Exam 1 ALL Flashcards
CN I & Function
Olfactory
Smell (Sensory)
CN II & Function
Optic
Vision (Sensory)
cn III & function
oculomotor
eye movement (motor)
cn IV & function
trochlear
eye movement (motor)
cn V & function
trigeminal
facial sensation, anterior 2/3 tongue (sensory)
mastication (motor)
cn VI & function
abducens
eye movement (motor)
cn VII & function
facial
taste anterior 2/3 tongue (sensory)
facial expressions (motor)
cn VIII & function
vestibulocochlear
hearing, balance (sensory)
cn IX & function
glossopharyngeal
taste posterior 1/3 tongue (sensory)
pharynx for swallowing (motor)
cn X
vagus
heart rate (sensory)
velar elevation, swallowing, tensing/stretching VFs, abducting/adducting VFs (motor)
cn XI & function
accessory
keeping head up, supportive function for swallowing (motor)
cn XII & function
hypoglossal
instrinsic (fine) and extrinsic (gross) movement of tongue (motor)
neurological perspective
language only, lesion
cognitive perspective
related to cognitive & lesion
functional perspective
communication masking cognitive
4 parts of aphasia definition
1) language level problem
2) receptive and expressive
3) multimodal
4) CNS dysfunction
aphasia operational definition
acquired selective impairment of language modalities from a focal brain lesion affecting communicative and social functioning, quality of life
aphasia is __ language loss
acquired
4 modalities
expressive
receptive
reading
writing
expressive
formulation/production
receptive
derive meaning
reading
processing written words
writing
producing shapes or words that make sense
paraphasia
error in phonemes, words, or phrases produced unintentionally due to higher level language deficits
phonemic/literal paraphasia
error at phonemic level
taple for staple
neologism/neologistic paraphasia
word produced is entirely different and more than 50% unintelligible
dowfler for pencil
semantic paraphasia
substitution of one word for another word that is similar in meaning
glass for cup
unrelated verbal paraphasia
substitution of one word for another word that is not similar in meaning
lunch for bicycle
perseveration
word that is said repeatedly and inappropriately
perseverative paraphasia
word said earlier is repeatedly and inadvertently produced
getting “stuck”
agrammatism
lack of grammar by omitting function words
functor words
in-between words used to frame major content words in a sentence
content words
words that carry majority of meeting
telegraphic speech
few words are used but words still carry a great deal of meeting
repetition deficits
inability to repeat due to lesion at arcuate fasciculus
arcuate fasciculus
pathway between broca’s and wernicke’s, allows for repetition of words
alexia
acquired impairment of reading
agraphia
inability to write letters or words
may write neologisms
self repair
speaker restates or revises word or phrase in order to produce it error free
perseverative self-repairing
decrease speech fluency, slow down rate of speech, make speaker frustrated, they get stuck
speech disfluencies
phoneme repetitions, word repetitions, part-word repetitions, phrase repetitions, prolongations, interjections
interjections
very common, “uhhhh”
preserved language
rote or overlearned language
counting to 10s, abcs
automatic language
language produced automatically or closely associated with a stimulus
swearing in pain
fluent
connected, not necessarily real words
nonfluent
speech not connected
nonfluent aphasias
broca’s, transcortical motor, mixed transcortical, global
fluent aphasias
conduction, anomic, wernicke’s, transcortical sensory
broca’s aphasia definition
marked deficiency of syntactical, structural words, functors, strikingly abnormal output
broca’s lobe
frontal
broca’s expressive language
agrammatic/telegraphic speech
NONFLUENT
impaired repetition
effortful, poorly articulated speech
no neologisms
impaired confrontation naming
broca’s receptive language
good comprehension
broca’s reading
intact reading comprehension
inability to read aloud
broca’s writing
difficulty comprehending written material
abnormal writing
telegraphic speech in broca’s
small function words absent
walk dog instead of i will take the dog for a walk
chronic agrammatic aphasia
deficits in using and understanding syntactic structures
limitation in ability to recognize correct grammatical structures
global aphasia
most severe, nonfluent, severe depression of all modalities
global aphasia expressive
reduced fluency
NONFLUENT
facial gestures
global aphasia receptive
comprehension impaired
can be alert of surroundings
global aphasia reading
impaired reading
global aphasia writing
impaired writing
transcortical motor aphasia
nonfluent, looks like broca’s
transcortical motor expressive
nonfluent
nonfluent, paraphasic, telegraphic
intact repetition
transcortical motor receptive
better comprehension than production
mixed transcortical aphasia
RARE
nonfluent
motor and sensory
global aphasia with ability to repeat
mixed transcortical expressive
nonfluent
unimpaired automatic speech
intact repetition
wernicke’s aphasia
fluent
temporal lobe
