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Aphasia > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Right hemisphere Damage

A

Caused by the same events that cause left hemisphere damage.

  • about half are results of right hemisphere strokes
  • compared to L-hemisphere, R-hemisphere functions seem to be arranged more diffusely, not as well localized (hard to say what will occur)
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2
Q

Common problems seen with R-hemisphere damage

A
  • problems comprehending complex visuospatial information
  • impaired ability to recognize ordinary objects in unique views (pg.404 scissors)
  • deficits of spatial orientation, such as problems judging distance and remembering spatial locations
  • impaired sustained attention
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3
Q

R-hemisphere damage (parietal lobe) associated with hemispatial neglect

A

Problem with spatial exploration &selective attention. Failure to respond to stimuli on the side of the body opposite of the brain injury (pg. 299 writing sample) can be with reading, writing, auditory

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4
Q

R-hemisphere damage (parietal lobe) associated with anosognosia

A

Lack of awareness of deficits, denial of illness

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5
Q

R-hemisphere damage (parietal lobe) associated with Topographical disability

A

Confusion about location even in familiar places. Trouble following familiar routes, reading maps, or giving directions

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6
Q

R-hemisphere parietal lobe damage associated with constructional impairments

A

Problems organizing complex actions in space (drawing or building)

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7
Q

R-hemisphere damage Temporal lobe

A

Associated with deficits in music processing (pitch, loudness, timing)

  • associated with nonverbal memory problems such as recognition &recall of complex visual pictures, faces, simple musical tones
  • associated with poor recognition of facial expression, vocal irony, and emotion (saying something, but meaning something else)
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8
Q

R-hemisphere damage frontal lobe

A

Associated with difficulty in planning, problem solving, divergent thinking, strategy formation.

  • Associated with reduced initiation
  • associated with problems using cues to adjust performance
  • associated with impaired temporal memory-what came first and second (sequencing) timeline is skewed
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9
Q

R-hemisphere: communication disorders

A

Diminished speech prosody— problems in producing normal prosody & recognizing prosody in others, reduced pitch variability. (monotone)

Anomalous content/poor organization of connected speech— confabulatory, inappropriate, poor topic maintenance, excessive details, diminished informational content.

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10
Q

communication disorders: impaired comprehension of narratives

A
  • have trouble understanding implied meanings, take figurative language literally, difficulty following the whole context of conversation.
  • May have trouble appreciating humor, possibly due to poor content integration
  • Premature assumptions & inferences, inability to revise them once proven incorrect
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11
Q

communication disorders: pragmatic impairments

A

awkward turn taking in conversation, poor eye contact, problems understanding listeners needs (e.g. topic introduction & change, breakdown repairs, can be egocentric in in conversation & impulsive.

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12
Q

Hemanopia

A

a visuosensory difecit resulting from an interuption of the visual pathways (optic tract) that send visual sensation to the cortex (p.60) there is an actual vision problem

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13
Q

visual neglect

A

an attention deficit where patient fails to respond to information presented on the side opposite their brain lesion.

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14
Q

Treatment of R-hemisphere disorders, General issues

A
  • Remember, we do not know with certainty the core deficits causing R-hemisphere cognitive-communicative impairments.
  • This contrasts with the L-hemisphere were there are models of language processing that can shape aphasia treatment.
  • No treatment approach is appropriate for every patient
  • Try to use treatment workbooks for hw assignments, not as the primary basis for your one-on-one tx
  • Work toward patient self-reliance
  • The patient should be working toward minimizing social & job handicaps caused by the r-hemisphere damage
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15
Q

Treatment of Pragmatic deficits

A
  • Barrier activities: to help patient understand listeners needs
  • PACE activities- can serve the same need
  • Role playing can give the patient changes to practice pragmatic communicative skills
  • *Teaching them to convey and receive messages efficiently ( these are working on communication as a whole)
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16
Q

Treatment of pragmatic deficits: direct intervention

A
  • you’re working on specific parts of language/communication
  • The “indirect” barrier or pact type of tx probably will need to be supplemented with direct tx deficits
  • Here the clinician & pt directly address such problems as eye contact, recognizing & repairing breakdowns, understanding irony & so forth
  • You tell them exactly what to do on explanation

Direct intervention— describing pictures or summarizing media reports, focusing on the main themes
Recognizing & explaining verbal or visual anomalies
Indentifying socially inappropriate comments & discussing alternatives

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17
Q

Producing prosody

A

Producing prosody— contrastive stress drills (practice saying underlined words in sentence that need to be stressed e.g. I don’t like that.
-Producing sentences with lexical (record), syntactic (? Vs. statement), or semantic (literal vs. figurative) ambiguity.

