Final Exam Study Guide Flashcards
What are Semantic Paraphasias?
Semantically related word is substituted
e.g., for for spoon, sweater for jacket
What are phonemic paraphasias?
Sound errors; sound tranpositions in words (e.g., shooshbruss for toothbrush)
What are neologisms?
made up words (e.g., dubeid for shoe)
What is jargon?
a string of neologisms into a phrase/sentence (e.g., emo donned oh yah beige)
What is anomia?
word-finding difficulties, the inability to name objects or to recognize the written names of objects
very common in the aphasias
What are agrammatic utterances?
Also known as telegraphic speech. Speech in which content words are used but most function words (articles, prepositions, conjunctions) are missing
A common characteristic of speech for adults with Broca’s Aphasia
What are paragrammatic utterances?
grammatical errors-such as wrong tense markers
misuse of pronouns among range of syntactical constructions
What is tangential speech?
the speaker wanders and shows a lack of focus, never returning to the initial topic of conversation
often associated with RHS & wernicke’s
What is disorientation?
loss of one’s sense of direction, position, or relationship with one’s surroundings
a temporary or permanent state of confusion regarding place, time, or personal identity
an early sign of dementia
geographic and topographical disorientation common in RHS
What is resource allocation?
a model of cognitive processing in which mental operations depend on allocatation of processing resources from a limited-capacity pool. Performance deteriorates if the demands for processing resources exceeds the capacity of the pool.
What is ALOC?
Altered level of consciousness
What is disinhibition?
A lack of restraint manifested in disregard for social convention, impulsivity and poor risk assessment.
What is anosognosia
denial of illness (common in RHS)
What is prosopagnosia?
inability to recognize faces (common in RHS)
Memory deficits**
not sure what to do with that one.. see study guide-Cathy’s portion.
What is Confabulation?
s/s of RHS
the production of fabricated, distorted, or misinterpreted memories about oneself or the world without the conscious intention to deceive
person is unaware that the information is false, and are generally very confident about their account of things. It is a memory disturbance
client imagines things bigger than they are
Creating fictitious accounts of past events, believing they are true, to cover a gap in memory
What is circumlocution
S/s of dementia & aphasia
intentionally speaking around the target word due to inability to retrieve word; common in context of anomia
What is verbosity?
s/s for RHS
Wordiness
Using more words than needed
what are unmodifiable risk factors for stroke?
Age, every decade after 55, the risk doubles
Gender, male > female
Race/ethnicity
Family history, genetic tendency + common lifestyle
Previous CVA / TIA
What are modifiable risk factors for stroke?
Hypertension (HBP)
Heart Disease (atrial fibrillation)
Diabetes
Atherosclerosis
Blood Cholesterol Levels
High Alcohol consumption
Head and Neck Injuries
Infections (viral and
bacterial infections)
Cigarette Smoking
“Stroke Belt” in U.S
What are some things you can do for stroke prevention?
Hypertension – Take Rx as ordered
Identify atrial fibrillation (Afib)–abnormal heartbeat
Stop smoking
Control alcohol use
Treat high cholesterol - > 200
Control/manage diabetes
Exercise
Diet
Treat circulation problems
Recognize/treat TIA (up to 40% of people who experience a TIA may have a stroke)
What are the types of strokes?
Ischemic
hemorrhagic
What are the types of ischemic strokes?
80% of strokes are of this type
Large artery
atherothrombotic
Small artery or lacunar stroke
Embolic stroke
Dissection stroke
What are predisposing factors to ischemic strokes?
Male Age Mortality rate is about 10% for people under 65 years of age following a stroke. The mortality rate increases with age. Family history of stroke Medical conditions such as: hypertension atherosclerosis myocardial infarction diabetes prior transient ischemic attacks (TIAs) smoking excessive alcohol consumption birth control pills obesity
a sedentary life style
What do ischemic strokes generally result from?
a thrombus or embolism
What is a thrombus?
A collection of fat and blood from the diseased artery that narrows it and blocks the flow of blood going to the brain, causing ischemia. A thrombus is stationary.
What is an embolism?
A blood clot containing arterial debris that travels to a smaller artery and “gets stuck”. The blood flow to that area of the brain is now blocked, causing ischemia.
Describe hemorrhagic strokes
Hemorrhagic events comprise 20% of strokes and are identified by location and subtype
Approximately 20% of all strokes are hemorrhagic.
The mortality rate for this type is about 50%
if you survive, better outcomes
What are the subtypes of hemorrhagic strokes?