wernicke’s expressive
fluent
rapid rate of speech
normal phrase length
severe word finding
empty speech
jargon
normal prosodic features
impaired repetition
wernicke’s receptive
poor language comprehension
lack of awareness of error
wernicke’s reading
impaired reading
wernicke’s writing
impaired writing
you know that smoodle pinkered and that i want to get him round and take care of him
fluent, flows
wernicke’s aphasia
beautiful handwriting, doesn’t make sense
wernicke’s
conduction aphasia
fluent, arcuate fasciculus lesion, impacted repetition
conduction expressive
fluent speech
impaired repetition
paraphasic speech
conduction receptive
good comprehension
conduction reading
abnormal read aloud
good reading comprehension
conduction writing
impaired writing
transcortical sensory aphasia (TSA)
fluent, similar to Wernicke’s, thalamus involved
transcortical sensory expressive
fluent but usually meaningless
impaired naming
echolalic behavior
repetition good to excellent
transcortical sensory receptive
impaired comprehension
prompting might help
anomic aphasia
mildest, word finding, appears with broca’s
anomic aphasia characteristics
inability to name people/objects, aware of nature but cannot name, impaired comprehension, disturbance in word retrieval
anomic aphasia has ___ localization value
little/no
word production anomia
inability to produce name of object presented
nonfluent aphasia
word selection anomia
inability to name object although patient can demonstrate or explain use
semantic anomia
inability to retrieve appropriate word from lexicon
difficulty understanding his own name
category-specific anomia
inability to name items in some categories while being able to name items in other categories
modality specific anomia
inability of patient to name objects presented to one sensory modality but not others
can’t see visual, but can do tactile
transcortical aphasias
RARE
repetition is better than expected
pure aphasias
alexia without agraphia (occipital)
agraphia without alexia (premotor cortex)
crossed aphasia
ipsilateral, right handed person lesions in right hemisphere
subcortical aphasia: thalamic
word finding
disturbances in rhythm
short term memory problem
naming errors
neologisms
progressive nonfluent aphasia
degeneration of frontal lobes, form of dementia, not lesions
progressive nonfluent aphasia characteristics
phonemic paraphasias
anomia
slow rates of speech
reduced phrase length
intact receptive language
semantic dementia
degeneration in temporal lobes, similar to wernicke’s
semantic dementia characteristics
semantic jargon
pragmatic deficits
significant anomia
aphasia in left handed
no set theory
sign language aphasia
similar to oral aphasia, language is dependent on hemisphere
sign language aphasia characteristics
difficulty understanding signs
impaired comprehension
dysfluent signing
hand shape paraphasias
omit movements
nonfluent signing
fluent but meaningless signing
associated disorders
coma, vision disorders, verbal memory disturbance, cognitive/affective disorders, depression, emotional or behavioral disturbances, emotional liability
psuedo bulbar affect
emotional outbursts due to brian damage
cortical lesions vs subcortical lesions
cortical may affect language function more
mild aphasia
resemble normal speakers, more burden on convo partners, compensation strategies, nonlinguistic aids
moderate aphasia
fundamentally different, phonemic errors, reduced lexicon, impaired vigilance, paucity of speech acts
severe aphasia
easy to identify, may demonstrate severe impairments of all modalities, may be nonverbal, may not make sense
3 divisions of brain
cerebrum, cerebellum, brainstem
central nervous system
brain and spinal cord
brain to body
EFFERENT
peripheral nervous system
body to brain
AFFERENT
efferent
exits
afferent
arrives
cerebrum
control center
highest cognitive functions
gyri sulci
cerebral meninges
dura mater, arachnoid matter, pia mater
protective
dura mater
tough mother, protective, outermost, thick
arachnoid mater
vascular supply to brain, openings for blood vessels, webbed
pia mater
gentle mother, delicate, innermost
cerebrospinal fluid
protective, nutritive
flows through ventricles, meninges, brain, spinal cord
removes waste
grey matter
unmyelinated neurons
top of neuron
white matter
axons, myelinated
dendrite
receives info
axon terminal button
sends info
3 white matter tracts
association fibers, commissural fibers, projection fibers
association fibers
1 structure, 1 hemisphere, do not cross over
commissural fibers
communicate between left and right, corpus callosum
projection fibers
leave the brain, cranial nerves
corpus callosum
keeps 2 hemispheres together
right hemisphere
interpret nonlinguistic signals, facial expressions, body language
right hemisphere comprehension deficits
concrete comprehension of language/prosody
inability to recognizes faces/facial expressions
inability to recognize/interpret music
right hemisphere expression deficits
monotone speech
flat affect
no melody or rhythm
right hemisphere environmental deficits
inability to understand nonspeech sounds
