Language cognition and communication in adults Flashcards
What 5 things does cognition comprise of?
Attention
Memory
Executive function
Interactions with sensory processing
Social cognition
What is executive function according to Brookshire?
Incorporates aspects of attention, memory, planning, reasoning, and problem solving to organise + regulate purposeful behaviour
What are the 7 levels of the communication chain?
What is social cognition?
How we operate together
note: can link to personality changes, think relationships
What are the 2 broad types of conditions the adult population can have that can affect LCandC?
Acquired
- stroke
- TBI
- progressive degenerative conditions (eg: dementia)
Developmental
What are the 2 approaches to studying language, cognition, and communication?
Individual and their mind/brain: medical model approach
Social interactions in everyday life: social model approach
What are 2 disorders that affect LCandC from neurological damage?
Aphasia (post-stroke, tumour)
Cognitive-linguistic disorders (TBI + dementia)
How does aphasia impair language processing?
Impairs how words are generated, impairs…
- auditory +reading comprehension
- spoken + written language production
At which ‘levels’ does aphasia affect language processing?
Single word level, sentence level, and how these are put together in discourse + conversation
Affects ability to communicate → limits life participation
Where can language breakdown occur for those with aphasia?
Meaning
Word form
What do those with cognitive-linguistic deficits have difficulty with? (5)
Word finding
Making inference & links
Abstract language
Remembering what info is shared (over/ under explaining)
Turn taking (reduced awareness)
What do those with cognitive-linguistic deficits fail to do? (5)
Self-correction, reliant on others for this
Start/maintain conversation
Ask for clarification
Read social cues
See other points of view
What do those with cognitive-linguistic deficits tend to have/do? (5)
Disorganised/confusing discourse
Topic bias (eg: stick/reverting to fav topic)
Repetitiveness
Perseveration (stuck on word/phrase/behaviour and can’t get past)
Confabulation (say something that isn’t true, individual believes it’s true in the moment)
What is the cognitive-linguistic function framework by Body & Perkins?
How do cognitive-linguistic disorders impact social interaction?
Where is damage in aphasia vs cognitive-linguistic disorder?
Aphasia: focal
CLD: diffuse
What is the cognitive status in aphasia vs cognitive-linguistic disorder?
Aphasia: usually good
CLD: impaired
What is the language status in aphasia vs cognitive-linguistic disorder?
Aphasia: impaired
CLD: variable
What is the communication status in aphasia vs cognitive linguistic disorder?
Aphasia: often better than language status
CLD: often worse than language status
What are the types of linguistic impairments contributing to communicative difficulties in aphasia vs cognitive-linguistic disorder?
Aphasia: lexical semantic + grammatical (not often pragmatic)
CLD: pragmatic (sometimes lexical semantic too)
What is the role of naturalistic observation for aphasia vs cognitive-linguistic disorder?
Aphasia: important for observing compensatory behaviours
CLD: important for observing impairments, and also compensatory behaviours
What is behaviour like in aphasia vs cognitive-linguistic disorder?
Aphasia: generally appropriate
CLD: may be ‘inappropriate’
What are the 3 functions of memory?
Putting information in
Holding information
Re-accessing information
What are 3 other words for ‘putting information in’ in regards to memory?
Acquisition
Input
Encoding
What are 3 other words for ‘holding information’ in regards to memory?
Consolidation
Storage
Maintenance
What are 4 other words for ‘re-accessing information’ in regards to memory?
Retrieval
Recall
Recognition
Manipulation
What are the 2 broad types of memory?
Working memory: short + limited
Long term memory (explicit): long + unlimited
What was working memory originally referred to as?
Short-term store/ short-term memory
- storage depot
- length of maintenance rehearsal determined likelihood of LT storage
How was working memory reconceptualised by Baddeley?
More emphasis on the nature of the processing mechanisms, than the time in ‘storage depot’
What is the contemporary construct of working memory?
