• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/177

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

177 Cards in this Set

  • Front
  • Back
Strokes may be ______ or ________
Ischemic or Hemorrhagic
Describe Ischemic strokes
These strokes are caused by a blocked or interrupted blood supply to the brain.
Blockage or interruption may be caused by two kinds of arterial diseases: _______ or _______
Thrombus or Embolus
Describe Thrombus
Collection of blood material that blocks the flow of blood.
Describe Embolus
Traveling mass of arterial debris or a clump of tissue from a tumor that gets lodged into a smaller artery and thus blocks the flow of blood.
Describe hemorrhagic strokes
type of stroke caused by bleeding in the brain due to ruptured blood vessels.
Ruptures in the brain may be ________ or _______
Intracerebral or Extracerebral
Describe intracerebral ruptures
within the brain ruptures
Describe extracerebral ruptures
within the meinges: subarachnoid, subdural and epidural varieties
More than ___% of those who survive a stroke have aphasia
50
Which sex is more prone to strokes?
Men
Which sex has a high incidence of stroke?
Women (because of their longevity)
Which two races have high prevalence of stroke?
African American and South Asian
What are other causes of aphasia?
Brain Trauma
Intracranial tumors
Infections
What are the nonfluent aphasias?
1) Broca's
2) Transcortical Motor Aphasia (TMA)
3) Mixed Transcortical Aphasia (MTA)
4) Global Aphasia
Brocas's area is which Brodmann's areas?
44 &45
Where is Broca's area?
Posterior inferior frontal gyrus of the left hemisphere.
What artery supplies Broca's?
Upper division of the Middle Cerebral Artery
How is Broca's aphasia characterized?
-Effortful, slot, halting, and uneven speech
-Short phrases and sentences
-Misarticulated/Distorted sounds
-Agrammatic or telegraphic speech (limited to nouns, verbs, with omissions of articles, conjunctions, and prepositions)
-Impaired repetitions--especially the grammatical elements of a sentences
-Impaired naming (especially confrontation naming)
-Rarely normal but better auditory comprehension of spoken language than production
-Difficulty in understanding syntactic structures
-Poor oral reading and poor comprehension of material that has been read
-Writing problems
-Monotonous speech
Do those with Broca's aphasia sometimes exhibit apraxia of speech and dysarthria?
Yes, those with Broca's may have one or more independent speech disorders
What are the behavioral characteristics of those with Broca's aphasia?
They may be depressed or react emotionally when confronted with difficult assessment tasks.
Where might you find a lesion that results in transcortical motor aphasia?
Anterior superior frontal lobe--often below or above broca's area (which is not affected)
Which artery supplies the area that results in transcortical motor aphasia?
Anterior Cerebral Artery and the Anterior branch of the Middle Cerebral Artery
How is Transcortical Motor Aphasia characterized?
-Speechlessness
-Echolalia and perseveration
-Absent/reduced spontaneous speech
-nonfluent, paraphasic, agrammatic, and telegraphic speech
-INTACT repetition skill*** (distinguishing feature)
-Awareness of grammaticality
-Refusal to repeat nonsense syllables
-Unfinished sentences
-Limited word fluency
-Simple and imprecise syntactic structures
-Attempts to initiate speech wiwth the help of such motor activities as clapping, hand waving, etc.
-Generally good comprehension of simple conversation; possibly impaired for complex speech
-Slow and difficult reading aloud
-Seriously impaired writing
Patients with TMA tend to exhibit such motor disorders as:
-Rigidity of upper extremities
-Absence or poverty of movement (akinesia)
-Lowness of movement (bradykinesia)
-Buccofacial apraxia
-Weakness of legs
Explain behavioral characteristics of those with TMA
Apathy, withdrawal, little interest in communication
Where are lesions located that result in Mixed Transcortical Aphasia?
Lesions in the watershed area of the arterial border zone of the brain (between the areas supplied by the middle cerebral arteries and the anterior and posterior arteries)
How is MTA characterized?
-Limited spontaneous speech
-Automatic, unintentional, and involuntary nature of communication
-Severe echolalia (parrot-like)
-Repetitions of an examiner's statement
-Severely impaired fluency
-Severely impaired auditory comprehension and neologism: impaired confrontation naming.
-Mostly unimpaired automatic speech
-Severely impaired reading, reading comprehension, and writing.
What kind of neurologic symptoms may be seen in those with MTA?
-Bilateral UMN paralysis (spastic paralysis that affects volitional muscles)
-Weakness of all limbs
-Visual field defects
What is the most severe form of nonfluent aphasia?
Global aphasia
Where are lesions located that result in Global aphasia?
Extensive lesions affecting all language areas (the perisylvian region)

