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Adult Lang Disorders > Weeks 9-11 > Flashcards

Weeks 9-11 Flashcards

1
Q

T/F damage is RH is often overlooked with respect to language and communicative competence

A

True

Symptoms tend to be more subtle with respect to communication

Mess obvious stroke symptoms → physicians (and families) are less likely to refer to SLP for cognitive-communication impairments

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2
Q

Extralinguistic impairments

A

Occurs with RH syndrome

Impairments in:
Pragmatics

Conversation cohesion

Linking sentences

Integrating verbal with nonverbal info

Understanding main idea

Standard aphasia batteries for linguistics won’t detect RH extralinguistic impairments

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3
Q

Linguistic impairments

A

Occurs with LH damage

Impairments in language structure

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4
Q

Why is RH syndrome difficult to study or underdiagnosed

A

No specific “communication areas” → Might be large networks involved in RH communicative functions

No clear patterns for categorization

Pragmatic and cognitive competence on spectrum

Normal declines in communication with aging

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5
Q

RH damage %

A

~50% with RHD have impaired verbal communication

~80% with RHD in rehab units have cognitive and/or communication impairments

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6
Q

Types of cognitive impairments with RHD

A

Attention

Visuospatial perception

Learning

Memory

SLPs look at cognition/attention to help figure out comprehension breakdown

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7
Q

T/F - RHD will affect pragmatic competence and discourse level communication MORE THAN word- and sentence- level processes

A

TRUE

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8
Q

Types of communication impairments with RHD

A

figurative/nonliteral language

Inference

discourse/pragmatics

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9
Q

RHD is often diagnosed as…

A

cognitive -communicative disorder/impairment

Or

Cognitive-linguistic impairment/disorder

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10
Q

T/F

RHD can respond appropriately to indiect questions in naturalistic contexts

A

TRUE

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11
Q

T/F

RHD can directly and indirectly make requests, but often do not justify or provide explanation for request

A

TRUE

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12
Q

T/F

Fewer formulaic expression produced following RHD when compared with individual with LHD

A

TRUE

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13
Q

How does RHD have difficulty with inferencing

A

When situation requires elaborative inferences

When situation has multiple potential interpretations

Difficulty with understanding nad interpreting humor, sarcasm, and emotions when different from their own emotion

Suppression-deficit hypothesis

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14
Q

What is suppression-deficit hypothesis

A

With RHD, can generate several interpretations, but reduced ability to suppress/inhibit less-likely interapations

E.g. cookie theft picture description task - may talk about the bushes rather than the action of the picture

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15
Q

What are the discourse-level impairments in RHD

name 7

A

Egocentric

tangential/off-topic/irrelevant content

Difficulty maintaining conversation and linking utternances to overall topic

Disorganized narratives

Theory of mind breakdown: Reduced ability to ID/repair conversation breakdowns

Reduced ability to judge appropriateness of conversation

confabulations : when people say something untrue but not aware it’s untrue

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16
Q

How to assess RHD

A

Informally test because most RHD tests are not sensitive enough to detect subtle changes in higher-level discourse

Informal test include: narrative, biography, conversation, story-retell, picture description —> responses will be “off” or irrelevant

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17
Q

Many RHD impairments are due to inability

A

False

Most impairments are due to inefficient processing NOT inability

Do well with straightforward tasks → taxiing system reveals inefficient processing

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18
Q

RHD treatment

A

Understudied

Target metaphor comprehension → emphasizing use of context

Use contextual clues to facilitate comprehension

Patient uses self-cueing (internal) rather than clinician-cueing (external)

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19
Q

What is aprosodia

A

RH injury; not aware of it

Difficulty in comprehension or use of prosody to signal linguistic boundaries, meaning of convey emotion

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20
Q

Treatment for aprosodia

A

Focus on use of prosody to express emotion

Motoric aspects of prosody

Both found to be successful with generalization

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21
Q

Left neglect vs left visual cut

A

Left neglect → doesn’t’ recognize left side needs attention

Left visual cut → Visual field is cut

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22
Q

How does RHD affect attention

A

Attention: ability to focus on a stimulus and filter our other stimuli

Inability to focus on one thing

Reduced sustained attention and topic maintenance

Reduced alternating attention

Reduced divided attention b/e multiple tasks

Reduced selective attention

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23
Q

How does reduced selective attention affect communication

A

Irrelevant content

Inability to shift topics appropriately

May also perseverate on one topic

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24
Q

RHD: Nonlinguistic impairments: neglect

A

Failure to report, respond, orient, attend to stimuli on the left side of body despite within functional limit of motor/sensory function