Dynamic, active system that serves both maintenance + manipulation functions
Operates in multiple sensory-perception modalities
What is maintenance, in regards to working memory?
Mentally holding info for brief periods after the actual stimulus presentation is over
What is manipulation in regards to working memory?
Performing a mental operation on the info over and about maintenance
- takes more concentration, less instantaneous
What is Baddeley’s more recent model of working memory?
What is the phonological store/loop?
Speech based
Storage buffer
What is the visuospatial sketchpad?
Visuospatially based
Storage buffer
What is the central executive?
Modality free
Attention-like
Resource allocator
Linked to subsystems
Modality free
What is the episodic buffer?
Diverse information
Demanding of central executive
Holds, integrates, binds
What is explicit, declarative, long-term memory?
Revealed when performance requires conscious recollection of previous experiences
What are 2 important subtypes of LT memory?
Semantic: facts
Episodic: events over time
What are other subtypes of LT memory?
Defined by modality (eg: verbal vs spatial)
Defined by operation (eg: source memory, meta cognitive knowledge of when something entered memory)
How does explicit LT memory link to communication?
Stored information necessary for speech, language, literacy, social interaction
Eg: naming/identifying, recalling verbal sequences
- this involves a large capacity and LT storage
What is an example of a working memory assessment that involves speech and language?
Digit span immediate recall *forward & backwards tasks)
What is an example of a LT memory assessment that involves speech and language?
Word list / sentence / story recall after a longer interval (minutes, hours)
What is an example of a working memory and LT memory assessment that involves speech and language?
Verbal fluency tasks (eg: name as many animals as you can in 1 min)
- uses LTM to access stored items
- uses WM to monitor spoken items, and not repeat them
What is perception?
The elaboration + interpretation of a sensory stimulus based on knowledge
Eg: may hear sounds, but perceive speech
How are stimuli and cognitive processes involved in information processing?
What is attention?
The prioritisation of external/internal stimuli
Describes various behaviours + cognitive processes + states of being
What are the 2 concepts relating to attention?
Physical orientation: overt attention
Cognitive resource allocation: covert attention
What is physical orientation in relation to attention?
Moving as needed to put the sensory system within gathering range of the stimulus
What is cognitive resource allocation in relation to attention?
Filtering stimuli from sensory-perceptual input so certain elements are available for further processing
Diverting focus between cognitive processes to prioritise
Sustaining concentration over time
What is inattentional blindness, as investigated by Simons and Chabris?
Filtering in visual attention
- ppts asked to watch video and count number of ball passes between those in white shirts
- most reported number of ball passes from those in white shirts
- none reported number of ball passes from those in black shirts
- few reported seeing the gorilla
What is the lab experiment studying filtering auditory input?
Dichotomy listening technique + shadowing: one message to left ear, one to right ear
- listener repeated one message whilst both presented
- little recall from non-shadowed message
Initial belief that only the attended message was processed from sensory-perceptual input into memory
BUT experience improved recall of non-shadowed message (attention is a plastic, dynamic system)
Which test is used to measure attention?
Stroop tests
- speeded reading (fastest)
- speeded colour naming
- speeded ink colour identification (slowest)
What part of cognitive processing does overt physical orientation affect?
Sensory reception
What part of cognitive processing does covert filtering affect?
Perception
What part of cognitive processing does covert prioritising/diverting affect?
Memory + other higher order cognitive functions
What is executive function at a basic level?
Means by which behavioural options are selected: highest activation = selected
What other system does executive function link to, according to Norman & Shallice?
Supervisory attentional system
- willed action for complex decision making
What is the formal definition for executive function?
Neuropsychological mechanisms
Enable rapid construction + evaluation of hypothetical social futures, while weighing immediate versus delayed outcomes
Simulation of actions tested mentally for consequences before response is selected
What is a more practical definition of executive function?
Doing what must be done to solve problems / achieve goals
What does executive function incorporate aspects of to organise + regulate purposeful behaviour?