Intracerebral hemorrhage: deep hypertensive hemorrhage and lobar hemorrhage
Extra-cerebral hemorrhage: subarachnoid hemorrhage and other hemorrhages that do NOT occur within the cerebrum, but within the skull.
What are the general features of a hemorrhagic CVA?
A blood vessel bursts in the brain causing blood to enter the surrounding tissue.
It can be caused by brain herniation, massive edema, use of cocaine or other illicit drugs.
It is often due to aneurysms, leukemia, clotting deficiency, diet pills, and brain tumors.
If hemorrhage is larger than 3cm, surgery is typically performed to evacuate the hematoma.
The majority are due to a ruptured congenital berry aneurysm.
Subarachnoid hemorrhage occurs more often in women 50-60 years old.
Describe the Western Aphasia Battery?
Assesses the linguistic skills most frequently affected by aphasia, in addition to key nonlinguistic skills, and provides differential diagnosis information
Employs a taxonomic (categorical) approach to classification—
Pts are assigned to diagnostic categories according to their scores on language subtests
The WAB was designed to provide a means of evaluating the major clinical aspects of language function: content, fluency, auditory comprehension, repetition and naming plus reading, writing and calculation
Criterion cut scores: Aphasia Quotient Cortical Quotient Auditory Comprehension Quotient Oral Expression Quotient Reading Quotient Writing Quotient Bedside WAB–R scores
Two main scores: Aphasia Quotient (AQ) score and Cortical Quotient (CQ) score
AQ can essentially be thought of as a measure of language ability, whilst CQ is a more general measure of intellectual ability and includes all the subscales
One apraxia (not AOS) subtest
Yields aphasia syndrome type
Describe the FAS
Used to assess verbal fluency–production of individual words under restricting search conditions
Client names as many words as they can that start with F, A, and S in 1 minute (1 min per letter)
The score is the sum of all admissible words for the three letters (proper nouns, wrong words, variations, and repetitions are not counted as correct)
Describe the Aphasia Book club
The book club program was initially developed by Berstein-Ellis and Elman at the Aphasia Center of California (ACC) in 1999 in Oakland, CA.
The purpose of Aphasia Book Clubs is to enhance one’s quality of life through social interaction and life participation.
In 2004 the ACC received funding to replicate their program at four sites in North America.
The Aphasia Center of California’s mission is to combine community service, student training and research, centered around individuals living with Aphasia
What are the need for bookclubs?
Community need
After a stroke, people continue to improve over a period of time (years). This can be a slow process for both the patient and the family. Individuals living with Aphasia need to learn compensatory strategies for communicating.
Most inpatient rehabilitation is limited to 16-24 days! Outpatient rehabilitation is often only 3-6 months, depending on insurance.
Persons with aphasia, their families, and clinicians are searching for low-cost options in the community that are readily accessible to them!
What are the benefits to aphasia book clubs?
Groups promote interaction and variety of communicative functions or speech acts
Groups provide opportunity for wider array of partners = more generalization
Groups promote language improvisation
Groups improve psychosocial functioning – Benefit of Community
Groups are cost effective
What are some strategies for communication partners for the Aphasia book clubs?
Increase pause time/decrease interruptions
Do not request known information or ask ‘performance’ questions (e.g., “What’s my name,” or “Tell Mary my name.”)
Utilize gestures, writing, and drawing to facilitate successful communication
Use what works best for each individual (e.g., the mini whiteboard)
Acknowledge that the person knows what he or she wants to say
Rephrase or expand what the person has communicated
Be patient, and verify topic
Acknowledge communication breakdowns (e.g., “That’s not what you meant?”)
What are the procedures for a successful book club?
Proxemics! Create a seating chart that strategically arranges book club members and volunteers for maximum ease of communication
Name tags
Start each session by “checking in” with members by reviewing last week’s discussion and taking time for questions
Priority: “Does anyone want to start us off today by telling us about something you found especially interesting in this week’s reading?”
Based our discussion points off of the chapter highlights
PowerPoints or “learning modules” focus on some specifics of the chapter as well as topics that were related to the chapter more broadly
As volunteers and facilitators, try to avoid taking on the role of the classroom teacher
Weekly worksheets to facilitate understanding:
Worksheets completed at home
Choose from worksheet A, B, or C (or all three) depending on the level of difficulty the book club member feels comfortable with
Always look for communication opportunities between members; try to get members talking to each other
“Word of the Day”
What are the Rancho Levels?
