neurogenic disorders Flashcards
what is ischemic penumbra
when the surround tissue function is compromised
what is a characteristic of hemorrhagic strokes
thunderclap headache with sudden onset
what is a semantic paraphasia
substitution of one word for another which may be related in meaning marker for pencil
what is a phonemic or literal paraphasia
error at sound level tup for cup
what is a neologism
nonword
what is logorrhea
excessive inappropriate productio of speech which is tangential
what is empty speech
using general words such as this, that, stuff etc to replace specific words
what are characteristics of Broca’s
- impaired naming
- nonfluent speech
- limited word output
- distored speech sounds
- telegraphic speech
- impaired repetition
- poor oral reading and comprehension
- difficulty writing
- monotonous
what are characteristics of transcortical motor aphasia
caused by lesions in the supplementary motor area supplied by the anterior cerebral artery and anterior MCA 1. no spontaneous speech 2. nonfluent 3. intact repetition 4. echolalia and perseveration 5. awareness of grammar 6. refusal to repeat nonsense words 7. unfinished sentences 8. attempts to initiate speech with the help of motor activities such as clapping, head noding and had waving 9. good comprehension 10 difficulty with oral reading 11. seriously impaired writing 12. lack of interest in communication
what is mixed transcortical aphasia
rare
cause by lesions in border zone of brain between middle, anterior and posterior arteries
results in limited spontaneous speech, automatic and unintentionl communication, s
mostly unimpaired automatic speech
severe echolalia
impaired auditory comprehension
impaired fluency
naming difficulty
bilaterl upper motor neuron paralysis (spastic), weakness of limbs, and visual field defects
what are characteristics of global aphasia
caused by extensive lesions in perisylvian region
usually due to occlusion of left MCA
wide spread destruction of the frontotemporoparietal region
what are characteristics of Wernickes aphasia
- fluent speech with normal phrase lenth
- rapid rate of speech with normal prosody
- intact grammar
- severe anomia
- semantic and literal paraphasias, extra syllables in words, neologisms
- circumlocution
- empty speech
- poor auditory comprehension for sentences and names of common objects
- worse comprehension in background noise
- o,[aored re[etotopm
- difficulty reading and writing
- anosognosia
- paranoia, depression
what are characteristics of transcortical sensory aphasia
lesions in temporoparietal region
arcuate fascicuus may be unaffected
parts of occipital lobe may be affected
posterior branch of the left MCA
1. fluent speech
2. paraphasias and empty speech
3. good repetition but poor comprehension of repetitions
4. echolalia of grammaticall incorrect forms, nonsense syllables and foreign languages
5. impaired auditory comprehension
6. difficulty pointing, obeying comands, or answering yes-no questions
7. normal automatic speech (counting)
8. tendency to complete sentences started by cliinician
9. good reading with poor comprehension
10. may have one sided neglect
what are characteristics of conduction aphasia
lesions in supramarginal gyrus and arcuate fasciculus
1. impaired repetition
2. speech fluency
3. phonemic paraphasias
4. word finding difficulties
5. empty speech
6. near normal comprehension
7. variable reading problems with better comprehension of silent reading
8. buccofacial apraxia: difficult performing buccofacial movement
9. no neurological symptoms i some, paresis of right face and limb in others
10 oral apraxia
11. right sensory impairment may be present
what can lesions to the basal ganglia produce
anomic global brocas wernickes transcortical motor aphasia
what can lesions to the thalamus cause
fluent aphasia with paraphasias and poor comprehension
word finding and naming problems
limited verbal output
neologisms
what can lesions to the cerebellum cause
limited fluency
mild anomia
mild speech comprehension problems may be the dominant symptom
what is included in a bedside evaluation for aphasia
- ask personal questions such as name
- ask for nonverbal responses (point to window)
- ask questions related to orientation ( is California a state in Canada)
- get a brief reading and writing smaple
what are possible screening tests for aphasia
- bedside western aphasia bettery
- BDAE-3 short form
- Mississippi aphasia screening test
what are functional communication assessments
