Comps - Mccaffrey

Front 1

types of stroke

Back 1

- ischemic (stenosis or thrombosis)
- hemorrhagic

Front 2

ischemic stroke

Back 2

- most common
- stenosis or thrombosis
- most likely to occur in am

Front 3

hemorrhagic stroke

Back 3

- occurs when cerebral artery ruptures causing bleeding within the cranium
- better chance for recovery, as brain absorbs blood allowing areas to heal
- may be completed or progressive

Front 4

temporary ischemic events

Back 4

- may be a warning sign for true stroke in near future
- transient disturbances of blood supply to localized part of brain
- produces temporary, focal lesion
- resolve in spontaneous and complete recovery
- TIA or RIND

Front 5

TIA

Back 5

- symptoms mimic stroke
- may cause temporary aphasia, numbness, dizziness and vision problems
- range from very mild to severe, which cannot be differentiated from actual stroke until recovery
- typically lasts between 2 and 15 minutes, but may last up to 24 hours
- can occur alone or repeatedly throughout a 24 hour period

Front 6

RIND

Back 6

- Reversible Ischemic Neurological Defect (RIND)
- extended TIA
- attacks typically continue for more than 12 hours without interruption, and can last for several days
- full recovery is expected, but may cause subtle permanent damage

Front 7

right hemisphere language disorders

Back 7

- specific language problems
inability to integrate information
- difficulty distinguishing significant/insignificant information
- difficulty understanding non-literal messages
- inability to interpret body language
- problems with conversational rules and confabulation

Front 8

left hemisphere language disorders

Back 8

problems with phonology, syntax and semantics

Front 9

Broca's aphasia

Back 9

- site of lesion: third frontal convolution of left frontal lobe, near motor cortex
- language recovery is typically better than for any other aphasia type
- telegraphic speech (consists largely of content words without syntax or morphological inflections)
- short sentence length
- labored and slow speech with limited inflection
- few paraphasias, usually literal
- impaired articulation, repetition, word finding
- comprehension abilities typically superior to expressive abilities
- hemiplegia/paresis of right side

Front 10

Wernicke's aphasia

Back 10

- site of lesion: located in posterior region of the left superior temporal gyrus
- severe impairment in auditory comprehension
- fluent, semantically inappropriate speech
- normal articulation and intonation
- impaired repetition, reading and writing
- many paraphasias
- not likely to have hemiplegia/paresis

Front 11

types of paraphasias

Back 11

- literal/phonemic: most of utterance is correct (pat for cat)
- neologistic: less than half the utterance is correct (pab for cat)

Front 12

coup-contra-coup

Back 12

- coup caused by hitting one's head causing bruising of brain and laceration of vessels below site of injury
- contrecoup caused by brain hitting the inside of the skull opposite site of injury
- injury may be more serious if brain hits bony prominence resulting in hemorrhage

Front 13

acceleration/deceleration trauma

Back 13

- caused by sudden stop
- head is thrown forward violently, then back
brain rebounds against bony prominence of skull, possibly multiple times
- often results in severe hemorrhaging
- shearing injuries may also occur as head twists causing diffuse white matter injury

Front 14

TBI diagnosis

Back 14

- mild: concussion, confusion and disorientation (13 to 15 on Glasgow)
- moderate: impaired consciousness (9 to 12 on Glasgow)
- severe: coma for longer than 6 hours (8 or less on Glasgow)

Front 15

types of TBI hemorrhages

Back 15

- epidural
- subdural
- sub-arachnoid
- interparynchemal
- tentorial herniation

Front 16

epidural

Back 16

- blood accumulation between skull and dura mater
- often caused by acceleration-deceleration trauma
- bleeding usually arterial (middle meningeal artery)

Front 17

subdural

Back 17

- blood between dura mater and arachnoid membrane
- causes hematomas, often over frontal and temporal lobes
- caused by damage to veins, so much slower than other types

Front 18

sub-arachnoid

Back 18

- bleeding into subarachnoid space
- often result of aneurysm or penetrating head wound

Front 19

interparynchemal

Back 19

- bleeding within structures of the brain
- caused by penetrating head wounds or bone fragments -from blunt head trauma
- high rate of mortality