Occurs in 80% of RHD patients

Attentional impairment → attention is on right side only

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25
Q

Assessments for neglect

A

scanning /canceling tasks → line bisetion task

Drawing → draw a clock at 10 o’clock

reading/writing

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26
Q

Types of neglect

Personal
Peripersonal 
Extrapersonal 
Viewer-centered
object-centered
A

Personal → neglects the left half of body → not shaving left side of face

Peripersonal → neglects half of space within arm’s length such as not eating food on left side of plate or not finding remote on left side of bed

Extrapersonal → neglect half of space beyond arm’s reach, not noticing a window or tv or visitor

Viewer-centered: neglects left side of space defined by patient’s midline; left side will move as patient turns head

Object-centered: neglects left side of an object, regardless of where it is placed; neglecting left side of photo even if the entire photo is place in right visual field

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27
Q

Treatments for neglect

A

Scanning tasks have limited generalization

External stimulation→ left-neck vibrations → reduced severity several days post tx

Presenting stimuli spanning the midline

Voluntary movement of attention by having patient ID items on left and right sides of pages

Training patient to activity manipulate object in space

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28
Q

RHD impairments in higher-level processing

A

50% of RHD patient in rehab

Effects on communication like:
organizing/sequencing,

reasoning (implied meaning and theory of mind),

problem solving (reduced ability to repair conversation)

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29
Q

RHD treatment for cognitive deficits

A

No specific protocol but can use other strategies like treatment for RH TBI

Compensatory strategies are too specific and RHD may have difficulty with abstract thinking, reason so don’t know when to use strategy appropriately

More beneficial to train habitual use (using it all of the time) of strategy to facilitate overcoming deficits

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30
Q

What is anosognosia

A

Lack of awareness of deficits or reduced awareness of deficits

Co-occurs with neglect

May need increase of supervision

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31
Q

Diagnosis criteria for major neurocognitive disorder (dementia)

A

Significant cognitive decline

Substantial impairment in cognitive performance

Cognitive deficits interfere with independence in everyday activities

Must specify: with or without behavioral disturbance

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32
Q

Diagnosis criteria for mild neurocognitive disorder (dementia)

A

modest cognitive decline

modest impairment in cognitive performance

Cognitive deficits do not interfere with independence in everyday activities

Must specify: with or without behavioral disturbance

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33
Q

What is mild cognitive impairment

A

Used for people who do not meet criteria for neurocognitive disorder (dementia)

34
Q

T/F: dementia is due to sudden/acute onset

A

False
More likely due to gradual onset of symptoms at a time rather than sudden/acute onset

Dementia progressively gets worse

35
Q

Describe short term memory

A

Involves encoding processes, temporary storage of limited capacity

36
Q

Describe long term memory

A

Retrieval processes, permanent storage of unlimited capacity

37
Q

Long term memory - declarative

A

Explicit

Person’s knowledge base, conscious awareness

Type of memories that go away

38
Q

Long term memory - nondeclarative

A

Implicit

Person’s knowledge of skills and action patterns. Unconscious awareness

More likely to maintain and remember

39
Q

t/f

Postmortem examination for definitive diagnosis

A

TRUE

40
Q

t/f

When diagnosing dementia, physicians look for neural changes in combination with cognitive/behavioral changes

A

TRUE

41
Q

Describe CT of dementia

A

Wide sulci
cortical atrophy
Enlarged ventricles

42
Q

Huntington’s Disease atrohpy

A

More atrophy in deeper parts of brain

43
Q

fMRI of dementia

A

Reduced blood flow in areas involved in memory and cognitive like hippocampus

44
Q

PET for dementia

A

Reduced glucose metabolism in areas associated with memory and cognition

45
Q

Postmortem studies of dementia

A

Required for definitive diagnosis

Reduction in brain volume

Decrease in neurons

46
Q

Where do neural changes occur for - parkinson’s disease
Lewy body dementia
frontotemporal

