Adult Neurogenics
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- What are some cognitive problems experienced by those with right hemisphere dysfunction?
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problems with..
- attention
- reasoning
- problem solving
- inferencing - What are 5 non-speech charactereistics of right hemisphere dysfucntion?
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* anosagnosia (denial of illness)
* impulsivity
* prosopagnosia (difficulty recognizing faces)
* neglect (in left hemispatial neglect, patients may fail to perceive tactice stimulation on the left sie of the body and fail to notice visual or auditory stimuli in left-sided space)
* attentional deficits - List 6 ways that attentional deficits may impact the right hemisphere dysfunction patient?
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- may be distractible, not being able to focus in therapy
- dificulty determining the overall meaning of situations and events
- may have trouble separating whats important from whats not
- difficulty identifying relationships among elements of information
- unable to maintain appropriate patterns of interactions with conversational partners
- trouble maintaining coherence in spech and writing - Name 8 communicative impairments associated with right hemisphere dysfunction.
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1) poor information processing
2) anomalous content and organization of connected speech
3)usually have good linguistic skills but may be poor communicator
4) difficulty recognizing emotions in others
5) impaired prosody
6) failure to comprehend intended meaning (ex: it's hot in here..means...open the window)
7) difficulty with complex communication events
8) pragmatic impairments including socail and interactional aspects of language; ending convo abruptly, talking excessively, etc - Name some treatment strategies focusing on orientation for the patient with a right hemisphere dysfunction. (7)
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1) biographical/family info
2) calendar
3) place/time (hospital, daily schedule, season, etc)
4) person (therapist, nurses, doctors)
5) historical info
6) recent events
7) hospital-oriented tasks - What is apraxia of speech?
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Apraxia of speech is a MOTOR speech disorder that frequently occurs in combo with aphasia (which is a language disorder)
- also called verbal apraxia
- almost alwasy associated w/ left hemi damage - What is the difference between oral apraxia and apraxia of speech?
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Oral apraxia is apraxia of the movements of the mouth, but NOT used to describe apraxia when those mov'ts are for sppech
- movements include puckering, sticking out tongue, etc
- apraxia of speech involves motor mov'ts associated with speaking - What are the 2 key characteristics of apraxia of speech?
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Difficulty PROGRAMMING and SEQUENCING the voluntary movements of the tongue, lips, soft palate, and vocal cords for speech sounds
1) programming -> getting the message of correct sounds from teh brain to the mouth
2) sequencing -> proper ordering of movements in order to say specific words and sounds - Treating Apraxia of speech...
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- primarily focus on consistency of speech sound productions, rather than improving/compensating
- systematic drill work often used...to 'overlearn' the motor program for a particular sound...moving from simple to more complex speech acts
- the hierarcy takies into accound sound complexity, place/manner of articulation, frequ of occurrence, visibility of sound, meaninfullness, context, rate of speech, etc...but the MOST important factor is word/lenth and complexity of sound sequences - What is the purpose of cueing and how do you do it?
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The purpose is to 'prime the system' or provide just enough assistance to help the individual produce the response when sh/he knows the response but has difficulty saing it
You can cue with...
1) phonemic cues (provide first sound, sound cluster or syllable...ex: 'pe-' for 'pen'
2) sentence completion cues (you write with a --- )
3) semantic cue (not effective for word retrieval probs but can help if person doesn't know answer, ex: its a type of a domestic animal'
4) combo phonemic/sentence completion cue (most effective...ex: you write with a p--) - What is the purpose of therapy for aphasia? (4)
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1) to help aphasic patient regain as muhc communication as he needs and can
2) to help him learn how to compensate for residual definicits
3) to help him accept the differneces b/w how he is now and how he was before the stroke
4) to help family members adjust to new forms of communication -
How do you manipulate stimuli in a treatment session?
(task variables) -
- salience (make it stand out)
- clariy and intelligibility
- redundancy
- context (ex: naming kitchen items while losking at a picture of somone in a kitchen) ** on test for sure
- relevance, meaningfulness (use objects and topics relevant to patient
- novelty and interest
-cues and promps - What should you remember when providing instructions in treatment?
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- be clear, concise and provide examples
- watch carefully for comprehension and make adjustments as necassry
- use repetition, paraphrasing and lead-in phrases to highlight important info and to allow extra time for processing
- use pausing to emphasize important elements
- provide positive feeadback but make it GENUINE...provide feedback with accuracy
- provide general encouragment, even for correction - What are teh 4 modalities of language?
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- written expression
- auditory expression
- written comprehension
- auditory comprehension - What is the hierarchy in auditory comprehension? (6)
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1) one common object by name
2) one common object by function
3) sequence of objects
4) 1 step directions
5) 2 step directions
6) 3 step directions - What are some activities and materials you can use with reading comprehension?