target daily living skills
may be assessed by observing how a client communicates their needs
what skills are necessary to assess in aphasia
- repetition: single words, objects names, verbs, function words; repetition of sentences
- assessment of naming skills: responsive naming (what color is snow) and confrontational naming
- word fluency (name all the animals you can think of)
- production of sentence when a word is supplied
- production of multiple sentences (tell me about…)
- narrative skills: retell a story
- discourse
- assess fluency
- assess functional communication
- assess auditory comprehension
- assess comprehension of single words
- assess comprehension of sentences, paragraphs, discourse
- assess reading
- assess writing
- gestures
- automated speech
how do you assess auditory comprehension of spoken language
- hearing eval
- visual eval
- appropriate response to verbal commands
- comprehension of multistep commands
what is restorative aphasia treatment
help patient regain skills lost by reducing the severity of the deficits
what is compensatory aphasia treatment
help individuals to function despite deficits by teaching compensatory behaviors
what is a social approach to aphasia treatment
minimize communication barriers by training communication partners
- goal is natural interaction designed to reduce social isolation
- teach compensatory strategies
- treatment held in naturalistic settings
what is the sequence of treatment for auditory comprehension in aphasia
- comprehension of single words
- comprehension of spoken sentences
- discourse comprehension
how is the comprehension of single words treated in aphasia
- point to named body parts and objects
- choose pictures representing specific actions
- increase the field size to make this more difficult
how is the comprehension of spoken sentences treated in aphasia
- ask yes-no questions
- follow spoken direction
- verify sentences by matching a sentence to a picture that represents it
how is verbal naming treated
1.initially model the response then cue to evoke a response
what are common cues for naming treatment
- incomplete sentences (you write with a …)
- phonetic cues ( starts with a p)
- syllabic cues ( starts with spoo…)
- silent phonetic cues (clinician exhibits a silent artic posture)
- personalized verbal cues ( he works on your Toyota)
- functional descriptions of objects
- descriptions and demonstrations of actions
what is semantic feature analysis
- for each stimulus picture, the features of group, description, and function are used to have the stimulus named and described
- instead of teaching isolated names of objects, naming skills are taught in the context of narration discourse, and conversation
what is Promoting Aphasic’s Communicative Effectiveness program
- teaches conversational exchanges between 2 people
2. emphasis on effective communication
what is the Helm Elicited Language Program for Syntax Stimulation method
- clinician tells a short story and asks questions
2. who, what, when ,where questions, declaratives, comparatives, and yes-no questions
what is the Response Elaboration Training method
teaches the production of expanded sentences that contain progressively increased amount of information
what is the sequence for treating reading skills
- survival reading skills ( letters, menus, maps etc)
- reading newspapers, books, letters
- reading and comprehension of printed words
- reading and comprehension of phrases and sentences
- reading and comprehensoin of paragraphs and extended material
what is the sequence for treating writing skills
- functional words (name etc)
- functional lists ( grocery etc)
- writing short notes
- filling out forms
- writing letters
which language do you target to treat bilingual aphasics
treatment in the weaker language may produce more generalization to stronger
what is pure alexia
- reading problem when writing and other language skills are intact
- due to lesion in inferior occipitotemporal region
what is agraphia
loss of ability to write due to lesions in foot of medial frontal gyrus
what is agnosia
impaired understanding of the meaning of stimuli
what is auditory agnosia
associated with bilateral damage to auditory association area
- impaired understanding of auditory stimuli with normal hearing
- difficulty matching obects with their sound despite normal vision
what is auditory verbal agnosia
- pure word deafness
2. impaired understanding of spokenwords
what is visual agnosia
