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Neuro/Adult Disorders

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Aphasia
A neurologically based language disorder that is a loss or impairment of language caused by recent brain injury. Comprehension and expression of language, along with reading and writing may be impaired.
Aphasia Causes
Caused by various neuropathologies. The most common cause are strokes
Stroke Types
Strokes may be ischemic (blocked or interrupted blood supply to the brain) or hemorrhagic (bleeding in the brain due to a ruptured blood vessel.) ; Ischemic Strokes have two types: Thrombus: collection of blood material that blocks the flow of blood. Embolus: a traveling mass of arterial debris or a clump of tissue from a tumor that gets lodged in a smaller artery and blocks the flow of blood
Nonfluent Aphasia
Characterized by limited, agrammatic, effortful, halting, and slow speech with impaired prosody
Broca’s Aphasia: (Nonfluent)
Caused by damage to Broca’s area (not always) in the posterior inferior frontal gyrus of the left hemisphere. (Broca’s is Broadman’s area 44. It also affects area 45.)
Broca’s Aphasia: (Nonfluent): Characteristics
Nonfluent, effortful, slow, halting, and uneven speech; Limited word output, short phrases and sentences; Misarticulated or distorted sounds; Telegraphic speech; Impaired repetition of words and sentences; Impaired naming, especially confrontation; Better receptive than expressive; Difficulty understanding syntactic structures; poor oral reading and comprehension on materials; Writing problems; Monotone speech
Broca's Aphasia: Other characteristics
May exhibit apraxia and dysarthria; May have right-sided paralysis; May be depressed or react emotionally to difficult tasks
Transcortical Motor Aphasia: (Nonfluent)
Caused by lesions in the anterior superior frontal lobe, often above or below Broca’s area, which is not affected
Transcortical Motor Aphasia: (Nonfluent): Characteristics
Initial speechlessness; Echolalia and perseveration; Absent or reduced spontaneous speech; Nonfluent, telegraphic speech; Intact repetition skill; Awareness of grammar; Refusal to repeat nonsense syllables; unfinished sentences; Simple and imprecise syntactic structures; Initiate speech with motor activities (clapping); Good comprehension of simple conversational speech ; Slow and difficulty reading aloud; Seriously disturbed writing
Transcortical Motor Aphasia: (Nonfluent): Other Characteristics
Motor disorders such as rigidity of upper extremities, absence or poverty of movement (akinesis), lowness of movement (bradykinesia), buccofacial apraxia, and weakness of the legs; Apathy, withdrawal, little interest in communication
Mixed Transcortical Aphasia (MTA): (Nonfluent)
Rare, caused by lesions in the watershed area or the arterial border zone. May include bilateral upper motor neuron paralysis, weakness of all limbs, and visual field deficits
Mixed Transcortical Aphasia (MTA): (Nonfluent): Characteristics
Limited spontaneous speech; Automatic, unintentional, and involuntary nature of speech; Severe echolalia; Severely impaired fluency and auditory comprehension; Marked naming difficulty ; Mostly unimpaired automatic speech (reciting months of year); Severely impaired reading, writing, and comprehension;
Global Aphasia: (Nonfluent)
Most severe form of nonfluent aphasia. Caused by extensive lesions affecting all language areas and widespread destruction of the fronto-temporo-parietal regions is common; Verbal and nonverbal apraxia may be present; Right sided paralysis and sensory loss, and neglect on the left side of the body may be present
Global Aphasia: (Nonfluent): Characteristics
Profoundly impaired language skills; Greatly reduced fluency ; Expressions limited to a few words, exclamations, and serial utterances; Impaired naming and repetition; Auditory comprehension reduced to single words at best; Perseveration; Impaired reading and writing
FLUENT APHASIAS
Characterized by relatively intact but generally less meaningful, or even meaningless, speech. The speech is generally flowing, abundant, easily initiated, and well articulated with good prosody and phrase length
Wernike’s Aphasia: (Fluent)
Caused by lesions in Wernike’s area. Sound confused, lack insight into their language problems, less frustrated; May be paranoid, homicidal, suicidal, and depressed; Free from obvious neurological symptoms, paralysis are uncommon
