CVA impairments 3 (consciousness, cognition, and communication) Flashcards
What are the 5 levels of arousal?
Full consciousness
Lethargy- general slowing of cognitive and motor processes
Obtundation -Dulled or blunted sensitivity
Stupor- state of semi-consciousness
Coma-Unconscious
What type of outcome measure/scale is used to measure level of consciousness post stroke? (typically seen more acutely used)
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
True or false: Total GCS score found to predict acute mortality within 75% accuracy
false, 88% accuracy, @ 2 weeks, 3 months
What type of deficit can impact GCS scores? And what section could potentially excluded due to this?
Communication deficits can affect GCS scores,
Research suggests the verbal response component can be excluded when appropriate without hurting predictive value
When are arousal levels fluctuating the most related to stroke?
In the acute phase, fluctuating arousal can be caused by a lot of things. Medications, interventions, neurological impairment
What is a way we can increase patient arousal pretty rapidly?
We can get them up!
What are the basic components of a cognitive exam?
Orientation, memory, attention, executive function, communication, and behavior
What kind of deficit makes evaluating cognition very difficult?
Communication
Typical characteristics of impaired orientation following a CVA, and what structures are damaged?
Disorientation denotes general intellectual dysfunction but can reflect difficulties with attention, memory
Often require increased cues, redirection encouragement
Multiple cortical regions involved
Typical characteristics of impaired attention following a CVA, and what structures are damaged?
*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
Typical characteristics of memory following a CVA, and what structures are damaged?
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
Typical characteristics of executive function following a CVA, and what structures are damaged?
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
What types of lesions can cause emotional changes? And what are some typical emotional changes seen post stroke?
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
What is aphasia?
“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
Which sided stroke is aphasia usually seen with? dominant or non-dominant?
Dominant hempishere lesion
Study aphasia anatomy review slides 16-17
:)
What is broca’s aphasia?
Sometimes referred to as motor aphasia
Impaired language production
aware of deficits and aware of what they are trying to say
What is Wernicke’s aphasia?
Impaired language comprehension
unaware of deficits, and thinks what they are saying makes perfect sense
What is global aphasia?
Wernicke’s and broca’s
What is transcortical aphasia? and what are the three types?
Ability to repeat with good accuracy is retained
seen commonly with ACA strokes
Transcortical motor
Transcortical sensory
mixed transcortical
What is transcortical motor aphasia?
non-fluent speech with greater effort required than Broca’s; comprehension intact
What is transcortical sensory aphasia?
fluent speech marked with paraphasias, word substitutions, poor comprehension
What is mixed transcortical aphasia?
severely disordered language except in repetition. Echolalia is common.
What is conduction aphasia?
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
What is anomic aphasia?
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
What are some tips on how to talk to someone with aphasia?
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
What is Alexia?
Impairment in reading ability
What is alexia without aphasia?
lesion to the dominant occipital cortex extending to the posterior corpus callosum (often PCA infarct)
What is agraphia?
Impairment in writing ability
What is agraphia without aphasia?
lesions of inferior parietal lobe of language dominant hemisphere
What is dysarthria?
Weakness, paralysis, or incoordination of the motor-speech system
Often leads to slurred, slowed speech
Often seen alongside with aphasia
What is it called when speech is completely unintelligible?
anarthria
What are some treatment strategies for dysarthria?
Slow rate of speech
Over-articulate
Speak louder
What is speech apraxia?
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
What is dysphagia?
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