Level I-no response: total assistance
Level II-Generalized response: total assistance
Level III-Localized response: total assistance
Level IV-Confused/Agitated: Maximal assistance
Level V-confused, inapprpriate, non-agitated: Maximal Assistance
Level VI- Confused, Appropriate: Moderate Assistance
Level VII- Automatic, Appropriate: Minimal Assistance for Daily Living
Skills
Level VIII- Purposeful, Appropriate: Stand-By Assistance
Level IX- Purposeful, Appropriate: Stand-By Assistance on Request
Level X- Purposeful, Appropriate: Modified Independent
Describe Level I of the Rancho Scales
Complete absence of observable change in behavior when presented visual,
auditory, tactile, proprioceptive, vestibular or painful stimuli.
Describe Level II of the Rancho Scales
Demonstrates generalized reflex response to painful stimuli.
Responds to repeated auditory stimuli with increased or decreased activity.
Responds to external stimuli with physiological changes generalized, gross body
movement and/or not purposeful vocalization.
Responses noted above may be same regardless of type and location of
stimulation.
Responses may be significantly delayed.
Describe Level III of the Rancho Scales
Demonstrates withdrawal or vocalization to painful stimuli.
Turns toward or away from auditory stimuli.
Blinks when strong light crosses visual field.
Follows moving object passed within visual field.
Responds to discomfort by pulling tubes or restraints.
Responds inconsistently to simple commands.
Responses directly related to type of stimulus.
May respond to some persons (especially family and friends) but not to others.
Describe Level IV of the Rancho Scales
Alert and in heightened state of activity.
Purposeful attempts to remove restraints or tubes or crawl out of bed.
May perform motor activities such as sitting, reaching and walking but without
any apparent purpose or upon another’s request.
Very brief and usually non-purposeful moments of sustained alternatives and
divided attention.
Absent short-term memory.
May cry out or scream out of proportion to stimulus even after its removal.
May exhibit aggressive or flight behavior.
Mood may swing from euphoric to hostile with no apparent relationship to
environmental events.
Unable to cooperate with treatment efforts.
Verbalizations are frequently incoherent and/or inappropriate to activity or
environment.
Describe level V of the Rancho Scales
Alert, not agitated but may wander randomly or with a vague intention of going
home.
May become agitated in reponse to external stimulation, and/or lack of
environmental structure.
Not oriented to person, place or time.
Frequent brief periods, non-purposeful sustained attention.
Severely impaired recent memory, with confusion of past and present in
reaction to ongoing activity.
Absent goal directed, problem solving, self-monitoring behavior.
Often demonstrates inappropriate use of objects without external direction.
May be able to perform previously learned tasks when structured and cues
provided.
Unable to learn new information.
Able to respond appropriately to simple commands fairly consistently with
external structures and cues.
Responses to simple commands without external structure are random and nonpurposeful
in relation to command.
Describe CILT
Constraint Induced Language Therapy (CILT) aka Constraint Induced Aphasia Therapy (CIAT)
CILT was developed for patients with chronic, stroke-induced Aphasia. It was developed in 2001 from the physical therapy technique of Constraint Induced Movement Therapy. This is where the patient, who tends to overuse their “good arm” due to a hemi, have their “good arm” tied to their body for 90% of the day, to prevent use of it. Therapy is intensive, but much research has shown that it is effective. This concept was taken and employed using a language perspective
What are CILT’s major components?
Constraint: ONLY VERBAL communication is allowed. NO compensatory nonverbal communication strategies may be used.
Forced Use: you MUST communicate by only talking
Massed Practice: Therapy occurs 2-4 hours per day
What does CILT tx look like?
Therapy basically looks like a modified version of Go Fish
What is Spaced Retrieval therapy?
SRT is a memory training procedure in which participants are trained to perform newly taught procedures, recognize newly taught stimuli, or remember to do something at a designated time, with gradually increasing time intervals between training and performance.
Forms of Spaced Retrieval Include:
Semantic memory (remembering facts, names of people, objects, etc…)
Procedural memory (remembering to perform some action–e.g., getting out of a chair, swallowing techniques)
Prospective memory (remembering future appointments, activities, or tasks)
Recent episodic memory (remembering recent personal events–e.g., one’s birthday, a dinner party)
What are SRT’s Major components?
to perform SRT several functional targets are selected
then one target is focused on at a time until maintenance level is achieved
the SLP asks a question to elicit the target
if the client answers correctly, increase the time interval and ask the question again.
if the answer is incorrect, provide immediate correction and ask the question again at the last correct time interval.
