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Adults and cognition 1 > Stroke and aphasia > Flashcards

Stroke and aphasia Flashcards

1
Q

When does a stroke occur?

A

When blood supply to part of the brain is cut off, or when there is bleeding around the brain

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2
Q

What is a transient ischaemic attack (TIA)?

A

Stroke symptoms and signs resolve within 24 hours

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3
Q

What is the epidemiology of stroke?

A
  1. more than 100,000 a year
  2. over 1.2 million people in UK living with effects of stroke
  3. biggest single cause of disability
  4. second leading cause of death worldwide
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4
Q

What are the different kinds of stroke?

A
  1. thrombotic
  2. embolic
  3. haemorrhagic
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5
Q

What is a thrombotic stroke?

A

gradual accumulation of cells on arterial walls leading to eventual blockage of an artery

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6
Q

What is an embolic stroke?

A

Break away cells from thrombotic area travel up an artery and lodge there (where it narrows)

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7
Q

What is a haemorrhagic stroke?

A

Blood leaking from a blood vessel and bleeding into and around the cortex

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8
Q

What are the main effects of stroke?

A
  1. motor - hemiplegia on contralateral side
  2. vision impairment
  3. sensory impairment
  4. effect on language and other cognitive functions
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9
Q

What are the regulations for when a stroke patient arrives at hospital?

A
  1. should have a brain scan withing one hour of arriving
  2. should be moved to a stroke unit within 4 hours of arriving
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10
Q

Why is fast treatment of stroke important?

A
  1. reduces damage caused
  2. increases survival rates
  3. reduces longer-term disability
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11
Q

What is thrombolysis?

A

a drug treatment to break up a blood clot blocking the artery

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12
Q

What is a thrombectomy?

A

operation to remove blood clot from artery in brain

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13
Q

When does stroke treatment happen?

A

Both need to be done soon after stroke onset - usually 4-6 hours

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14
Q

What percentage of right handed people are left hemisphere language dominant?

A

96%

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15
Q

What percentage of right handed people are right hemisphere language dominant?

A

4%

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16
Q

What percentage of right handed people are both hemisphere language dominant?

A

0%

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17
Q

What percentage of left handed or ambidextrous people are left hemisphere language dominant?

A

70%

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18
Q

What percentage of left handed or ambidextrous people are right hemisphere language dominant?

A

15%

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19
Q

What percentage of left handed or ambidextrous people are both hemisphere language dominant?

A

15%

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20
Q

What is the role of the right hemisphere language centre?

A
  1. has a role in communication and language (e.g. pragmatics, discourse, prosody)
  2. producing discourse
  3. understanding discourse
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21
Q

What is asprodia?

A

difficulties comprehending or expressing changes in pitch/intonation

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22
Q

Define aphasia (Papathanasiou et al, 2017)

A

an acquired selective impairment of language modalities and functions resulting from a focal brain lesion in the language dominant hemisphere that affects the person’s communicative and social functioning, quality of life, and the quality of life of their relatives and caregivers

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23
Q

What is anomia?

A
  1. difficulty in retrieving the correct words for concepts
  2. most common symptom of aphasia
  3. can occur to people without brain injury aswell
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24
Q

What is the occurrence of aphasia?

A
  1. more than 300,000 people in UK
  2. 1/3 of people who survive a stroke
  3. chronic aphasia affects up to a third of stroke survivours
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25
Q

What is chronic aphasia?

A

aphasia lasting more than 6 months post onset

26
Q

What causes individual variation in aphasia?

A
  1. location and size of stroke
  2. severity of aphasia
  3. type of aphasia
  4. age
  5. recovery and response to intervention
  6. adaptation
27
Q

Where is Broca’s aphasia?

A

3rd convolution in the frontal lobe of the left hemisphere

28
Q

How was Broca’s area identified?

A
  1. from patient ‘Tan’
  2. could only say ‘Tan’ and expletives
  3. post mortem found large lesion in left lower frontal cortex
  4. similar findings in other patients confirmed importance in language processing
29
Q

What occurs of there is damage to Broca’s area?

A
  1. difficulties formulating expressive language
  2. good understanding
  3. called Broca’s aphasia
  4. non-fluent aphasia
30
Q

Where is Wernicke’s area?

A

in the left tempero-parietal region

31
Q

What does Wernicke’s area do?

A

important for decoding spoken language

32
Q

What can damage to Wernicke’s area cause?

A
  1. fluent spoken language which may not make sense and use neologisms, and difficulties understanding spoken language
  2. Wernicke’s aphasia
  3. fluent aphasia
33
Q

What is the cognitive neuroscience approach?

A
  1. studies how info is processed and retained in the brain
  2. study effects of brain damage on normal processing
  3. builds on theories of normal processing based on evidence of impaired processing
  4. focus is on function and behaviour, not anatomical lesion sites
34
Q

What is the psycholinguistics approach?

A
  1. a cognitive neuropsychological framework which investigates and describes how the brain processes language
  2. models use boxes (identify mental stores) and arrows (links between the mental stores
  3. is modular
35
Q

How is psycholinguistics used in aphasia?

