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SPA FINAL Flashcards

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1
Q

What is a CVA?

A

Cerebral Vascular Accident (Brain Attack) is a type of stroke

The temporary or permanent disturbance of brain function due to vascular disruptions is caused by either blood loss to the nerve tissue or bleeding into the neural tissue.

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2
Q

Types of Strokes

A

-Ischemic
-hemorrhagic
-Transient Ischemic Attack

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3
Q

TIA (Transient Ischemic Atack)

A

Temporary blocked artery
“mini-stroke”
causes no permanent damage

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4
Q

Ischemic Stroke

A

87% of strokes
Clot-caused stroke (interruption of blood supply to the brain)

Two types: embolic and thrombotic

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5
Q

Ischemic Stroke: Embolic

A

Plaque fragment that travels from the heart (to another place in the body)

Usually travels to the brain through the bloodstream

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6
Q

Ischemic Stroke: Thrombotic

A

A blood clot that forms inside the artery which supplies blood to the brain, may interrupt blood flow and cause stroke

(Does not travel)

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7
Q

What is the difference between the CIA and the TIA

A

A TIA does not cause permanent damage whereas a CIA can

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8
Q

What are the warning signs of a stroke?

A

F: Face drooping
A: Arm Weakness
S: Speech Difficulty
T: Time to call 911

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9
Q

What are the Additional Signs of a Stroke?

A

-Sudden NUMBNESS or weakness of face, arm, leg, especially one side of the body

  • Sudden CONFUSION, trouble speaking or understanding speech

-Sudden TROUBLE SEEING in one or both eyes

-Sudden TROUBLE WALKING, dizziness, loss of balance or coordination

-Sudden SEVERE HEADACHE, with no known cause

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10
Q

What are Stroke Factors we CAN control?

A

-Health
- Smoking
- Drinking

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11
Q

What are Stroke Factors we CAN NOT control?

A

-Age
-Genetics
-Accidents (TBI)

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12
Q

What is Aphasia

A

An acquired communication disorder that impairs a person’s ability to process language Affects: production/comprehension of speech, and ability to read or write (Left hemisphere controls language)

Intelligence is still intact just have difficulty accessing thoughts through language

Types: Brocas, Wernickes, Anomic, and Global

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13
Q

What causes Aphasia?

A

Due to brain injury, most commonly from a stroke, particularly in older individuals. May also arise from head trauma, brain tumors, or infections

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14
Q

What is the difference between fluent and nonfluent aphasia?

A

Fluent: Ease of producing connected speech is not as affected

Non-Fluent: Connected Speech is Affected

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15
Q

Define Broca’s Aphasia

A

(Non-Fluent) Interior frontal lobe lesion

Speech is minimal: usually less than 4 words

Expressive Language affected

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16
Q

Define Wernicke’s Aphasia

A

(Fluent) Superior Temporal Lobe Lesion

The ability to grasp the meaning of spoken words is chiefly impaired

-Sentences do not hang together and irrelevant words intrude

-Reading and Writing are often Severely impaired

Receptive Language affected

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17
Q

Define Anomic Aphasia

A

(Fluent)

Inability to supply the right words for what they want to say (nouns and verbs) but understand speech

Expressive Language affected

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18
Q

Define Global Aphasia

A

(Non-Fluent) Most Severe

Can produce few recognizable words and understand little to no spoken language, can not read or write

Receptive and Expressive affected

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19
Q

What does it mean to “rebuild your identity” in the post-stroke life of a survivor?