Attention
Memory
Planning
Reasoning
Problem solving
What 4 things does executive function include?
Initiating intentional/daily behaviour
Planning behavioural routines to accomplish intentions
Maintaining + regulating goal-directed behaviour
Monitoring + modifying behaviour in response to situational variables
What are 4 important concepts related to executive function?
Inhibit responses appropriately
Use working memory (in relation to hindsight + foresight)
Regulate + control behaviour
Flexibility
Which lobe of the brain play a role in executive function?
Frontal lobes, particularly prefrontal cortex
note: personality + social understanding also interact with executive function
What is the term for impairments to executive function / frontal lobe damage?
Dysexecutive syndrome
What do people act like with less severe executive function impairment?
Carry out familiar, highly practised activities
Don’t do activities requiring planning / LT goals
What is the concept of resource allocation relating to executive function?
Capacity + access of resources
- more complex task = more resources
- brain injury = lack resources
If resource demand > resource availability, mental operations slow/shut down/inefficient
What is the Wisconsin card sorting task?
Participants sorts cards into categories according to the examiner’s feedback, with sorting principle changing after participant has deduced it
Why may someone with poor executive function struggle with the Wisconsin card sorting task?
Requires
-working memory
- process of elimination/ t&e
- flexibility + responding to feedback
- perceptual processing
- attention
What is the behavioural assessment of dysexecutive syndrome (BADS)? Wilson et al
6 subtests, majority timed
Scored + compared to norm
Also dysexecutive syndrome questionnaire (self + significant other rating), when things don’t go to plan
- discrepancies = patient lacks of insight / awareness
What are the 6 subtests of Wilson et al’s behavioural assessment of dysexecutive syndrome (BADS)?
Rule shift cards (similar to Wisconsin)
Action program
Key search
Temporal judgement
Zoo map
Modified six elements
What is the action program subtest of Wilson et al’s behavioural assessment of dysexecutive syndrome (BADS)?
Planning
- test-taker removes cork from narrow plastic tube while following a set of rules
What is the key search subtest of Wilson et al’s behavioural assessment of dysexecutive syndrome (BADS)?
Planning + organisation
- test-taker plans strategy to find key in lost field
What is the temporal judgement subtest of Wilson et al’s behavioural assessment of dysexecutive syndrome (BADS)?
Reasoning
- test-taker estimates length of everyday time intervals
What is the zoo map subtest of Wilson et al’s behavioural assessment of dysexecutive syndrome (BADS)?
Planning
- test-taker plots route on map according to a set of rules
What is the modified six elements test (SET) subtest of Wilson et al’s behavioural assessment of dysexecutive syndrome (BADS)?
Planning + organisation + self monitoring
- test-taker must divide available time among three tasks (picture naming, arithmetic, and dictation) while following a set of rules
Why may not everyone with executive function difficulties struggle on formal, clinical assessment?
Controlled, quiet environment
Less demanding than real life: pressure, distractions, flexibility
What is a more functional assessment of executive function?
Multiple errands test (MET) by Shallice & Burgess
What is the multiple errands test (MET)?
‘Real world’ shopping task
Client has written instructions/rules
Self rating scale pre/post task for efficiency
How is the multiple errands test (MET) scored?
Joint assessment: SLT + OT
Post session, therapists score
What are some examples of instructions in the multiple errands test (MET)?
Buy the following 6 things:
Find out the following information:
20 minutes into the task, meet me by the red post box outside boots and tell me the time
What are some examples of rules in the multiple errands test (MET)?
Carry out task in any order
You have £10 but spend no more than £5
No shop should be entered unless to buy something
Don’t go back into a shop you have already been in
Tell the person observing you when you have finished
What is the rationale for using the multiple errands test (MET)?
Less structured/controlled environment
Gives observational data for skills not observed in clinical situations (eg: unforeseen circumstances)
Additional qualitative + observational evidence
When are changes in adult brain anatomy and function detected?
From 20 years
What are the changes in adult brain anatomy and function?