Who does SRT help, and what is essential for it to be successful?
SRT should help a person with dementia recall trained information for up to several months after training.
SRT will not improve generalized memory function.
Selecting specific and functional targets is key for the client to obtain improved independence.
What is the formula for a SMART goal?
Pt. will (action) with ___% accuracy with (amount of assistance) by (time frame)
Write a SMART goal If we know they can copy at the single letter stage…
Pt. will copy simple single words (e.g., 3-5 letters), with 80% accuracy with min. assistance.
Write a SMART goal if we know they follow 1 step commands at 100%, but 2 step commands at only 50%…
Pt. will follow simple/basic 2 step commands (e.g., point up, then touch your nose) with 80% accuracy with min. assistance.
Write a SMART goal if If we know they can read at single sentence step, but they break down at the paragraph level…
Pt. will read at the single/compound sentence level, with 80% accuracy with mod. assistance.
Just read: Other examples of SMART goals
- Given a colored photo, Pt. will match single/simple sentences in a field of 3 (f/3), with 90% accuracy given occasional assistance.
- Given a (novel/complex/abstract paragraph), Pt. will answer multiple choice concrete questions from a field of 3, with 90% accuracy, with min. assistance.
- Pt. will independently use learned compensatory strategies to engage in two way conversation with an unfamiliar communication partner during six turn-taking events with 80% accuracy with min. assistance.
- Using the non-dominant (L) hand, the patient will independently formulate and write at the single/simple sentence level with 90% accuracy with minimal assistance by July 2015.
What are the different dementias
- Cortical
- subcortical
- mixed
What is cortical dementia?
Changes in cerebral cortex
What diseases fall under cortical dementia?
- Alzheimer’s
- PPA (primary progressive aphasia)
What is Alzheimer’s disease?
- Dementia is a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment.
- Consciousness is not clouded. Impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behavior, or motivation.
- Dementia produces an appreciable decline in intellectual functioning, and usually some interference with personal activities of daily living, such as washing, dressing, eating, personal hygiene, excretory and toilet activities.
Early signs of Alzheimer’s
- Memory failure
- Disorientation
- Lapses in judgment
- Difficulty performing activities of daily life
- Difficulty performing mentally challenging tasks
- Misplacing things
- Apathy and loss of initiative
- Changes in mood
Facts about Alzheimer’s
- fastest growing and most expensive disease
- Affects more women than men
- 3 microscopic changes in brain neurons: neurofibrillary tangles, neuritic plaques, and granulovaculoar degeneration
- Tx: tranquilizers, antidepressants, Cognex and Aricept
- 1st symptoms: memory lapses, faulty reasoning, poor judgment, disorientation, mood changes
- Language less affected than cognition
What is subcortical dementia?
- changes in basal ganglia, thalamus, and brain stem
- Motor impairments (tremors and gait)
- volitional movement impairments
- first signs of dementia appear months to year after appearance of motor impairments (as disease progresses)
- Cortical function impairments occur in the later stages
- Motor impairments are evident in the early stages
- Most SDs are delayed consequences of extrapyramidal system disease and reveal volitional movement impairment
- Assess and tx for speech impairments
- Screen for cognitive involvement & dysphagia
What diseases fall under subcortical dementia?
- Parkinson’s
- Huntington’s
- Progressive Supranuclear Palsy
- AIDS
Cognitive and communication characteristics of Parkinson’s disease
- Weak voice
- Reduced vocal loudness
- Speech rate increases/reduced articulation
- Rapid, stuttering-like repetitions of syllables, words, and phrases
- Micrographia is common
- Drooling/swallowing, middle stages
- Vocabulary, syntax, and grammar are preserved until late stages
- Most individuals die within 15-20 years of onset
Facts about Parkinson’s
- Affects more men than women and appears between 50-65
- Caused by deterioration of dopaminergic neurons in basal ganglia and brain stem
- 60% of these neurons are destroyed and 1st symptoms emerge: resting tremor, pill rolling, muscle rigidity, slowness, diff. initiating movement
- Primary treatment: levodopa (L-dopa)
What is Parkinson’s disease?
- disturbances of movement including muscle rigidity, tremor, slowness/abolition of movements, and loss of balance.
Cognitive communication deficits with Huntington’s disease
- Dysarthria
- Dysphagia
- Final stages: Mute, incontinent and profoundly demented
What is Huntington’s disease?
inherited degenerative neurologic disease
Facts about Huntington’s disease
There is no cure, only medication to control movement, emotional, and psychological effects
Appears between 40-60 years
1st symptom: involuntary movements
What subcortical disease resembles Parkinson’s?
