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Aphasia > Quiz #3 > Flashcards

Quiz #3 Flashcards

1
Q

Etiologies

A
  • Stroke
  • Trauma
  • Cancer
  • Seizure disorder
  • Infection
  • Hypoxia
  • Poison
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2
Q

RH functions

A
  • Processes non-linguistic & emotional elements of communication: prosody, facial expressions, body lang/gesture, visuospatial skills, music/art
  • Inferencing
  • Gestalt
  • Interpreting emotion
  • Maintaining attention
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3
Q

Sustained attention

A

How well you can maintain your attention to a task

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4
Q

Selective attention

A

Can you focus on something & tune out distractions?

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5
Q

Alternating attention

A

Doing 1 thing & then another, then go back to 1st thing

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6
Q

Divided attention

A

Can you focus on 2 things at once?

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7
Q

Communication deficits

A

Prosodic deficits (receptive & expressive)

  • Trouble not sounding monotone
  • Can’t perceive differences in prosody

Poor narrative cohesion/organization
-Not good storytellers or good at giving directions

Poor pragmatics

  • Preoccupied w/ self
  • Behaviorally passive (may not respond to things in their environment)
  • Understanding & showing facial expression

Poor awareness (unaware or inattentive to physical/mental limitations)

Poor arousal
-How to maintain arousal: altering signals, repositioning the person, bright lights, increase task complexity, give them performance incentives (relaxing, food, going outside, calling family)

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8
Q

Inferencing deficits

A
  • Doesn’t perceive humor, sarcasm, & non-literal language
  • Perseverates on details of picture w/o grasping overall whole (gestalt)
  • Misses general topic, purposes of discourse
  • Cultural backgrounds; taboos
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9
Q

Discourse deficits

A
  • Limited inferencing
  • Difficulty paying attention
  • Lack of ability to make repairs
  • Pedantic style of speaking (talking monotone)
  • Difficulty with turn-taking
  • Difficulty with topic maintenance
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10
Q

Visuospatial deficits

A
  • Simultagnosia
  • Achromatopsia
  • Neglect
  • Prosopagnosia
  • Somatophrenia
  • Constructional deficits
  • Topographic impairment
  • Geographic disorientation
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11
Q

Simultagnosia

A

Can’t perceive more than 1 object at a time

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12
Q

Achromatopsia

A

Can’t perceive colors

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13
Q

Prosopagnosia

A

Unable to recognize faces

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14
Q

Somatophrenia

A

Don’t believe that a limb is theirs

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15
Q

Topographic impairment

A

Decreased ability to follow routine, follow maps/directions

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16
Q

Neuropsychiatric disorders

A
  • Anosognosia
  • Reduplicative paramnesis
  • Capgras delusion
  • Depression
  • Hallucinations
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17
Q

Anosognosia

A

Denial of illness

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18
Q

Reduplicative paramnesis

A

Duplicate of person, body part

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19
Q

Capgras delusion

A

A delusion that a friend, spouse, or close family member (or pet) has been replaced by an identical-looking imposter

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20
Q

Issues in assessment

A
  • Inconsistent referrals –> changes can be extremely subtle

- Measurement concerns –> extremely hard to measure some of these changes

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21
Q

Informal tests

A
  • Orientation
  • Conversation: looking & listening
  • Picture description
  • Line bisection
  • Copying drawings
  • Card sorting/attention tasks
  • Visual organization tests
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22
Q

Objectives in assessment

A
  • Establish a behavioral profile
  • Provide dx (also severity)
  • Determine candidacy for tx
  • Determine level of handicap
  • ID pt’s/family’s concerns & goals
  • Formulate tx focus
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23
Q

Other assessment tools

A
  • Neuropsychologically oriented assessments
  • Behavioral assessments
  • Task analysis & probe procedures
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24
Q

Treatment

A
  • Caregiver counseling & support
  • Pragmatics (“Theory of Mind”)
  • Denial of impairment
  • Prosody
  • Discourse
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25
Q

Treatment (reading)

A
  • Visual scanning therapy

- “Edgeness” for neglect

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26
Q

Treatment (pragmatics)

A

Teach overt rules of social interaction by watching others, then attempting to transfer

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27
Q

Treatment (sustained attention)

A
  • Object sorting
  • Trail-making (#s, word-finding)
  • Listening for targets
  • Simple games (checkers, tic-tac-toe, Go Fish, poker, solitaire)
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28
Q

Selective attention

A

Stroop task

  • Say colors, ignore words
  • Say words, ignore colors

Letter cancellation

Distractors (radio, tv)

