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Adult Language Disorders > Recovery Related Issues > Flashcards

Recovery Related Issues Flashcards

1
Q

2 Types of Recovery

A

Natural/Spontaneous and Post-natural

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2
Q

Natural/Spontaneous Recovery

A

maximal, rapid, dramatic; duration of 3-12 weeks; treatment can make the patient progress even faster

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3
Q

Post Natural Recovery

A

patient continues learning, but is much slower and less dramatic 6 months is the limit

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4
Q

Physiology of Acute Phase

A

Visible microscopic changes in 24-48 hours

Edema in large infarcts

Increased intracranial pressure and tissue compression by 3rd day

Brain response to ischemia by autoregulatory mechanisms (vasodilation, diaschisis, circle of willis)

Bilateral reduction of blood circulation (depression of the neural metabolism)

Auto-regulatory Mechanisms: robbing Paul to pay Peter, if the brain needs blood it tries to find it from other areas

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5
Q

Acute Phase

A

No collateral circulation - quick loss of energy is needed to maintain the ionic balance, if this doesn’t happen it leads to cellular energy loss

Cellular Energy Loss

  • Release of glutamate and aspartate
  • Excitatory-toxicity to calcium channels
  • Excessive calcium to many destructive enzymes
  • Inflammatory changes followed by Chromatolysis and Necrosis
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6
Q

Chromatolysis

A

10-18 days Disintegration of micro-molecules, nissl bodies, and nucleolus displacement

Everything becomes liquified

After the 18 days, if the cell is healthy it will come back, if not it will die.

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7
Q

Second Week, post stroke

A

Diminished swelling

Capillaries and astrocyte invasion

Necrotic tissue liquefaction

Phagocytosis of tissue-macrophagic cells (eats up debris)

Phagocytosis - can take up to 3 months if its a large lesion.

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8
Q

Astrocyte Scar

A

Small lesion, post stroke

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9
Q

Cystic Cavity Formation

A

Occurs in 3-6 months Lg. Lesion Basis for pessimism

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10
Q

Sequence of Necrotic Process

A
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11
Q

Repair Process

Structure/Function/Reaction

A
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12
Q

Early & Late Reactions and the Functional Results

A
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13
Q

Core Cells

A

Core cells are dead and can’t be saved

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14
Q

Penumbra Cells

A

Penumbra Cells are the cells that surround the core cells.

The ischemic penumbra has idle neurons (electrically silent but metabolically ready for membrane potentials

idle neurons may survive for 20 mins without collateral circulation and 6-8 hours with collateral circulation

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15
Q

Means of Reperfusion

A

Stent

tPa (clot-dissolving medication)

Merci retrieval system (remove the clot)

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16
Q

Factors Contributing to Natural Recovery

A

Reperfusion with Collateral circulation - Collateral circulation is very closely related to the circle of Willis

Recovery from diaschisis - In the beginning the whole brain is reacting negatively, but after 2-3 weeks the swelling lowers; this is long-distance recovery

Recovery from Structural Disconnections - the pathways have been disconnected/some are broken

Intra-hemispheric reorganization

edema attenuation - reduced pressure

cell recovery in penumbra

17
Q

Positive Recovery Profile

Wertz, 1987

A

Tx benefits patients with single LH thrombo-embolic infarct, mild-moderate loss

post-onset period of 3 or less months, if given 3 hrs/week for 5 months

intensive Tx beneficial if 8-10 hrs/week for 3 months, begin in less than 6 months post-onset

18
Q

Culton Spontaneous Recovery

A

Found Support for natural restitution

These patients didn’t have any treatment

Non-chronic patients:
Most dramatic difference in results between the first and second tests

Chronic patients:

Testing between all the different times are very similar

This tells us that something is happening within the brain even without treatment

