eye-opening (spontaneous, none, etc.), verbal response (oriented, confused, words but not coherent, sounds but no words), motor response (6=obeys command; 5= localizing; 4 = normal flexion; 3=abnormal; 2= extension). Mild=13-15; Mod=9-12; Severe=3-8
Period of time between injury and recovery of continuous memory: ___ _____ _____
Post traumatic amnesia (PTA)
Relationship between length of PTA and the severity of TBI
> 5 min=very mild; 5-59 min=mild; 24 hours= mod; 1-7 days= severe >7 days= very severe
Altered States of Consciousness: complete state of unconscious with no environmental interaction is a…..
coma
Altered States of Consciousness: Some eye-opening and periods of wake or sleep is a …
Persistent Vegetative State
Altered States of Consciousness: persists for more than 1 month with no functional changes is a …
Permanent vegetative state:
Altered States of Consciousness: inconsistent control of voluntary movements or behaviors;
Minimally conscious state: (Demonstrate 1+ of the following: Limb withdrawal to stimulus
Some visual tracking to follow person or object in room; Inconsistent grabbing of objects or following of commands; Some communication via yes/ no or gesture
Common deficits following TBI include: (more than 5)
Orientation Attention Memory Executive functioning Processing speed Self-awareness Language Pragmatics Dysphagia (trouble swallowing) Motor speech (dysarthria) Hearing Vision
WHO-ICF is the
World Health Organization’s Classification of Functioning, Disability, and Health (WHO-ICF) is a globally recognized model for assessing deficits at the impairment, activity, and functioning levels within the recovery continuum
Focus on FUNCTIONAL evaluation and treatment; look at QoL (quality of life)
TBI: Adequate assessment at the functioning level includes the following 5 objectives:
Evaluate strengths and weaknesses and their effect on pre-morbid abilities
Guide the development and implementation of short- and long-term treatment goals
Guide the development of remedial and compensatory strategies
Steer discussion with patients and family members regarding challenges within the recovery process
Serve as an anchor for future changes resulting from recovery and treatment
TBI: Types of Assessments (early assessment, ___, ____, ___, ___, ___)
Early assessment Scales and Observational checklists Self-report and Quality of Life measures Standardized Assessment measures Functional Assessment measures
Self-report and Quality of Life measures for TBI?
Behavior Rating Inventory of Executive Functioning (BRIEF-A)
Quality of Life after Brain Injury (QOLIBRI)
National Institute of Health Toolbox Measures
Brain Injury Screening Questionnaire (BISQ)
Mayo-Portland Adaptability Inventory (MPAI)
Motivational Interview Techniques
TBI: Standardized Assessment measures
The Brief Test of Head Injury (Helm-Estabrooks & Hotz, 1991)
Scales of Cognitive Ability for Traumatic Brain Injury (Adamovich & Henderson, 1992
TBI: Functional Assessment measures
Observational reports; Social skills, fatigue, emotional lability, motivation; Discourse analysis
TBI: Treatments
Sensory Stimulation= aimed at those who are in altered states of consciousness (visual-photos; Auditory-preferred music/tv, voices of family/friends, Tactile, Olfactory, gustatory, kinesthetic-raise bed)
Cognitive Therapy (attention, memory, executive functioning)
Motor Speech & Voice
Discourse & Pragmatics
AAC
How many sustain mTBI/ Concussion?
42-62 million worldwide; 6-8 million in US; Most recover quickly, but some have symptoms for months or years
mTBI Diagnosis (loss of consciousness lasts for how many minutes or hours?
Loss of Consciousness <30 min.; GCS score of 13-15; altered mental status, amnesia, confusion. Usually have PTA <24 hrs (post-traumatic amnesia)
3 Categories of mTBI?
SRC- sports related concussion; MM-Mixed mechanism (fall; MVA); Military-related (blast, blunt force trauma
Neurophysiology of Concussion: Diruption in the ____ balance. ____ (K) rushes out of the cells. ___ (Na) and ____ flood into the cells. Excess amounts of ____ (a neurotransmitter) are released. Too much causes toxic synapses, slowed communication between neurons, brain in hyperactive state consuming lots of E & resources quickly.
-Disruption in ionic balance of the neurons
- Potassium rushes out of cells
- Sodium and calcium flood into cells
- Excess amounts of glutamate (neurotransmitter) are released
- Combination of dysfunction in sodium-potassium pump & too much glutamate causes:
–Toxic synapses
–Slowed communication between neurons
–Brain Temporarily goes into a “hyperactive” state consuming lots of energy & resources quickly
–Followed by 7-10 day decrease in cerebral blood flow & hypometabolism
Causing many of the acute symptoms associated with mTBI
Microstructural Changes (mTBI) may occur
- Diffuse axonal injury
- Edema
- Inflammation
There are no current, definitive biomarkers, neuroimaging procedures, or neuropsychological tests that can diagnose remote mTBI events (T/F)
True
TBI: Acute and persistent symptoms fall within 3 categories
- Physical
- Emotional
- Cognitive
You are completing a chart review on your patient who comes with cognitive complaints that have persisted 2 months following a concussion. You review imaging available which includes a CT and MRI. Both indicated normal results. Is the lack of findings on imaging important to the diagnosis?
No, it’s not as important because both MRI and CT scans can appear normal in people with mTBI and the patient is complaining of cognitive symptoms which should likely be addressed.
Regarding the emotional problems caused by mTBI, would it be best for you to treat these yourself or refer? To whom might you refer?
No, it would be better to refer to a neuropsychologist.
TBI: How might auditory comprehension impairments in patients with mTBI impact your evaluation or treatment?
Evaluation should include attempting various strategies to help determine which strategies help the patient with comprehension. For example, visuals (pictures) can be helpful as well as orthographic (written) cues either written by the clinician or by the client depending on their skills.
Stuttering in mTBI is likely neurogenic. True/ False
False. Can be due to medications
Can be related to PTSD, depression, anxiety or other psychological issues
Not likely to be neurogenic (unlikely neurogenic)
Chronic Traumatic Encephalopathy (CTE); when _____ _____ _______ accumulates in the brain
where hyperphosphorylated tau protein accumulates in the brain
Causing progressive deterioration of neurologic function
Resulting in dementia
This tau is distinct from plaques & tangles in Azheimer’s disease
In CTE, tau accumulates throughout the brain (diffuse?);
Including hippocampus, amygdala, cortical areas
Diagnosis of CTE..
Remain unsettled & based on post-mortem brain pathology studies
Symptoms attributed to the diagnosis of CTE are based on personal reports by family & friends of the deceased individual
Decreased memory & Executive Function
Aggression; depression; erratic behaviors
Changes in motor function & balance problems