-Widespread destruction of the fronto-temporoparietal regions of the brain is common.
Which artery supplies the areas affected that result in global aphasia?
Middle Cerebral Artery
How is Global aphasia characterized?
-Profoundly impaired language skills and no significant profile of differential skills
-Greatly reduced fluency
-Expressions limited to a few words, exclamations, and serial utterances
-Impaired repetition
-Impaired naming
-Auditory comprehension limited to single words at best
-Perseveration
-Impaired reading and writing
What may also be present in patients with global aphasia?
Verbal and nonverbal apraxia
What kind of neurological symptoms may be seen in those with Global Aphasia?
-Right-sided paresis/paralysis
-Right-sided sensory loss
-Neglect of the left side of the body may be observed
What are the three umbrella classifications for aphasia?
1) Fluent Aphasia
2) Non-Fluent Aphasia
3) Subcortical Aphasia
How are fluent aphasias characterized?
By relatively intact fluency but generally less meaningful, or even meaningless speech
What are the four Fluent Aphasias?
1) Wernicke's Aphasia
2) Transcortical Sensory Aphasia (TSA)
3) Conduction Aphasia
4) Anomic Aphasia
Where are lesions found in the brain that result in Wernicke's aphasia?
Wernickes Area
-Posterior portion of the superior temporal gyrus in the left hemisphere of the brain
Which artery supplies Wernicke's area?
Posterior branch of the left Middle Cerebral Artery
How is Wernicke's Aphasia characterized?
-Incessant, effortlessly produced, flowing speech with normal, or even abnormal, fluency (logorrhea, or press or speech) with normal phrase length
-Rapid rate of speech with normal prosodic features and good articulation
-Intact grammatical structures
-Severe word-finding problems
-Paraphasic speech containing semantic and literal paraphasias, extra syllables in words, and creation of meaningless words (neologisms)
-Circumlocution
-Empty speech (subs general words with this, that, stuff, and thing)
-Poor auditory comprehension--especially for sentences and names of common objects and is much worse with background noise, movement, or conversation
-Impaired conversational turn taking
-Impaired repetition skills
-Reading comprehension problems (difficulty recognizing sounds associated with written words and meanings of printed words)
-Writing problems (excessive but meaningless writing, frequent misspellings, and neologistic writing)
-Generally poor communication in spite of f
Are Wernicke patients frustrated with their failed attempts at communication?
No, they have lack of insight into their language problems
What behavioral characteristics do those with Wernicke's aphasia possess?
Paranoid, homicidal, suicidal and depressed.

Therefore, they may be confused with psych patients
Do Wernicke's aphasia patients have other neurological symptoms?
They are generally free from obvious neurological symptoms such as paresis and paralysis
Where is there damage to the brain with Transcortical Sensory Aphasia?
Temporoparietal region of the brain--especially the posterior portion of the middle temporal gyrus.
Which artery supplies the area affected in Transcortical Sensory Aphasia?
Posterior branches of the left middle cerebral artery
How is TSA characterized?
-Fluent speech with normal phrase length, good prosody, normal articulation, and apparently appropriate grammar and syntax
-Paraphasic and empty speech
-Severe naming problems and pauses due to those problems
-Good repetition skills but poor comprehension of repeated words
-Echolalia of grammatically incorrect forms, nonsense syllables, and words from foreign languages (unlike those with TMA)
-Impaired auditory comprehension of spoken language
-Difficulty in pointing, obeying commands, or answering simple y/n questions
-Normal automatic speech (counting)
-Tendency to complete poems and sentences started by the clinician
-Good reading (aloud) but poor comprehension of material that has been read
-Generally better oral reading than other language skills
-Writing problems that parallel those in expressive speech
Are there neurologic impairments that pair with TSA?
Hemiparesis associated with the onset may disappear, leaving the patient with no obvious neurologic impairment.

Neglect of one side of the body may be common.
What is the main difference between TSA and Wernicke's aphasia?
They sound similar.

However, repetition is intact with TSA where it is not intact with Wernickes.
Which aphasia is a rare fluent aphasia?
Conduction Aphasia
Where is the lesion associated with Conduction Aphasia located?
In the region between Broca's area and Wernicke's area, especially in the supramarginal gyrus and the arcuate fasciculus.

Lesion sites are controversial
How is Conduction Aphasia characterized?
-Disproportionate impairment in repetition*** (distinguishing characteristic); especially impaired repetition of longer words, function words, and longer phrases/sentences.
-Variable speech fluency; generally less fluent than Wernickes
-Paraphasic speech
-Marked word-finding problems, especially for content words
-Empty speech because of omitted content words
-Efforts to correct errors in speech, though not always successful.
-Good syntax, prosody, and articulation
-Severe to mild naming problems
-Near-normal auditory comprehension, especially for routine conversational speech
-Being better at pointing to a named stimulus than at confrontation naming
-Highly variable reading problems: better comprehension of silently read material
-Writing problems in most cases
-Buccofacial apraxia
Symptoms of conduction aphasia are similar to those with ________ aphasia. What is different is those with conduction aphasia have good to normal auditory comprehension.
Wernicke's Aphasia
What are some accompanying neurological effects with conduction aphasia?
Some may have none.

