Midterm Review Flashcards
What does ACREOS stand for?
Attention, Cognition, Receptive Language, Expressive Language, Oral Motor, Speech/Swallowing
combining together; given a list and asked to categorize them; one correct answer
Convergent
multiple correct answers; given a category and have to name items that belong to that category
Divergent
The brainstem involves what three structures:
Midbrain, Pons, Medulla
This controls many sensory and motor functions, including eye movements, postural reflexes, and coordination of visual and auditory reflexes.
Midbrain
This is in control of interpreting auditory signals and balance
Pons
This controls the autonomic functions of digestion, breathing (impacting phonation) , blood pressure, and heart rate
Medulla
This coordinates and modulates the force and range of body movements
Cerebellum
Damage to the cerebellum is associated with which type of dysarthria and what is affected?
Ataxic Dysarthria
Articulation & prosody
What does an ataxic dysarthric sound like?
Drunken speech
This is the structure in between the brainstem and the cerebral hemispheres; home to the thalamus
Diencephalon
This integrates sensory experiences and relays ten to cortical areas; plays a major role in consciousness and alertness
Thalamus
This structure plays an important role in modulating movement because they produce important neurotransmitters.
Basal Ganglia
The basal ganglia produces which neurotransmitters:
Dopamine, GABA, Acetylcholine
The motor disorders associated with impaired function of the basal ganglia include:
Dyskinesia, hypokinesia, bradykinesia
abnormal movement; such involuntary movements as tremors
Dyskinesia
low tone movement; more tone influenced; retracted range of movement
Hypokinesia
slow movement; more speed influenced;
Bradykinesia
Responsible for all higher brain functions including everyday thinking; logical, abstract, and mathematical reasoning, memory, language production, artistic and scientific achievements, judgement and emotional experience
Cerebrum/ Neocortex
Controls voluntary movements of skeletal muscles on the contralateral side of the body
Primary Motor Cortex
Controls the motor movements involved in the production of speech
Broca’s area
Where is the Broca’s Area located:
Left Inferior lateral frontal lobe
Broca’s area is associated with Impaired language___________
expression
Impaired auditory perception is larger in the left
Primary Auditory Cortex
This area is important in comprehension of written and spoken language.
Wernicke’s Area
Where is the wernicke’s area located:
Left posterior superior temporal lobe
Wernicke’s area is associated with Impaired language ___________
comprehension
When you have damage to the parietal lobe, what do you expect?
impaired proprioception (touch/position in space / body awareness) Left Neglect (damage to the right parietal lobe)
A condition in which the patient is unaware of objects and person on the left side
Left Neglect
Damage to the super marginal gyrus results in
Agraphia (writing problems)
Damage to the angular gyrus results in
transcortical sensory aphasia (naming, reading and writing)
Prevents cerebral penetration of harmful chemicals and bacteria from the blood
Blood Brain Barrier
WHAT ARE THE FACTORS THAT CAN LEAD TO APHASIA?
Stroke, high blood pressure, stress, high cholesterol, arterial sclerosis
mini strokes that last a few seconds and the patient recovers without more permanent disability
Transient Ischemic Attacks
Symptoms of TIA:
Suddent weakness, numbness, or paralysis in facial muscles, are, or leg; sudden impairment n understanding speech; slurred or garbled speech; sudden blindness or double vision; dizziness, impaired balance, or disturbed consciousness
Blockage or interruption in blood flow
Ischemic Stroke
Ruptured blood vessels causing cerebral bleeding
Hemorrhagic Stroke
blood clot
Thrombis
arteries harden and narrow
Atherosclerosis
moving or traveling fragments of arterial debris blocks a small artery and cannot pass
Embolism
Hemorrhage caused by ruptures within the brain or brainstem
Intracerebral
Hemorrhage caused by ruptures within the meninges
Extracerebral
Other causes of stroke include:
brain trauma, inter cranial neoplasms, bacterial/ viral infections, brain abscess, toxemia
Believe aphasia is a unitary disorder whose somewhat varied symptoms do not justify a classification into types
Ex: You have a patient with Mild Aphasia
Nontypological
Trying to categorize aphasia in distinct types
Ex: Brocas vs. Wernickes aphasia
Typological
Definitions are based on the idea that cognition underlies language and that, if language is impaired, some aspect of cognition my also be impaired
Ex. If he patient is able to functionally use a comb even though they are unable to describe it accurately.
Cognitive
How does it affect them?
Are the goals functional to the patient??
Social
injury in the posterior portions of the cortex
Wernicke’s Aphasia and Transcortical sensory aphasia
Fluent Aphasia
Lesions in the frontal regions of the cortex
Broca’s Aphasia and Transcortical motor aphasia
Non-fluent Aphasia
contrasts persons with more severe problems in spoken language comprehension against those with language expression.
