Neuro/Adult Disorders
Terms
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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