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29
Q

Alternating attention

A
  • Sorting

- 2 simultaneous games

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30
Q

Divided attention

A

Answering questions while completing a taks

31
Q

Other treatment targets

A
  • Impulsivity
  • Memory (metamemory)
  • Problem solving/reasoning
  • RC
  • Homonyms
  • Inferencing
  • Humor
  • Error recognition
  • Distractibility
  • Slower rate of learning
  • Motivation
  • Judgement
32
Q

General tx tips

A
  • Performance prediction/appraisal
  • Build/maintain rapport
  • Counsel pt/family
  • Practice patience
  • Generalization is key
  • Measure outcomes (functional, QOL, NOMS system)
  • Consider degree of neglect
  • “Sell” the rationale
  • Utilize pt’s spontaneous productive strategies
  • Practice for generalization
  • Self reliance is the goal
33
Q

Naturalistic tasks

A

Natural settings for tasks
-Barrier tasks (e.g., PACE)

Targets of opportunity
-Teachable moments

Incorporate self-monitoring/instruction

34
Q

Prognostic indicators

A
  • Medical issues
  • Age
  • Education
  • Social involvement
35
Q

Outcomes

A

FIMS

  • Asks about pt’s competency
  • Multidisciplinary
36
Q

Termination criteria

A
  • Maximum benefit
  • Decision will often be mutual
  • Special problem of college clinics
37
Q

Data

A
  • There’s nothing you can’t count
  • Use probes for efficient documentation
  • Don’t keep data in your head
  • Document generalization
  • Be creative
38
Q

TBI

A
  • Major cause of death in U.S.
  • High risk groups: racial & ethnic minorities, service members/veterans, homeless, those in correctional & detention facilities, survivors of intimate partner violence, those in rural areas
39
Q

Causes of TBI in U.S.

A
  • Falls lead to nearly 1/2 of TBI related hospitalization
  • Firearm related suicide is most common cause of TBI related deaths
  • MVAs & assaults are also common
  • TBI can be overlooked among older adults
  • About 10% of TBIs are due to assaults
  • Men were nearly 3x as likely to die as women
  • Falls were leading cause among children ages 0-14 & adults 45 years +
  • MVAs were leading cause of hospitalizations for adolescents & young adults ages 15-44 years
  • 40-60% of pts are intoxicated when admitted
40
Q

Other factors: causes of TBI

A
  • School adjustment (poor academic performance)
  • SES
  • Divorce rates 4x likely
  • Type A > Type B
  • Homeless 3x greater than general public
  • High risk sports
41
Q

Demographics of TBI

A
  • ~6 million survivors alive today
  • As many as 1/2 admitted to hospital w/ TBI are intoxicated (male drivers 16-44 2x as likely to be intoxicated)
  • 50% of young males have poor academic history; increased probability of 2nd TBI
42
Q

TBI primary damage

A

Actual impact to brain

43
Q

TBI secondary damage

A
  • Infection
  • Hypoxia
  • Edema
  • Increased intracranial pressure
  • Infarction
  • Hematoma
44
Q

TBI physiological changes

A
  • Fatigue
  • Seizure activity
  • Spasticity
  • Changes in bowel/bladder
  • Dysphagia
45
Q

Open head injury

A

Penetrating head injury

46
Q

Closed head injury

A
  • Non-penetrating brain injury (no opening or breakage of skill)
  • More common thna open head injuries
  • Most often caused by MVAs
47
Q

Contra-coup injury

A

1 side of head is hit but impact causes opposite side of brain to be injured (whiplash)

48
Q

Diffuse axonal injury

A

When cell bodies on outside of brain are injured in 1 place but b/c brain is shaken around, fibers become twisted & ripped & can’t send messages to other areas –> creates a lot of problems

49
Q

Blast injury

A
  • Struck by particles impelled w/ violent force from an explosion
  • Nothing hits head primarily
  • Levels of damage: primary (explosion itself), secondary (energized fragment move around), tertiary (thrown from blast into object), fourth (blood loss, amputation, inhalation of toxic gas)
50
Q

Closed head injury: acceleration injuries

A

Sudden acceleration or deceleration of the head, causing brain & brainstem to suffer diffuse damage caused by their movement inside skull

51
Q

Closed head injury: linear acceleration injuries

A

Caused by sudden acceleration of head by a force that moves through midline

52
Q

Closed head injury: angular acceleration injuries

A

Sudden deflection & rotation of head by a force that strikes head at an angle

53
Q

Closed head injury: nonacceleration injury

A

Causes less severe brain damage than acceleration injuries. Deformation of skull by impact of object striking skull

