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Fluency Disorders > RHS/ Dementia/ TBI > Flashcards

RHS/ Dementia/ TBI Flashcards

1
Q

Symptoms of RHS depend on….

A

severity and site of lesion!

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2
Q

What are some of the PERCEPTUAL impairments of RHS?

A
  • Denial of illness
  • Neglect
  • Constructional impairment
  • Topographic impairment
  • Geographic disorientation
  • Visuoperceptual impairments
  • Facial recognition deficits
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3
Q

The denial of illness is particularly common in patients with …..

A

PARIETAL LOBE damage! (sensory!)

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4
Q

Patients with RHS typically have _______________ neglect!

A

LEFT SIDE neglect! (left hemi-spatial)

  • not perceive stimuli on the left side of the body
  • do not notice visual or auditory stimuli on left side
  • reading pts with neglect omit words on the left side (e.g. baseball = ball)
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5
Q

What is motor neglect?

A

That is when the patient may fail to use their left side of the limbs even though there is NO motor problems with the limbs!

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6
Q

T or F:

Can neglect occur with damage to either hemisphere?

A 
TRUE! 
However it is more severe and persistent with RH damage! 
2/3 with RH damage have neglect 
vs. 
1/3 with LH damage have neglect
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7
Q

What is constructional impairment?

A
  • Problems with COPYING or DRAWING geometric designs/shapes.
  • Those with RH damage tend to act impulsively and quickly and try to correct mistakes by adding extra lines or rearranging block designs.
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8
Q

What is visuoperceptual impairments?

A
  • People with RHS have more difficulty understanding what the stimuli is when it is incomplete or distorted.
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9
Q

What perceptual/sensory disorder causes a person not to recognize familiar faces?

A

PROSOPAGNOSIA!

  • People with RHS can’t recognize familiar people’s faces.
  • Diff. discriminating women vs. men’s faces / old from young etc.
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10
Q

What is topographic impairment?

A

Problems with EXTRAPERSONAL space!

  • difficulty following familiar routes, reading maps, giving directions.
  • difficulty recognizing visual cues or familiar landmarks.
  • may “talk” to themselves through directions to a place
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11
Q

Geographic disorientation?

A

*Person recognizes their surroundings but don’t know the location where they are! (may believe their are in a different country or city)

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12
Q

What are some of the COMMUNICATIVE impairments with RHS?

A
  • Diminished speech prosody
  • Don’t pick up on prosodic cues of emotions or facial expressions
  • Attentional impairments - problems maintaining and shifting attention and focusing!
  • Connected speech tends to be confabulatory, inappropriate, , excessive, rambling, irrelevant, tangential, digressive and inefficient!
  • Impaired comprehension of narratives and conversations! (diff. with non-literal expressions and humor!)
  • Pragmatic impairments ( diff. turn-taking, staying on topic, eye contact etc)
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13
Q

What are some of the characteristics of diminished speech prosody?

A
  • lack of normal intonation
  • monotonous speech
  • decreased speech variability
  • loudness variability
  • speech lacking emotion
  • reduced gestures
  • slower rate / robotic spacing b/w words/syllables
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14
Q

What are 3 STANDARDIZED tests for RHS?

A

1) Right- Hemisphere Language Battery: (RHLB)
- 7 subtests looking at metaphors, humor, discourse and emphatic stress.

2) Mini-Inventory of Right Brain Injury (MIRBI)
- 10 categories including visual scanning, integrity of body image, reading and writing,, affective language, humor, absurdities, incongruities, and figurative language.

3) Rehabilitation Institute of Chicago Evaluation of Communicative Problems in Right Hemisphere Dysfunction (RICE)

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15
Q

Can non-standardized tests be used to assess people with RHS?

A

Yes! There are some protocols that have been developed , assessing similar items as the standardized tests.

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16
Q

What are some of the most common tests used to asses visual and spatial perception?

A

1) CANCELLATION/scanning TESTS!
* Pts with RHS usually ignore stimuli on the left side.

2) BISECTION TESTS! - used for visual neglect.
Pts are asked to divide lines into 2 equal parts. People with RHS draw the line more towards the right.

3) Copying and drawing from memory tests- also used to assess neglect.
4) Person has to identify incomplete visual stimuli.

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17
Q

How is pragmatics assessed?

A

Using rating scales such as the RICE & RHLB

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18
Q

How is attention assessed?

A

1) Sustained Attention : presented with visual stimuli (e.g. flashing light) and pt pushes a button for each occurrence.
2) Selective Attention: presented with more than one stimuli and has to focus on one!

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19
Q

T of F:

A SLP should start working with a patient with RHS right away even though they are in denial.

A

FALSE
A clinician should wait to see if the denial gets resolved b/c it would be very difficult to work with a person that does not accept treatment.