Wernike’s Aphasia: (Fluent): Characteristics
Incessant, effortless, flowing speech with normal fluency; Rapid rate with good articulation; Intact grammatical structures; Severe word finding problems; Paraphasic speech, extra syllables in words and meaningless words; Circumlocution & empty speech; Poor auditory and reading comprehension; Impaired conversational turn taking and repetition skills; Writing problems ; Generally poor communication in spite of fluent speech
Transcortical Sensory Aphasia (TSA): (Fluent)
Caused by lesions in the tempro-parietal region, especially in the posterior portion of the middle temporal gyrus. Hemiparesis only during onset, neglect one side of the body is common; Sounds similar to Wernike’s Aphasia except repetition in intact
Transcortical Sensory Aphasia (TSA): (Fluent): Characteristics
Fluent speech with normal phrase length, good prosody normal; Paraphasic and empty speech; Severe naming problems; Good repetition skills but poor comprehension of repeated words; Echolalia ; Impaired auditory comprehension; Difficulty in pointing, obeying commands, or answering simple yes/no Qs; Normal automatic speech; Tendency to complete poems and sentences started by the clinician; Good oral reading but poor comprehension; Better oral reading than other skills; Writing problems that parallel those in expressive speech
Conduction Aphasia: (Fluent)
Caused by lesions in the region between Broca’s area+B45 and Wernike’s area. It is controversial. Symptoms similar to Wernike’s aphasia. Difference is Conduction aphasics have good to normal auditory comprehension. May have paralysis on the right side
Conduction Aphasia: (Fluent): Characteristics
Disproportionate impairment of repetition; Variable speech fluency, less fluent than Wernike’s; Paraphasic speech; Word finding problems and naming problems; Empty speech; Efforts to repair speech not always successful; Good syntax, prosody, and articulation; Near-normal auditory comprehension; Variable reading and writing problems; buccofacial apraxia in most
Anomic Aphasia: (Fluent)
Caused by lesions in different regions. Controversial. Most language features, except naming, are relatively unimpaired
Anomic Aphasia: (Fluent): characteristics
Pervasive word finding difficulty, however pointing is unimpaired; Generally fluent speech; Normal syntax; Empty speech; Verbal paraphasia (word substitutions); Circumlocution; Good auditory comprehension of spoken language; Intact repetition; v; Normal oral reading and good reading comprehension; Normal writing skills
Subcortical Aphasia: (Fluent)
Caused by cortical or subcortical damage. Lesions in areas surrounding the basal ganglia and the thalamus have been linked to subcortical aphasia
Treatment of Auditory Comprehension
Comprehension of single words, spoken sentences, and discourse comprehension
Treatment of Verbal Expressing: Naming
Skills are expanded into longer and grammatically more correct and communicatively more functional utterances. Select words that are client specific and word that are functional
Treatment of Verbal Expressing: Naming Types
Modeling of responses ; Incomplete sentences; Phonetic cues; Syllablic cues; Personalized verbal cues; Functional descriptions of objects; Descriptions and demonstrations of actions; Patient’s description as stimulus for naming; Patient’s description of function as stimulus for naming; Paired objects with their printed name; Patient’s spelling and writing as stimulus; Associated sounds as stimulus; Synonyms
Treatment of Verbal Expression: Expanded Utterances
Systematically increasing the length and complexity of target responses; May use names, action-filled pictures and stories, and description of daily activities
Treatment of Reading Skills
Survival reading skills; reading newspaper, books and letters; reading and comprenhension of printed words; reading and comprehension of phrases and sentences; reading and comprehension of paragraphs and extended materials
Treatment of Writing Skills
Writing functional words and lists; writing short notes, reminders, addresses, and filling out forms; writing letters; pointing to printed words, names and phrases; saying printed words shown; tracing printing words; copying printed words and phrases; spelling words correctly; spontaneously writing
Alexia
The loss of previously aquired reading skills due to brain damage