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18
Q

Comprehension of prosody

A

Comprehending prosody— begin with discussion of how someone’s voice can convey emotion

  • Identify attitude in sentences that are linguistically & prosodically the same.
  • Match prosodic stimuli to a single mood (e.g. I lost the game to a choice of happy, angry or bored)

Comprehending prosody— Introduce discrepancies (E.g. I had an enjoyable vacation, is said in a sad voice)

  • Discuss situation where discrepancies are normally produced (e.g. teasing, sarcasm)
  • Practice identifying spoken instances of sarcasm & teasing
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19
Q

Comprehending indirect responses

A

Comprehending indirect requests— First facilitate understanding of an indirect and a direct request (e.g. its been a long time since we went out to eat, meaning Lets eat out tonight)

  • Let patient match direct and indirect requests
  • Patient can produce a direct request when given the indirect equivalent, vica versa.
  • Describe a scenario where someone makes an indirect request (e.g. pt must interpret the request directly)
  • Compensatory strategies can be used too: asking other only to use direct requests when speaking to patient.
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20
Q

Visual Neglect

A
  • Verbal cueing— clinicians can give repeated verbal cues to increase attention to the left
  • Visual and tactile cues—for reading, a heavy red line can be drawn in the left margin of a page; pt is cued to look for red line before starting to read the line
  • Anchors—the placement of large letters or numbers to the left & right of printed sentences
  • Environment manipulation— items in the patients environment (phone, self care objects) can gradually be moved from r-side placement to left side.

*Left-side searching tasks—
Cancellation tasks client crosses items out (can be used for sustained attention too) pg. 419

  • Manipulation of stimuli dimension at first keep things in visual field, then move stimulus items to the left
  • Right-left alternation tasks looking from one side to the other (objects e.g. eraser)
  • Edgeness & bookness tasks edgenes: using edge of boz or anything to line up objects on edge, gives pt cue (feel the edge of the box to find the left one.
  • Bookness: using edge of book & teaching pt to look for the edge for a cue on left side.

-It might be helpful to have the patient be actively involved in setting up these activities
For example, have patient place the blocks in the edgeness tasks, with the clinician giving verbal feedback & physical prompts (if needed)

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21
Q

Conversation skills

A
  • Learn to verbally mention when they are changing topic
  • Learn to balance self & others as topics of conversation
  • Identifying when the pts explanation of something is rambling or off topic
  • Learn to carefully use pronoun referents (e.g. He was planting flowers..who?)
  • Heightening awareness of signals that others are ready for the conversation to end (e.g. gathering up items and saying “ I need to get going”)
  • Work on verbal & nonverbal cues from listeners when they are confused
  • Learn to ask for feedback “is that clear?” or self monitor “oh that’s not making sense, I’ll try again”
  • Family members can be taught to prompt the patient when for example, referents are unclear or the topic of conversation has been lost
  • Thus should provide focused consistent requests for clarification, mentioning where the problem lies.
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22
Q

Dementia Defined

A

a cognitive decline from a previously higher level of functioning, and manifested by impairment of memory & of two or more cognitive domains (orientation, attention, language, visuospatial functions, executive functions, motor control, & praxis), deficits should be severe enough to interfere with acitivities of daily living.
-Praxis is awareness of movement.

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23
Q

Alzheimer’s Disease

A
  • The most common dimentia by far
  • The casue is unknown
  • memory problems are the most common initial symptom
  • slow, insidious onset
  • memory problems expand into cognitive problems & confusion
24
Q

Alzheimer’s Disease in later stages

A
  • agitation, hallucinations, delusions, & violent outbursts may be seen
  • physical decline is seen
  • the typical progression is 10 years
  • early parkinsonian signs may indicate a more rapid decliene (motor tremors, ect)
25
Q

Frontotemperal Dementia (Picks Disease)

A
  • a degenerative dementia of unknown cause
  • sometimes called dementia of frontoal lobe
  • typicaly personality changes precede intellectual decline
  • language abilities may be affected before memory
26
Q

Symptoms of Picks Disease (frontotemperal dementia)

A
  • Fall into two clinicial patterns either: (1) changes in behavior or (2) changes with language
  • The first type features behavior that can be either impulsive (disinhibited) or bored and listless (apathetic) and includes inappropriate behavior
27
Q