impaired visual recognition of objects
tactile agnosia
impaired tactile recognition of objects when visual feedback is blocked
who are more likely to get Alzheimer’s
- women
- family history of Down syndrome
- prior brain injury
- low level of education
what is the neuropathology of Alzheimers
- neurofibrillary tangles: structures in nerve cells that are thickened, twisted, tangled, forming loops and triangles
- amyloid plaques: deposits of protrein that causes tissue degeneration. Cerebral cortex and hippocampus vulnerable
- granulovacuolar degeneration: fluid filled cavities containing granular debris
- neuron loss. shrinkage in temporal and parietal lobe
- neurochemical change: depletion of transmitters such as acetylcholine, somatostatin, vasopressin, and corticotropin
what happens in the early stage of Alzheimers
typically lasts 2 years following diagnosis
- subtle memory problem for recent events
- difficulty with new learning and visuospatial problems
- behavior changes such as self neglect and avoidance of routine tasks
- depression slight disorientation in new surroundings and subtle language change
what happens in the mid to late stage of Alzheimers
- severe recall problems
- intensified visuospatial problems
- widespread intellectual deterioration
- hyperactivity, restlessness, agitation,
- problems with arithmetic
- disorientation to place, time, and person
- problems with self care
- difficulty managing daily routines
- loss of initiative
- paranoid delusions
- aggressive or disruptive behavior
- inappropriate humor
- symptoms worse in the evening
- seizures, myoclonic jerks, decline in motor function
what language problems are associated with Alzheimers
- word finding, naming, verbal and literal paraphasias, circumlocution
- problems comprehending abstract meaning
- impaired picture description
- difficulty generating a list of words that begin with a specific letter
- echolalia, empty speech
- incoherent, rapid speech
- pragmatic problems
- reading and writing problems
- mutism, complete disorientation in fnal stages
what are the pathological characteristics of frontotemporal aphasia
- degeneratin of nerve cells in left and right frontal lobes, temporal lobe or both
- in Pick’s disease, possible focal atrophy in anterior and orbital frontal lobes as well as temporal
- presence of Pick bodies (dense intercellular formations in neuron cytoplasm and Pick cells (ballooned and inflated neurons)
- atrophied, gliosed, and swollen brain cells
what are the behavioral characteristics of FTD
- behavior disorders ( uninhibited and inappropriate social behavior, compulsive, excessive eating, delusions)
- emotional disturbances (depression, apathy, irritability, euphoria)
- impaired reasoning and judgment
what are the language behaviors of FTD
- language problems but better preserved memory
- anomia
- progressive loss of vocabulary
- difficulty defining common words
- limited spontaneous speech
- impaired comprehension of speech and printed material
what is primary progressive aphasia
- form of FTD
- nonfluent, semantic and logopenic variants
- aphasia in beginning with intact cognitive skills
- eventually leads to dementia
- onset is slow
what are characteristics of nonfluent PPA
- earliest signs are anomia, phonemic paraphrasias, apraxia, reduced fluency, artic problems, impaired repetition, prosodic impairments
- memory and cognition preserved until 2 years post onset
- behavioral changes include apathy, disorganization, inappropriateness and aggression within 2 years
- 8-10 year survival rate
what are the characteristics of semantic PPA
- progressive loss of word meaning
- anomia
- semantic paraphasias
- initially intact fluency and repetition, intact phonological skills, motor skills, orientation to time and space
- excessive and disinhibited speech (logorrhea)
- impaired turn taking
- visual agnosia and prosopagnosia
- progressively shorter sentences with eventual mutism
- behavior changes (disinhibition, irritability, bizarre food choices, compulsive behavior)
what are the characteristics of logopenic PPA
- severe difficulty repeating phrases and sentences with intact repetition of short single words in initial stage
- impaired sentence comprehension
- behavior changes (apathy, anxiety, irritability, and agitation)
what are characteristics of a subcortical dementia
motor symptoms precede intellectual deterioration
what is the pathology of dementia with Parkinsons
- basal ganglia and brainstem degeneration