A
  • Finding Purpose
    -Rediscover how you define yourself
  • Regaining skills you used to have
  • Changes in lifestyle to adjust for changes
  • New habits/routines
    -Learning to accept new self
  • Adapting to new communication style
  • Being open-minded to therapy and help
    -Patience, support, reasonable goals
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20
Q

Describe Auditory Comprehension

A

The ability to assign meaning to what we hear

Listening comprehension and memory are inner-related

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21
Q

Ways to Improve Auditory Comprehension

A
  • Getting persons attention
  • Find quiet times (be sensitive to noise)
  • Make sure the person is rested
  • Do not raise your voice
  • Do not speak more slowly (although pauses may help)
  • Make phrases direct and short
  • Be redundant
  • Ask yes/no questions; avoid open-ended questions
  • Make sure your face is visible
  • Make messages personally relevant
  • Supplement the message with pictures and words-visual info
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22
Q

Define Apraxia of speech

A

A neurological disorder that involves problems with the programming of placement and sequencing of the articulators for speech. (rhythm and timing of speech affected)

Defined as inconsistent articulations

NOT due to weakness or paralysis of speech muscles

NOT a language disorder

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23
Q

Define Dysarthria

A

Refers to a group of speech disorders resulting from weakness, slowness, or incoordination of the speech mechanism due to damage to any of a variety of points in the nervous system.

Is a disorder of speech production NOT language (use of vocab and grammar)

Speech errors that occur are highly consistent

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24
Q

What is the difference between Apraxia of speech and Dysarthria

A

Apraxia is not due to weakness or paralysis of speech muscles (neurological where dysarthria is motor)