A
  1. maps language in aphasia onto psycholinguistic model - identifies what is intact and impaired
  2. uses subtraction hypothesis
  3. basis of single word processing assessments in aphasia
36
Q

What is subtraction hypothesis?

A

a damaged systems works minus the function of the impaired module(s)

37
Q

What data does the psycholinguistic approach use and why?

A
  1. case studies
  2. allows in depth exploration of language processing
  3. allow examination of intact and impaired processing
  4. allow theories about processes to be developed
38
Q

How is the psycholinguistic approach relevant for rehabilitation?

A
  1. targets impaired processes and utilises retained processes
  2. work on restoring language process or compensating
  3. often used as part of a more holistic approach or means to achieving a goal
39
Q

What are biopsychosocial frameworks?

A
  1. more holistic approach to characterising health and disability
  2. acknowledges complex interaction of multiple factors impacting on client presentation and experience
40
Q

What is the ICF?

A
  1. The International Classification of Functioning and Health
  2. considers health along: body functions and structure, activity, participation
41
Q

How is the biopsychosocial framework useful for rehabilitation?

A
  1. considers strength of individual and their environment
  2. assessment and rehabilitation would consider all aspects of ICF with overall focus on function and participation in daily life, and maintenance of psychosocial wellbeing
42
Q

What are the social approaches?

A
  1. address ‘participation’ of ICF
  2. focus is on individuals ability to engage in meaningful interactions in everyday life
  3. explores emotional impact, psychosocial wellbeing, quality of life for individual and carers
43
Q

What are the main features of the social approaches according to Hallowell (2023)?

A
  1. communication seen as social interaction and transaction
  2. communication seen as collaborative
  3. foregrounds the perspectives of people with aphasia
44
Q

What are the implications of the social approaches on assessment and rehabillitaiton?

A
  1. explores individual’s lived experience and puts client at centre of decision making
  2. goals are enhancing participation, real life changes, and promoting empowerment
  3. personal and environmental factors are intervention targets
  4. compensatory and adaptive approaches
  5. life participation approach to aphasia (LPPA)
45
Q

How might aphasia affect multilinguals differently to monolinguals?

A
  1. equal/parallel recovery of languages
  2. non-parallel recovery across languages
  3. differences in order of/pattern of recovery
46
Q

Which language is usually least affected in multilinguals with aphasia?

A
  1. the dominant language
  2. may be due to widespread, well established neural networks
  3. complicated
47
Q

What multilingual variables may impact aphasia presentation and recovery?

A
  1. age of acquisition
  2. context of acquisition
  3. degree of pre-stroke efficiency and language use before and after aphasia onset
  4. purpose of use
48
Q

What else must be considered when working with multilinguals with aphasia?

A
  1. sociocultural history (may affect therapy goals)
  2. availability of appropriate assessment tools to assist aphasia diagnosis
  3. assessment and treatment needs to consider unique profile and needs
49
Q

When is spontaneous recovery?

A

includes the acute phase (first 3 weeks after stroke) and subacute phase (up to 6 months post stroke onset)

50
Q

Why can language recovery occur during spontaneous recovery?

A
  1. reoxygenation of tissue
  2. decrease of cerebral oedema
  3. recovery of pnumbria
  4. restoration of diaschis
  5. neuroplastic changes in brain
51
Q

What occurs during longer term recovery (chronic phase)?

A
  1. mainly therapy related
  2. spontaneous recovery minimal, but neuroplastic change can still occur
52
Q

What is plasticity?

A

learning and behaviour induced changes to synaptic connections in the brain

53
Q

What are the 10 key principles of Kleim and Jones’ (2008) dependent neural plasticity?

A
  1. use it or lose it
  2. use it and improve it
  3. specificity
  4. intensity
  5. time matters
  6. salience matters
  7. age matters
  8. transference
  9. interference
  10. repitition
54
Q

What does specificity refer to (Kleim and Jones, 2008)

A

nature of training and experience dictates the nature of plasticity

55
Q

What does time matters refer to (Kleim and Jones, 2008)?

A

different forms of plasticity occur at different times during training

56
Q

What does salience matters refer to (Kleim and Jones, 2008)?

A

the training experience must be sufficiently salient to induce plasticity

57
Q

What does transference refer to?

A

plasticity in response to one training experience can interfere with the acquisition of other behaviours

58
Q

What are the different levels of lesion?

A
  1. mild lesion - spontaneously recovers
  2. moderate - some recovery occurs and is dependent on rehabilitation
  3. severe - does not recover and rehabilitation does not improve function at a neuropsychological level
59
Q

How does degree of lesion affect clinical decision making?

A
  1. mild - no intervention
  2. moderate - theoretically motivated rehabilitation enables behaviour-induced plastic cortical changes
  3. severe - compensation
60
Q

What might rehabilitation goals work on?

A
  1. re-establishing function
  2. enabling adaptation/compensation where necessary
  3. facilitate coping with living with the effects of stroke

Adults and cognition 1 (7 decks)

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