Loss in neuronal number + size
Decreased volume of cortical grey matter
Reduction in efficiency of cellular functions
Damage is cumulative
When does IQ peak and drop?
Peaks at 25
Falls rapidly after 65
What is the variability amongst cognitive aging in adults?
Individual differences in when it starts and how it progresses; acceleration of neural aging can occur any time (eg: early onset)
What is brain aging and plasticity like in adults?
Ability to repair + regenerate after damage is limited
But synaptic connections among neurons do continue to reorganise, largely in response to environmental conditions
- myelination in some areas of cortical white matter continues through 40s
- olfactory bulb + hippocampus neuronal addition/ replacement
How does performance on world knowledge change throughout adult life span?
Preserved
- tested via vocabulary measures
How does performance on working memory, long time memory, and processing speed change throughout adult life span?
Declines with increased age
- tested via digit symbol measures
How do sensory abilities change with age?
Hearing sensitivity declines, affects most healthy adults >70
Central + peripheral vison declines
- dual sensory decline may also occur
How do sensory changes directly affect the ability to perceive + cognitively process information above and beyond the level of visibility/audibility?
More cognitive resources needed to decode degraded sensory stimuli
Leaves fewer cognitive resources for encoding + rehearsal
Why may sensory changes not directly affect the ability to perceive + cognitively process information above and beyond the level of visibility/audibility?
Form of compensation may not work for highly complex stimuli / be sustainable LT
Correcting may improve function, but not necessarily maintain improvement in cognition
How does cognitive change with age in healthy adults occur in regards to working memory?
↓ WM span (buffers + stores)
↓ attentional inhibition, reduced ability to suppress irrelevant info (central executive)
How is verbal fluency related to WM and LTM?
LTM to access stored items
WM to monitor spoken items and not repeat
How does cognitive change with age in healthy adults occur in regards to long term memory?
Difficulty with retrieval
More frequent tip-of-the-tongue, but can be accurate with longer retrieval time
Knowing event occured, but not when/how
- some experientially based measures improve/remain intact for longer (eg: vocab)
What is covert attention?
Aspects closer to perceptual filtering level + capacity limits of system
Aspects closer to cognitive prioritising level
How does covert attention at the perceptual filter / capacity limit level change with age?
Reduced attentional inhibition of irrelevant/competing info, often due to prolonged access to irrelevant info
- like a slower refresh rate
How does covert attention at the cognitive prioritising level change with age?
Parallel-processing cognitive more difficult: dual-task interference
Slower/less accurate performance = dual task cost
What is cognitive change with age in adults associated with?
Environmental factors across the lifespan, linked to early life
Biological factors
Wider context: social + cultural + economic
Which brain systems & associated cognitive functions are involved (eg: frontal lobe late to develop, sensitive to early change)
How is sex linked to dementia?
Alzheimer’s more common in women
Which type of intelligence is highest in early adulthood?
Fluid intelligence
Which type of intelligence is highest in age adulthood?
Crystallised intelligence
What is cognitive reserve?
Latent pool of neural resources that allow a person to show good cognitive function in face of existing neuropathological burden
How is cognitive reserve built to preserve cognitive function?
Physical and enviornmental means…
- health/fitness
- education/learning
- social interaction
How is mild cognitive impairment improved?
Training in memory exercises
What is traumatic brain injury (TBI)?
Trauma to the head from an outside force + subsequent complications which can follow and further damage brain
How can TBI occur?
Road traffic accident
Assult
Fall
What are some of the complications associated with TBI?
Lack of O2
Rising pressure + swelling in brain
According to Nguyen et al, what is the incidence rate of TBI?
349 / 100,000
Of the people with TBI, which proportion have mild vs moderate-severe?
Mild = 68%
Moderate-severe = 32%
Why are men more likely to have TBI than women?
Professions
Motorcycles
Risk seeking behaviours driven by testosterone
What are the prime age groups for TBI and why?
