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Neuro > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

In aphasia, cognitive skills are ___ and language skills are ___.

A

High, low

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2
Q

In TBI, cognitive skills are ___ and language skills are ___.

A

Low, high

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3
Q

Define cognitive communication disorders according to Hartley.

A

Alterations in communication due to deficits in a variety of linguistic/non-linguistic processes.

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4
Q

Define cognitive communication disorders according to Adamovitch.

A

Widespread diffuse damage that generally occurs following TBI usually leads to impairments in areas such as memory, information processing and attention, which in turn affect an individual’s ability to communicate effectively.

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5
Q

Define cognitive communication disorders according to CASLPO.

A

Difficulties in communication (listening, speaking, reading, writing, conversation, social interaction) that result from generalized cognitive deficits (attention, memory, organization, information processing, problem-solving, executive function)

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6
Q

What are functional cognitive communication skills and why are they important?

A

Skills necessary for a person’s individual functioning, social interaction and behavioural control; need to target functional cognitive communication skills in Tx because abstract concepts won’t generalize

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7
Q

What are the processes in the Hartley model?

A

Stored knowledge, cognitive processes, subcortical and limbic input, executive control centre

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8
Q

What are the products in the Hartley model?

A

Comprehension of communication, communication behaviour

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9
Q

Subcortical and limbic input entails:

A

Arousal, emotional state, motivation

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10
Q

What network is involved in arousal?

A

Reticular activating system (arousal regulation is precise)

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11
Q

T/F

The RAS is particularly susceptible to damage.

A

True – because it has multiple projections

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12
Q

What structure regulates mood?

A

Hypothalamic amygdaloid complex

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13
Q

What regulates motivation?

A

Basal ganglia and its connections to the limbic system, especially hypothalamus

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14
Q

____ typically affects pathways connecting the sub
cortical and limbic structures with each other and the
prefrontal regions.

A

DAI

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15
Q

During an observation of arousal, motivation and mood, what are questions you should be considering?

A

-Is the person impulsive, responding before
directions are completed?
-Is the person angry, frustrated or over anxious?
Does this interfere with their ability to perform the
task?
-Are emotions displayed appropriate to age and
situation?
-Was an appropriate level of effort used to
complete the task?
-Did the person spontaneously ask for clarification?
-Is there a range of emotions displayed?
-Does the individual initiate any questions or
conversation on their own?
-Is the individual generally cooperative and
compliant with instructions and demands?
-Did the person comment on their own
emotional status?

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16
Q

Stored knowledge and access to it is known as ______

A

Schemata

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17
Q

T/F

Schemata are fundamentally expressive.

A

False – appear expressive, fundamentally receptive

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18
Q

T/F

Memory structures of interrelated information are formed through experience.

A

True

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19
Q

Access to schemata provides the structure for ____.

A

New learning

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20
Q

T/F

TBI is more traumatic in adults than in children.

A

False – more traumatic in children because they lose the capacity to learn.

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21
Q

List the 5 processes listed under cognitive processes in the Hartley model.

A

Memory, attention, perception, visuo-spatial processing, linguistic processing

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22
Q

What is memory?

A

The ability to absorb, learn, retain and recall information derived from experience

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23
Q

In TBI memory impairment is more common in patients with __________, ___________ and _______.

A

longer periods of coma, lower admitting GCS and anoxia at the time of injury

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24
Q

What brain structures are most important for new learning?

A 
– Hippocampus
– Thalamus
– Frontal lobes
– Mammillary bodies and other components of the
limbic system
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25
Q

The different types of memory are:

A
  1. declarative (episodic, semantic)/procedural (skills, priming, simple classical conditioning, other)
  2. immediate (working, sensory)/STM/LTM
  3. recent/remote
  4. visual/verbal
  5. recall (retrieval)/recognition (storage)
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26
Q

Frontal lobe damage tends to produce deficits with
_______ and not _______ memory.
_______memory is also much more consistently impaired than ______.

A

Declarative, procedural

Semantic, episodic

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27
Q

What is immediate memory?

A

-temporal holding or storage of information - necessary for such complex cognitive tasks
as language comprehension, learning, reasoning
-also known as working memory although probably more dependent on attention than memory

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28
Q

What is short term memory?

A
  • retention of information over a short time or after brief distraction
  • also called recent memory, delayed memory, delayed recall, anterograde memory
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29
Q

Short-term memory is facilitated by ____ and ______.

