Day 4 - Aphasia, Neglect, Apraxia, Dysphagia Flashcards
Define aphasia
Aphasia is inability to communicate. It affects all aspects of language: speaking, gesturing reading, writing, and understanding language.
Bedside Aphasia Assessment
- Does the patient understand? Say a command.
- Is the patient able to talk?
- Can the patient repeat?
- Can the patient read?
- Can the patient write?
DeLisa Chapter 44
Paraphasias - Anomia - Echolalia
Paraphasias: Incorrect substitution of words or parts of words
Echolalia: Repetition (“echoing”) of words or vocalizations made by another person
Anomia: Difficulty recalling words; word-finding difficulty
List 4 FLUENT APHASIA
- Transcortical sensory
- Wernicke’s
- Conduction
- Anomia
List 4 NONFLUENT APHASIA
- Broca’s
- Transcortical motor
- Global
- Mixed transcortical
Types of aphasia 🔑
- Broca’s
- Transcortical motor
- Global
- Mixed transcortical
List 4 Non-Pharmacological Interventions for Aphasia
- Speech Language Therapy
- Computer-Based Treatment
- Training Conversation / Communication Partners
- Group Therapy
List 4 types of dysarthria 🔑
Pyramidal
- UMN → SPASTIC (eg pseudobulbar palsy).
- LMN → FLACCID (eg bulbar palsy).
- MIXED (eg ALS, MS, Wilsons disease).
ExtraPyramidal
HYPOKINETIC: extra-pyramidal (eg. Parkinsonism).
HYPERKINETIC: Extra-pyramidal (basal ganglia).
a. Quick: chorea, myoclonus, tourettes.
b. Slow: athetosis, dyskinesias, dystonia.
c. Tremors: organic voice tremor.
Cerebellum
- ATAXIC: cerebellum (eg. Cerebellar ataxia).
Delisa Table 15.1
Wernicke’s aphasia
Broca’s aphasia
Global aphasia
Anomic aphasia
Conduction aphasia
Transcortical sensory aphasia
Transcortical motor aphasia
Why is Left Sided Neglect More Common than Right Sided Neglect? 🔑
Neuroanatomical findings have identified that the left hemisphere is responsible for modulating arousal and attention for the right visual field, whereas the right hemisphere controls these processes in both right and left visual fields.
This may explain why unilateral spatial neglect is not typical for those with left hemisphere damage (LHD) post-stroke because the intact right hemisphere is capable of compensating for perceptual deficits that result from LHD
Types of Unilateral Spatial Neglect 🔑
a) Egocentric neglect أناني يشوف بصوب واحد
Neglect of the body or personal space, tendency to neglect the opposite side of the lesion, in reference to the midline the body.
b) Allocentric neglect لا مركزي
- Peripersonal space refers to space within the patient’s normal reach.
- Extrapersonal refers to object /environment beyond the patient’s normal reach.
Stroke Rehabilitation Clinician Handbook
Anosognosia
Anosognosia, also called “lack of insight”: unaware of their own mental health condition or that they can’t perceive their condition accurately.
List 2 tests for neglect 🔑
- Object Cancelation
- Line Crossing
- Clock drawing
- Scene Copy
List 4 Compensatory Approach for Unilateral neglect? 🔑
- Prisms adaptation
- Limb activation therapy
- Trunk rotation
- Eyepatching and Hemispatial Glasses
- Feedback training
- Neck muscle vibration
List 3 Treatments in Unilateral Spatial Neglect
Think of adding stimulation to the brain via:
- Visual Scanning
- Computer-Based Scanning in Neglect
- Virtual Reality Therapy for Neglect
Stroke Rehabilitation Clinician Handbook
Definition of apraxia 🔑
Disorder of voluntary movement execution:
Patient cannot execute purposeful activity
Despite the presence of adequate mobility, strength, sensation, co-ordination and comprehension.