Receptive and Expressive Aphasia
Inability to put things in a proper order; errors in speech consisting of unintended word or sound substitutions
Paraphasia
The entire word is substituted
Verbal paraphasia
substituted word is semantically related [“friend” for” husband”]
Semantic paraphasia
substituted words not semantically related [“sleep” for “school”]
Random paraphasia
patients who cannot recall the name of an object and uses an invented, nonsensical terms
Neologistic paraphasia
Substitution of one sound for another or addition of a sound [“sood” for “food”; “strudy” for “study”]
Phonemic/Literal paraphasia
Criteria for disfluency includes:
less than 50 words a minute
Speech that approximates the normal rate, typical word output, length of sentences, and the melodic contour.
Fluency
Ability to repeat words, phrases, sentences
Conduction Aphasia ________
Transcortical motor and sensory ________
Repetition
impaired
intact
word finding and naming difficulty
Anomia
Naming in response to a verbal demand (What is this?)
Confrontational naming
When the object is not shown (you write with a _____?)
Responsive naming
Telegraphic speech is using more filler words- > uhm, the, like
.
may match language impairment; Inability to Write
Agraphia
Inability to Read
Alexia and Dyslexia
The Aphasic speaks:
- Little with ______ :______
- Abundantly with _____; __________
struggle; telegraphic speech
jargon Anomic; stereotypical speech
The Aphasic will present with:
Word-finding; paraphasia; circumlocution/ preservation; latency of response; poor listener perspective
Aphasic Patients can be Characterized by:
Communication is either sparse and meaningful or abundant but full of meaningless jargon.
Slow, halting speech -> Invent meaningless “words”
Substitute sounds
Omit Sounds within words or whole words
Repeat themselves or hesitate during speech
Stereotypes expressions
Incorrectly repeat what they hear
Cicumlocution
Unaware listeners do not understand them
Language comprehension deficits
Difficulty pointing to objects named
Word “Deafness”
Omit details when retelling a story
The two hemispheres of the brain are anatomically and functionally ___________.
Morphological differences are greatest in certain areas surrounding the ___________
asymmetrical
lateral sulcus
The Right brain is responsible for these things:
Arousal, orientation, and attention. Visual perception Emotional experience and expressions. Perception of temporal order. Perception of musical harmony. Certain aspects of communication.
Factors that cause RHD:
Cerebrovascular accidents
Tumors
Head Trauma
Various neurological diseases
Patients who sustain RHD because of frontal lobe injury do have _______________.
motor disabilities
Perceptual and Attentional Deficits include:
Left Neglect; Visuospatial impairment; forms of disorientation
Reduced sensitivity to stimuli, reduced awareness of space, or absence of previously learned responses to stimuli in certain visual fields.
Left Neglect
Facial Recognition Deficits
Prosopagnosia
patients who entertain a delusional belief that their friends and family members are not their real selves but imposters or doubles.
Capgras syndrome
Form of visuospacial impairment
Characterized by:
Problems constructing block designs, difficulty reproducing two-dimensional stick figures, errors in drawing or copying geometric shapes
Constructional impairment
Characterized by:
Reduced state of arousal, difficulty in sustaining attention, difficulty in paying selective attention
Attentional Deficits
Characterized by: Topographic disorientation (confusion about space), geographic disorientation, reduplicative paramnesia (a belief in the existence of multiple and identical persons, places, and body parts)
Disorientation
Difficulty recognizing line-drawn pictures or incomplete drawings
Drawings that distort the representation by showing unusual size, dimension, or orientation
Drawings that are superimposed on other drawings
Visuoperceptual Deficits
The right hemisphere is largely responsible for mediating the expression of emotions and appreciation of emotions other people express.
Affective Deficits
Prosodic deficits in a RHD patient include:
monotonous, impaired stress patterns, reduced in rate, devoid of emotions, impaired in prosodic comprehension.
Impaired discourse in a RHD patients includes:
discourse is a set of social communication skills; difficulty narrating events, pictures, or personal experiences in coherent, well-organized, and precise manner
Semantic problems in a RHD patient includes:
difficulty understanding implied, alternative, or abstract meaning; failure to grasp overall meaning of situations, events, stories, or story pictures; failure to understand the meaning of proverbs, idioms, and metaphors; problems in naming abstract categories in contrast to the names of items within; difficulty understanding irony, humor, and sarcasm; problems in undersanding logical errors in sentences.
Pragmatic deficits in a RHD patient includes:
Difficulty in conversational turn-taking; difficulty in topic maintenance; difficulty in maintaining eye contact; insensitivity to communicative contexts
LHD = focal pattern of deficits RHD= diffuse pattern of deficits
.