Others: paresis of the right side of the face, limbs, or oral apraxia and right sensory impairment. Patients may recover from most of these impairments
Which form of fluent aphasia is controversial?
Anomic aphasia
Where are the lesions in the brain associated with Anomic Aphasia?
May be caused by lesions in different regions of the brain:
-Angular gyrus
-Second temporal gyrus
-Juncture of the temporopareietal lobes
How is Anomic Aphasia characterized?
-A most debilitating and pervasive word-finding difficulty*** (distinguishing feature)
-Generally fluent speech
-Normal syntax except for pauses
-Use of vague and nonspecific words, resulting in empty speech
-Verbal paraphasia
-Circumlocution
-Good auditory comprehension of spoken language
-Intact repetition
-Unimpaired articulation
-Normal oral reading skills and good reading comprehension
-Normal writing skills
What is the distinguishing feature of anomic aphasia?
Generally, most language functions, except for naming, are relatively unimpaired
Which areas of the brain have been linked to subcortical aphasia?
Lesions in the brain surrounding the basal ganglia and the thalamus
How is subcortical aphasia caused by lesions in the Basal Ganglia characterized?
-Fluent speech, with pauses/hesitations
-Intact repetition skills
-Normal auditory comprehension for routine conversation
-Articulation problems (similar to those with Broca's)
-Prosodic problems
-Word-finding problems
-Semantic paraphasia in some cases
-Relatively preserved writing skills
-Limb apraxia if lesions extend posteriorly to deep white matter in the parietal areas
How is subcortical aphasia caused by lesions or hemorrhages in the left thalamus characterized?
-Hemiplegia, hemisensory loss, right-visual field problems, and in some cases, coma
-Initial mutism, which may improve to paraphasic speech
-Severe naming problems
-Good auditory comp of simple material and poor comp of complex material
-Good repetition skills
-Impaired reading and writing skills
Explain the Boston Diagnostic Aphasia Examination-3 (BDAE-3)
Helpful in evaluating:
-articulation
-fluency
-word finding
-repetition
-serial speech
-grammar
-paraphasias
-aud comprehension
-oral reading
-reading comprehension
-writing
-musical skills
----This test tries to classify aphasia into types
Explain the Western Aphasia Battery (WAB)
Evaluates:
-speech content
-fluency
-aud comp
-repetition
-naming
-reading
-writing
-calculation
-drawing
-nonverbal thinking
-block design
----Tries to classify aphasia into types
Explain Minnesota Test for DIfferential Diagnosis of Aphasia (MTDDA)
Evaluates:
-Aud disturbances
-Visual and reading disturbances
-Speech and language disturbances
-Visuomotor and writing disturbances
-Numerical and arithemetic disturbances
Explain the Neurosensory Center Comprehensive Examination for Aphasia (NCCEA)
Evaluates:
-language (comprehension, production, reading, writing, word fluency, digit and sentence repetition, visual object naming, sentence construction, and articulation)
-Visual and tactile functions
Explain the Multilingual Aphasia Examination (MAE)
Evaluates:
-Language functions (naming, repetition, fluency, auditory comprehension, spelling, and writing)
Explain the Bilingual Aphasia Test
Evaluates:
-skills in forty languages with parallel forms.
-A patients phonologic, morphologic, syntactic, lexical, and semantic skills in primary and a secondary language may be assessed.
Explain the Aphasia Diagnostic Profiles
Evaluates:
-Overall severity of aphasia along with such specific skills such as comprehension, word retrieval, repetition, and alternative communication.
-Helps classify aphasia
Functional or Standardized tests may be less biased in evaluating clients from linguistically and culturally diverse backgrounds.
Functional
What are the functional assessment tools that may be used for aphasia?
1) Functional Communication Profile
2) Communicative Abilities in Daily Living- Second Edition
3) Communicative Effectiveness Index
4) ASHA Functional Assessment of Communication Skills for Adults
5) Amsterdam-Nijmegan Everyday Language Test
Outline a typical Aphasia Assessment:
1) Repetition skills
2) Naming skills
3) Auditory Comprehension of Spoken Language
4) Comprehension of Single words
5) Comprehension of sentences and paragraphs
6) Writing skills
7) Gestures and Pantomime
8) Automated Speech and Singing
When is the prognosis better in the case of aphasia patients?
-younger and healthier
-better educated and in verbally demanding occupations
-lesions are smaller
-no other medical/behavior disorders
-good hearing acuity
-normal/adequate vision
-better motor skills
-better preserved language skills
-aphasia is less severe
-treatment is initiated soon after onset
-receive effective treatment in accurate manner for long duration
-family involvement
-maintain health during treatment
In respect to auditory comprehension for Aphasia, lesions within the posterior superior temporal lobe suggest a _____ prognosis than those outside the PST
Better
Auditory comprehension treatment for aphasia is sequenced as follows:
-Comprehension of single words
-Comprehension of spoken sentences (question, directions, sentence verification)
-Discourse comprehension
Naming treatment techniques for aphasia:
-Incomplete sentences "you write with a ____"
-phonetic cues "the word starts with a p."
-syllabic cues "the word starts with spoo_"
-Silent phonetic cues "exhibits silent articulatory posture for /p/ for pen"
-personalized verbal cues
-functional descriptions
-descriptions/demo actions
-patients description as stimulus for naming
-patients demo of function as stimulus for naming
-paired objects/pics with printed name as stimuli
-patients spelling
-patients spelling & writing
-associated sounds
-rhyme
-synonyms
Treatment of reading skills for Aphasia may be sequenced as follows:
-survival reading skills
-newspapers, books, letters
-reading/comp of words
-reading/comp of phrases/sentences
-reading/comp of paragraphs & extended material
Treatment of writign skills for aphasia may be sequenced as follows:
-functional words (name, family)
-functional lists (grocery list)
-writing short notes, reminders, addresses, etc
-filling out forms
-writing letters
Depending on writing skills for aphasia, treatment procedures include the following:
-point to ptinter letter
-point to word/phrase
-say sound of letter
-say word
-tracing letters
-copying words/phrases
-spelling correctly
-writing to dictation
-spontaneous writing of phrase/sentence
-spontaneous extended writing
Loss of previously acquired reading skills due to recent brain damage
Alexia
Difficulty in learning to read; genetic and manifested beginning in childhood
Dyslexia
Loss/impairment of normally acquired writing skill due to lesions in the foot of the second frontal gyrus of the brain AKA Exner's writing area.
Agraphia
Impaired understanding of the meaning of certain stimuli even though ther eis no peripheral sensory impairment.