Constructional & Dressing apraxia: definition and site of lesion.🔑
Constructional Apraxia
- Inability or difficulty to build, assemble, or draw objects.
- Either parietal lobe, right > left
Dressing Apraxia
- Inability to dress oneself despite adequate motor ability.
- Either hemisphere, right > left
Stroke Rehabilitation Clinician Handbook
List 4 Signs and Symptoms of Dysphagia 🔑
Dysphagia is the medical term for swallowing difficulties:
- Slow effortful eating
- Drooling
- Pocketing
- Chocking
- Coughing after meal
- Food and liquid avoidance
List 2 Complications of Dysphagia 🔑
- Dehydration
- Malnutrition
Phases of swallowing & problem seen with each phase 🔑
- Oral Preparatory Phase → Drooling and pocketing
- Oral Propulsive Phase → Drooling and pocketing
- Pharyngeal Phase → Aspiration
- Esophageal Phase → heartburn and food sticking
List 2 clinical screening tests for dysphagia 🔑
- Impaired pharyngeal sensation
- Failure on 50 ml water test
List 3 diagnostic tools for dysphagia
- Bedside swallowing evaluation
- Videofluorographic swallowing evaluation (VFSS)/Modified barium swallow (MBS)
- Fiberoptic endoscopic evaluation of swallowing (FEES)
List 4 Indication for VMBS Studies 🔑
- Brainstem stroke.
- Obvious signs of choking or wet, hoarse voice after drinking.
- Problems maintaining adequate nutrition and hydration. (malnutrition)
- Recurrent respiratory infections.
- Follow-up of previous positive VMBS study
Define Penetration vs Aspiration 🔑
Penetration
Entry of material into the larynx but not below the true vocal cords.
Aspiration
Entry of material into airway below level of true vocal cords
Predictors of aspiration on “bedside swallowing exam”
- Abnormal gag reflex
- Cough after swallow
- Dysphonia
- Voice change after swallow (wet voice)
Risk factors for development of aspiration pneumonia.
Think of bed ridden patient on multi devices and tissue under his chin:
- Decreased level of consciousness
- Tracheostomy
- Emesis
- Reflux
- Nasogastric tube (NGT) feeding
- Dysphagia
Risk Factors Associated with Aspiration Difficulties Post-Stroke
- Brainstem stroke.
- Poor oral hygiene.
- Difficulty swallowing oral secretions.
- Coughing/throat clearing, choking or wet gurgly voice quality after swallowing water.
- Weak voice and cough.
- Immunologically compromised or chronic lung disease.
- Recurrent lower respiratory infections.
- Aspiration or pharyngeal delay on VMBS.
Stroke Rehabilitation Clinician Handbook
List 6 Compensatory Strategies.
- Chin tuck
- Chin up
- Head rotation
- Head tilt
- Supraglottic swallow
- Super supraglottic swallow
- Mendelsohn maneuver
List 6 Low-Risk Feeding Strategies
- Make sure its the correct type of food
- Minimize distractions
- Bed at 90 degrees, neck slightly flexed
- Mouth care before eating to remove bacteria
- Use metal teaspoons, do not use plastic!
- Slow rate of feeding
- Make sure to fully swallow the bolus
- Preform mouth care and remove all food debris
- Observe for 30mins to check for any signs and symptoms
- Keep him upright to clear esophagus and reduce reflux
- Document his food and liquid intake also if any issue raises
Complications of Malnutrition Post-Stroke 🔑
- Decreased response to physiotherapy. (Low therapy adherence)
- Increased length of stay. (Always on bed, now he developed bed sore)
- Greater risk of bedsores and UTIs.
- Lower Barthel Index scores at 1-4 months. (Poor outcome)
How to tell patient is underweight? Malnourished? 🔑
Body Mass Index (BMI) value less than 18.5 is considered to be underweight.
Assessment of Swallowing Post Stroke at Time of Admission.
