Lecture 14: Communication and Praxis Flashcards
what is dysarthria
lesions in CNS or PNS causing issues with muscles in the mouth
can people with expressive aphasia draw and write
drawing would be intact, but writing would be impacted
what type or aphasia might speak like this: Boy … cuh …. Cuh .. Cookie … girl … mama …. Kay … water … sinking….ice … ay … ch .. Ch… water … sinking … ee … Why?”
Brocas expressive
what type of aphasia might talk like this:
“Had that beofre … chories … this guy is a messo …sheisokay. Hehasamesson …alloverhere. She is just stupid. Oh, what is that? That’s ju … those are nice, pretty … and that’s’ a mess and then goots. He’s pretty stupid. She is okay. She’s cute. This is inside… outside.”
wernicke’s (receptive)
what is global aphasia
All language modalities are severely impaired (both aspects of aphasia)
Speech may be limited to:
Automaticisms (yes, social greetings & cursing!)
- Speech repetition may be limited to serial speech (counting or over learned material like prayers or lyrics)
what is important to keep in mind when communicating with someone who has aphasia
Short direct sentences paired with explicit language
what is the order of the two steps you must take when initiating a session with someone with aphasia
A. Ensure a reliable yes/no
“I would like to make sure we are understanding each other”.
B. Obtain consent
“Now that I understand you, I would like to explain what I plan to do today and ask you if we may continue.”
what are the 3 components of praxis
ideation - an idea of what I would like to do
motor planning- how do I do this new thing
execution - actually doing it
what are the 2 main types of apraxia
Ideational apraxia
Ideomotor apraxia
what is apraxia
inability to complete planned motor acts
what is ideational apraxia
“What would I like to do?”
Impaired object recognition and mental process connecting object name to completing the task
what is commonly seen in those with ideational apraxia
Objects are used improperly
tasks completed in improper order
what is ideomotor apraxia
Know what to do – trouble is with execution
Performance of task appears clumsy
what is commonly seen in those with ideomotor apraxia
if movement is automatic, like covering the mouth to cough, its fine, but if the person is asked to cover their mouth, they will struggle to perform the movement
More spatial-temporal errors (timing, posture, speed, direction)
in what order do you assess apraxia
- Sensory/Perceptual System
- Conceptual system (Ideation: “Idea of what I want to do”)
- Production system (Motor planning: “How do I do the task”)
what is constructional apraxia
Inability to combine or organize a task from the sum of its parts; difficulty articulating the parts to make the whole
what issues are commonly seen with constructional apraxia
difficulty making a sandwich, setting a table, etc
difficulty propelling a wheelchair
what is the cueing hierarchy with someone with apraxia
verbal cueing
physical cuing
feedback
how do you navigate verbal cueing for the function of a task?
Determine level of awareness
- Is client aware? Yes or No
If no, draw awareness to issue - Provide minimal/just right level of assistance
how do you navigate verbal cueing for awareness?
ask “hows it going?”
and determine next steps based off of response
what to say when someone says things are going fine but they aren’t (poor awareness)
- Does that look right to you?
- What about this does not look correct?
- Do you notice ___________?
- This is not correct because…
what to say when someone says they need help or things aren’t going well (good awareness)
- What seems to be the trouble?
- How can I help you?
- Have you tried…..
what is the order of physical cueing
- Manual contact
“Do you notice your left arm (touch) looks different than your right arm (touch)”
“I’d like you to stop what you are doing” (gently touch arm)
- Task Simplification
(de-clutter environment sensed give items only when required) - Hand over Hand
how to manage feedbaclk upon completion of the task
- How did that go? (Assess level of awareness)
- Knowledge of results (basic)
- Knowledge of performance (more advanced)