Front 20

tentorial herniation

Back 20

- brain matter forced through tentorial notch due to edema
- causes excessive pressure in brain affecting crainal nerves

Front 21

UMN

Back 21

- first order neuron
- unable to leave CNS
- synapse with LMN which carry messages to muscles of the rest of the body
- travel through pyramidal and extrapyramidal tracts

Front 22

LMN

Back 22

- second order neuron
- consist of cranial and spinal nerves
- cell bodies located in brain stem
- axons can leave the CNS to synapse with muscles
- all spinal nerves have LMN component
- sensory-only cranial nerves do NOT have LMN components

Front 23

TX for AOS

Back 23

- emphasis primarily on visual modality, followed by auditory, then tactile and kinesthetic
- important for patient to see and feel how sounds are produced
- goal is to help patient regain conscious control over articulatory programming
- develop hierarchy of phoenmic categories and utterance length
- use automatic speech to provide brain with sensory feedback from fluent speech

Front 24

AOS tx methods

Back 24

- phonetic placement method: describe correct manner, place and voice of articulation
- melodic intonation therapy: teaches patients to sing words or phrases, thought that music helps involve right hemisphere in speech production
- gestural systems and communication boards may be used
- imitation, repetition, exaggeration of intonation and stress, phonemic contrasting encouraged

Front 25

tips for successful AOS tx

Back 25

- ensure high level of success
- use extensive, intensive drill
- work on articulators and prosody
- introduce meaningful and functional material ASAP
- manipulate variables that effect response accuracy

Front 26

TX for mild to moderate dysarthria

Back 26

- focus on compensatory strategies and achieve intelligibility
- compensatory placement (use alternative articulatory placement)
- reduce rate of speech and pronounce syllables one by one
- reduce phrase length to increase loudness
- monitoring techniques for patients with reduced or excessive loudness
- use exaggerated movements and produce exaggerated sounds
- use prosthetic device (e.g. electrolarynx, obdurator)

Front 27

TX for severe dysarthria

Back 27

Dworkin techniques for spastic (also hyper-, hypo- and flaccid)
- relaxation techniques (tone reduction)
- strengthening exercises
- isometric training (increase force)
- phonetic stimulation in various contexts

Bobath method
- first stage: inhibit abnormal reflexes through posture, manual manipulation of oral structures
- second stage: more developmentally mature movements are facilitated
- third stage: movements put under voluntary control of patient

Front 28

areas of TX for RH disorder

Back 28

- compensatory techniques for attentional/perceptual deficits
- pragmatic skills and communicative effectiveness
- compensatory skills for prosopagnosia

Front 29

RH TX for attentional/perceptual deficits

Back 29

- Edgeness
- technique used to help recognize boundaries of relevant space
- involves retrieving and rearranging different colored blocks on a grid
- increasingly difficult tasks

Front 30

RH TX for pragmatic skills

Back 30

Promoting Aphasics' Communication Effectiveness (PACE)
- turn-based exchange of information between patient and clinician
- patient chooses mode of communication to describe and identify words/phrases
- may also practice summarizing paragraphs, identify important/unimportant pieces of information, and listen/watch tapes of self conversing with others
- practice understanding alternative meanings of language (explain jokes, metaphors, proverbs, indirect language)

Front 31

aspiration before swallow

Back 31

caused by delayed or absent initiation or poor tongue control

Front 32

aspiration during swallow

Back 32

- caused when vocal folds fail to adduct or larynx fails to elevate
- accounts for only 5% of dysphagias

Front 33

aspiration after swallow

Back 33

- may occur if patient pockets food in oral cavity, then reclines
- food may get continously stuck in pharyngeal recesses
- if patient has CVA or TBI, may not have sensory faculties to realize this
- reduced laryngeal elevation may result in food remaining on top of larynx

Front 34

laryngeal substage of swallow

Back 34

consists of three actions:
- larynx and hyoid bone pulled upward and forward, enlarging pharynx and creating a vacuum to pull bolus downward and relax cricopharyngeous muscle
- true and false vocal folds adduct
- epiglottis drops over larynx to protect airway and divert bolus into pyriform sinuses

Front 35

TX for swallow

Back 35

- thermal stimulation
- suck-swallow
- oral motor exercises
- posture manipulation
- change food consistency
- Mendelsohn maneuver
- effortful swallow