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Aphasia > Factors affecting Recovery > Flashcards

Factors affecting Recovery Flashcards

1
Q

List the main prognostic factors for recovery in stroke

A
  • type of stroke
  • severity/type of impairment
  • site of lesion
  • age at onset
  • gender
  • handedness
  • ethnic/cultural background
  • bilingual recovery
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2
Q

How does type of stroke affect recovery?

A

-better recovery with hemorrhagic than ischemic

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3
Q

How does severity/type of impairment affect recovery?

A
  • larger lesion = less recovery
  • severity of dysfunction is predictive of recovery (estimation of severity for prediction of recovery is most stable after 2 weeks)
  • initial severity of auditory comprehension appears to be a factor in recovery, but not with severe aphasia
  • good initial word comp is predictive of good recovery in naming
  • severity of anomia associated with functional language gain
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4
Q

How does site and extent of lesion affect recovery

A
  • large effect, depending on whether the lesion is in the primary language zone, or in borderline areas around that zone
  • initial extent of infarct important predictor of recovery
  • subcortical and cortical lesions recover differently, patients with subcortical lesions usually recovery dramatically over time
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5
Q

How does age of onset affect recovery?

A
  • mixed results
  • language severity correlated with age, but age not correlated with functional communication or language recovery
  • age is a positive predictor of functional outcome and ADL recovery
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6
Q

How does gender affect recovery

A
  • evidence mixed
  • women may have greater stroke severity and poorer functional outcomes, with higher incidences of depression & cognitive impairment
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7
Q

How does handedness affect recovery

A

-evidence scarce and mixed

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8
Q

How does ethnic/cultural background affect recovery?

A
  • Africans and caucasians don’t differ

- Minority populations at risk for brain injuries, greater severity of consequences and reduced rehab outcomes in US

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9
Q

What is the Rule of Ribot in bilingual recovery?

A

the first learned or native language recovers first

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10
Q

What is the rule of Pitres

A

the most frequently used language recovers first

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11
Q

If the Rule of Ribot or Pitres more common in recovery?

A

-Rule of Pitre (esp for patients under 60, and more for multilingual than bilinguals)

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12
Q

What is the synergistic parallel recovery pattern?

A

both languages impaired to same degree and recover at same rate

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13
Q

What is the synergistic differential recovery pattern?

A

languages are impaired to different degrees but recover at same rate

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14
Q

What is the selective pattern?

A

one language is affected more than the other

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15
Q

What is the successive recovery pattern?

A

one language improves first, followed by the other language improving

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16
Q

What is the antagonistic recovery pattern?

A

one language improves to the detriment of the other

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17
Q

What is the intermingled recovery pattern?

A

you get a lot of code switching

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18
Q

What is the alternate antagonism recovery pattern?

A

a see-saw, while one language improves, the other has a slight decrease and then it switches

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19
Q

Paradis found that the most likely recovery pattern for bilinguals was what?

A

synergistic parallel

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20
Q

How does pre-stroke depression affect stroke recovery?

A

associated with reduced stroke and aphasia recovery

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21
Q

How does post-stroke depression affect stroke recovery?

A

associated with poorer functional outcomes

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22
Q

The likelihood of post-stroke aphasia is _________ with aphasia

A

higher

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23
Q

How does educational level affect stroke recovery

A

evidence mixed

24
Q

How does SES affect stroke recovery?

A

Lower SES associated with power functional recovery

25
Q

For Time Post onset to SLP treatment, the greatest gains function occur within the first ________ months

A

3-4

26
Q

How does exercise affect stroke recovery?

A

no studies on aphasia per se, but aerobic exercise has positive effects on brain function

27
Q

How do spouses affect stroke recovery?

A
  • marital status predictive of discharge location
  • spouse either enriches or diminishes recovery process
  • psychosocial attributes of spouse important
28
Q

How does family affect stroke recovery?

A

positive emotional and social support from family predictive of positive outcomes

29
Q

How do friends affect stroke recovery?

A

satisfaction with social support from friends associated with increased QOL

30
Q

How does society affect stroke recovery?

A

access to community vs. barriers has impact on QOL

31
Q

Incidence of aphasia after first ischemic stroke ranges from what percentages

A

23-35%

32
Q

Stoke is the ________ leading cause of death

A

third

33
Q

Compared to stroke patients without aphasia, patients with aphasia are …

A
  • older
  • have more severe strokes
  • have more severe disabiity
  • discharged to LTC more frequently
34
Q

Presence of aphasia is predictive of …

A
  • longer hospital stays
  • increased use of rehab disability
  • higher rates of thrombolytic therapy
35
Q

T or F: out of many diseases and health conditions, aphasia was found to have the largest negative relationship with health related QOL measure in LTC settings

A

true

36
Q

-Only ____% of society has a basic knowledge of aphasia

A

6

37
Q

What is recovery at the micro level?

A

at a cellular or neural level

38
Q

What is recovery at the macro level?

A

at a system or behavioural level

39
Q

What are the 4 mechanisms of recovery at the micro level?

A
  • resolution of diachisis
  • restoration
  • recruitment
  • retraining
40
Q

Define resolution of diaschisis

A

Diaschisis is the temporary inhibition of brain areas connected to the infarcted area. Due to affected neuronal pathways.
-Resolution involves the process of diaschisis getting better

41
Q

Define restoration

A
  • reactivation of brain areas that are immediately dysfunctional after injury
  • occurs to a certain extent without therapy
42
Q

Define recruitment

A

-the brain enlists parts of the brain that weren’t originally involved in the lost function to now be a part of carrying out that function

43
Q

Define retraining

A
  • as a result of rehabilitation, the brain areas now can perform the tasks that they were unable to as a result of the injury
  • basically restoration after training
44
Q

What are the primary changes that occur within a week post stroke and then stabilize

A
  • necrosis
  • inflammation
  • retrograde/anterograde degeneration
45
Q

What are the secondary changes that occur as a result of primary changes and evolve over time?

A
  • transneuronal degeneration
  • denervation supersenstivity
  • development of diaschisis
  • vascular disruption
  • collateral sprouting
46
Q

Describe transneural degeneration

A

Refers to the loss of connections between areas that are in communication with the cells. The communication lines degenerate between connected cells

47
Q

Describe denervation supersensitivity

A

Neurons that have lost most of their input from the infarcted area, become increasingly sensitive to any residual input

48
Q

Secondary changes can either be ________(changes within individual cells) or ________ (changes to neuronal connectivity)

A

structural

functional

49
Q

What are the 4 behavioural mechanisms that occur as a result of intervention

A
  • restitution
  • reorganization
  • relearning
  • compensation
50
Q

Define restitution

A
  • behavioural mechanism
  • the idea that the original site of activity is reinnervated and will be able to carry out the function it was previously doing before the injury
51
Q

Define reorganization

A
  • behavioural mechanism
  • Rerouting different parts of the brain to carry out the same task, being able to do what you used to do but via different means
52
Q

Define relearning

A
  • behavioural mechanism

- You have to relearn how to do something that you lost how to do. Relearn it from scratch rather than re-accessing it

53
Q

Define compensation

A
  • behavioural mechanism
  • A different system that is supported by a different brain area, one that remained intact. The original system won’t be able to do this task either by restitution, reorganization or relearning.
54
Q

What cognitive factors are implicated in aphasia

A
  • attention
  • working memory
  • executive function
55
Q

What executive function skills are required for communication?

A
  • attending to partner
  • sequence information
  • monitor ongoing communication
  • shift strategies
  • inhibit irrelevant information

Aphasia (10 decks)

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