Dysarthria speech errors are highly consistent whereas apraxia is inconsistent

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25
What are strategies to use when communicating with people who have aphasia?
- Make sure you have the person's attention - Minimize or eliminate background noise - Keep communication simple but adult (not patronizing) - Use other modes of communication - Give them time to talk - Reduce your rate of speech - Do emphasize keywords - Do not talk louder
26
What is dementia?
Dementia is a syndrome (constellation of signs and symptoms) A condition in which the affected individual exhibits diffuse impairment of intellect and cognition
27
What clinical features are necessary for the diagnosis of dementia?
Experiencing memory loss, poor judgment, and confusion.
28
What are the risk factors for AD?
-Age -Family history - Education - Head Trauma - Gender - Minimal Cognitive Impairment
29
What are some of the effects of dementia on our nation?
of people with AD doubles every 5 years, intervals between 65-90 6th leading disease in the US 6 million Americans with AD
30
Define MCI (Mild Cognitive Impairment)
Presents with normal general cognitive function and normal ADLs (function fairly normal) No diagnosis of dementia Demonstrate abnormal difficulty in at least one cognitive domain Widely accepted as a possible precursor of AD (8 out of 10 in 7 years)
31
Define VD ( Vascular Dementia)
Loss of cognitive function to a degree that interferes with ADLs, resulting from stroke or from heart disturbances that injure brain regions important for memory, cognition, and behavior Sudden- stroke, gradually- small vessels Prevalence increases with age and tends to be higher in men Risk Factors: Smoking, high blood pressure, obesity poor diet
32
Define DLB (Dementia with Lewy Bodies)
Lewy bodies are round lumps of proteins in the cell-processing neurons - Attention deficits - Memory loss - Constructional dyspraxia (can't build or draw) - Visual hallucinations - Delusions - Trouble interpreting visual info - Confusion and alertness vary significantly from one day to another
33
Define PD (Parkinsons Dementia)
Cognitive difficulties reflect frontal lobe involvement: general slowing cognitive processes, executive function deficits, and problems processing emotional information. - Muffles speech - Delusions - Depression/ Anxiety - Trouble interpreting visual info - Changes in memory - Decline in thinking and reasoning
34
Define FTD (Frontotemporal Dementia)
various degenerative conditions nerve cell damage caused by FTD leads to loss of function in the frontal and temporal love causing deterioration in behavior, personality, language disturbances, and changes in muscle or motor functions Caused by a family of brain diseases and difficult to predict
35
What are the primary characteristics that differentiate AD from VaD?
VaD means a cardiovascular or circulatory disturbance while AD is plaques, tangles, and atrophy
36
Where does Alzheimer’s disease begin in the brain?
It begins in the perirhinal cortex (medial temporal lobe) the hippocampal complex in the temporal love, the basal forebrain (areas important to episodic memory)
37
When tissue from the brain of a patient with AD is examined microscopically, what is seen? What are they called?
Granuloavacular degeneration- fluid-filled spaces within cells that contain granular debris Beta- Amyloid- bits, and pieces of degenerating neurons that clump together (plaques) Neurofibrillary Tangles- are disintegrating microtubules Atrophy- Shrinking of tissue
38
Describe the Early stage of AD
Last from 2-4 years. Earliest changes reported by caregivers (noticed prior to dx) 1. difficulty handling finances 2. memory problems 3. concentration problems 4. difficulty with complex tasks 5. forgetting the location of objects 6. decreased awareness of recent events. Mental Status: Disoriented for time, but not place or person Motor Function: Good; ambulatory Basic ADLs: Generally able to carry out basics; bathing, dressing, feeding, toileting Linguistic Communication: Speech is fluent, no dysarthria Spoken language is grammatical; written language has grammar & spelling problems Content of language changes; tangential; increased word-finding problems (empty words -> thing, it). Mild dysnomia, usually semantically related (lime for lemon,) Oral discourse contains more fragments, less cohesive Comprehension- generally comprehends what they hear and read, but quickly forgets it.
39
Describe the Middle stage of AD
Typically occurs 4-10 years after clinical dx. During this stage, pt changes most dramatically becoming more dependent on others. Mental Status: Disoriented for time and place, orientation to self is intact Motor Function: Good; become restless Memory Function: Worsening of episodic memory, shortening of attention span, worsening of encoding and retrieval deficits, and degradation of semantic memory. Hard time focusing attention, easily distracted, can be difficult to engage in activities. Visual-perceptual deficits are apparent. Basic ADLs: Supervision and environmental support for bathing, dressing, feeding, and toileting. IADLs are problematic (taking messages, managing finances). Driving becomes an issue. They can manipulate the controls and mechanically drive a car, problems with attention, judgment, and memory make them dangerous to themselves and other drivers. Linguistic Communication: Speech is fluent, although often slower and halting Form of Language: generally intact, but content is affected. Oral discourse contains fewer nouns relative to verbs; less cohesive, and more “empty” speech. Exhibit diminished comprehension of written and spoken language. Most do well at the word and phrase level. Mechanics of reading are spared, but comprehension is impaired due to memory. Language Use: Word-finding difficulties are more obvious; repetition is more common in conversation or in picture descriptions; tendency to interpret nonliteral language literally. Reading – oral reading and reading comprehension at the word level Follow simple commands
40