Dyslexia
A difficulty in learning to read, genetically based on manifested in childhood
Agraphia
The loss or impairment or normally acquiring writing skills
Agnosia
The impairment understanding the meaning of certain stimuli even though there is no peripheral sensory system. Impairment of: auditory, auditory verbal, visual, tactile
Apraxia of Speech (AOS)
A neurological speech disorder characterized by senorimotor problems in positioning and sequentially moving muscles for the volitional production of speech. A disorder of volitional movement in the absence of muscle weakness, paralysis, or fatigue
Apraxia of Speech (AOS) characteristics
Difficulty executing volitional movements involved in speech. Coexistence of apraxia and aphasia (especially Broca’s) is common
Nonverbal oral apraxia
A disorder of nonverbal movement involving the oral muscles. AOS is frequently associated with nonverbal oral apraxia
Neuropathology of AOS
Caused by injury or damage to speech-motor programming areas in the dominant hemisphere; such areas as Broca’s and supplementary motor areas often are involved
Neuropathology of AOS characteristics
"Vascular lesions that cause strokes; Frontal and parietal lesion (temporal occasionally in combo with others); Degenerative neural diseases (Alzheimer’s disease, MS & Primary
General Symptoms of AOS
Impaired oral sensation in some patients; When dysarthria coexists, there’s facial and lingual weakness; May have limb apraxia
Communicative Deficits with AOS
Independent problem of auditory processing deficits; General awareness of their speech problems; Use compensatory strategy of reduced rate
Speech programming and production errors are the dominant features associated with AOS
"Problems with volitional or spontaneous sequencing of movements for speech with relative unaffected automatic speech; High variability of speech errors; Speech sound substitutions (more common), distortions, and omissions of speech sounds; voicing errors may be frequent, especially thesubstitution of a voiceless phoneme for a voiced (ie. pet for bet); More profound difficulty with consonants than vowels; Anticipatory substitutions (ie. lelo for yellow); Postpositioing errors (ie dred for dress); Metathetic errors (ie. tefalone for telephone); Insertion of schwa; Increased errors on longer words; Groping and struggling; Greater difficulty with initial sound in some cases; Easier automatic productions; Attempts self-corrects, often unsuccessful
Prosodic problems that include associated with AOS
Slow rate of speech; Silent pauses; Impaired intonation; Fluency problems
Treatment for AOS
Automatic speech to less automatic to spontaneous speech; Simpler productions before more complex; Articulatory accuracy, slower rate, systematic practice, gradual increase in rate, and normal prosody; Concerned with speech movement as opposed to non-speech movements; Practice with sounds and sound combinations; Treatment procedures should include instructions, demonstration, modeling, shaping, phonetic placement, frequent cuing, use of rhythm, and immediate positive or corrective feedback; Cuing for placement of articulators, simultaneous production with clinician, clinician’s modeling followed by imitation, delayed imitation, and so on; Cues faded to promote more spontaneous speech; Pushing on abdomen to achieve vocal fold closure; Emphasis on total communication (speech, gestures, writing); Teaching accurate sound production in conversation is important; Increasing speech rate to normal is important ; Teaching self-monitoring skills is important for maintenance; Techniques for treating articulation and phonological disorders; For severe apraxia, caretakers and family should speak slower, use shorter sentences, reduce background noise, talk when client is focused, and use total communication
DYSARTHIAS definition
Neurologically based speech disorders resulting from impaired muscular control of the speech mechanism, involving peripheral or central nervous system damage. Muscle weakness, spasticity, incoordination, rigidity, and movement disorders
Dysarthria: characteristics
Degenerative neurological diseases (Parkison’s, ALS, MS, Huntington’s); Nonprogressive neurological conditions (CP, toxic effects -drugs/alcohol); Lesion Sites include lower motor neuron, unilateral or bilateral upper motor neuron, cerebellum, and the basal ganglia (extrapyramidal system.)