15-24: driving, risk taking
>75: more falls, esp in winter
What are the different types of TBI?
Closed or open/penetrating
Focal or diffuse
What is a closed TBI?
Brain injured, head exposed to forces
- fall
- car accident
What is an open TBI?
Skull is breached/penetrated
- gunshot
What is a focal TBI caused by?
Produced by external force, causing compression of tissue underneath skull at site of impact (coup) or tissue opposite (contre-coup)
What is a diffuse TBI caused by?
Rapid acceleration + deceleration of head, widely distributed damage to axons
What is the primary injury from TBI?
Immediate tissue damage due to direct impact (open/closed) eg: axonal shearing, haemorrhage
What is the secondary injury from TBI?
Hypoxia in minutes post injury
Brain bruising / swelling / bleeding / blood clots → raised ICP in 24-48h
How is the severity of TBI measured?
Duration of loss of consciousness (Glasgow Coma Scale)
Duration of post-traumatic amnesia
What is post traumatic amnesia (PTA)?
Disorientation in time, place, and person and/or inability to remeber new experiences
How does the Glasgow Coma Scale (GCS) work?
Mild = 13-15
Moderate = 9-12
Severe = ≤8
How does attention present in an individual with TBI?
Short attention span
Distractible
Unable to multi task
Struggles with noise/busy
How does memory/learning present in an individual with TBI?
Difficulty retrieving info
Forgetting things
Repeating requests
Word finding problems
Comprehension difficulties
Difficulty learning new things
How does executive function present in an individual with TBI?
Difficulty…
- organising
- achieving goals
- problem solving
- making inferences
- flexiblity
- judgements/decisions considering consequences
How does perception present in an individual with TBI?
Reduce spatial awareness
Clumsy
Misjudges movements
Neglecting one side
How does behaviour/social interaction present in an individual with TBI?
Irritability
Aggression
Rude comments
Laughing inappropriately
Disinhibited
Inappropriate sexual behaviour
Paranoia
Personality changes
What % have communication difficulties after TBI? What is this known as?
75%
Cognitive-linguistic deficits
Higher level language deficits
Social communication disorders
What are the communication difficulties faced after TBI?
Language intact but pragmatics is poor → difficulties at level of interaction/discourse
May also have speech difficulties (eg: dysarthria, apraxia), swalloing difficulties
What is the framework for cognitive-linguistic disorders
How may those with cognitive-linguistic deficits have disorganised/confusing discourse?
Topic shift
Topic drift
Getting lost in less relevant detail, struggling to focus on bigger picture
Inappropriate quantity of info
What is the impact of TBI on the person/family?
Unseen
Anxiety, mood disorders, fatigue
Communication difficulties affects relationships + education + employment
Reduced social activity/networks
How does the employment rate change for those with a moderate-severe stroke?
80% pre-injury
55% 3 years after
What are 3 different ways to assess communication for TBI?
Assess cognitive-linguistic function
Questionnaires for client/family
Functional assessment (MET, multidisciplinary)
What are 6 different assessments for cognitive-linguistic function?
Mount Wilga
Measure of cog-ling abilities (MCLA)
Cog-ling quick test (CLQT)
Scales of cognitive ability for TBI (SCATBI)
Speed of comprehension test
Six elements test
What is an example from the Mount Wilga test?
“What is ridiculous about these stories?”
What does the cognitive-linguistic quick test (CLQT) test?
5 primary domains of cognition
What does the Scales of Cognitive ability for TBI (SCATBI) test?
Scales assessing perception / orientation / organisation
Recall reasoning
What does the Speed of comprehension test do?
Sentences are judged as sensible/non-sensible under time pressure
What does the Six elements test have?
Written word finding component → word finding abilities in absence of time/organisational pressure
What are some considerations when assessing communication?
Insight
Self-awareness
Self-monitoring
Artificial inflates performance
What are some examples of questions from the La Trobe communication questionaire?
What does rehab for TBI focus on?