Describe the Late stage of AD
Mental Status: Disoriented for time and place- often become disoriented to person Motor Function: Impairment may be present; very late stage may be nonambulatory incontinence of bowel and bladder Memory Function; Intellect is devastated by the global failure of working and declarative memory systems Basic ADLs: Unable to carry out basic ADLs. Linguistic Communication: Speech is typically fluent, but slower and more halting Meaningful output is greatly reduced. Some folks are mute, others exhibit palilalia (repetition of phrases, words, or syllables that tend to increase in speed at the end of utterance) or echolalia or jargon. Others may be able to contribute to conversation, state their name, and retain aspects of social language. Reading comprehension is severely impaired; some can orally read single words. Virtually all are unable to express themselves in writing
41
What are the primary differences in communicative functioning between healthy elders and individuals with mild AD?
Mental status declined motor function declines memory function: impaired basic ADLs
42
What is a red flag of depression vs. dementia in assessment?
People with depression have difficulty concentrating, whereas those affected by Alzheimer's have problems with short-term memory. Writing, speaking, and motor skills aren't usually impaired in depression.
43
What is episodic memory ?
Memory for personal events and experiences that are specific to time and place
44
How can we reduce demands on episodic memory?
- Rely on recognition rather than recall - Use choice questions - Label - Recreate the conditions that existed when the memory was made
45
What is working memory?
Remembering incoming info, synthesizing info, forming intentions, and deciding on a course of action
46
What are the components of working memory?
- Central Executive (attention, memory recall, decision) - Phonological loop (holds verbal info -temp) - Visuospatial sketchpad (holds visual/spatial info- temp) - Episodic buffer (combines all other 3 into one)
47
What are the effects of aging on WM?
- Limited capacity for processing and storing info - Impairment in holding and manipulating info in the mind and adding lists of numbers in the head. Lose ability to recall names, faces. events
48
Define and discuss executive function
doing what must be done to solve a problem or achieve ones goals includes aspects of attention, memory, planning, reasoning, and problem-solving, to organize and regulate purposeful behavior
49
What are some possible effects of aging on executive function ?
Processing and action speed decline
50
Define and describe declarative memory
Conscious recollection of events (episodic, semantic, lexical memory) What we know about things (storage and retrieval) ex. remembering a past birthday party
51
Define and describe non-declarative memory
Implicit recollection/ performance of action (procedural memory, priming conditioned response) Knows how retrieval on a subconscious level ex. brushing teeth
52
What are the effects of aging on long-term memory?
- Event recall, multi-tasking, and attention shifting all decline
53
The Cognitive Communication CHECKLIST for Acquired Brain Injury (CCCABI) provides a nice summary of Functional Daily Communications and Specific Functional Difficulties that may be present with acquired brain injury. List the Domains
Domains: - Auditory comprehension and info processing - Expression, discourse, and social communication Factors: -Reading comprehension - Written expression - Thinking Reasoning
54
Cognitive Communication CHECKLIST: Auditory comprehension and info processing
Hearing, attention, memory, receptive language, comprehension, integration, reasoning, and speed of info processing Problems: Understanding words in sentences, long statements
55
Cognitive Communication CHECKLIST:Expression, discourse, and social communication
Articulation, word finding, language, memory, attention, social communication, fatigue, fluency, reasoning, executive functions, social cognition, perception, self-regulation Problems: words, understanding emotion and cues
56
Cognitive Communication CHECKLIST: Reading comprehension
Any written materials, print or electronic, Problems: decoding letters/words, reading aloud fluently, reduced stamina for reading
57
Cognitive Communication CHECKLIST: Written expression
Any written materials Problems: hand movements, writing words, constructing sentences, spelling, organizing thoughts in writing
58
Cognitive Communication CHECKLIST: Thinking Reasoning
Executive functions, self-regulation, required for communication Problems: insight, awareness, recognizing there is a problem,, making and expressing decisions, discussing without being overwhelmed, upset or withdrawn, brainstorming, planning, evaluating, prioritizing
59
What is Right Hemisphere Brain Damage (RHD)?
Damage to the right hemisphere of brain that can cause problems in thinking, memory, and communication,
60
What are the domains and subdomains that can be impacted in RHD?
- Emotional - Cognitive - Communication
61
What would Emotional deficits in (RHD) look like?
-affect emotional responses, attitudes, states - the individual might seem flad or overly animated - appear less empathetic - difficulty understanding/ expressing emotion - Theory of mind deficits
62
What would Cognitive deficits in (RHD) look like?
- Executive function - Awareness - Memory - Attention - Unilateral Neglect: people appear to not see things located on the L side, not a vision problem can shift when reminded to look L
63
What would Communication deficits in (RHD) look like?
Asparagmatism: difficulty conveying or comprehending the meaning/intent of a message and can include any or all communication modes -Prosody and TOM can be affected Prosody: Person(speech pitch and rhythm) so a person could sound flat and difficult to judge mood TOM: Theory of mind is the ability to understand other people have different perspectives, emotions, knowledge, and feelings so may not understand this

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