A

Rehearsal, practice

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30
Q

What kind of information is stored more easily in short-term memory?

A

Information that’s more emotionally charged or important

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31
Q

What is long-term memory?

A
  • information that is stored and retained over a longer time frame such as months, years or a lifetime
  • also known as remote or distant memory
  • includes autobiographical memory
32
Q

Frontal lobe damage tends to produce deficits in _______, not ________ memory.

A

Short-term/working, not long-term

33
Q

What is recent memory?

A

information learned or presented after the onset of TBI

34
Q

What is remote memory?

A

information acquired before TBI

35
Q

Between recent and remote memory, which is more impaired following frontal lobe damage?

A

Recent

36
Q

What is visual memory?

A

memory for information that is not language-based and is processed by the brain with little or no language component

37
Q

What is verbal memory?

A

memory for information that is language

dependent regardless of whether it is spoken or written

38
Q

T/F

Frontal lobe damage results in deficits in verbal memory but not visual.

A

False – deficits in both verbal and visual memory

39
Q

What is recall/retrieval of information?

A

a person’s ability to spontaneously or freely recall information upon demand

40
Q

What is recognition/storage?

A

person’s ability to identify the information previous learned when given cues/multiple choice which reflects how well the material was stored by the brain

41
Q

T/F

Frontal lobe damage tends to produce deficits in recognition/storage of information.

A

False – produces deficits with retrieval

(and not storage) of new information

42
Q

Summarize the effects of frontal lobe damage on memory.

A

Frontal lobe damage produces deficits with:

  • retrieval (and not storage) of new information
  • declarative (and not procedural) memory –
  • working/STM (not LTM)
  • recent (not remote) memory
  • impaired recall of temporal order (i.e. recalling which information was learned first second etc.)
  • poor insight into memory problems and their consequences
  • difficulty generalizing information learned in one context to another
43
Q

Questions to consider when observing memory are:

A

-Does the individual require repetition of
instructions or need steps to be broken into smaller units?
-Does the individual confabulate when memory
failures are present?
-Does the individual attempt to reauditorize or
repeat information to process it?
-Does the individual repeat their previous
statement or topic in conversation/narrative tasks?
-Does the individual forget work that has already
been done?
-Do they repeat stories/incidents?
-Do they recognize when therapy materials are
repeated?
Does the individual perform better in cued than free recall?
-What cues help?
-Does person consistently remember first or last
information?
-Does the individual spontaneously use strategies? What strategies?
-Is the individual aware they are having difficulty
remembering?
-How much is too much information?

44
Q

What is attention?

A

How individuals respond to and process stimuli in their environment

45
Q

Attention has a huge functional impact across:

A

learning, ADLs, memory, problem-solving, social interaction, vocational functioning

46
Q

Attention is highly dependent on:

A

Arousal, which is modulated by the RAS and thalamus

47
Q

T/F

A patient can be fully alert and still have significant attentional deficits.

A

True

48
Q

The _______ are involved in the regulation and direction of attention.

A

Frontal lobes

49
Q

What factors can affect attention?

A

age, medications, endurance, fatigue, pain, motivation, emotion, psychological factors such as anxiety or depression

50
Q

What is immediate attention span?

A

The amount of information an individual can grasp at any one moment in time - may also be referred to as working memory

51
Q

T/F

Speed of processing is unrelated to attention.

A

False - Mental speed or rate of information processing is a related function to attention and is often impaired with attention disorders

52
Q

What is spatial attention?

A

The ability to visually scan the environment and to direct attention to the most salient stimuli in all visual fields

53
Q

Impairments in spatial attention are called _____ and are most often associated with _______.

A

Neglect, RH syndromes

54
Q

The 3 basic components of attention are:

A
  1. The capacity to focus attention
  2. The capacity to sustain attention
  3. The capacity to shift attention
55
Q

What is focused/selective attention?

A
  • The ability to highlight or monitor the most important information or stimuli in the face of competing distractions
  • Incorporates the notion of distractibility
56
Q

What is the purpose of sustained attention/vigilance?

A

To maintain attention/focus over extended period

57
Q

What is divided attention?

A

The ability to respond to more than one task at a time or to multiple demands within the same activity

58
Q

What is alternating attention?