Focus on functional communication: effective + independent
Interventions to improve discourse, social comm, QOL
Maybe specific/multiple cognitive processes
What is considered in rehab for TBI?
Client + family goal centered
One2one vs group
Communication partner training
INCOG 2.0 guidelines
When does a stroke happen?
aka: brain attack
Blood supply to part of brain is cut off / bleeding around brain
This disrupts delivery of oxygen + nutrients to brain areas
What is the difference between a stroke and a transient ischaemic (TIA)?
Sudden, acute onset of signs + symptoms, last >24hours
TIA = signs + symptoms that resolve within 24h
How many strokes happen in the UK every year?
> 100,000
How many people in the UK live with the effects of stroke?
> 1.2 mil → biggest single cause of disability, second leading cause of death worldwide
What are some traits that make people more likely to have a stroke?
Older
Men
African American + Asian
Hereditary
What are some examples of preventative factors for stroke?
Heart disease
Smoking
Diabetes
What are the different types of strokes?
Arterial ischaemic stroke (blood clot)
→ thrombotic
→ embolic
Haemorrhagic
What is a thrombotic stroke?
Gradual accumulation of cells on arterial walls to eventual blockage of artery
What is an embolic stroke?
Break away cells from thrombotic area travel up a lodging (where artery narrows)
What happens if a stroke obstruction persists?
Death/neurosis of cerebral substance
What is a haemorrhagic stroke?
Blood leaking from blood vessel, bleeds into + around cortex
What are the effects of stroke?
Onset is acute
Motor → can result in hemiplegia affecting contralateral side of body
Hemianopia → vision impaired if visual cortex involve
Hemispatial neglect → attending to things on one side
Sensory → contralateral impairment (eg: numbness)
Affects language + other cognitive functions
What is the campaign to spot the signs of stroke?
FAST
In terms of initial stroke treatment, what should happen when arriving to hospital? Why does treatment need to be fast?
Brain scan 1h after arriving at hospital
Stroke unit within 4h after arriving at hospital
→ reduces damage
→ reduces longer-term disability
→ increases survival rate
What are 2 examples of stroke treatments? When are these done?
Thrombolysis
Thrombectomy
→ soon after stroke onset (usually within 4-6h)
What is thrombolysis?
Drug treatment to break up blood clot that is blocking artery
What is thrombectomy?
Operation to remove blood clot from an artery in brain
How is language represented across the brain?
Unilaterally (language lateralisation)
For most in dominant left hemisphere
What is the relationship between language (cerebral dominance) and handedness?
Most are LH dominant and right handed
Are right or left handed people more likely to have aphasic disorders?
Left = more frequent BUT less severe
What does the right hemisphere play a role in re: language?
Communication + language processing eg: pragmatics, discourse, prosody
What is aprosodia?
Difficulties comprehending/expressing changes in pitch/intonation
Difficulties understanding discourse (eg: big picture, abstract, jokes)
Difficulty producing discourse (eg: amount, organisation)
What is aphasia NOT?
A loss of intelligence
What is the formal definition of aphasia? (Papathanasiou et al)
Acquired, selective impairment of language modalities + functions
What does aphasia result from?
Focal brain lesion in language-dominant hemisphere
What is the most common symptom of aphasia?
Anomia
- difficulty retrieving the correct word for concepts
- do often have access to some info (eg: first sound)
How many people in the UK have aphasia?
> 350,000
How many people who survive a stroke have aphasia?
1/3
What are some less common causes of aphasia?
Closed head injury
Tumour
Infection
What is the heterogeneity (individual variation) of aphasia following stroke?
Location + size of stroke
Severity of apahsia
Type of aphasia
Age
Recovery + response to intervention
Adaptation
How many people adapt to having aphasia?
Gestures
Drawing
Conversation partner
What is the classical approach to aphasia?
Localisation of symptoms (Broca + Wernicke)
Theories on neurological organisation of language based on clinical + post mortem observations
Where is Broca’s area?