A

PD = substantia nigra
Lewy body = Lewy bodies in coritcal and subcortial regions
Frontotemporal = pick bodies

47
Q

Why is it good to diagnosis dementia before onset of symptoms

A

Stop disease progression

Minimize disease severity

Reverse disease symptoms

48
Q

Greatest cause of dementia

A

Alzheimer’s Disease
60-70% of all dementia cases

Anti-inflammatory meds protective against AD

49
Q

Hallmarks of AD

A

Memory loss is hallmark of AD

Early disease: working memory is intact but see semantic memory loss secondary to imparied storage or retrieval

Progressive disease: loss of recent past first

Retain childhood memories for longer time

Procedural memory and formulaic language preserved

50
Q

Alzhiemers Disease: effects on Language and Communication

A

Word find issues

Comprehension of formulaic expressions like idioms are poor but production of conversational formulaic language preserved

Use of vague terms like thing or stuff

Discourse decent on surface level like good syntax and phonology but difficult maintain topics and conversation cohesion

Late stage: ambiguous speech and incoherent mumblings and repetition

51
Q

AD can occur with/without behavioral disturbance (non-communicative behaviors)

A

90% of patients have behavioral disturbance

Personality changes

Delusions

Manic mood

Sleep disturbances

Sundowning

Pacing/wandering

52
Q

Describe Vascular Dementia

A

Differeiented based on artecioscerotic changes in blood supply to brain

2nd most common cause

Abrupt onset of cognitive symptoms in a fluctuating but progressive course

Early: memory loss, personality changes, excessive dysfunction

Deficits depend on where in the brain the affected blood vessels are located

53
Q

Frontotemporal dementia: primary progressive aphasia

A

Gradual loss of language function in the context of relatively well-preserved memory until the advanced stages

Fluent or nonfluent

Gradual onset and decline in language-specifc functions

Acute awareness of deficits unlike other types of dementia

Primary effects left frontal and temporal lobe language areas

54
Q

Lewy body dementia

A

build up for protein deposits neurons

Similar to PD → tremors, rigid

Worse than AD → verbal fluency impairment and psychomotor slowing

Similar to AD → episodic memory impairment and language disturbance

55
Q

Dementia can be secondary to these diseases

A

PD

Huntington’s disease (onset younger in adulthood)

HIV

56
Q

Dementia evaluation - what is used

Additional cognitive batteries are useful when evaluating for dementia

A

Screening tools good for assessing range of cognitive abilities but age and culture may affect scoring

Mental status rating scales provide stages of disability

Mini Mental Status Exam (MMSE) looks at orientation, memory, visual-spatial, repetition; low score = most severe

Cognitive Batteries like Ross Information Processing Assessment - 2 (RIPA)

Memory assessments like Wechsler Memory Scale-III

57
Q

t/f BDAE and WAB can be used to evaluate language and communication in dementia

A

TRUE

58
Q

When evaluating dementia- describe daily functional status

A

Has there been a change in functioning?

Justifies need for therapy to improve interaction in social environments

Test: CADL or ASHA FCMs (NOMS)

Activities of Daily Living Instrumental Activities of Daily Living

59
Q

T/F: ASHA NOMS level 1 - individual ability is independent

NOMS tests functional level for dementia

A

False

Level 1 is most severe - unable to speak in meaningful or familiar way

60
Q

Dementia behavioral treatment - 3 strategies of Memory Treatment

A

Internal, external, environmental

61
Q

Describe internal strategies for memory treatment for dementia

A

Internal:
mild/normal aging declines → WOPR, mnemonic devices and visual association

Spaced retrieval → recall info over time; relies on preservation of reading and procedural memory

But these might be difficult for someone with dementia to know when to use strategies

62
Q

Describe external strategies for memory treatment

A

External:
Compensation → used when we know we won’t be changing person’s cognitive ability

Environmental cues like written reminders, calendars

Written information/pictures in “memory wallet”

People with dementia benefit from external strategies

63
Q

Describe environmental strategies for memory treatment

A

Environmental:
Combo of internal and external strategies

Special care units → reduced environmental complexity, low stimulating environment

