Exam 3 Flashcards
not born with it
acquired
born with it
congenital
Not degenerative
aphasia
degenerative
dementia
generally have problems with language
aphasia
generally have problems with memory
dementia
talk, understand, and repeat well
anomic aphasia
only problem is anomia
anomic aphasia
echolalia
transcortical mixed aphasia
most severe type of aphasia
global
all transcorticals and anomic:
repeat better
blow from an external force
traumatic brain injury
skull not penetrated
closed head injury
skull penetrated
open head injury
non-traumatic brain injury
caused by strokes, encephalopathies, toxins, or tumors
brain does not get enough oxygenated blood
stroke
characteristics very similar to injuries by a blow from an external force
non-traumatic brain injury
likelihood of sustaining a TBI
males are 2x as likely as females
% of population with TBI
50% over age 18
50% under age 18
cause of TBI: < 5 yo
falls
cause of TBI: infants
shaken baby syndrome
cause of TBI: >65 yo
falls
vehicle accidents combined account for _______% of injuries
46
also plays a factor in TBI causes
drugs and alcohol
brain weight
2-3 lbs
brain consistency
jello/soft-boiled egg
focal injuries
primary impact - where the brain hits the skull; then skull is thrown front to back
axonal damage/diffuse axonal injury (DAI)
shearing/twisting
shearing/twisting results in:
DIFFUSE damage at the cellular level
most concerned with focal or diffuse?
diffuse
many times, MRI/CT scans will not show
the potential damage
shaken-baby syndrome: focal or diffuse?
diffuse
concussion
Minor (mild) TBI
no unconsciousness
Minor (mild) TBI
10% have life long problems
Minor (mild) TBI
motor
anterior
sensory
posterior
nausea, headaches, confusion, learning problems
Minor (mild) TBI
problems with employment and social interaction
Minor (mild) TBI
a period of unconsciousness (>30 minutes to 24 hours)
Moderate TBI
33% have life-long problems
Moderate TBI
more motor problems
Moderate TBI
more difficulty with cognitive communicative impairments
Moderate TBI
coma > 6 hours
severe TBI
severe motor problems
severe TBI
75% have life-long impairment
severe TBI
medical problems associated with TBI
seizures
orthopedic problems
bowl/bladder control - incontinence
sensory problems - hearing, vision, etc.
physical problems associated with TBI
can be mild (paresis = weakness) to serious (paralyzed/plegia)
watch from balance, strength, and coordination problems
perceptual-motor problems associated with TBI
visual neglect
motor apraxia-motor planning problems
cognitive-communication problems associated with TBI
dysarthria/apraxia of speech
tangential speech
confabulations
hyperverbosity
problems in writing, language, articulation, abstraction, reading comprehension
anomia
memory/attention/concentration problems
poor-problem solving
problems in executive functioning
egocentric thinking
tangential speech
taking multiple tangents
confabulations
says false statements, but does not know its false
hyperverbosity
too much talking
anomia
word finding problems (AKA dysnomia)
dysexecutive syndrome
problems in executive functioning
behavior problems associated with TBI
poor judgment/motivation
apathy, lethargy
emotional lability
impulsivity
disinhibition, anger outbursts
social problems associated with TBI
often the biggest concern
withdraw
easily distracted/influenced
bossy/argumentative
misperceive social actions and events
poor responsibility/dependency
loneliness/stubbornness
mood changes
perseveration
sexually inappropriate behavior
reluctance to see assistance
proactive intervention for TBI
look at what is ahead
determine obstacles/challenges they will confront
plan viable solutions for those problems
exercise creativity, ingenuity, and flexibility
involve key people
use many of the strategies used for LLD/DLD and ADHD
denial of injury
symptom of frontal lobe injury
strokes and aphasias
non-traumatic brain injuries
two types of strokes
ischemic
hemorrhagic
ischemic stroke
AKA occlusive
deficiency of blood
caused by blockage or constriction usually from within an artery
sticks to side of artery wall, does NOT move
thrombus
moves within arteries
embolus
hemorrhagic stroke
blood escaping into brain tissue
strokes can occur
anywhere in the brain or skull
knowing where a stroke happened can
give you clues about what problems the person may have following the stroke
damage to the left hemisphere/cortex
aphasia
damage to the right hemisphere/cortex
right-hemisphere syndrome/disorder
damage to the front of the brain
motor problems (output/expressive)
damage to the back of the brain
sensory problems (input/receptive)
frontal lobe
front of the brain
temporal and/or parietal lobes
back of the brain
fluent aphasia
receptive aphasia/sensory aphasia
Wernicke’s aphasia
posterior of temporal lobe
receptive
damage behind or below Wernicke’s
transcortical sensory aphasia
occur with lesions in the posterior portions of the left hemisphere (temporal lobe)
Wernicke’s & Transcortical Sensory Aphasias
relatively fluent speech
poor auditory comprehension
POOR repetition
Wernicke’s aphasia
relatively fluent speech
poor auditory comprehension
relatively GOOD repetition
Transcortical Sensory aphasia
arcuate fasciculus
connects Broca’s & Wernicke’s
conduction aphasia
receptive
occurs with a lesion in the areas that connect the anterior and posterior portions of the cortex
conduction aphasia
relatively good/fluent speech
good auditory comprehension
poor repetition
Conduction aphasia
Anomic aphasia location
no specific location
Anomic aphasia
can occur in various portions of the cortex
good speech
good auditory comprehension
good/decent repetition
Anomic aphasia
main problem is word finding problems/word retrieval problems
Anomic aphasia
Broca’s & Wernicke’s is fine, but connection is broken
Conduction aphasia
Nonfluent aphasia
expressive aphasia
motor aphasia
Broca’s aphasia
expressive
damage to anterior of frontal lobe
damage above or in front of Broca’s
Transcortical Motor aphasia
where does repetition happen?