- presence of Lewy bodies in substantia nigra
- frontal lobe atrophy
- reduced inhibition
- neurofibrillary tangles and plaques
what are the neurologic symptoms of Parkinsons
- slow voluntary movement
- resting tremor
- rigidity
- mask face
- reduced blinking
- festination
- swallowing disorders
- sleep disturbance
- cogwheel rigidity
what are speech characteristics of Parkinsons
- reduced volume
- monopitch and monoloudness
- long pauses in speech
- slow, fast, or festinating speech rate
- dysarthria
- memory problems , abstract reasoning and problem solving
- apathy, confusion, delirium
- micrographia
what is the pathology of Huntingtons’s
- loss of neurons in basal ganglia
- atrophy in prefrontal, temporal, and parietal lobes
- reduced levels of inhibitory neurotransmitters GABA and Acetylcholine
what are the symptoms of Huntingtons
- chorea
- gait disturbance, reduced voluntary movement
- behavior disorders (excessive complaining, nagging, eccentricity, irritability, emotional outbursts, false sense of superiority, depression or euphoria, schizophrenis like behaviors and suicide attempts
what are the speech/language problems of Huntingtons
- deterioration in intellectual functions
- impaired word list generation
- naming problems
- dysarthria
- muteness in final stages
what are the characteristics of dementia with HIV
- HIV itself can cause infection
- slow onset, but rapid deterioration in final stages
- disturbed gait, tremor, headache, seizures, ataxia, rigidity, motor weakness, facial nerve paralysis,
- dementia symptoms include forgetfulness, poor concentratin, impaired thinking, apathy, depression delusions, memory loss
- language problems less prominent until mutism
what are characteristics of dementia with Creutzfeldt-Jakob disease
- infectious dementia caused by a prion (abnormal protein ) found in brain
- spongiform state in the brain
- neuron loss
- fatigue
- cerebellar ataxia, tremor, rigidity, chorea, and visual problems
- memory problems and reasoning impairment
- depression, anxiety, euphoria, delusion
- final stage is stupor, mutism, seizure and pneumonia which leads to death
what is lewy body dementia
- caused by lewy bodies similar to that in Parkinsons and Alzheimers
- degeneration begins in cortex
- hallucinations and delusions are vivid and present early in progression
- unlike parkinsons, it does not respond to L-dopa
What is Wernicke-Korsakoff syndrome
- caused by vitamin B1 deficiency often related to chronic alcohol abuse
- initial symptoms are confusion, vision problems, coma, hypothermi, and ataxia
- amnesia, disorientation, tremor, coma and memory problems
how is dementia diagnosed
- case history
- clinical exam
- family interview
- neurologic assessment
- communication assessment
- cognitive assessment
can only be positively diagnosed during autopsy
how is communication assessed in dementia
- best diagnosed during verbal description, storytelling, of immediate and delayed events, word fluency (all words that belong to a class
- assess
awareness and orientation
mood
speech and language
memory, executive functions
abnormal thinking (hallucinations)
visuospatial skills
what are some dementia screening tests
- mini mental state exam
2. montreal cognitive assessment
what are some diagnostic dementia tests
1.Arizona Battery
2. Functional Linguistic Communication Inventory
3, Addenbrooks CognitiveFunction
4. Global deterioran scale
5. Repeatable Battery fr Assessmentof Neuropsychological Status
6. Progressive Aphasia Severity Scale
7. Functional Communication Profile
8. some tests of aphasia may be helpful and picture descritpion tests can assess temporal sequencing, logical connections, grammar
How is dementia managed
- management of daily activities, memory, and communication skills
- communication training (functional communication, family training)
- counseling and support for family and caregivers
what are some strategies that caregivers can be trained to do
- approach slowly, touch gently, establish eye contace, and engage attention
- use gestures, smiling, posture
- elimnate environmental distractions
- talk about simple concrete events
- simplify speech
- ask yes-no questions
- avoid slow speech
- point out topic before speaking about it
- structure room to establish routine
- always say goodybe or give departing signal
what is typically treated in right hemisphere disorder
attention
impulsive behavior
pragmatic problems
visual neglect
what are the attention and perctual symptoms of right hemisphere disorder