Social groups

64
Q

t/f
TBI is 30% of all injury-related deaths
And falls are the leading cause of TBIs

A

TRUE

Mostly kids and older adults over 65

65
Q

Define TBI

A

Craniocerebral injury from blow from an external mechanical force causing temporary or permanent impairments in brain function

The external force is what distinguishes TBI from stroke or infection

66
Q

What is coup-contrcoup

A

Contusions on opposite sides of head

Coup = 1st point of impact
Contrecoup = 2nd point of impact

Closed head injury associated with acceleration-deceleration movement

About 50% of all TBIs

67
Q

TBI: Primary damage vs secondary damage

A

Primary:
Immediate effects

Coup-contrecoup (primary/focal-secondary/diffuse) or penetrating wound (focal)

Vascular injury

Secondary:
Affected post trauma

Ischemia

Increase in intracranial pressure

68
Q

What is glasgow coma scale

A

15 point scale based on eye opening and verbal and motor responses

The lower the score the more severe

Verbal also incorporates cognitive
Motor also incorporates attention

69
Q

Describe loss of consciousness severity

A

0-30 min = mild
30-<24 hrs = moderate
24hrs + = severe

Most qualitative with unclear boundaries

70
Q

TBI prognosis

A

MRI/CT dhow depth of lesion associated with poorer outcomes (brain stem is most severe)

GCS = lower the score, the poorer the outcome

Duration of coma: severe disability “uniquely” with coma < 2weeks;

positive recovery “unlikely” with coma >4weeks

Basically, the lower the score, the deeper the damage and damage occurring both sides of brain = poorer outcoes

71
Q

t/f

The cause of the TBI does not predict outcome

A

TRUE

72
Q

When compared with less dependent TBI patients, more dependent TBI patients at admission to rehab _____, _____, etc. at discharge

A

More dependent:

  • Make more progress
  • Remain more dependent
  • Slower rate of recovery

Less dependent = Shorter distance to go = less progress

73
Q

End goal for TBI rehabilitation

A

Community reintegration

74
Q

t/f

Common to all TBI survivors = reduced ability to pursue pre-injury career and leisure activities

A

True

Secondary cognitive impairment: attn, memory, organizing, communication, reasoning. Inhibition

Cognitive and communicative symptoms most likely the cause preventing patient to return to pre-injury QoL

75
Q

Describe coma

A

State of unconsciousness, eyes closed, pt does not wake

Results of persistent, severe diffuse injury to both cortex and subcortical regions like brainstem

76
Q

TBI cognitive impairments may affect:

A

Orientation (frontal lobe implications) → AAO

attention/concentration (thalamo-frontal pathways)

Memory - LTM, STM, working

Executive function

Anosognosia

Behavioral like immature, egocentric, irritable and impulsive

Communication → issue with lang. USE

77
Q

What is AAO

A

Awake alert orientation

Cognitive rating for TBI

1 = person
2 = person and place 
3 = person place time
4 = person place time situation
78
Q

What is minimally conscious state

A

Often transitional state reflecting improvement in consciousness

Behavioral evidence of self or environments

Ability to follow simple commands unlike PVS can’t follow commands

Act of engaging in a response

Intentional movements (not reflexive)

79
Q

assessments for cognitive-comm impairment in TBI

A

Standardized tests paired with Naturalistic informal testing (ST should not occur in isolation)

SLP scope: cognitive processes related to communicative behavior and language

Guideline developed by Academy of Neurologic Comm dis and Sciences (ANCDS)

80
Q

Interventions (with evidence) for cognitive-comm impairments in TBI

A

Attention training → stimulus-drill approaches make best generalizations

External memory aids → not effective for mod-severe memory impairments (better for mild)

Instructing people with acquired memory impairments; evidence that structuring introduction of and use of procedures improves strategy learning

Self-monitoring → training strategies help to generalize

Behavioral intervention → traditional contingency management and positive behavior interventions (or both together) are valid EBP options

81
Q

Treating TBI - what’s important!

A

The roles of family/caregivers and educating on nature of TBI and educating them on strategies to use

Adult Lang Disorders (4 decks)

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