between Broca’s & Wernicke’s
repeat better than TSA
Transcortical Motor aphasia
occurs with lesions in the anterior portions of the left hemisphere
Broca’s & Transcortical Motor aphasia
halting, effortful speech
relatively good comprehension
relatively POOR repetition
Broca’s aphasia
halting, effortful speech
relatively good comprehension
relatively GOOD repetition
Transcortical Motor aphasia
worst kind of aphasia to have
global aphasia
lesion covers both anterior and posterior portions of the left hemisphere
Global aphasia
patients have POOR everything
Global aphasia
Transcortical Mixed location
no site in brain
echolalia
Transcortical Mixed aphasia
very similar to global aphasia
repetition is slightly BETTER than speech production & auditory comprehension
Transcortical Mixed aphasia
both anterior & posterior
global aphasia
poor repetition
Wernicke’s & Broca’s
relatively good repetition
Transcortical Sensory & Motor
four main things to check when classifying aphasia by type
conversation abilities
repetition
auditory comprehension
naming abilities
Conversation abilities
fluent or nonfluent?
anomia?
paraphasias?
speech coherent?
semantic paraphasias
brother for sister
salt for pepper
yes for no
phonemic paraphasias
math for path
noorway for doorway
lazorblades for razorblades
neologistic paraphasias
hawkatoe for brother
nonsense word
neologistic paraphasias
paradont for water bottle
neologistic
niece for granddaughter
semantic
cough drop for toothpick
semantic
pelatant for elephant
phonemic
lepitopter for helicopter
phonemic
corn for comb
phonemic
naming abilities
Confrontational naming
Free recall AKA word fluency
Recognition naming
auditory comprehension
ask patient to Point to objects/pictures
ask patient to Follow commands
ask patient to Respond to yes/no ?s
repetition
ask patient to repeat items which are increasingly more difficult
consider low freq./low prob (HARDER) & high freq./high prob. items (EASIER)
auditory comprehension tests:
receptive language (sensory input)
you need ____________ memory to be able to do anything
working
short term memory
working memory
working memory examples
“repeat after me”
remembering names
finding your way around a building
long term memory
declarative & procedural
explicit memory
declarative
declarative memory
semantic
episodic
lexical
implicit memory
procedural
procedural memory
motor
cognitive
semantic memory
declarative (explicit)
facts
episodic memory
declarative (explicit)
semantic + context
scenes
lexical memory
declarative (explicit)
words
motor memory
procedural (implicit)
“doing”
cognitive memory
procedural (implicit)
“automatic thinking”
autobiographical memory
episodic memory
what memory do you have to retrieve information
episodic
knowing what
declarative
knowing how
procedural
most common cause of aphasia
stroke
most common cause of dementia
Alzheimer’s
Global Deterioration Scale (GDS)
normal
early mild
late mild
early moderate
late moderate
early severe
late severe
normal AD area of language affected
none
early mild AD area of language affected
none
late mild AD area of language affected
content
early moderate AD area of language affected
content (& use somewhat)
late moderate AD area of language affected
content, form, & use
early severe AD area of language affected
content, form, & use
late severe AD area of language affected
content, form, & use
bed-bound
late severe AD
AD
Alzheimer’s-Type Dementia
false info; not lying on purpose
confabulation
strongest memories between ages:
10-30 yo
communication goals for AD
reduce demands on episodic memory
support working memory
provide stimuli to evoke positive fact memory, emotion, & action
avoid recall memory situations; instead, use RECOGNITION memory situations
reduce demands on episodic memory
use choice questions
reduce demands on episodic memory
provide permanent cues for location of important things, like displaying labels, schedules, calendars, or instructions
reduce demands on episodic memory
recreate conditions that existed at the time of memory was made
reduce demands on episodic memory
reduce distractions
support working memory
highlight important cues; keep information visible & short. consider size and color. use mixture of upper and lower case letters. dark lettering on light background.
support working memory
work within the patient’s memory span
support working memory
chunk information into smaller units
support working memory
use patient’s strongest sensory modality
support working memory
write instructions and keep them visible
support working memory
use multi-sensory stimulation to help patients focus on important information
support working memory
manipulate the environment. keep the patient in a comfortable, high sensory, home-like environment and use the context for conversation
provide stimuli to evoke fact memory, emotion, & action
modify the clinician’s language
provide stimuli to evoke fact memory, emotion, & action
Spaced-Retrieval Training (SRT)
- tell the patient the associations to be made
- engage the patient in another activity for a short time
- ask the patient to recall the association
- if pt. answers correct: increase time interval before asking to recall again
if pt. answers incorrect: provide correct answer - repeat step 2, varying time interval
- repeat step 3