- left neglect
- denial of illness: anosognosia
- confabulation regarding disabiity (exaggerated clams about a disabled body part)
- facial recognition deficits (prosopagnosia)
- constructional impairment (reproducing designs)
- attentional deficits
- disorientation
- visuoperceptual deficits: difficulty recognizing line drawings or drawings that are distorted
what are the affective deficits with right hemisphere disorder
- difficulty understanding others emotions
- difficulty describing emotions on printed faces
- understanding emotions of others
what are the communicative deficits with right hemisphere disorder
- lack of communicative effectiveness
- prosodic deficits
- impaired discourse and narrative skills (knowing what is trivial info)
- canfabulation and excessive speech (attention to minor details)
- difficulty understanding implied or abstract meanings
how do you assess right hemisphere disorder
- bedside screen: questions about time, day, date, repeating common words, describe a picture,
what are standardized screening assessments for right hemisphere disorder
Mii Inventory of Right Brain Injury
Burns Brief Inventory
Mini Mental State Exam
what are diagnostic tests for right hemisphere disorder
RIC Evaluation of Communication Problems in Right Hemisphere Dysfunction
Right Hemisphere Laguage Battery
TEst of Visual Neglect
Behavioral Inattention Test
How do you treat Right Hemisphere Disorder
- Denial and indifference: give immediate feedback on errors to increase awareness. Video record sessions
- impaired attention: draw attention to treatment stimuli, give specific directions, repeat directions throughout treatment, stop therapy when patient’s attention wanders
- Impulsive behavior: nonverbal signals to wait before giving an impulsive response
- discourse: include story retell and story generation with hierarchical cues
- pragmatic impairments: video record conversations to draw attention. Give frequent reminders to maintain eye contact, staying on topic etc.
- impaired reasoning: use activities that require reasoning (planning a vacation) and reinforce correct logical sequences
- ipairedinference: use pictures that depict situation that require inference
- impaired comprehension of metaphors: practice correct interpretation
- visual neglect: visual scaning techniques: cacellation tasks,
what is an open-head TBI
fractured or perforated skull
torn or lacerated meninges
high velocity missiles (bullet)
what are closed head TBI
no open wound or penetration
menengies are intact
what are acceleration-deceleration injuries
coup, contrecoup injuries
moving brain is lacerated by bony projections in head
auto accidents
what are no acceleration injuries
restrained head hit by moving object
what is a concussion
closed head injury here consciousness is lost for less tha 20 minutes
what communication disorders are associated with TBI
initial mutism for varying period of time
- confused language, naming difficulties, perseveration, reduced word fluency, difficulty initiating conversion, problems in topic initiation, lack of narrative cohesion, impaired prosody, difficuty with abstract language, auditory comprehension deficits
- impaired social interactions
- reading and writing problems
- dysarthria
what is a typical bedside evaluation for a TBI
- screen the conditin with questions about time, place, person and events surrounding the inury
what are screening tools for TBI
- Brief Test of Head Injury
2. Montreal Cognitive Assessment
what are some TBI diagnostic tests
- Coma Recovery Scale
- Scales of Cognitive Ability for Traumatic Brain Injury
- Glasgow Coma Scale
- Galveston Orientation and Amnesia TEst
- Disabiity Rating Scale
- Rancho Los Amigos Levels of Cognitive Function
- Cognitive Lingustic Quick Test
what is cognitive rehabiitation
- clinicians train attention, visual processing, and memory which may bot result in improved communication
what is communicatin treatment for TBI
- train communication partners
- systematic reinforcement of attendig behaviors, relevant speech, etc will decrease inappropriate behaviors
- patients orientation can be increased by asking questins about their whereabouts
- post written signs to help patient remember the day of the week
- improve memory for family members by asking patient to name pictures of family
- create a simplestructured routine with few activities
- give signals such as listen carefully now
- warm client about topic changes