54
Q

Swallowing impairments (dysphagia)

A

Evident in ~25% of all TBI clients

Most common problems:

  • Delayed triggering of swallow responses
  • Reduced tongue control
  • Reduced pharyngeal transit
  • Sensory problems

Worsened by:

  • Cognitive impairments
  • Respiratory impairment
  • Inability to cough
  • Medications
55
Q

Cognitive deficits: attention

A
  • Focused attention
  • Sustained attention (vigilance)
  • Selective attention
  • Alternating attention
  • Divided attention
56
Q

Cognitive deficits: amnesia

A

Pre-traumatic amnesia (retrograde)
-Doesn’t remember anything before incident

Post-traumatic amnesia (anterograde)
-Remember everything up to incidents, but difficulty forming new memories

57
Q

Linguistic functioning

A

“Cognitive-Communication Disorder”

All of the above deficits impact language & communication

  • Bilateral & diffuse damage compound communication problems
  • Attention deficits interfere w/ comprehension
  • Aphasia may or may not be clearly present (usually fluent or anomic & deficits in all 4 modalities)
58
Q

Behavioral functioning

A

People with TBI generally experience:

  • Irritability
  • Aggression
  • Anxiety
  • Depression
  • Dis-inhibition (impulsiveness)
  • Social inappropriateness
  • Rage reaction
  • Pseudo-bulbar affect
59
Q

Other common characteristics of TBI

A
  • Slowed processing
  • Excessive cautiousness
  • Perseveration
  • Concreteness
  • Catastrophic reactions
  • Sexual frustation
60
Q

Prognostic indicators in TBI

A

Duration of coma (generally longer in coma, poorer prognosis)

Duration of posttraumatic amnesia (longer is lasts, poorer prognosis)

Patient related variables

  • Age
  • Substance abuse
  • Education
  • Intelligence
  • SES
  • Personality
61
Q

Evaluating cognitive communication disorders

A

Warnings:

  • Use caution when using existing standardized tests
  • Evaluate individual’s pre-injury characteristics
  • Collaborate w/ other professionals in interpreting level of impairment
62
Q

Levels of consciousness & response to stimulation

A

Coma (typically come out 3-4 wks after injury, but not always)

Vegetative state
-Persistent vegetative state lasts no longer than 1 month

Minimally conscious state –> have to exhibit 1 or more of the following:

  • Follow simple commands
  • Intelligible verbalizations
  • Movements/emotional responses to environmental stimuli (purposeful reaching, frowning, crying, visual tracking)
63
Q

Treatment: goals of therapy

A
  1. Inform patient & caretaker(s) about nature & consequences of disorder
  2. Provide appropriate treatment approaches & techniques
64
Q

4 major themes of treatment

A
  • Management of health & disability
  • Management of grief & coping
  • Acceptance of injury & redefinition of self
  • Development of social support networks
  • Empowerment
65
Q

Cognitive rehab: restorative

A

Neuronal growth through repetitive exercises & drills

66
Q

Cognitive rehab: compensatory

A

Circumventing the impaired functions (component training)

67
Q

External compensations

A

Anything you do to environment to make person more aware of impairments

68
Q

Situational compensations

A

Train person to use compensatory strategies in certain situations

69
Q

Recognition compensations

A

Training person to evoke strategy when they perceive that a problem is occurring

70
Q

Anticipatory compensations

A

Teach person to use strategy at 1st sign of impending problem or maybe even before problem happens

71
Q

Interventions: TBI

A
  • Sensory stimulation
  • Orientation
  • Behavior management
  • Pharmacologic intervention
  • “Component training” e.g., memory, attention, awareness, reasoning, problem solving, visual processing
72
Q

Crosson’s method

A

Poor awareness:

  1. Intellectual awareness: basic understanding that there’s an impairment
  2. Emergent awareness: how they are conducting themselves when engaged in task
  3. Anticipatory awareness: reflective on future & consequences of their actions
73
Q

Visuospatial intervention

A
  • Scanning drills
  • Figure-ground discrimination
  • Mental manipulation of visual stimuli
74
Q

Interventions: TBI

A

Language & communication

Time pressure management

Compensatory memory strategies

  • Internal strategies: mnemonic devices, imagery, self-talk
  • External aids: checklists, calendars, phones
  • Environmental compensation
  • Setting these everyday routines
  • Group treatment

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