Communication deficits of patients with ______ may partly be due to other deficits; ____ may be more direct result of their brain injury
RHD
LHD
RHD comm deficits are further complicated by their denial of illness, indifference to their impairments, confabulation, left-neglect, impulsive behavior, reduced attention and increased distractability, and deficits in reasoning skills
LHD patients are less motivated than RHD patients
.
Injury to the brain sustained by physical trauma or external force
TBI
Penetrating is ________
Nonpenetrating is ________
Open head
Closed head
Open wound in the head due to some crushing or penetrating agent
Penetrating brain injury
High and low velocity injuries; fractured/ perforated skull; torn meninges; various degrees of brain tissue damage
Penetrating brain injury
What are the results of Penetrating brain injury?
Increased intracranial pressure, death/ brain tissue death, fluctuating blood pressure, reduced cerebral blood flow, bleeding/ infection/ hydrocephalus
Intact meninges; closed head injury; less quantifiable; skull may be fractured; induced more complex symptoms than the other type
Nonpenetrating Brain injury
A striking force at midline
Linear
A striking force off midline with head rotation
Angular
Point of impact due to skull compression
Coup
Additional injury opposite the point of impact
Contrecoup
muscle restraint; structure that hold the head and the neck will cause it to decelerate or decrease in speed
Deceleration
Cranial deformity (meninges intact); moving object strikes the head or the moving head strikes a stationary object
Impression/ Impact Trauma
moving object hits restrained head (crushing blow)
nonacceleration
Name the different biomechanics of NPI:
- Acceleration
- Deceleration
- Impression/ Impact trauma
- Nonacceleration
Primary Effects of TBI:
Lacerations of fractures of the skulls; Diffuse axonal injury; Primary brainstem injury; Diffuse vascular injury; primary focal lesions
Secondary Effects of TBI:
Intracranial hematoma; increased intracranial pressure; ischemic brain damage; seizures; infection
Behavioral effects of TBI include:
altered consciousness, confusion/ disorientation, memory compromise, speech and language compromise, dysphagia, behavioral and psychiatric changes
Speech Disorder related to TBI include:
Dysarthria (spastic most common), voice disorders, dysfluency, poor prosody
TBI in comparison to Aphasia:
More confusion, less organization; more similar to RHS (frontal lobe damage); cognition affects language
Neurological syndrome associated with progressive deterioration
Dementia
Which skills are seen to deteriorate in dementia:
language; cognition/ memory; visuospacial skills; emotion/ personality
Improving the ______ of life needs to go hand in hand with ___________ life
quality
prolonging
impaired consciousness associated with cognitive deficits; quick onset and may be temporary
Delirium
Dementia has a more diffuse cerebral pathology than ______.
Aphasics
The typical onset of persistent dementia is _______ whereas that of confusion and aphasia is more ________
gradual
acute
What are the three major types of dementia:
cortical
subcortical
mixed
DAT and dementia due to Picks disease can be classified as _______
cortical
Dementia associated with Parkinsons disease and human immunodeficiency virus can be classified as ________
subcortical
these are due to treatable diseases or disorders; if caught early and treated effectively
Reversible Dementia
Give an example of something that contributes to Reversible Dementia:
Post-anoxic dementia; B1/B12 Deficiency; Low/high calcium; drug/alcohol abuse; toxic metal exposure; aids/creutzfeldt-jakob disease
Common risk factors associated with progressive dementias:
advanced age, family history, down syndrome, head trauma, limited education/intellectual activity, reduced cerebral blood flow/inflammation
Some examples of progressive dementias include:
alzheimers, parkinsons disease, picks disease, huntingtons disease
DAT = Dementia of the Alzheimer’s Type
.
Damage is predominant in the temporoparietal-occipital junctions and inferior temporal lobe
DAT
What are the three dominant structural neuropathology’s associated with DAT:
neurofibrillary tangles, neuritic plaques, neuronal loss
Filamentous structures in the nerve cell’s body dendrites and axons; In DAT these are T/T/T
Neurofibrillary tangles
what does T/T/T stand for
Thickened twisted and tangled
cortical and subcortical tissue degeneration (no synapses)
Neuritic plaques
Concentrations of this suggest a potential metabolic impairment that may contribute to the cerebral pathology in patients with Alzheimer’s diseases
B-amyloid protein
Cerebral cortex shrinks
Neuronal loss
Cause or effect of neuronal death?