If the person continues to be in denial an SLP should then use simple treatment goals and simplify the environment.

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20
Q

What are some SUSTAINED attention activities that an SLP give to a patient with RHS?

A
  • Drills to improve using various tasks )
    • pen and pencil tasks (mazes)
    • auditory listening tasks
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21
Q

What are some SELECTIVE attention activities that an SLP give to a patient with RHS?

A
  • Drills where the patient has to pay attention to a particular task
    • using background interference (radio playing) while having to focus on something else.
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22
Q

How can a clinician address impulsivity?

A

Working on STOP and GO signals so the patient understands when is it appropriate to respond/ talk/ take turns etc.

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23
Q

How can a clinician work on reasoning and problem solving ?

A

Have the client solve simple problems. (What would you do? )
(e.g. The boy feel of the bike and you were watching…what would you do? )

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24
Q

How to work on reading impairments?

A
  • Provide visual cues (look to the left!) by using colored markers or verbal cues
  • Teach client to trace boundaries of an edge or page of book
  • Give words on the right side of the page that don’t make sense unless they look towards the left.
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25
Q

How to work on pragmatics?

A
  • use structured activities to practice turn taking skills
  • provide visual/ verbal cues
  • videotape patient so they can evaluate their behavior
  • work on humor/ metaphors
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26
Q

T or F:

Patients with RHS have usually trouble generalizing. (carrying over knowledge to other situations)

A

TRUE

  • An SLP should help the patient learn how to generalize across tasks
  • e.g. patient learns how to greet in the clinic, he can greet the same way in other situations
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27
Q

T or F:

Most TBI injuries are open head injuries.

A

FALSE!

closed-head!!!

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28
Q

T or F:

Males are two to three times as likely to have a TBI as females

A

TRUE!

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29
Q

What are some risk factors?

A
  • age
  • gender
  • substance abuse
  • school adjustments and social history
  • personality types
  • participation in high risk sports
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30
Q

Penetrating brain injuries are usually caused by….

A

missiles, bullets, stones

* amount of damage depends on velocity of missle

31
Q

In closed head injuries the _________________ is NOT penetrated.

A

Meninges!

32
Q

What are the two categories of CHI?

A

1) Non-acceleration : when the restrained head is stuck by a moving object. Produces less severe damage than acceleration injuries
2) Acceleration: injury caused by sudden acceleration or deceleration of the head.

33
Q

Cranial nerves are often damaged in _____________ injuries.

A

acceleration!

34
Q

What are two types of acceleration injuries?

A

pg. 453 images
1) LINEAR acceleration injuries: when the head is suddenly hit and pushed into acceleration by an outside force. The skull starts to move in the direction of the outside force. This causes the skull to slam to the brain! (COUP-INJURIES) (CONTRA-COUP INJURIES) is when
2) ANGULAR acceleration injuries: Caused by a blow that hits the head off -center and cause the skull to rotate away from the blow. Causes a TWISTING & SHEARING motion of the midbrain, basal ganglia, brain stem and cerebellum.

35
Q

T or F:

Angular acceleration is more severe than linear acceleration.

A

TRUE

36
Q

T or F:

Coup and Contra coup ONLY occurs with linear acceleration injuries and typically in the front and back of the head.

A

TRUE

37
Q

Diffuse axonal injury can result from ___________________ an/or __________________.

A

angular o linear acceleration!

38
Q

Another common occurrence in non-penetrating brain injuries is _____________________ and ____________.

A

traumatic hemorrhage & hematoma!

39
Q

CEREBRAL EDEMA = ?

A

Fluid accumulates in cerebrum and causes increased intracranial pressure. (swelling! )

40
Q

ISCHEMIC BRAIN DAMAGE = ?

A

Reduced oxygen to brain

41
Q

CEREBRAL VASOSPASM =?

A

Contractions of muscles surrounding blood vessels.

42
Q

What are some of the prognostic indicators of TBI?

A
  • Duration of Coma - longer the worse
  • Duration of post-traumatic amnesia (memory events following injury) When amnesia lasts less than 2 weeks recovery is 80% better of cases
  • Patient related variables (age, SES, substance abuse etc)
43
Q

How can you assess coma?

A

1) Glasgow Coma Scale - rates level of consciousness based on eye opening, motor behavior, and verbal responses.
2) The Comprehensive Level of Consciousness Scale (CLOCS)

44
Q

How can you assess amnesia?

A

Galveston Orientation and Amnesia Test (GOAT)

  • assesses orientation and memory (place, person, time)
  • designed for pts emerging from coma
45
Q

What are two other popular assessment batteries used to measure outcome?