Often limited to one sensory modality
Agnosia
This is associated with bilateral damage to the auditory association area and is characterized by:
-impaired understanding of the meaning of auditory stimuli
-normal peripheral hearing
-difficulty in matching objects with their sound
-normal visual recognition of objects
Auditory agnosia
This is associated with bilateral temporal lobe lesions that isolate wernicke's area and is characterized by:
-impaired understanding of spoken words
-normal peripheral hearing
-normal recognition of nonverbal sounds
-normal recognition of printed words
-normal or near-normal verbal expression and reading
Auditory Verbal Agnosia
This is a rare disorder often associated with bilateral occipital lobe damage or posterior parietal lobe damage and is characterized by
-impaired visual recognition of objects- can be intermittent
-normal auditory or tactile recognition of objects
Visual Agnosia
This is associated with lesions in the parietal lobe and is characterized by:
-unoaured tactuke recognition of objects when visual feedback is blocked
-impaired naming of objects client can feel in their hands
-impaired description of objects felt in hands
Tactile Agnosia
Patients with this have sensorimotor problems in positioning and sequentially moving muscles for volitional speech production.
Apraxia of Speech (AOS)
What is AOS caused by?
Damage/injury to speech-motor programming areas in the dominant hemisphere.
Is AOS associated with prosodic problems?
Yes
Is AOS caused by muscle weakness or neuromuscular slowness?
No
AOS most frequently coexists with aphasia, especially ______ and less frequently with _____ of UMN type.
Brocas, Dysarthria
______ is a basic disorder of volitional movement in the absence of muscle weakness, paralysis, or fatigue.
Apraxia
T/F AOS may also be caused by degenerative neural diseases such as dementia, MS, and primary progressive aphasia
TRUE
What are the general symptoms of AOS?
-Impaired oral sensation in some patients
-When DYSARTHRIA is coexisting--facial and lingual weakness may be present.
-May have limp apraxia as well
What communication deficits are noted in AOS?
-May have independent problem of aud processing deficits
-most pts have awareness of issues
-initiation of speech may be slowed/delayed
-may use compensatory technique of reduced rate
-speech programming and production errors are the dominant symptoms of apraxia
What are the typical speech programming and production errors in AOS?
-volitional/spontaneous sequencing of movements for speech with unaffected automatic speech
-high variability of speech errors
-speech sound subsitutions
-distortions
-omissions of speech sounds
-voicing errors (sub voiceless for voiced)
-more difficulty with consonants than vowels
-anticipatory subs (a phoneme that occurs later in word may replace one that occurs earlier 'lelo' for 'yellow')
-metathetic errors (switched position of phonemes in words 'tefalone'
-insertion of a schwa into consonant clusters or between syllables
-increased frequency of errors on longer words
-trail-and-error groping
-greater difficulty with word-initial sounds
-easier automatic productions than volitional/purposive productions
-attempts of self-correction are often uncessful
Patients with AOS frequently have prosodic problems, which include:
-slow rate (difficulty when rate is challenged)
-silent pauses between words
-impaired intonation
-fluency problems including silent pauses, especially at beginning of speech initiation, and repetitions bv of false starts and attempts at self-correction
Assessment of AOS includes:
-tape recording and transcribing
-evoke imitation
-evoke repetitive production of syllables
-repetition of miltiple syllables
-imitative production of longer words
-imitate repeated words/phrases
-imitate sentences
-evoke picture descriptions
-counting
-oral reading
-comple diadochokinetic
-limb assessments
-Apraxia Battery for Adults (ABA)
What does treatment of AOS include?
-move from more automatic speech to less then to spontaneous
-simpler productions before complex
-speech movements as opposed to nonspeech
-include variety of sounds and sound combos
-articulatory accuracy, slower rate, systematic practice, gradual increase in rate, and normal prosody
-may include tactile cues
-contrastic stress tasks, phonetic contrasts, carrier phrases, and singing may be useful
-emphasis on total communication
The ____ are distinct from AOS, a neurogenic speech disorder of motor planning (programming) of speech movements with no muscular weakness or paraylsis.
Dysarthrias
Where are the common sites of lesion for dysarthrias?
1) LMN
2) Unilateral or Bilateral UMN
3) Cerebellum
4) Basal Ganglia
_____ dysarthria results from damage to the cerebellar system and is characterized predominantly by articulatory and prosodic problems
Ataxic
Major characteristics of ataxic dysarthria:
-gait disturbances: instability of trunk/head, rocking motions, rotated/tilted head posture, hypotonia

-movement disorders: over-or undershooting of targets, uncoordinated, jerky, inaccurate, slow, imprecise, and halting mvmtns

-Articulation disorders: imprecise consonants, irreg artic breakdown, vowel distort

-Prosodic disorders: excessive and even stress, prolonged phonemes, intervals between words/syllables, slow rate

-Phonatory disorders: monopitch, monoloudness, and harshness

-Speech quality: impression of drunken speech
______ dysarthria results from damage to the motor units of cranial of spinal nerves that supply speech muscles (LMN involvement)
Flaccis
Which CNs may be involved in flaccid?
1) trigeminal (V)
2) Facial (VII)
3) Glossopharyngeal (IX)
4) Vagus (X)
5) Hypoglossal
What are the major characteristics of flaccid dysarthria?
-Various muscular disorders (weakness, hypotonic, atrophy, diminished reflexes.)