The second type of symptoms of Frontotemperal Dementia (Picks Disease0

A
  • Symptoms of language disturbance including difficulting making or understanding language/speech, often in conjunction with behavioral types of symptoms.
  • Spatial skills & memory remain intact.
  • There is a strong genetic component to this disease; often runs in families
28
Q

Progression of Frontotemperal Dementia (Picks Disease)

A
  • Progresses faster than alzheimers
  • Progresses steadily and often rapidly ranging from less than 2 years to some individuals go more than 10 years in others
  • Eventuall some individuals will need 24 hour care & monitoring at home or in a institutionalized care setting
29
Q

Creutzfeldt-Jakob Disease

A
  • a rare fatal disease, causing degeneration of frontal & temporal lobes
  • The cause is unknown but may be the result of a protein called prion
  • Nearly all patients die within a year
  • Early symptoms include memory & motor deficits, as well as behavioral changes
30
Q

Later symptoms of Creutzfeldt-Jakob Disease

A
  • Pronounced mental deterioration, involuntary movements, blindness, weakness, coma
  • There is no effective treatment
31
Q

The leading scientific theory of Creutzfeldt-Jakob Disease

A
  • The protein Prion can be harmless or infections and are nearly identical but infection form takes a different folded shape than the normal protein
  • Currently researchers are examining whether the transmissible agent is, in fact a prion and trying to discover factos that influence prion infectivity & how the disorder damages the brain
  • using roden model of the diesease and brain tissue from autopsies, we need to know the identifying factors that influence a persons susceptibility and discovering when in life the disease appears
32
Q

Parkinsons Disease

A
  • a degenerative disorder of the basal ganglia and substantia nigra
  • Affects about 1% of people over 65
  • characterized by tremor, bradykinesia, akinesia, muscle rigidity, and abnormal postural reflexes
  • often treated with L-dopa & deep brain stimulation
33
Q

Other characteristics of Parkinsons Disease

A
  • About 30% of people with parkinsons show a dementia
  • characterized by forgetfulness, slowing of the thought process, apathy, & depressions
  • It is often difficult to tell if patient actually has co-occuring Alzheimers dementia rather than Parkinsons Dementia
34
Q

Huntington’s Disease

A
  • an inherited disease that causes the gradual degeneration of the cerebral cortex and basal ganglia
  • the first symptom is a very subtle intellectual decline
  • eventually, chorea is present (abnormal involuntary movements)
  • Progressive cognitive decline, hyperkinetic movements, and personality changes are noted
35
Q

Progressive supranuclear Palsy

A
  • Rare disorders caused by degernation of nuerons in the basal ganglia and brainstem
  • symptoms include gait disturbance, eye movement problems, & moodiness
  • Includes many parkinsonian symptoms because the substantia nigra is affected.
  • A mixed spatic-hypokinetic dysarthria is often present
  • a slowly progressive dementia is associated with PSP usually leaving language abilities intact, until later stages of disease
36
Q

AIDS encephalopathy

A
  • about a third of AIDs patients develop dementia
  • symptoms can be caused directly by the virus or by opportunistic infections & lymphomas in the brain
  • Patients complain of decreased concentration, forgetfulness, and slowing of thoughts.
37
Q

Multi-infarct dementia

A
  • small, multiple strokes cause a stepwise decline in neurological function over time
  • Symptoms vary widely among patients, but memory and personality are usually not affected until later in the progression
  • can show early signs of depression, irritibility, & emotional liability
  • Accounts for 15-20% of demetia cases
  • control of vascular risk factors such as hypertension & cigarettes can alter the natural progression of the condition
38
Q

Lewy Body Dementia

A
  • memory impairment, visuospatial deficits, attentional difficulties, falls, muscle rigidity
  • no cure
  • casued by proliferation of Lewy Bodies:
    - abnormal proteins that become deposited within a neron cell bodies
    - causes loss of dopamine & acetycholine (nuerotransmitters)
39
Q

Classification of Dementia

A

Cortical (personality
-Alzheimers, Picks, (primary progressive Aphasia)

Subcortical (movement)
-Parkinsons, huntingtons, progressive nuclear palsy, AIDS encephalopathy

Mixed (both)
-vascular dementia, Lewy Body dementia, Frontotemporal Dementia

Other
-creutzfeldt-Jakob Disease

40
Q

Communication changes in Alzheimers Dementia, early stages: Pragmatic abilities

A
  • unable to maintain conversations
  • some trouble giving instructions & story telling
  • Frequent requests for clarification (both ways)
  • May drift from topic of conversation
  • Expresses appreciation (over & over again or not at all)
41
Q