Third convolution in frontal lobe, left hemisphere
What happens with Broca’s aphasia?
Difficulties formulating expressive lang → non-fluent
Understands language well
Likely to also have apraxia
Where is Wernicke’s area?
Left temporo-parietal region
What happens in Wernicke’s/sensory aphasia?
Hard to decode spoken language
Fluent spoken lang, although may not make sense
What is Wernicke’s aphasia called if severe?
Jargon aphasia
- semantic paraphasias
- neologisms
- empty speech
What is it called when someone is unaware of their language difficulties?
Anosognosia
- further affects communication difficulties
- hinders rehab
What is non-fluent aphasia?
Hesitant
Laboured/effortful
Interrupted
Awkwardly articulated
Melodic line significantly disturbed
Single words/short phrases
Telegraphic speech (mainly nouns & verbs)
What is fluent aphasia?
Ease + facility in articulation
Melodic line of spoken language = undisturbed
Long runs of words with no effort/hesitation
What are 6 other types of aphasia, in addition to Broca/Wernike’s?
Anomic
Conduction
Transcortical sensory aphasia
Transcortical motor aphasia
Mixed transcortical aphasia
Global aphasia
Describe anomic aphasia
Fluent
Good auditory comprehension
Can repeat words + phrases
Word-finding difficulties
Describe conduction aphasia
Fluent
Good auditory comprehension
Repetition and spontaneous speech disturbed
Word-finding difficulties
Describe transcortical sensory aphasia
Fluent
Relatively intact repetition
Poor auditory comprehension
Unintelligible
Describe transcortical motor aphasia
Good auditory comprehension
Relatively intact repetition
Non-fluent
Describe (rare) mixed transcortical aphasia
Relatively intact repetition
Poor auditory comprehension
Non-fluent
Describe global aphasia
Learned automised sequences preserved
Non-fluent
Poor auditory comprehension
Disturbance of all language functions
When conceptualising aphasia, what does cognitive neuropsychology and psycholingusitics say?
Language networks involve more areas of the brain
What is cognitive neuropsychology?
Studies how info in the brain is processed + retained
Studies effects of brain damage on processing (absence of usual skills)
How does cognitive neuropsychology build theories of normal processing?
Evidence from impaired processing
FOcus ib function/behaviour, not anatomical lesion sites
What is psycholinguistics?
A cognitive neuropsychological framework which investigates + describes how the brain processes language (input & output)
Models incorporate…
- boxes = mental stores
- arrows = links between stores
Modularity: independent processing modules
How is language mapped in aphasia onto the psycholinguistic model?
Identify what is intact / impaired
Subtraction hypothesis: damaged system works minus function of impaired modules
What are 2 modules where errors could be made when speaking?
Semantic
Circumlocution (tip of the tongue)
Phonological
What do case studies help us discover about language?
In depth-exploration of language processing
Allows examination of intact + impaired processes
Allows theories to be developed
eg: ‘Pick Rabbit’
What is the relevance of a cognitive neuropsychological approach for rehab?
Targets impaired processes & utilises retained processes
Restoring language process or compensating (holistic)
What is the biopsychosocial framework for conceptualising aphasia?
Holistic
Acknowledges complex interaction of multiple factors on client presentation
ICF considers health conditions along 3 domains of functioning (body functions + structure, activity, participation)
How is body structure + function affected by aphasia?
Brain’s ability to process cognitive + linguistic info
How are activities + participation affected by aphasia?
Ability to speak, listen, read, write
Way person uses these to engage in social, professional, other daily activities
What is also considered in the biopsychosocial framework?
Strengths of individual + environment
- ability to write key words to support spoken output
- aware of errors made
- mobility unaffected
- motivated
- supportive family network
What would assessment and rehabilitation of the biopsychosocial framework consider?
All aspects of ICF
Overall focus on function + participation in daily life
Maintenance of psychosocial well-being
What does a social approach to conceptualising aphasia address?