-Fasciculations, fibrillations (contractions of individual muscles)

-Rapid and progressive weaknesswith the use of a muscle and recovery with rest

-Respiratory weakness in combo with CN weakness

-Phonatory disorders, breathy voice, audible inspir, short phrases

-Resonance disorder: hypernasality, imprecise consonants, nasal emission, short phrases

-Phonatory-prosodic: harsh, monopitch, monoloudness

-Articulation: more pronounced with lesions of CN V, VII, and XII
_______ dysarthria results from damage to the basal ganglia (extrapyramidal system). Associated with involuntary movement and variable muscle tone. Prosodic disturbances are dominant.
Hyperkinetic
What are the major characteristics of hyperkinetic dysarthria include what?
-Movement disorders (bc of damage to BG control circuit); abnormal and involuntary movement of orofacial muscles

-Myoclonus (involuntary jerks), tics of face/shoulders, tremor, chorea, spasms

-Dystonic (results from contractions of antagonistic muscles that cause abnormal postures, spasmodic torticollis (intermittent dystonia & spasms of the neck muscles), blepharospasm (forceful and involuntary closure of eyes due to spasm of orbicularis oculi muscle)

-Communicative disorders, specfic symptoms depending on the dominant neuro condition (chorea, dystonia, athetosis, spasmodic torticollis)

-Phonatory disorders: voice tremor, intermittently strained voice, voice stoppage, vocal noise, harsh voice

-Resonance disorders: predominantly intermittent hypernasality

-Prosodic disorders: slower rate, excess loudness variations, prolonged interword intervals, and equal stress

-Respiratory problems: aud inspiration and forced and sudden inspiration or expiration

-Inconsistent articulation problems, including imprecise consonant productions and distortion of vowels
_______ dysarthria results from damage to the BG (extrapyramidal system).
Hypokinetic
Hypokinetic dysarthria is characterized by:
-Tremors in resting facial, mouth, and limb muscles that diminish when moved voluntarily

-Mask-like face with infrequenc blinking and no smiling

-Micrographic writing (small print)

-Walking disorders (slow to begin, the short, rapid shuffling steps)

-Postural disturbances (involuntary flexion of the head, trunk, and arm; difficulty changing positions

-Decreased swallowing (saliva in the mouth & drooling)

-Phonatory disorders: monopitch, low pitch, monoloudness and harsh/contiuously breathy voice

-Prosodic disorders: reduced stress, inappropriate silent intervals, short rushes of speech, variable and increase rate in segments, short phrases

-Ariculation: imprecise consonants, repeated phonemes, resonance disorders and mild hypernasality

-Respiratory problems: reduced vital capacity, irreg breathing faster rate of respiration
__________ dysarthria results from bilateral damage to he UMNs (direct and indirect motor pathways). Lesions in multiple areas, incliding cortical areas BG< internal capsule, pons, and medulla
Spastic
Spastic dysarthria is characterized by
-Spasticity and weakness, especially bilateral facial weakness, though jaw strength may be normal and lower face weakness may be less severe

-Movement disorders, including reduced range and slowness loss of fine and skilled movement, increased muscle toe

-Hyperactive gag reflex

-Hyperadduction of VFs and inadequate closure of the velopharyngeal port

-prosodic disorders, including excess and equal stress, slow rate, monopitch, monoloudness, reduced stress and short phrases

-articulation disorders: imprecise production of consonants and distorted vowels

-phonatory disorders: continuous breathy voice, harshness, low pitch, pitch breaks, strained-strangled quality, short phrases slow rate

-resonance: hypernasality
_________ dysarthria is a combination of two or more pure dysarthrias are possible, although a combination of two types is more common than a combination of three or more.
Mixed dysarthria
_____________ dysarthria results from damage to the UMN that supply cranial & spinal nerves involved in speech production
Unilateral UMN dysarthria
UUMN is characterized by
-Unilateral lower face weakness, unilateral tongue weakness, unilateral palatal weakness and hemiplegia /hemiparesis

-articulation disorders: imprecise production of consonants, irregular articulatory breakdown

-Phonatory disorders: harsh voice, reduce loudness, strained harshness

-Prosodic disorders: slow rate, increased rate in segments, excess and equal stress, monopitch, monoloudness, low pitch, and short phrases

-Resonance disorders: hypernasality

-Dysphagia, aphasia, apraxia, and RHI
What do most clinicians do for assessment of dysarthria?
-Record extended conversational speech sample
-Use variety of speech tasks
-Assess diadochokinetic rate or AMRs and SMRs
-Assess the speech production mechanism during nonspeech activities (oral-mech)
-Assess respiratory problems
-Assess phonatory disorders ('ah')
-Assess articulation disorders (consonant production)
-Assess prosodic disorders (rate of speech, phrase lengths, stress patterns, pauses, short rushes
-Assess resonance disorders: hypo/hyper
-Assess speech intelligibility
This is a major health problem primarily found in people 5 years of age and older. It is an acquired neurological syndrome persistent of progressive deterioration in intellectual functions, language, memory, emotion, and behavior.
Dementia
Prevalence of dementia may be as high as ____ in people 65 years and older. After this age, the prevalence of dementia doubles every 5 years.
25%
What can dementia be related to that is caused by prolonged alcohol abuse?
Wernicke-Koraskoff syndrome
When can dementia be reversible?
metabolic disturbances, nutritional deficiencies, chronic renal failure, persistent anemia, drug toxicity, and lung and heart diseases
What are the classifications of dementia?
1) Cortical
2) Subcortical
3) Mixed
In this form of cortical dementia, intellectual and language deterioration precedes motor deficits. Approximately 50% of irreversible dementia is due to this disease.
Alzheimer Type
When is the typical onset of alzheimer's?
When people are in their 70s ad 80s. More women than men are affected. It is associated with a family history of Down syndrome and also history of brain injury.
What kind of neuropathology may be involved in DAT?
Neurofibrillary tangles: filamentous structures in nerve cells, dendrites, and axons

Neuritic plaques: AKA senile plaques. minute areas of cortical and subcortical tissue degeneration

Neuroal loss: nerve cells are destroyed fluid-filled cavities containing granular debris.

