CVA impairments 3 (consciousness, cognition, and communication)

Question 1

What are the 5 levels of arousal?

Answer 1

Full consciousness
Lethargy- general slowing of cognitive and motor processes
Obtundation -Dulled or blunted sensitivity
Stupor- state of semi-consciousness
Coma-Unconscious

Question 2

What type of outcome measure/scale is used to measure level of consciousness post stroke? (typically seen more acutely used)

Answer 2

Glascow coma scale

Measures 3 areas of consciousness: eye-opening, motor response, verbal response​

Scores 3-15​

< 8 severe ​

9-12 moderate​

13-15 mild

Question 3

True or false: Total GCS score found to predict acute mortality within 75% accuracy

Answer 3

false, 88% accuracy, @ 2 weeks, 3 months

Question 4

What type of deficit can impact GCS scores? And what section could potentially excluded due to this?

Answer 4

Communication deficits can affect GCS scores,

Research suggests the verbal response component can be excluded when appropriate without hurting predictive value

Question 5

When are arousal levels fluctuating the most related to stroke?

Answer 5

In the acute phase, fluctuating arousal can be caused by a lot of things. Medications, interventions, neurological impairment

Question 6

What is a way we can increase patient arousal pretty rapidly?

Answer 6

We can get them up!

Question 7

What are the basic components of a cognitive exam?

Answer 7

Orientation, memory, attention, executive function, communication, and behavior

Question 8

What kind of deficit makes evaluating cognition very difficult?

Answer 8

Communication

Question 9

Typical characteristics of impaired orientation following a CVA, and what structures are damaged?

Answer 9

Disorientation denotes general intellectual dysfunction but can reflect difficulties with attention, memory​

Often require increased cues, redirection encouragement

Multiple cortical regions involved

Question 10

Typical characteristics of impaired attention following a CVA, and what structures are damaged?

Answer 10

*Most common cognitive deficit found post stroke (46-92%!)​

Difficulty in processing and assimilating new information and techniques, motor learning, dual task ​

Dysfunction correlated with balance impairment, falls

Pre-frontal cortex and reticular formation damaged

Question 11

Typical characteristics of memory following a CVA, and what structures are damaged?

Answer 11

Difficulty with carry-over of newly learned or retained tasks ​

Long-term memory typically remains intact

ST: prefrontal cortex, limbic system​

LT: hippocampus, temporal lobe

Question 12

Typical characteristics of executive function following a CVA, and what structures are damaged?

Answer 12

Inappropriate interactions, poor self-monitoring and self-correcting ​

Impulsive, inflexible thinking, decreased insight, impaired organization, sequencing and planning abilities, impaired judgement

Damaged- pre-frontal cortex

Question 13

What types of lesions can cause emotional changes? And what are some typical emotional changes seen post stroke?

Answer 13

Apathy: shallow affect, blunted emotional responses​

Euphoria: Exaggerated feelings of well-being​

​

Depression: persistent feelings of sadness accompanied by feelings of hopelessness, worthlessness, and/or helplessness​

Correlation found with left frontal and right parietal lesions​

Also can happen as secondary sequelae of impact of injury​

​

Pseudobulbar Affect: state of emotional lability due to neurological insult ​

Correlated with inferior frontal and inferior parietal lobe damage (R or L)​

Emotional outbursts of uncontrolled or exaggerated laughing or crying ​

Inconsistent with actual mood

lesions affecting frontal lobe, hypothalamus, and limbic system can produce notable emotional changes

Question 14

What is aphasia?

Answer 14

“A disturbance of one or more aspects of the complex process of comprehending and formulating verbal messages that result from newly acquired disease of the central nervous system

Question 15

Which sided stroke is aphasia usually seen with? dominant or non-dominant?

Answer 15

Dominant hempishere lesion

Question 16

Study aphasia anatomy review slides 16-17

Answer 16

:)

Question 17

What is broca’s aphasia?

Answer 17

Sometimes referred to as motor aphasia
Impaired language production
aware of deficits and aware of what they are trying to say

Question 18

What is Wernicke’s aphasia?

Answer 18

Impaired language comprehension
unaware of deficits, and thinks what they are saying makes perfect sense

Question 19

What is global aphasia?

Answer 19

Wernicke’s and broca’s

Question 20

What is transcortical aphasia? and what are the three types?

Answer 20

Ability to repeat with good accuracy is retained
seen commonly with ACA strokes

Transcortical motor
Transcortical sensory
mixed transcortical

Question 21

What is transcortical motor aphasia?

Answer 21

non-fluent speech with greater effort required than Broca’s; comprehension intact

Question 22

What is transcortical sensory aphasia?

Answer 22

fluent speech marked with paraphasias, word substitutions, poor comprehension

Question 23

What is mixed transcortical aphasia?

Answer 23

severely disordered language except in repetition. Echolalia is common.

Question 24

What is conduction aphasia?

Answer 24

The main impairment is in the inability to repeat words or phrases.

Polar opposite of transcortical aphasia- the only thing they struggle with is repeat after me tasks

Caused by a lesion in the arcuate fasciculus,​

Or, less commonly, left temporal lobe in the auditory association area​

referred to as a mild aphasia

Question 25

What is anomic aphasia?

Answer 25

Word finding difficulty within fluent, grammatically well-formed speech Speech output is somewhat vague, and patient may use circumlocution as a compensatory strategy Lesion site is usually variable but is common in left angular gyrus

Question 26

What are some tips on how to talk to someone with aphasia?

Answer 26

Simple, short phrases​ Give additional time​ Do not talk over them, like they are kids, speak too loud​ Simple yes/no versus elaborate questions​ Gestures to facilitate understanding​ Consult speech therapy

Question 27

What is Alexia?

Answer 27

Impairment in reading ability

Question 28

What is alexia without aphasia?

Answer 28

lesion to the dominant occipital cortex extending to the posterior corpus callosum (often PCA infarct)

Question 29

What is agraphia?

Answer 29

Impairment in writing ability

Question 30

What is agraphia without aphasia?

Answer 30

lesions of inferior parietal lobe of language dominant hemisphere

Question 31

What is dysarthria?

Answer 31

Weakness, paralysis, or incoordination of the motor-speech system​ Often leads to slurred, slowed speech​ ​ Often seen alongside with aphasia

Question 32

What is it called when speech is completely unintelligible?

Answer 32

anarthria

Question 33

What are some treatment strategies for dysarthria?

Answer 33

Slow rate of speech ​ Over-articulate​ Speak louder

Question 34

What is speech apraxia?

Answer 34

Labored speech – articulatory difficulty, speech errors, slow rate “halting”, slow transition between sounds, and impaired prosody in the absence of impaired strength or coordination of the motor speech system​ Difficult to initiate speech​ Periods of error-free speech followed by errors as speech progresses NOT a product of weakness, spasticity, involuntary movements, or language production/comprehension.​ ​ Difficult to diagnose with aphasia​ Trick: Ask pt to sing happy birthday

Question 35

What is dysphagia?

Answer 35

A swallowing disorder caused by various medical conditions in the oral cavity, pharynx, or esophagus. Common in a multitude of CNS disorders, and non-CNS pathology too! ​ ​ HUGE aspiration risk