right hemisphere macrostructure deficits
gestalt
gestalt
inability to piece small parts together to see the bigger picture
right hemisphere visuospatial deficits
inability to track depth, distance, shapes
right hemisphere sustained attention deficits
inability to stay focused, easily distracted
right hemisphere selective attention deficits
inability to fade out stimuli
left hemisphere deficits
language
broca’s area
frontal lobe, brodmann 44 + 45
wernicke’s area
temporal lobe, brodmann 22
central sulci
divides frontal and parietal lobes
lateral sulci
divides temporal from frontal and parietal
frontal lobe functions
expressive language, personality, some memory, motor movements
prefrontal cortex
frontal lobe
personality, some memory, executive functions like decision making
primary motor cortex
frontal lobe, motor strip
motor movements
left primary motor planning for speech
motor homunculus
frontal lobe
more surface area to parts with fine motor movement than gross motor movement
parietal lobe functions
sensory
primary sensory cortex
parietal lobe
tactile/proprioceptive informatoin
left from right, right from left (contralateral)
sensory homunculus
parietal lobe
more surface area to structures with more sensory receptors than fewer
temporal lobes functions
memory created and housed, auditory cortex
hippocampi
temporal lobe
short term to long term memory
primary auditory cortex
temporal lobe
in front of wernicke’s areas
occipital lobe functions
vision
primary visual cortex
occipital lobe
info from eyes
contralateral
visual association areas
occipital lobe
processes and interprets visual info
visual perception
subcortical structures
beneath level of awareness
brainstem, cerebellum, thalamus, basal ganglia
brainstem
connects spinal cord to brain
involuntary life functions
midbrain, pons, medulla
midbrain
in brainstem
centra hautica
dopamine
pons
in brainstem
cranial nerves pass through and decusate (cross over)
medulla
in brainstem
lesion above medulla contralateral hemiplegia
lesions below medulla ispilateral hemiplegia
cerebellum
in brainstem
contralateral hemisphere processing
vermis connects hemispheres
error control, body movement coordination, monitors intent of motor planning
thalamus
on top of brainstem
sensory relay station for all cranial nerves except olfactory
receives afferent info from body
receives motor plans from cerebellum
basal ganglia
cuadate nucleus, putamen, globus pallidus
initiation of movement, muscle tone maintenance, inhibition of extraneous movements
acetylcholine
basal ganglia
excitatory
action, when to move
circle of willis
bloody supply to the brain
central location for arteries
blood flow to all areas of brain
safety valve during occlusion
anterior cerebral artery (ACA)
blood to frontal and parietal lobes, basal ganglia, corpus callosum
middle cerebral artery (MCA)
most common
blood to broca’s, wernicke’s, temporal lobe, primary motor cortex
posterior cerebral artery (PCA)
blood to occipital lobes, cerebellum, and inferior temporal lobes
spinal cord
white and grey matter in spinal column
transmits sensory (afferent) info to brain
transmits motor (efferent) info to body
phrenic nerve
innervates diaphragm
bilateral innervation
both contralateral and ipsilateral hemispheres
protective redundancy
protective redundancy
allows body part to still function if one cerebral hemisphere is damaged
what causes aphasia
cva
tbi
brain tumors
degenerative diseases
medical procedures
cva
cerebrovascular accidents
cva or stroke caused by
interruption of blood supply to brain, oxygen supply cut
cva symptoms
most common: one sided weakness
confusion, difficulty speaking, difficulty seeing, difficulty walking, dizziness, loss of balance, severe headache, fainting
types of strokes
ischemic, hemorrhagic
ischemia
blod clot blocks arterties and cuts blood supply to brain
85% of strokes ischemic
infarct
death of area of tissue
ischemic stroke
blood clot
transient ischemic stroke TIA
mini stroke
blockage temporary, short symptoms
usually no permanent damage
thrombotic stroke
clot (embolus) blocks blood flow to one or more arteries of brain
result of unhealthy blood vessels clogged with cholestorol or fatty deposits
2 types of thombosis
large vessel and small vessel
large vessel thrombosis
most often in large arteries
most common, best understood
hardening and narrowing of artery
smoking, high BP, high cholesterol
small vessel disease
lacunar infarction
blood flow is blocked in small arterial vessel
closesly linked to hypertension
watershed stroke
ischemia
between territories of 2 major arteries in brain
10% of ischemic strokes
severe communicative deficits
hemorrhagic stroke
stroke caused by breakage or bursting of blood vessel in brain
aneurysm
weak or thin spot on blood vessel wall
usually present at birth, can start to balloon
takes years
2 types of hemorrhagic strokes
subarachnoid, intracerebral
subarachnoid hemorrhage
aneurysm bursts in large artery on or near meninges
blood contaminates CSF
intracerebral hemorrhage
bleeding from blood vessels in brain
hypertension main cause