Neurochemical changes: depletion of neurochemicals that help transmit messages across brain structures.
What are the symptoms of early stage DAT?
-subtle memory problems
-somewhat pronounced difficulty with new learning and visuospatial problems
-poor reasoning/judgement in social situations
-behavior changes, including self-neglect and avoidance of routine tasks
-depression, slight disorientations, subtle language changes
What are the symptoms of later-stage DAT?
-intensified early-stage symptoms
-severe problems recalling remote and recent events
-intensified visuospatial problems
-widespread intellectual deterioration
-hyperactivity, restlessness, agitation, meaningless handling of objects
-profound disorientation to place, time, and person; wandering
-problems with self-care
-arithmetic calculations issues
-difficulty managing daily routines
-lack of affect, tact, and judgement
-paranoid delusions
-aggressive/disruptive behaviors
-inappropriate humor and laugher
-seizures, myoclonic jerks
What are the language problems associated with DAT?
-naming problems, verbal and literal paraphasias, and circumlocutions
-problems comprehending abstract meanings
-impaired picture description
-difficulty generating a list of words that begin with a specific letter
-echolalia
-empty speech, jargon, and hyperfluency
-incoherent, slurred, and rapid speech
-pragmatic language problems, including inattention to social conventions (greetings), difficulty initiating conversation, and difficulty maintaining topics of conversation
-reading/writing probs
-in final stages: no meaningful speech, mutism. and complete disorientation to time, place, people, and self
This is a group of heterogeneous diseases that includes Pick's disease. Constitutes 12% of dementia cases diagnosed in people under 65; typical onset of PiD takes place between 40 and 60.
Frontotemporal dementia
What kind of neuropathology is associated with frontotemporal dementia?
-degeneration of nerve cells in the L and R frontal, temporal, or both loves in two hemispheres
-atrophy may be focal, involving anterior frontal & temporal lobes, orbital front lobe, and medial temporal lobe
-presence of Pick bodies and pick cells (balooned and inflated neurons)
-Absence of pick bodies and pick cells in some variants of FTD but presence of atrophied, gliosed, and swollen brain cells
What symptoms are seen with frontotemporal dementia?
-notable behavior changes with marked right-sided atrophy; notable language changes in those with left atrophy
-behavior disorders, including uninhibited and inappropriate social behaviors, compulsive, excessive eating, delusions; more pronounced in pts with right-sided atrophy
-emotional disturbances: depression, withdrawal, irritability, mood fluctuations, occasional euphoria, excessive jocularity, exaggerated self-esteem
-imapired judgement and reasoning and lack of insight
What language issues are associated with frontotemporal dementia?
-Dominant language problems with somwaht better preserved memory and orientation
-Anomia, more pronounced with temporal lobe atrophy
-Progressive loss of vocab and consequent paraphasia and circumlocution
-Difficulty defining common words and problems in reciting category-specific words (animals)
-Limited spontaneous speech, echolalia, and nonfluent speech
-Impaired comprehension of speech and printed material
This dementia is associated with which disease?
-Only 35-55% of these pts have dementia
-____ is more common in males than females, and onset is typically between 50-56 years
-Classified dementia is defined as subcortical (morot symptoms precede intellectual deterioration)
-Genetic factors and such environmental factors as pesticide and herbicide are hypothesized factors
Parkinson's Disease
This dementia is associated with which disease?
-Classified as subcortical
-This disease affects 40-70 persons in a million, onset is 35-40 and affects M/F equally
-A malformed protein kills the brain cells that control movement
-Genetic etiology is supported
Huntington's Disease
Several infectious disease lead to dementia. Dementia due to HIV infection is subcortical and known as what?
AIDS dmentia complex of HIV encephalopathy
What are the characteristics of AIDS dementia complex
Forgetfulness, poor concentration, slow or impaired thinking, apathy and loss of interest in work, depression, mania, confusion, hallucinations, delusions, and memory loss

Language problems less prominent until mutism that settles in the finnal stage
What are the symptoms of dementia due to Creutzfeldt-Jakob disease?
-Wideform spongiform state in the brain, neuron loss may be found in cortical areas, BG, thalamus, brainstem, and spinal cord
-Fatigue, sleep disturbances
-cerebellar ataxia, tremor, ridigity, chorea, athetosis, and visual problems
-memory problems and resoning impairments
-psychiatric symptoms: depression, anxiety, euphoria, hallucinations, and delusions
-final stage: stupor, mutism, seizures, pneumonia that often leads to death
This dementia is associated with chronic hypertension and has a sudden onset.

