Neurological Disorders

Front 1

Define melodic intonation therapy (MIT)... what/who is it good for?

Back 1

- rehabilitative treatment for pts with language deficits caused by brain injury, especially speech centers in the right brain
- uses singing to improve connections in the brain involved in speech
- good for Broca's Aphasia

Front 2

Define melodic intonation therapy (MIT)... how is therapy conducted?

Back 2

- begins with therapist humming and tapping of intoned phrases... pt joins in
- pt sings intoned phrases, repeating therapists
- pt will sing the phrases alone

Front 3

Define melodic intonation therapy (MIT)... best candidates for it have... ??

Back 3

- good attention
- auditory comprehension
- emotional stability

Front 4

Review the important aspects of the assessment of dementia.

Back 4

- important to differentiate between reversible causes and permanent ones
- Pts should undergo full medical screening by healthcare professional to rule out treatable causes of dementia
- medical screening includes thorough medical and social history, diagnostic tests
- assess pt's orientation to person, place, and time as well as the ability to recognize familiar people, objects, and places.
-assessment of memory, ability to abstract, awareness of spatial relationships, expressive and receptive language, ability to calculate, and ability to perform activities of daily living
** Important to assess mobility and swallowing

Front 5

Review the important aspects of the treatment of dementia.

Back 5

- treatment is based on individual needs
- may include speech therapy, physical therapy, safety training, medications, and psychosocial counseling
** family members should play a large part in treatment strategies
** modification of the pt's environment to improve safety and orientation is extremely important

Front 6

Rancho Scale: Actual levels are...
*Highest functioning?
*Lowest functioning?

Back 6

Levels:
1: no response to stimulation: total assistance
2: generalized response to stimulation: total assistance
3: localized response to stimulation: total assistance
4: confused, agitated behavior: maximal assistance
5: confused, inappropriate, non-agitated behavior: maximal assistance
6: confused, appropriate behavior: moderate assistance
7: automatic, appropriate behavior: minimal assistance for daily living skills
8: purposeful, appropriate: stand-by assistance
9: purposeful, appropriate: stand-by assistance on request
10: purposeful, appropriate: modified independent

Front 7

Name the most common types of neurodegenerative causes of dementia (4).

Back 7

1. Alzheimer's Disease
2. Parkinson's Disease
3. Huntington's Disease
4. Frontotemporal Dementia (Pick's Disease)

Front 8

Alzheimer's Disease

Back 8

- accounts for 70% of all causes of dementia
- histological deficit is deposition of protein in cortical areas of the brain
-pts. first present with mild to moderate short-term memory loss with slow progression
- many pts retain long-term memory
- ability to perform activities of daily living becomes hampered by loss of intellectual ability, decreased visual spatial perception, and loss of language fluency

Front 9

Parkinson's Disease

Back 9

- results from a disruption in the conduction of the neurotransmitter dopamine within the basal ganglia
- pts first display movement abnormalities such as poor balance, slow gait, muscle rigidity, slow speech, difficulty swallowing, and tremor
*dementia occurs in the later stages of the disease

Front 10

Huntington's Disease

Back 10

- genetic disease caused by the degeneration of neurons in the frontal lobe and basal ganglia
- pts display motor deficits typical of uncontrolled, jerky movements (chorea)
- speech is slurred and slow
- dementia is an end-stage result

Front 11

Frontotemporal Dementia (Pick's Disease)

Back 11

- caused by degeneration of cells in the frontal temporal lobes
- deficits are similar to Alzheimer's with the addition of personality changes and often complete loss of speech

Front 12

Explain the important aspects of dementia

Back 12

- slowly progressive decline in cognitive functioning; memory, language, and intellectual abilities will be impaired
- pts have poor judgement and lose the ability to think abstractly
-pts may suffer hallucinations, delusional thinking, or depression
- language becomes nonfluent, comprehension declines, and pts have difficulty word finding

Front 13

What is the prevalence of dementia?

Back 13

- ages 65-70, 1.4% of population
- doubles as age increases

Front 14

What are the most common causes of dementia (overall)?

Back 14

- Alzheimer's Disease
- vascular dementia caused by blockages of small arteries in the brain
- frontotemporal dementia
- tumors
- alcohol/substance abuse
- injury
- infections (HIV, Jakob-Creutzfeldt disease)
- neurodegenerative diseases (Parkinson's, etc)

Front 15

What is dysarthria?

Back 15

- a mechanical speech disorder caused by injury of the central or peripheral nervous system.
- inability to produce intelligible speech due to an abnormality in motor function of the speech-producing structures of the mouth or vocal folds.

Front 16

Explain the important aspects of dysarthria.

Back 16

- speech is typically slow and slurred
- may be temporary and may be caused by intoxication, medication side effects, or dental problems
- determination of specific muscle abnormalities of the mouth or vocal apparatus is important
- pt's ability to perform mouth tasks (i.e.: blowing out a candle) or the repetition of syllable and words can help define specific abnormalities and help to direct treatment

Front 17

What are the most common causes of chronic dysarthria?