Communication changes in AD, early stages: semantic abilities

A
  • word fluency & word finding impaired
  • circulocutions can be evident
  • difficulty comprehending abstract or complex concepts
42
Q

Communication changes in AD, early stages: syntactic phonological abilities

A

-usually there are no errors at this srage

43
Q

Communication changes in AD:Middle stage: pragmatic abilities

A
  • poor topic maintanence
  • frequent but confusing use of pronominal references (he/she)
  • responds to questions (answers may be perseverated)
  • frequently repeats ideas or topics
  • uses stereotypical phrases
  • known when to talk
44
Q

Communication changes in AD: Middle stage: semantic abilities

A
  • poor word fluency & confrontation naming abilities
  • diminished vocabulary
  • unrelated word substitutions may occur
45
Q

Communication changes in AD: Middle stage: syntactic abilities

A
  • some grammatical errors may occur

- some problems with comphrension of complex material

46
Q

Communication changes in AD: Mddle Stage: phonological abilities

A

-no errors at this stage

47
Q

Communication changes in AD: Late stage: Pragmatic and semantic abilities

A

Pragmatic–>

  • difficulty maintining eye contact, difficulty with conversational turn taking
  • verbal output may be meaningless
  • reduced words & utterances
  • mutism is common in final stages

Semantic abilities–>

  • may show paraphasic speech.
  • May show echolalia or palilalia
  • auditory comprehension is poor
48
Q

Communication changes in AD: Late stage: syntactic and phonological abilities

A

Syntactic
-sentence fragments common, but grammer may be generally preserved

Phonological abilities
-errors may be present, but no non-native language sound combinations appear

49
Q

Intervention for Dementia: ethical issues

A
  • ASHA says hat SLPs should be involved in assessment & treatment of these patients. We shoudl provide programs & maintain functional communication and quality of life for as long as possible
  • However MDs, seldom order treatment, and 3rd party payers are reluctant to pay
50
Q

Types of Direct treatment for Dementia: Reminiscence

A

-talking with these individuals about events in their lives. Especially good because it concentrates of long term memory. The point is to watch video and talk about something personal in their life from that period (e.g. video time machine app)

51
Q

Types of direct treatment for Dementia: Life review

A

-organizing & evaluating the overal picture of ones life. Use music, food, poems, faces, objects, and smells to recall details from life. Computers are a wonderful took for this

52
Q

Types of direct treatment for Dementia: Memory compensations

A

-External strategies such as written notes, alarms, pill organizers, & written calendars can help maintain independence

Direct memory interventions

  • spaced retrieval (e.g. when the clock hits 12, they do an activity. when they see or hear stimulis they do something, gradually space out time between stimulus and resposne.
  • Lots of drill based therapy techniques, hard to get lots of results with this kind of therapy. Categories is the best way to memorize things.
  • *alot of what we do is patient and caregiver education
53
Q

Working with caregivers: caregiver responsibility

A
  • caregivers must try to understand the persons needs & expressions of needs
  • care givers are responsible to reassure and comfort the patient
  • caregivers must provide the link between the person and the enviornment
54
Q

Working with caregivers: controlling communication

A
  • nonverbal messages always accompany the verbal messages
  • whent hey don’t match, more weight is given to the nonverbal cues, such as facial expression, gestures, postures, stance, body tension, and affect
  • an unhurried, uncluttered enviornment can reduce distractions
55
Q

Working with caregivers: controlling communication 2

A
  • have provisions for privacy
  • setting of chairs & people can foster communication togetherness
  • present yourself in a calm matter of fact manner
  • use a non-demanding approach; humor & cheerful
  • use touch in a non-threatening way
  • begin conversations socially before approaching tasks
56
Q

Working with caregivers: rules of communication

A

Rules of communication

  • initially get the persons attention
  • use posture, stance, facial expression to convey attention & interest
  • use polite phrases on an adult level conveying respect
  • orient the person to identify yourself & others giving clues to relationships & purpose
  • During conversation speak slowing in a low pitched voice at normal volume
  • use simple concrete language in short sentences conveying one idea, choice or direction
  • Dont ask too many questions
  • let the person lead the conversation and focus on things they do remember and can talk about
  • use positive statements instead of negative ones (e.g. please do this.. instead of dont do that)
  • avoid idioms
  • humor can be good but should not be aimed at persons inadequacies
  • never call attention to deficits or point out discrepencies

Aphasia (2 decks)

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