Communicative Disorders with Dysarthria:
Respiratory: forced inspirations/expirations that interrupt speech, audible or breathy inspiration, grunting at the end of expiration; Phonatory: pitch disorders, loudness disorders, vocal-quality problems; Articulation: imprecise consonants, prolongations, repetitions, irregular breakdowns, distortion of vowels, and weak production of pressure consonants; Prosodic: rate problems, shorter phrases, stress problems, inappropriate pauses, short rushes of speech; Resonance: hyper/hyponasality, and nasal emission
Communicative Disorders with Dysarthria: Other Irregularities
Other: irregular DDKs, palilalia (compulsive repetition of one’s utterances with increasing rate and decreasing loudness), decreased intelligibility of speech
Ataxic Dysarthria
Results from damage to the cerebellar system
Ataxic Dysarthria Characteristics
Characterized predominately by articulatory and prosodic problems; Gait disturbances; Movement disorders; Articulation disorders; Prosodic disorders; Phonatory disorders
Flaccid Dysarthria
Results form damage to the motor units of cranial or spinal nerves that supply muscles (lower motor neuron involvement)
Flaccid Dysarthria Characteristics
"Muscular disorders; Fasciculations (Isolated twitches of resting muscles) and fibrillations
Hyperkinetic Dysarthria
Results from damage to the basal ganglia (extrapyramidal system); Involuntary movement and variable muscle tone. Prosodic disturbances are dominant
Hyperkinetic Dysarthria characteristics
"Movement disorders; Myoclonus (involuntary jerks of the body), ticks, tremors, contractions,
Hypokinetic Dysarthria
Results from damage to the basal ganglia (extrapyramidal system.) (With Parkinson’s 50% of time.)
Hypokinetic Dysarthria Characteristics
Tremors; Mask-like face; Micrographic writing (small); Walking disorders; Postural disorders; decreased swallowing and drooling ; Phonatory disorders; Prosodic, Articulation, and Respiratory disorders
Mixed Dysarthria
Combination of two or more pure dysarthrias. All combinations are possible but two most common are flaccid-spastic and ataxia-spastic.
Spastic Dysarthria
Results from bilateral damage to the upper motor neurons (direct and indirect motor pathways). Lesions in multiple areas, including the cortical areas, basal ganglia, internal capsule, pons, and medulla
Spastic Dysarthria Characteristics
Spasticity and weakness; Movement disorders; Hyperactive gag reflex; Hyperadduction of vocal folds, inadequate closure of velopharyngeal port; Prosodic disorders; Articulation disorders; Phonatory disorders
Unilateral Upper Motor Neuron Dysarthria
Results from damage to the upper motor neurons that supply cranial and spinal nerves involved in speech
Unilateral Upper Motor Neuron Dysarthria characteristics
Unilateral lower face weakness; Articulation disorders; Phonatory disorders; Prosodic disorders; Resonance disorders; Dysphagia, aphasia, apraxia, and right hemisphere syndrome
Treatment for Dysarthria
Treatment goals include modification of respiratory, phonatory, articulatory, resonatory, and prosodic problems and increasing the efficiently, effectiveness, and naturalness of communication; Teaching self-correction, self-evaluation, and self-monitoring skills; Teaching compensatory skills and AAC; Treatment procedures include intensive, systematic, and excessive drill, instruction, demonstration, modeling and imitation, shaping, prompting, fading, and differential reinforcement
Dementia
An acquired neurological syndrome associated with persistent or progressive deterioration in intellectual functions, language, memory, emotion, and personality
Dementia associated characteristics
Related to Wernicke-Korsakoff Syndrome caused by prolonged alcohol abuse; Typically progressive, but is reversible in 20% of cases; Reversible dementia is a temporary intellectual impairment du to such factors as metabolic disturbances, nutritional deficiencies, chronic renal failure, persistent anemia, drug toxicity, and lung and heart diseases; Controversially classified as cortical, subcortical, or mixed
Dementia of the Alzheimer Type
a form of cortical dementia. Intellectual and language deterioration preceded motor deficits. In subcortical forms, motor deficits precede intellectual deterioration; Onset in 70s and 80s, with more women than men