A

1) Glasgow Outcome Scale

2) Rancho Los Amigos Scale of Cognitive Levels

46
Q

What to assess in a patient with TBI?

A

ASSESS IF PATIENT:

  • is easily aroused from sleep through sounds or verbalization, touching etc.
  • responsiveness to stimulation when awake
  • response to speech
  • response to visual stimulation
  • response to tactile stimulation
  • response to olfactory stimulation
47
Q

When you assess orientation you ask:

A

person, place , time!

48
Q

When patients are in level __________ of RLAS they may be able to tolerate testing for cognition and communication.

A

LEVEL 5!

49
Q

T or F :

Is it common for TBI patients to get easily agitated?

A

TRUE

50
Q

T or F:

Patients with TBI do not have any problems with abstract concepts or abstract thinking

A

FALSE

51
Q

What are the three test batteries for TBI?

A

1) RIPA - Ross Information Processing Assessment (15-adults)
2) SCATBI - Scales of Cognitive Ability for Traumatic Brain Injury
3) BTHI - Brief Test of Head Injury (14-adults)

52
Q

Tests for general population are:

A
  • Woodcock- Johnson Psychoeducational Battery
  • ” “ Tests of Cognitive Abilities
  • ” “ Tests of Achievement
  • Peabody Individual Achievement Test
53
Q

Difference between Comatose vs Semi-comatose

A

Comatose : deeply unconscious, does not respond to any stimuli

Semi comatose: mild unconsciousness , does respond to some stimuli (vegetative state)

54
Q

Can medicine help a patient with TBI be less agitated as well as improve attention and alertness?

A

YES !

55
Q

What is dementia?

A

An ACQUIRED neurological syndrome associated with persistent or progressive deterioration in intellectual functions.

56
Q

A person with dementia must show deficits in these areas:

A
  • short term memory
  • long term memory
  • impairment in at least one of these:
  • abstract thinking
  • personality
  • judgement
  • language
  • praxis
  • visual recognition
  • constructional abilities
57
Q

There are two types of dementias ________

A

SUBCORTICAL AND CORTICAL

58
Q

Impairments of memory, IQ, and language occur later in _____________ than in _________ dementias?

A

subcortical

cortical

59
Q

Motor problems are first impairments in __________ dementias.

A

subcortical!

60
Q

Subcortical dementia can occur in the following:

A

1) Parkinson’s disease (mild to moderate)
2) Huntington’s disease (more severe)
3) Progressive Supranuclear Palsy (rare/ final stages)
4) HIV

61
Q

What is mixed dementias?

A

Caused by multiple infarcts at different location of the brain- it is a vascular disease.

62
Q

What are some CORTICAL dementias?

A

1) Alzheimer’s disease

2) Pick’s disease

63
Q

Alzheimer’s is characterized by changes in neurons:

A

1) Neurofibrillary tangles: thread like structures in cell bodies, dendrites and axons,
2) Neuritic plaques- small areas of tissue degeneration
3) Granulovacular degeneration- found inside neurons of hippocampus, Fluid-filled spaces, called vacuoles enlarge cell’s body and cause it to malfunction
4) Decrease in Acetyl choline levels!

64
Q

What are some of the common first symptoms in Alzheimer’s?

A

lapses in memory, judgement , reasoning, disorientation in unfamiliar environments, mood changes.

65
Q

Pick’s Disease occurs between ____ and ____ years of age.

A

40 and 60 !

66
Q

Pick’s is characterized by 2 neuronal abnormalities:

A

1) pick cells = enlarged neurons

2) pick bodies = globe like formations in the neuron

67
Q

Is there an effective cure for pick’s disease?

A

NO!

68
Q

What is the difference between Alzheimer and Pick’s disease?

A

Memory and orientation last longer in Pick’s BUT Pick’s has more early language problems!

69
Q

What should be used to identify dementia?

A

Rating scales are typically used however they are not sensitive enough.
Standardized tests should be used in the early stages to identify dementia!

70
Q

Which is comprehensive test battery is used to assess dementia ?

A

**Arizona Battery for Communication Disorders or Dementia (ABCD)

Other tests can be used like the WAB, CADL (functiona abilities) PPVT (receptive vocabulary)

71
Q

Speech production assessments:

A

BNT - Boston Naming Test

BDAE “cookie theft” picture description

72
Q

Korsakoff’s syndrome is a neurological disorder caused by the lack of ____________ in the brain.

A

thaimine (vitamin B) !

73
Q

There are six major symptoms of Korsakoff’s syndrome:

A
  • antegrade amnesia: loss of ability to create new memories.
  • retograde amnesia: unable to recall events that occurred before development of the amnesia.
  • confabulation
  • lack of insight
  • apathy: lose interest in things quickly

Fluency Disorders (7 decks)

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