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- most reading materials for children aren't appropriate for adults, so you can use signs, calendars, maps, menues, phone book, magazines, newspapers, books, etc)
- activities may be
* recognizign the printed letter string
* preforming phonological analysis (breaking down by sound)
* performing whole-word analysis (meaning and grammar)
* syntactic analysis
* semantic analysis - 3 part question on naming...need to think creatively..but remember these points...
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Naming Issues
- semantic field: understanding that 'dog' fits within the category 'animal'
- lexical field:
includes close relationships to the words (ex: synonym and anotonyms)
Naming
- most aphasics have naming difficulties
- more likely in severe patients - What are the challenges one would face when treating fluent aphasia? (4)
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- they talk instead of listen
- they don't recognize thier errors
- they are difficult to assess formally (instructions hard for them to follow)
- they may not acknowledge a need for treatment - What is PACE and what are the benefits?
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- PACE is a barrier game.
-you give adequate info so person can reproduce a drawing
- teaches listening
- auditory comprehension or verbal expression
- heightens sensitivity to what the listener needs to know if they are the one's giving instructinos - How do we manipulate the environment in aphasia treatment?
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Environmental Management for clinicians and family
- elaborate with facial-gesural cues
- natural (not exaggerated), slow -> give patient time to respond
- offer response alternatives
- offer physical prompts
- respond to message vs content or form
- be savvy re patients yes/no
- consider conversational coaching strategies -
Other Questions...
(refer to handouts) -
* How do you treat global aphasia?
* question on written expression in Broca's/Wernicke's aphasia
* group aphasia treatment
* What is aphasia? (given symptoms and identify the type)
* questions on role of CDA
* know whether disorders are language or speech disorders
* question on families
* big question on setting up a communication book
* how to relate to a speech pathologist - What are the benefits of group aphasia treatment?
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- facilitates functional communication
- adds psychosocial aspect to aphasia treatment
- helps people with aphasia “participate in lifeâ€
- fosters multidisciplinary approach - What is MIT?
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Melodic Intonation Therapy
--purpose: to help severely aphasic people achieve a basic recovery of ability to use some language accurately
- capitalizes on intact right hemisphere, the hemisphere that is dominant for music in most “non-musician†right-handed people
- good candidates: nonfluent aphasics, extreme paucity of speech, good awareness and concern re reduced ability to produce speech, good auditory comprehension - Why is hi-tech less effective than low tech for AAC patients?
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high tech less effective because:
o tend to have inappropriate or limited vocabulary
o poor physical design for their needs
o limited relevance for adults
o comprehension difficulties
o word retrieval difficulties
o attentional problems
o inconsistent performance
o limited initiation
o may have impaired memory
o older adults may resist high technology
o habit: most resistant to any method that doesn’t utilize natural speech - Paraphasias
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o defined as: speech errors produced by a person with aphasia
o two main types:
o literal paraphasias:
 also called phonemic paraphasias
 sound substitutions
 e.g. shooshbruss for “toothbrushâ€; tessorant for restaurant
o verbal paraphasias
 word substitutions
 these can be classified in different ways
 semantic paraphasias: when they are related in meaning (uncle for father)
 verbal paraphasias: when the words are unrelated in meaning (table for father) - Perseveration
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Perseveration Treatment
definition – inappropriate recurrence or continuation of a response in the face of changing task
treatment – increase awareness of perseveration; a sign that tells patient; time intervals, cueing, intervening instructions - 'stuck in set' perseveration
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o “stuck-in-set “ perseveration: inappropriate maintenance of a framework of response after a new stimulus
 e.g. pointing to body parts and then pointing to something in room; patient may continue to point to body parts
 make sure patient understands new task requirements (alerting)
 slow your pace
 introduce pause
 point out perseverations - o continuous perseveration
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o continuous perseveration: inappropriate prolongation or continuation of a behaviour without cessation and without intervening stimuli
 e.g. write mnmnmn (three times) and patient continues to write this series several times
 strategies determined by nature of task (e.g. saying requirements aloud while writing in above example; pausing, writing window - recurrent perseveration
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o recurrent perseveration: inappropriate occurrence of part (phonemic) or all (semantic) of a previous response after a new intervening response and/or stimulus (most common type)
 e.g. asking the patient to repeat the word “bedâ€, which he does successfully and then asking him to repeat the word “pencil†and he again responds with “bedâ€; part word: “wrench†and then “wristwrench†instead of “wristwatchâ€
 strategies utilize heightened awareness of perseveration (hold up card that says “PERSEVERATIONâ€, imposing time intervals, cueing, intervening instructions