Dementia of the Alzheimer Type: Familiar history with Down syndrome and brain injury. Genetic inheritance
Neurofibrillary tangles; Neuritic plaques; Neuronal loss; Neurochemical changes
Dementia of the Alzheimer Type: Early symptoms: (Most are subtle)
Memory problems; poor reasoning and judgment; behavior changes; depression, disorientation, language changes
Dementia of the Alzheimer Type: Later Stage Symptoms
Intensified early-stage symptoms; Problems recalling recent and remote events; Visuospacial problems; Intellectual deterioration; Hyperacticity, restlessness, agitation, meaningless handling of objects; Disorientation, wandering; Problems with self care; Difficulty managing routines; Lack of effect, tact and judgment ; Loss of initiative, indifference; Paranoid delusions and hallucinations; aggressive and disruptive behaviors; inappropriate humor and laughter; Seizures, jerks and physical deterioration in later stages
Dementia of the Alzheimer Type: Language Problems
"Naming problems and circumlocution; Comprehending abstract meanings; Impaired picture description; Echolalia; Empty speech, jargon, and hyperfluency; Incoherent, slurred, and rapid speech; Pragmatic language problems; Reading and writing problems; In final stages, no meaningful speech, mutism, and complete
Frontotemporal Dementia (Including Picks Disease)
A group of heterogeneous diseases including Pick’s disease.
Dementia Associated with Parkinson’s Disease
Subcortical, motor symptoms precede intellectual deterioration; 35-55% of Parkinson patients have dementia; More common in males than females
Dementia Associated with Huntington’s Disease
Subcortical; Onset is 35-40; Mutation on the short are of chromosome 4
Infectious Dementia
Can be due to HIV or Jackob-Creuzfeldt disease
Other Forms of Dementia
Vascular dementia; Dementia associated with multiple cerebrovascular accidents (strokes); Dementia associated with TBI
Clinical Management of Dementia
Help client manage their daily routines and family cope; In early stages, communication, memory, and behavioral management are targeted; Family members and caregivers need counseling and support
Right Hemisphere Syndrome (Brain Damage)
Left hemisphere specializes in language, the right specializes/controls: Visual perception, geometric and spacial information; Facial recognition, drawing and coping; Arousal, attention and orientation; Emotional experience and expression; Perception of musical harmony; Certain prosodic features of communication
Right Hemisphere Syndrome (Brain Damage) Characteristics
Functions are more diffusely organized than the left hemisphere; Posterior lesions don’t produce motor problems whereas frontal lobe injuries do
Right Hemisphere Syndrome Symptoms: 1. Perceptual and attentional deficits
Left neglect; Denial of illness; Confabulation regarding disability; Facial recognition deficits; Contructional deficits; Attentional deficits; Disorientation; Visuoperceptual deficits
Right Hemisphere Syndrome Symptoms: 2. Affective deficits
understanding, describing, recognizing emotions of others; Understanding emotional tone and expressing emotion
Right Hemisphere Syndrome Symptoms: 3. Communicative deficits
Prosodic deficits; Impaired discourse and narrative skills; Confabulation and excessive speech; Pragmatic deficits; Difficulty understanding implied, alternate, or abstract meaning
Traumatic Brain Injury
Injury to the brain is sustained by physical trauma or external force. More often men versus women. Caused by car accidents, falls, interpersonal violence, and alcohol and drug abuse
TBI: Penetrating
Open-head injuries, penetrating brain injuries involving a fractures or perforated skull, torn or lacerated meninges, and injury that extends to brain tissue
TBI: Nonpentrating
Closed-head injuries, with no open wound in the head, a damaged brain within the skull, and no penetration of a foreign substance into the brain. Even if the skull is fractured but the meninges are intact, it is nonpenetrating
TBI: Nonpentrating Characteristics
"Acceleration-deceleration; Non-acceleration injuries (head hit by a moving object); Brain injury at point of impact (blow to the head) Coup and contrecoup
Treatment for TBI

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