A

The ability to shift focus or attention between activities, tasks or ideas

59
Q

Examples of questions to consider during an observation of attention are:

A
  • Orientation/response when you enter room?
  • Is the individual able to focus on your questions and listen to explanations?
  • Speed of response to info?
  • response to multistep questions/instructions?
  • speed of info processing – appropriate or slow?
  • Does arousal or alertness vary over time?
  • Is the individual able to maintain attention to each task until it is completed or are reminders needed?
  • Does fatigue impair ability to finish a task? What behaviours demonstrated fatigue?
  • Is the individual able to shift to a new task as required?
  • Is the individual able to inhibit response to extraneous objects, noises or stimuli in the environment?
  • Does the presence of others affect the individual’s ability to initiate attend or persist at an activity?
  • Insight into attentional problem?
  • Distracted by internal/external stimuli?
  • What specific behaviours demonstrate lack of attending (slowed/no rate of response, eye gaze, topic switch, verbal comment, novel behaviour (singing, finger play…), anger, frustration?
60
Q

What is perception?

A

The manner in which sensory information is perceived. Can be auditory, tactile, olfactory, visual

61
Q

Visual perceptual deficits can include:

A
  • Neglect – inattention
  • Scanning
  • Perception of angulations
  • Visual organization - visual closure
  • Visual interference
62
Q

What are some implications of visual/spatial processing on communication?

A

reading, facial affect, personal space, interpretation of physical environment

63
Q

Executive function entails:

A

Regulation of behaviour and emotion (inhibition/disinhibition), organization, synthesis/integration, goal setting (formulation), planning & sequencing, initiation (goal-directed behaviour), self-monitoring, abstract thinking, problem solving, judgment, social perception/abstract attitude, self-awareness, metacognition

64
Q

What does executive control do?

A

Regulates/integrates cognitive and behavioural functioning

65
Q

What is communicative competence?

A

dynamic relationship between cognitive, linguistic, environmental, psychological processes

66
Q

The components of communicative competence are:

A
  • Processing skills: process and comprehend incoming stimuli (written and spoken)
  • Verbal expressive skills: linguistic aspects and discourse production (written and spoken)
  • Non-verbal skills: paralinguistic (pragmatic)
67
Q

T/F
In TBI, impaired comprehension of complex material is most frequently reported, even in presence on intact component level comprehension.

A

True

68
Q

T/F
You need to discern the impact of receptive language,
attention, speed of processing, reasoning, memory, and expressive language on a comprehension deficit and distinguish comprehension from expressive language deficits.

A

True

69
Q

What is the relationship between auditory comprehension and listening?

A

Hearing/listening should be intact when assessing auditory comprehension.
To be a true linguistic-based comprehension difficulty, the person must be able to attend to, perceive and retain the information, but when they
come to understanding, they are not able to extract the complete meaning from the words.

70
Q

How does anomia in TBI patients differ from anomia in aphasia patients?

A

TBI – errors are personal, environmental, confabulations

Aphasia – errors are semantic/phonetic paraphasias

71
Q

In what contexts is anomia more evident?

A
  • more difficult, higher level tasks
  • may see word-finding issues in generative conversation or story-telling that are not evident in confrontation naming or sentence generation
72
Q

Describe discourse in TBI.

A
  • disorganized language beyond syntactic/morphological level
  • cognitive issue rather than linguistic
  • productivity impaired on both procedural (giving
    directions) and narrative tasks (telling story) although narrative tasks more compromised
  • story retelling incomplete with fewer cohesive ties and episodes
  • Story generation more compromised than story retelling
  • Narrative discourse more impaired than conversation
  • Stories more fragmented and difficult to follow
  • Organization of narrative poor
  • Lengthier explanations; slow to generate information
73
Q

Verbal/pragmatic deficits following TBI include:

A
  • Irrelevant conversation response
  • Fragmented and tangential (written and spoken) conversational language – involves impairments in connections between ideas/thoughts, impairments in abstract thinking, confusion, decrease in selective focus, inability to maintain a topic
  • Difficulty introducing/selecting, changing a topic
  • Difficulty with appropriate amounts of information
  • Lack of inhibition
  • Poor logical sequence between thoughts
  • Disjointed content
  • Poor referencing (fewer cohesive ties, incomplete ties)
74
Q

Non-verbal pragmatic deficits following TBI are in the following areas:

A
  • Prosody
  • Intonation
  • Body control/position
  • Posture
  • Eye contact
  • Facial expression
  • Gestures
  • Affect
  • Turn-taking
75
Q

T/F

Dysarthria is represented on the Hartley model.

A

False

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