Can be bilateral cortical, subcortical, or mixed
Vascular dementia
In assessing dementai which skills/domains are typically sampled?
-Awareness and orientation to surroundings
-Mood and affect (depression/lack of emotional responses)
-Speech and language
-Memory and other cog fx
-Abnormal thinking
-Visuospatial skills
What is a test of aphasia that is helpful in assessing communication problems associated with dementia?
Arizonia Battery for Communication disorders of Dementia (ABCD)

-Especially designed for dementia associated with alzheimers
-Speech discrimination, visual perception, literacy, visual fields, visual agnosia, mental status, linguistic expression, linguistic comprehension, visual-spatial construction
Which assessments helps evaluate changes in performance in eight everyday activities and changes in fourteen habits.
Blessed Dementia Scale
Clinical management of dementia consists of management of daily activities involving teaching the following strategies:
-Establishing simple routine
-Using various reminders
-Writing down a to do QAM
-Keeping #s and possessions in specific place
-Writing checklist
-Always carrying a card with names, address, and # of caregivers
-Always wearing a bracelet with identifying info
What advice might be given to families with members who have dementia?
-Approach slowly, touch gently, establish eye contact, speak clealy and slowly
-use gestures, smiling, posture, and other cues
-talk about simple and concrete events and talk in simple short sentences
-point out topic, person, thing before speaking about it
-ask yes/no questions
-restate important info
-structure client's room and living environment to establish routine
-always give departing signals
-reduce emotional outbursts by analyzing conditions uder which they occur and eliminate conditions
-minimize demands on client
Which dementia includes Pick's disease?
Frontotemporal
While the left hemisphere controls most aspects of language, the right hemisphere controls what?
-Understanding holistic gestalt stimuli, visual perception, geometric and spatial information
-Facial recognition, drawing and copying
-Arousal, attention, and orientation
-Emotional experience and expression
-Perception of musical harmony
-Certain prosodic features of communication, understanding ambiguous meaning, expressing and understanding the emotional tone of speech, understanding discourse, and pragmatic language skills
What do the symptoms of RHD look like?
-Perceptual and attentional deficits dominate the symptom complex of RHD
-Affective and communicative deficits accompany them, but pure linguistic deficits are not typical of RHD
What are the attentional and perceptual deficits seen in RHD?
-Left neglect
-Denial of illness
-Confabulation regarding disability
-Facial recognition deficits
-Constructional impairment
-Attentional deficits
-Disorientation
-Visuoperceptual deficits
What is anosognosia?
Denial of illness

Pt may deny the existence of a paralyzed arm an be indifferent to admitted deficits or problems
Explain confabulation regarding disability
This refers to exaggerated claims regarding a diabled body part

A man with a paralyzed hand may claim to be painting with that hand
Explain visuoperceptual deficits
These deficits involve difficulty recognizing line drawings; drawings that are distorted in size, dimension, or orientation, and drawings that are superimposed on another
Explain affective deficits seen in RHD
-Understanding emotions and other people expressions
-Describing emotions expressed on printed faces in storybooks
-Recognizing emotions expressed in isolated verbal productions
-Understanding emotional tone of voice
-Expressing emotions (not experiencing emotions)
Only about half the number of pts with RHD have communication deficits. What are these deficits?
-Prosodic deficits: monotone, impaired stress patterns, reduced speech rate, lack of affect, difficulty understanding prosodic meanings of other people's speech

-Impaired discourse and narrative skills: confusion between significant and irrelevant pieces of info in a picture description or conversational speech

-Confabulation and excessive speech: too much detail to minor detalis, saying too much

-Difficulty understanding implied, alternate, or abstract meanings: difficulty grasping the overall meaning of situations or stories, difficulty understanding the central message of conversation, underlying theme,

-Pragmatic

-Other communicative deficits: naming problems, especially collective nouns (e.g. 'flower' but no problem naming particular type of flower); difficulty comprehensing complex verbal information and impaired oral reading of sentence
What kind of standardized exams exist for assessing RHD?
1) Mini-Inventory of Right Brain Injury: visual scanning, integrity og gnosis, integrity of body image, reading/writing, drawing, and affective/abstract language

2) The Right Hemisphere Language Battery: comprehension of spoken/printed metaphors, inferred meanings, appreciation of humor, and discourse

3) Clinical Management of RHD: typical symptoms + nonverbal communication skills. Includes interview schedule and observation of pts interaction w/ others

4) Test of Visual Neglect

5) Bells test

6) Behavior Inattention Test: techniques to assess neglect in such functional taska as reading maps, menus, and newspapers and using a telephone
What does the relatively new and not much researched treatment of RHD look like?
-Increase awareness
-Work on attention
-Impulsive behavior
-Pragmatic impairments (videotape conversations)
-Impaired reasoning
-Impared inference
-Impaired comprehension of metaphors/idioms
-Visual neglect: force attention to text on the left side, keep a finger on the left side, point to beginning of each line, etc.
For every female with a TBI, there are ___ males with TBi
3-5
Is there suggestive evidence that TBI is more common among AA and Hispanic Americans than the rest of the population?
Yes
What is the most common cause of TBI?
Falls--children and the elderly are especially vulnerable

-MVA
-Being struck or crashing into objects
-Assults/Violence
These are penetrating brain injuries and involve a fractured or perforated skull, and low-velocity impacts (blows to the head) are the most frequent causes
Open-head injuries
These are nonpenetrating brain injuries and involve no open wound in the head, no penetration of a foreign substance in the brain, and a damaged brain within the skill.

Even when the skull is fractured, the injury is classified as nonpenetrating if the meninges are intact.
Closed-head injuries
Closed-head injuries may be of two types. What are these types?
1) Acceleration-deceleration
2) Nonacceleration
In this kind of injury, a head is set into motion by physical forces. When the head moves, the brain is still static. The brain begins to move. When the head stops moving, the brain keeps moving and thus strikes the skull on opposite side of initial impact.