Back 17

stroke, trauma, tumor, or neurological degenerative diseases, such as myasthenia gravis, ALS, or Parkinson's disease

Front 18

How is dysarthria different from apraxia?

Back 18

Speech errors produced in dysarthria are consistent.

Front 19

Classifications of dysarthria (6):

Back 19

1. ataxic
2. spastic
3. flaccid
4. hyperkinetic
5. hypokenetic
6. unilateral motor neuron dysarthria

Front 20

Speech problems associated with dysarthria are...

Back 20

- phonation difficulties of voice qualities and voice loudness
- resonance abnormality, namely hypernasality
- abnormal prosody, namely monotonous pitch and improper speech rate
- abnormal articulation with slurred speech, voicing errors, and difficulty with fricative and affricates

Front 21

What is flaccid dysarthria?

Back 21

Flaccid dysarthria is caused by injury of the motor neurons of the medulla and posterior pons. This injury causes paralysis of the mouth, palate, and vocal folds and leads to speech that is slurred, has high nasal quality, and is raspy. There may be difficulty with bilabial sounds and sounds that require vibration of the vocal folds.

Front 22

What is ataxic dysarthria?

Back 22

Ataxic dysarthria is caused by injury to the cerebellum. This injury causes speech with irregular rhythm and that is uncoordinated with breathing. Underarticulated or explosive speech is common.

Front 23

What is spastic dysarthria?

Back 23

Spastic dysarthria is caused by damage to upper motor neurons in the pyramidal tract. This damage causes slow, strained, monotonous speech due to impairment of fine motor movements of the mouth and vocal apparatus muscles.

Front 24

What is hypokinetic dysarthria?

Back 24

Hypokinetic dysarthria is caused by damage to the basal ganglia, as with patients with Parkinson's disease. Speech is slurred, rapid, and monotonous. The volume of speech decreases progressively at the end of sentences.

Front 25

What is hyperkenetic dysarthria?

Back 25

Hyperkenetic dysarthria is caused by damage to the frontal lobes and basal ganglia and is typical in patients with Huntington's disease. Speech is characterized by prolonged syllables, and sentences are often interrupted by silence or occasional bursts of speech

Front 26

Explain the general concepts of treatment for dysarthria.

Back 26

Therapy consists of the strengthening of muscles involved in speech, breath control, and speed control. Clients may improve with speech drills, modeling, and phonetic placement. Prosthetic devices or computer-aided devices may be used in severe cases.

Front 27

Explain the important aspects of therapy for aphasia.

Back 27

1. adequate assessments (determine deficits)
2. treatment is directed toward improving expressive speech, receptive language, and reading and writing skills when appropriate
3. pts need therapy to improve complex language, narrative discourse, and language prosody

Front 28

Define Aphasia

Back 28

Aphasia is a disorder in language communication due to brain injury. Language deficits may be partial or total. Deficits may include a loss of receptive and expressive language; loss of reading skills, both verbal and comprehensive; or loss of writing skills.

Front 29

Common etiologies of aphasia:

Back 29

stroke, brain tumor, trauma, and infection

Front 30

Explain the important aspects of apraxia of speech.

Back 30

Apraxia of speech is characterized by the inability to create meaningful language due to lack of voluntary coordination of the oral structures that produce speech. There is a deficit in the synchronization of the muscles rather than of muscle strength. **The coordination deficit is inconsistent.

Given that pts with apraxia are aware of their disorder, they often appear to be struggling to produce the correct word and phrases.

Front 31

Define acquired apraxia.

Back 31

Acquired apraxia is typically due to damage to the speech areas of the brain (notably the dominant hemisphere), especially those areas that control motor planning. Causes of acquired apraxia include stroke, trauma, and neurological diseases such as Alzheimer's and myasthenia gravis.

Front 32

Define developmental apraxia.

Back 32

In developmental apraxia, the cause is unknown. Boys are often more affected than girls are. Pts with this disorder have difficulty placing syllables and words in the correct order; therefore they produce slow, choppy speech with poor prosody.

Front 33

Explain the speech deficits found in apraxia.

Back 33

Apraxia is a disorder in motor planning and voluntary speech movements due to central nervous system injury. There is no motor weakness or muscular disorder present. The congenital form of apraxia found in children is called developmental apraxia of speech. Acquired apraxia can affect a person of any age.

Front 34

Explain the general concepts of treatment for apraxia.

Back 34

Therapy is essential in recovery, especially in children. One-on-one therapy is important and my include speech movement sequencing, speech imitation, and speed control. The use of pictures to expand vocabulary is helpful. Sign language can be used to enhance oral language and reduce frustration. Therapists often use touch cueing an physical prompting.

Front 35

Explain the typical characteristics of speech typical to developmental apraxia.

Back 35

Children often make great efforts to speak while having difficulty in placing sounds and syllables in correct order. Consonant, vowel, and word cluster errors are seen.

- articulation errors are inconsistent
- incorrect prosody (speech rhythm and infections are off)
- ability to understand language is present
- spelling and reading difficulties possible
- speech sounds are prolonged and repetitious
- may have problems with phonation and resonance
- may have other problems related to motor coordination, such as feeding, and may not be able to copy mouth movement or sounds proficiently