19
Q

Vignolo, 1965

A

Developed the Token Test

Pts with mild-moderate loss will do better than those with profound loss

People who are young (under 50) improved the best

20
Q

VA Cooperative Study on Aphasia

Wertz 1981

A

Patients randomly assigned to individual or group therapy

both groups improved beyond 26 weeks post-onset

recovery continued beyond spontaneous recovery period

individual Tx was better overall, but both groups improved

21
Q

Kertesz & McCabe Recovery Patterns

A

Anomics had full recovery

Broca and Conduction with best recovery

Globals with poor recovery

Wernicke bimodal recovery (little recovery in patients with jargon, better without jargon)

evolution into different aphasia types

22
Q

Lomas & Kertesz

Patterns of Spontaneous Recovery

A

Patients divided into 4 groups: LFLC (globals), LFHC (Broca’s), HFLC (Wernicke’s), HFHC (anomics)

equal improvements noted for all language tasks for groups with high comprehension

selective improvement in comprehension and imitation for patients with low comprehension

23
Q

Anna Basso

Prognostic Factors in Aphasia

A

Review of literature on prognostic factors, including age, sex, handedness, etiology, site and extent of lesion, severity and type of aphasia, restitution

Age relationship to recovery - Good predictor of recovery

Gender relationship to recovery - No significant difference in the severity and recovery rate across genders

Personality relationship to recovery - Pleasant and cooperative help in recovery

24
Q

Basso

Initial Severity Relationship to Recovery (1-10 weeks)

A

good predictor of aphasia outcome

greater initial severity is a negative recovery sign

mild initial aphasia has good recovery (95% plateaued within 2 weeks)

moderate initial aphasia 95% plateaued within 6 weeks

severe initial aphasia 95% plateaued within 10 weeks

Sparing of critical cortical area - Greater prognostic significance

25
Q

Basso Extent of Recovery

A

Good for patients with anomia and conduction aphasia

fair/good for patients with Broca and Wernicke

poor for patients with global

26
Q

Basso Rate of Recovery

A

Fast for patients with conduction and Wernicke

intermediate for patients with Broca

slow for patients with anomia and global

27
Q

Basso Recovery Pattern

A

Anomic aphasia is a common end-stage for both recovering fluent and non-fluent aphasics

28
Q

Overview of Contributing Factors (General)

A

Site and Lesion Size - the larger the lesions, the poorer the prognosis

Lesion Nature - Multiple lesions render a poor prognosis
Bilateral lesions - aphsasic residuals
Silent stroke - 11% of patients with silent lesions prior to first stroke

Multiple strokes = bad prognosis

29
Q

Overview of Contributing Factors in a Natural & Trained Restitution

A

Age - younger = better

personality - postive = better

severity - profound loss of lang. at initial eval. = bad prognosis

Motivation - education = bad candidate because you question everything. Motivation = doesn’t really translate into better results

handedness - better recovery in left handedness following LH stroke

time post onset - less than 6 months = better

gender - no effect

social milieu - Pts. who are socially active do better

general health - Someone who has only stroke has better prognosis than someone who is complicated health wise

personality - positive = better

lesion size - bigger = worse

lesion nature - poor for multiple lesions

30
Q

Aphasia Recovery & Bilingualism

A

Synergetic patterns = Nearly 50%
1. Parallel (41%) : both languages impaired similarly in the

beginning and recovered at the same rate ​
2. Differential (9%) : Both languages impaired to different

degrees, but improved at the same rate

Selective Recovery = (27%) only one lang. improves

Successive = (6%) One recovers after the other

Antagonistic = (4%) one lang. progressed whiel the other regressed

Alternate antagonistic = Different lang. prevails at different periods

If you provide tx in mother language it doesn’t generalize to L2, but if you provide tx in L2 it generalizes to L1.

31
Q

Aphasia Recovery & Bilingualism

Robot’s and Pitre’s Rules

A

Robot’s Rule = Primary Language

Pitre’s Rule = Most frequent language

Adult Language Disorders (9 decks)

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