Moving brain is lacerated or torn bc the money projections on the base of the skull.
Acceleration-deceleration Injuries


**more serious than nonacceleration injuries
Occurs when a restrained head is hit by a moving object. A collapsing car crushing the head of a mechanic working under it is an example.

These injuries may fracture the skull, but they produce much less serious consequences for the brain and the behavior of the person.
Nonacceleration injuries
The brain injury at the point of injury is called?
Coup injury
The brain injury at the opposite side of the impact cause by moving brain striking the skull is called what?
Contrecoup injury
What are some general assessments of patients with TBI?
1) Glascow Coma Scale: eye opening, motor responses

2) Brief Test of Head Injury: screnning test for orientation, following commands, and other related

3) Comprehensive Level of Consciousness Scale: posture, resting eye pposition, spontaneous eye opening, ocular movements, pupillary reflexes, motor functioning, responsiveness, and communicative effort

4) Galveston Orientation and Amnesia Test: test amnesia, orientation, and memory

5) Disability Rating Scale: eye opening, verbal responses, motor responses, feeding, toileting, etc

6) Rancho Los Amigos Levels of Cognitive Function: cognition and behavior at the levels of no response, generalized response, localized response, confused-agitated, cofused, inappropriate, etc.
What are the two modes of treatment that are the most important?
(1) Cognitive Rehab: clinicians train such components as attention, visual processing, and memory, which may not result in improved communication.


(2) Direction Communication Training: involved direct behavioral procedures. Systematic reinforcement of attending behaviors, appropriate discourse, topic maintenance, self-correction, and so fourth, will result in their increase and a concomitant decrease in many inappropirate behaviors.
What are the causes of swallowing disorders?
-Strokes (esp brainstem and anterior cortical strokes)
-Oral & Phrayngeal tumors
-Various neurologic diseases
-Surgical or radiation treatment of oral, pharyngeal, and laryngeal cancer
-TBI; cervical spine disease
-Poliomyelitis, COPD, CP
-Genetic: dysautonomia: autonomic impalance
-Side effects of certain prescription drugs.
Explain oral prep phase
Food place in the mouth is masticated and made into a bolus.
Name some disorders of oral prep phase
-Problems chewing food bv of reduced range of lateral and vertical movement, reduced range of lateral mandibular movement, reduced buccal tension, poor alighment of mandible and maxilla

-Difficulty in forming and holding the bolus, abnormal holding of the bolus, slippage of food into anterior and lateral sulcus, aspiration before swallow mostly due to weak lip closure, reduced tongue movement, and inadequate tongue and buccal tension
Describe oral phase:
Begins with the anterior-to-posterior tongue action that moves the bolus posteriorly (toward back of the mouth)

Ends as the bolus passes through the anterior faucial arches when the swallowing reflex is initiated
Name some disorders of the oral phase:
-Anterior, instead of posterior tongue movement and generally weak tongue movement; tongue thrust, reduced range of movement and elevation, reduced labial, buccal, and tongue tension & strength
-Food residue in various places suggesting incomplete swallow
-Premature swallow of solid and liquid food and aspiration before swallow, caused by apraxia of swallow
Attempts at swallowing abnormally small amouhts of the bolus:
Piecemeal swallow
Describe pharyngeal phase
Consists of reflex actions of the swallow. Reflexes are triggered by the contact the food makes with the anterior faucial pillars.

-Involved velopharyngeal closure,
-laryngeal closure by an elevated larynx to seal the airway,
-reflexive relaxation of the cricopharyngeal muscle for the bolus to enter,
-and reflexive contractions of the pharyngeal contractors to move the bolus down and eventually into the esophagus.
Name some disorders of the pharyngeal phase:
-Difficulties in propelling the bolus through the pharynx and into the pharyngoesophageal sphincter segment; delayed or absent swallow reflex, nasal and airway penetration of food
-Food coating on the pharyngeal walls, food residue in valleculae, top of airway, in pyriform sinuses, and throughout the pharynx
-Reduced pharyngeal peristalsis, or constricting and relaxing movements of the pharynx; pharyngeal paralysis
-Inadequate closure of the airway; aspiration before and after swallow
-Reduced movement of the base of the tongue; reduced laryngeal movement; cricopharyngeal dysfunctions
Describe esophageal phase
Not under voluntary control. Begins when the food arrives at the orifice of the esophagus; food is propelled through the esophagus by peristaltic action and gravity and into the stomach. Bolus entry into the esophagus results in restored breathing and a depressed larynx and soft palate.
Name some of the disorders of the esophageal phase:
-Difficulty passing bolus through the cricopharyngeus muscle and past the 7th cervical vertebra
-Backflow of food from esophagus to pharynx; reduced esophageal contractions
-Formation of diverticulum ( a pouch that collects food)
-Development of tracheoesophagal fistula
-Esophageal obstruction
How does one go about assessing swallowing disorders?
-Before beginning: ask for dietary resrtictions due to health/culture
-Screen speech, voice, language, and writing
-Screen concrete and abstract comprehensions
-Conduct laryngeal exam
-Administer test swallows. Collect necessary materials
-Correctly position the pt for test swallows
-Appropriately place food in mouth (place it in more normal side, use straw/syringe for placing liquids posteriorly.
-FOUR FINGER: index finger below chin, middle finger on the hyoid, third and fourth at the top and bottom of the thyroid to take note of the submandibular, hyoid, and laryngeal movements during swallowing or aspiration
What kind of procedures help treat swallowing disorders?
Direct, indirect and medical