Neurochemical changes
Patients with neurofibillary tangles in substantial nigra are likely to exhibit _____________
Parkinsons symptoms
What are the early stage symptoms of DAT:
Memory deficit, visuospacial/language deficits, divided attention compromise, poor resigning and judgment, disorientation, behavioral change/depression
What are the later stage symptoms of DAT:
Restlessness / Agitation increases Agnosia Delusions with aberrant behaviors Loss of initiation / initiative Periodic incontinence / physical deterioration Dysphagia
What are the Early Language and Communication problems seen in patients with DAT:
Anomia Verbal paraphasia / circumlocution Decreased ABSTRACT comprehension Impaired picture description Difficulty with topic maintenance More fluent speech
What are the Later Language and Communication problems seen in patients with DAT:
Literal paraphasia
Jargon / Confabulation / Language of Confusion
NON-CONTINGENT
Hyperfluency
Verbal incoherence / Impaired conversation
Multi-modes impairment
ECHOLALIA / PALILALIA / LOGOCLONIA
Degeneration in the frontal and temporal lobes; Early Onset; Location is different from DAT
Frontotemporal Dementia and Pick’s Disease
significant behavioral change poor recognition initially with right-sided atrophy; left-dominant atrophy presents as language disturbances; shifting moods and behaviors
Frontotemporal Dementia and Pick’s Disease
Some general symptoms of FTD and PiD include:
APATHY/EUPHORIA/DEPRESSION/DELUSION/ REPETITION/ UNINHIBITION/ difficulty recognizing names,faces and voices of known people
Language disorders associated with FTD and PiD
language disturbances are predominant
Anomia
progessive shrinkage in expressive vocabulary
spontaneous conversation reduced
echolalia
nonfluent speech with phonological problems
muteness
Parkinsons is a parkinsonism disease but not all parkinsonism diseases are parkinsons
.
idiopathic because the auses are unknown
Parkinson’s
Parkinson’s alone has _____ bodies which are a brain protein
Lewy
Parkinson’s alone responds positively to _______
dopamine therapy
Degeneration of nuclei and widened sulci; loss of cells in substantial nigra; neurofibrillary tangles/ neuritic plaques; lewy bodies; reduced dopamine
Parkinson’s Disease
Which disease is the only one with decreased dopamine levels?
Parkinsons
How does a person with Parkinsons disease present?
Bradykinesia; tremor/rigidity; disturbed gait and posture; falls/freezing; dysphagia
What is the most common prescribed drug treatment for patients with parkinson’s disease?
Levadopa for long-term
What are the types of treatment associate with Parkinson’s disease patients?
Functional neurosurgery, deep brain stimulation, stem cells, drugs
Genetic neurodegenerative disease
Huntington’s disease
a malformed protein that kills brain cells that control movement and memory
Huntington
Loss of neurons primarily in the basal ganglia
Huntington’s disease
Patients with hunting tons disease will experience what types of problems:
behavioral change, chorea, tics, rigidity, gait disturbances, slow movement, impaired memory, dysarthria
degenerative neurological disorder whose symptoms are similar to those found in parkinsons disease
Progressive supranuclear palsy
The basal ganglia and the briainstem are mainly associated with this:
Progressive supraanuclear palsy
characterized by early onset of dysarthria and impair downgaze and eye movements; jerky movement of the face and jaw; hypertonia of face
Progressive supranuclear palsy
Progressive supra nuclear palsy is classified as a form of ____________
subcortical dementia
No tremors associated with this
Progressive supranuclear pasly
What are the three types of stoke:
ischemic, thrombic, hemorrahagic
What is the difference between and infarct vs DAT?
DAT: plaque is caused by B-amyloid protein
Infarct: mini stroke
Give me an example of neurodegenerative disease with early onset?
Picks and Huntingtons
Worse aphasia:
Best Aphasia:
Global
Anomic
Telegraphic speech is consistent with Broca’s aphasia
.
List the nonfluent aphasia’s:
Broca’s, Transcortical motor, Mixed transcortical, global
List the fluent aphasia’s:
Wenicke’s, transcortical sensory, conduction, anomic
Non-fluent and agrammatic speech with relatively preserved auditory comprehension
Broca’s
Non fluent speech with good repetition
Transcortical Motor
Severe impairment in production and comprehension of language, with the preservation of repetition.
Mixed Transcortical
Severe impairment in production and comprehension of language effecting all modes of communication, including nonverbal.
Global
Fluent but jargon-filled speech and defective auditory comprehension are the hallmarks of this syndrome
Wernicke’s
Fluent, well-articulated, paraphasic, somewhat echolalic, empty speech in the context of poor auditory comprehension. Repetition is preserved in these patients.
Transcortical Sensory
Fluent and paraphasic speech with naming difficulties and impaired repetition.
Conduction
Overriding feature is a persistent and severe naming problem in the context of relatively intact language skills
Anomic