Addresses participation aspect of ICF
Focus on ability to engage in meaningful, collaborative everyday interactions (eg: with conversation partner)
Explores emotional impact, psychosocial wellbeing, QOL
What are the implications of the social approach?
CLient-centred
Goals enhance participation (life participation)
Targets include personal + environmental factors
Compensatory + adaptive approaches
How do multilinguals with aphasia recover differently to monolinguals?
Equal/parallel recovery of language
Non-parallel recovery across langyages
Differences in order / pattern of recovery
- usually most dominant language least affected
What are multi-lingual related variables impacting on aphasia presentation of dif languages?
Age of acquisition
Context of acquisition (eg: home, work)
Degree of pre-stroke proficiency + language use
Purposes of use (eg: formal, informal)
What are 3 important considerations when working with multilingual individuals with aphasia?
Sociocultural history (dif cultural values, may impact language choice to work on in therapy)
Availability of assessment tools for both/all languages to assist diagnosis
Assessment and treatment needs to consider unique profile + needs (eg: interpreters)
How does one recover from aphasia according to Kiran?
Spontaneous recovery
- acute phase (first 3w post stroke)
- subacute phase (up to 6m post stroke)
Longer-term recovery (chronic phase, therapy related)
Why can recover of language occur during spontaneous recovery?
Reoxygenation of tissue
Secrease of cerebral oedema
Recovery of penumbra
Restoration of diaschisis
Neuroplastic changes in brain
What is neuroplasticity / cortical plasticity?
Learning and behaviour induced changes to synaptic connections in the brain
Brain, regardless of age is flexible and capable of structural + functional change
According to Kleim and Jones, what are the 10 principles of experience determining neuroplasticity?
- Use it or lose it
- Use it and improve it
- Specificity
- Repetition
- Intensity
- Time matters
- Salience matters
- Age matters
- Transference
- Interference
What is the principle of experience ‘use it or lose it’?
Failure to drive specific brain functions can lead to functional degredation
What is the principle of experience ‘use it and improve it’?
Training that drives a specific brain function can lead to enhancement of that function
What is the principle of experience ‘specificity’?
Nature of training experience dictates nature of plasticity
What are the principles of experience ‘repetition’ and ‘intensity’?
Induction of plasticity requires sufficient repetition and sufficient training intensity
note: hard to achieve due to NHS/personal capacity
What is the principle of experience ‘time matters’?
Different forms of plasticity occur at different times during training (more intense in early stage)
What is the principle of experience ‘salience matters’?
Training experience must be sufficiently salient (relevant + meaningful) to induce plasticity
What is the principle of experience ‘age matters’?
Training-induced plasticity occurs more readily in younger brains
What are the principles of experience ‘transference’ and ‘interference’?
Plasticity in response to one training experience can enhance the acquisition of similar behaviors OR interfere with acquisition of other behaviours
What is the triage of recovery patterns, according to Robertson and Murre, that determines rehabilitation?
Severity of lesion…
- mild: spontaneous recovery
- moderate: some recovery, dependent on rehab
- severe: dos not recover, rehab does not improve function at neurological level
Clinical decision making…
- mild: no intervention
- moderate: theoretically motivated rehab enables behaviour induced plastic cortical changes
- severe: compensation
What is a limitation of Robertson and Murre’s approach to clinical decision making?
Impairment based approach
- all clinical decision making should take into account individual presentation + goals
In rehabilitation, what may some goals focus on?
Re-establishing function
Enable adaptation/compensation
Living with effects of stroke
What are 10 national clinical recommendations for aphasia post stroke?
A → Assessed early
B → Opportunity given to improve lang + comm
C → Offered access to digital therapy (telerehabilitation)
D → Supported in using aids/assistive tech
E → Offered access to participatory activities
F → Info about aphasia in preferred language
G → Intensitive SLT offered from 3m
H → Monitored for depression
I → Carers receive info + training from SLT
J →Offered info about local/national groups