Progressive Supranuclear Palsy
Facts about Progressive Supranuclear Palsy
- Rare; 1 in 20,000 adults in U.S.
- Begins between 50 and 80
- No known tx
What is Progressive Supranuclear Palsy and what is the progression?
Caused by neuronal loss, neuronal abnormalities, and proliferation of glial cells through the brain cell and basal ganglia
Progression:
Pt loses vertical and lateral eye movements, limbs become stiff and rigid, dysarthria, and dysphagia
Cognitive and Communication deficits with Progressive Supranuclear Palsy
- dysarthria,
- speech is slow,
- repetitions,
- reduced vocal loudness,
- language remains intact,
- mutism is common in very late stages
Personality changes with Progressive Supranuclear Palsy
depression & dementia
Early symptoms of Progressive Supranuclear Palsy
Paralysis of muscles responsible for downward gaze, rigidity of neck muscles, facial muscle weakness
Facts about AIDS
- Complex signs/symptoms
- Weakens the immune system
- AIDS Dementia Complex (HIV encephalopathy)
- 70% of persons w/ AIDS develop AIDS dementia complex
- Infection causes pathologic changes in subcortical white matter and basal ganglia (eventually reaching the cortex)
early symptoms of AIDS
extrapyramidal pathology (weakness, slowness, rigidity, dyskinesia) and later symptoms reveal cortical involvement (declined perception, memory, intellect, language)
Cognitive and communication deficits with persons with AIDS
- early stages may reveal mildly reduced word retrieval,
- later speech is dysarthric and labored,
- eventually reduced to single words.
What diseases fall under mixed dementia?
- Vascular dementia
- Lewy Body Dementia
- Frontotemporal dementia (FTD)
- Behavioral- variant FTD (bvFTD)
- Pick’s disease (confirming)
- PPA (Primary progressive aphasia)
Facts about vascular dementia
- Important cause of dementia in adults
- 2nd only to AD!
- Dx is complicated and controversial
- Pure vascular dementia is relatively uncommon; majority have both AD and VD
- Most common type: Multi-infarct dementia
- Lacunar state
- Multiple cortical infarcts
- Binswanger’s disease (rare; caused by multiple infarcts in subcortical white matter)
Facts about Lewy Body Dementia
- Usually after 75 years of age
- males > females
- one of the most common progressive dementias, accounting for 10% yo 15% of all cases, behind Alzheimer’s.
Cognitive and communication deficits of Lewy Body Dementia
- visuospatial abilities language - attention - working memory - executive functions similar to the impairment of person with Alzheimer's dementia, but with memory somewhat better preserved
What is Frontotemporal dementia (FTD)
- There are multiple subtypes
- Leads to tissue shrinkage and reduced function in the brain’s frontal and temporal loves, which control planning and judgement; emotions, speaking and understanding speech; and certain types of movement
- FTD was once considered rare, but it’s now thought to account for up to 10 to 15 percent of all dementia cases, but less common than Alzheimer’s disease, vascular dementia and Lewy body dementia
- In those younger than age 65, FTD may account for up to 20 to 50 percent of dementia cases. People usually develop FTD in their 50s or early 60s, making the disorder relatively more common in this younger age group
What are the categories for FTD?
- Behavioral-variant FTD (bvFTD)
- Semantic dementia
- Pick’s disease
- PPA (primary progressive aphasia)
What are the behavioral symptoms of behavioral-variant FTD (bvFTD)?`
- Hyperoral behaviors include overeating, dietary compulsions, in which the person restricts himself to eating only specific foods (such as a certain flavor of Lifesaver, or eating food only from one fast food restaurant) or attempts to consume inedible objects. Patients may consume excessive amounts of liquids, alcohol and cigarettes.
- Stereotyped and/or repetitive behaviors can include re-reading the same book multiple times, hand rubbing and clapping, humming one tune repeatedly or walking to the same location day after day.
- Personal hygiene habits deteriorate early in the disease progression, as the person fails to perform everyday tasks of bathing, grooming and appropriate dressing.
Hyperactive behavior is exhibited by some patients, and can include agitation, pacing, wandering, outbursts of frustration and aggression. - Hypersexual behavior can range from a preoccupation with sexual jokes to compulsive masturbation.
- Impulsive acts can include shoplifting, impulsive buying and grabbing food off another person’s plate.