brain tumor
mass of abnormal cells that can be benign or malignant
primary or metastic
fast growing, rapidly spreading
primary tumor
developed in brain
30-50% experience aphasia
metastic tumor
begins in other parts and spreads
neoplastic aphasia
aphasia secondary to cancer
degenerative diseases of aphasia
frontotemporal dementia, spongiform degeneration, alzheimer’s, lewy body, cruezfeldt jacob disease, HIV
HIV stroke
opportunistic infection
vasculopathy
cardioembolism
coagulopathy
sickle cell disease
blood platelets become deformed into sickle shapes
major cause of strokes in african americans
neuroplasticity
recover itself
brain’s ability to change either at micro level or macro level, allowing brain to respond to environmental or changes in organism itself
adaptive or maladaptive
brain can create new connections
micro level
neural plasticity
macro level
behavioral plasticity
adaptive
efficient rerouting
maladaptive
inefficient rerouting, poor recovery
restoration
macro level
back to original level
compensation
macro level
skill not regained, support strategy
habituation
macro level
learned new skill not there before
subsitution
macro level
learning whole new thing
recovery vs. compensation (behavioral)
recovery: capacity to perform previous impaired task in same manner as before injury
compensation: use of new strategy to perform previously impaired task in same manner as before injury
recovery vs. compensation (neurophysiologic)
recovery: restoration of function within area initially lost, recreating connections, functioning similarly
compensation: different neural tissue takes over functions lost after injury
acute
recent, just had it
subacute
few weeks, few months
chronic
lasting more than few months, 6+
rapid recovery
few hours or days after
steady improvement
over several weeks
prognostic variables in language recovery
age at stroke onset
history of previous stroke
history of earlier treatment
premorbid health status
education
handedness
post-onset time
stimulability**
support networks
emotional and psychosocial changes
health disparities
difference in incidence, prevalence, morbidity, and burden of disease and health conditions that exist among specific population groups
health care disparities
difference in health care access and use between 2 or more groups
causes of health disparities
poverty
discrimination
nonexistent/poor medical care early in life
neighborhood wealth
poor living and working situations
major factor of health care disparities
lack of insurance
vulnerable populations
racially diverse
low ses
residence
sex/gender
incarcerated
veterans
homeless
chronic diseases implicated in CVAs
hypertension
heart disease
cavernous venous malformations CVMS
diabetes
lifestyle contributors in CVAs
alcoholism
obesity
smoking
access to health care
____ have highest rates of hypertension
african americans
___ is a significnt risk factor for stroke because of relationship to coronary artery disease
obesity
obesity places individual at higher risk for ___ and ____
hypertension and diabetes
highest prevalence of obesity amongst ____
african american women
prevalence of diabetes in AAs is nearly ___% higher than non-hispanic whites
70
___ at highest risk for diabetes
african americans,
hispanics
american indians
combo of diabetes and hypertension increases risks for ___ and ___
stroke and dementia
cavernous malformations
vascular disease of brain that casues headaches, epilepsy, seizures, and cerebral hemorrhage
cavernous malformations are found more in ___ than in any other ethnic group
hispanic americans
CMs inherited from common ancestor in ___ or ___ form
sporadic or familial
___ disease is implicated in both stroke and dementia
heart
____ have highest rates of risk factors for cardiovascular disease
native americans
_____ at highest risk for stroke
pacific islanders
stroke belt
area down south, high percentage of AAs, little access to healthy foods, prevalent health care disparities, obesity, low SES
greatest incidence of disability is amongst ___
african american females
____ and ___ 2x more likely to have recurrent strokes
hispanic and african americans
chronic alcohol abuse
more than 3-4 drinks per day
___ have highest prevalence of heavy drinking
native americans
followed by whites then hispanics
culture
language, thoughts, communications, actions, customs, beliefs, values, and institutions of ethnic, religious, or social groups
competence
capactity to function effectively within context of cultural beliefs, behaviors, and needs of consumers
cultural competence
set of congruent behaviors, attitudes, and policies that enables effective work in cross-cultural situations
cultural responsiveness
incorporating attributes and characteristics and knowledge of another author’s culture, reciprocal action
cultural sensitivity
being aware that differences and similarities exist between people without assigning value
cultural dissonance
lack of acceptance between provider and culturally diverse patient when provider does not understand patient’s values, norms, and beliefs