Day 4 - Aphasia, Neglect, Apraxia, Dysphagia

Question 1

Define aphasia

Answer 1

Aphasia is inability to communicate. It affects all aspects of language: speaking, gesturing reading, writing, and understanding language.

Question 2

Bedside Aphasia Assessment

Answer 2

1. Does the patient understand? Say a command.
2. Is the patient able to talk?
3. Can the patient repeat?
4. Can the patient read?
5. Can the patient write?

DeLisa Chapter 44

Question 3

Paraphasias - Anomia - Echolalia

Answer 3

Paraphasias: Incorrect substitution of words or parts of words

Echolalia: Repetition (“echoing”) of words or vocalizations made by another person

Anomia: Difficulty recalling words; word-finding difficulty

Question 4

List 4 FLUENT APHASIA

Answer 4

1. Transcortical sensory
2. Wernicke’s
3. Conduction
4. Anomia

Question 5

List 4 NONFLUENT APHASIA

Answer 5

1. Broca’s
2. Transcortical motor
3. Global
4. Mixed transcortical

Question 6

Types of aphasia 🔑

Answer 6

1. Broca’s
2. Transcortical motor
3. Global
4. Mixed transcortical

Question 7

List 4 Non-Pharmacological Interventions for Aphasia

Answer 7

1. Speech Language Therapy
2. Computer-Based Treatment
3. Training Conversation / Communication Partners
4. Group Therapy

Question 8

List 4 types of dysarthria 🔑

Answer 8

Pyramidal

• UMN → SPASTIC (eg pseudobulbar palsy).
• LMN → FLACCID (eg bulbar palsy).
• MIXED (eg ALS, MS, Wilsons disease).

ExtraPyramidal

HYPOKINETIC: extra-pyramidal (eg. Parkinsonism).

HYPERKINETIC: Extra-pyramidal (basal ganglia).

a. Quick: chorea, myoclonus, tourettes.
b. Slow: athetosis, dyskinesias, dystonia.
c. Tremors: organic voice tremor.

Cerebellum

• ATAXIC: cerebellum (eg. Cerebellar ataxia).

Delisa Table 15.1

Question 9

Wernicke’s aphasia

Answer 9

Question 10

Broca’s aphasia

Answer 10

Question 11

Global aphasia

Answer 11

Question 12

Anomic aphasia

Answer 12

Question 13

Conduction aphasia

Answer 13

Question 14

Transcortical sensory aphasia

Answer 14

Question 15

Transcortical motor aphasia

Answer 15

Question 16

Why is Left Sided Neglect More Common than Right Sided Neglect? 🔑

Answer 16

Neuroanatomical findings have identified that the left hemisphere is responsible for modulating arousal and attention for the right visual field, whereas the right hemisphere controls these processes in both right and left visual fields.

This may explain why unilateral spatial neglect is not typical for those with left hemisphere damage (LHD) post-stroke because the intact right hemisphere is capable of compensating for perceptual deficits that result from LHD

Question 17

Types of Unilateral Spatial Neglect 🔑

Answer 17

a) Egocentric neglect أناني يشوف بصوب واحد

Neglect of the body or personal space, tendency to neglect the opposite side of the lesion, in reference to the midline the body.

b) Allocentric neglect لا مركزي

• Peripersonal space refers to space within the patient’s normal reach.
• Extrapersonal refers to object /environment beyond the patient’s normal reach.

Stroke Rehabilitation Clinician Handbook

Question 18

Anosognosia

Answer 18

Anosognosia, also called “lack of insight”: unaware of their own mental health condition or that they can’t perceive their condition accurately.

Question 19

List 2 tests for neglect 🔑

Answer 19

1. Object Cancelation
2. Line Crossing
3. Clock drawing
4. Scene Copy

Question 20

List 4 Compensatory Approach for Unilateral neglect? 🔑

Answer 20

1. Prisms adaptation
2. Limb activation therapy
3. Trunk rotation
4. Eyepatching and Hemispatial Glasses
5. Feedback training
6. Neck muscle vibration

Question 21

List 3 Treatments in Unilateral Spatial Neglect

Answer 21

Think of adding stimulation to the brain via:

1. Visual Scanning
2. Computer-Based Scanning in Neglect
3. Virtual Reality Therapy for Neglect

Stroke Rehabilitation Clinician Handbook

Question 22

Definition of apraxia 🔑

Answer 22

Disorder of voluntary movement execution:

Patient cannot execute purposeful activity

Despite the presence of adequate mobility, strength, sensation, co-ordination and comprehension.

Question 23

Constructional & Dressing apraxia: definition and site of lesion.🔑

Answer 23

Constructional Apraxia

• Inability or difficulty to build, assemble, or draw objects.
• Either parietal lobe, right > left

Dressing Apraxia

• Inability to dress oneself despite adequate motor ability.
• Either hemisphere, right > left

Stroke Rehabilitation Clinician Handbook

Question 24

List 4 Signs and Symptoms of Dysphagia 🔑

Answer 24

Dysphagia is the medical term for swallowing difficulties:

1. Slow effortful eating
2. Drooling
3. Pocketing
4. Chocking
5. Coughing after meal
6. Food and liquid avoidance

Question 25

List 2 Complications of Dysphagia 🔑

Answer 25

* Dehydration * Malnutrition

Question 26

Phases of swallowing & problem seen with each phase 🔑

Answer 26

1. Oral Preparatory Phase → Drooling and pocketing 2. Oral Propulsive Phase → Drooling and pocketing 3. Pharyngeal Phase → Aspiration 4. Esophageal Phase → heartburn and food sticking

Question 27

List 2 clinical screening tests for dysphagia 🔑

Answer 27

1. Impaired pharyngeal sensation 2. Failure on 50 ml water test

Question 28

List 3 diagnostic tools for dysphagia

Answer 28

1. Bedside swallowing evaluation 2. Videofluorographic swallowing evaluation (VFSS)/Modified barium swallow (MBS) 3. Fiberoptic endoscopic evaluation of swallowing (FEES)

Question 29

List 4 Indication for VMBS Studies 🔑

Answer 29

1. Brainstem stroke. 2. Obvious signs of choking or wet, hoarse voice after drinking. 3. Problems maintaining adequate nutrition and hydration. (malnutrition) 4. Recurrent respiratory infections. 5. Follow-up of previous positive VMBS study

Question 30

Define Penetration vs Aspiration 🔑

Answer 30

Penetration Entry of material into the larynx but not below the true vocal cords. Aspiration Entry of material into airway below level of true vocal cords

Question 31

Predictors of aspiration on "bedside swallowing exam"

Answer 31

1. Abnormal gag reflex 2. Cough after swallow 3. Dysphonia 4. Voice change after swallow (wet voice)

Question 32

Risk factors for development of aspiration pneumonia.

Answer 32

Think of bed ridden patient on multi devices and tissue under his chin: 1. Decreased level of consciousness 2. Tracheostomy 3. Emesis 4. Reflux 5. Nasogastric tube (NGT) feeding 6. Dysphagia

Question 33

Risk Factors Associated with Aspiration Difficulties Post-Stroke

Answer 33

1. Brainstem stroke. 2. Poor oral hygiene. 3. Difficulty swallowing oral secretions. 4. Coughing/throat clearing, choking or wet gurgly voice quality after swallowing water. 5. Weak voice and cough. 6. Immunologically compromised or chronic lung disease. 7. Recurrent lower respiratory infections. 8. Aspiration or pharyngeal delay on VMBS. Stroke Rehabilitation Clinician Handbook

Question 34

List 6 Compensatory Strategies.

Answer 34

1. Chin tuck 2. Chin up 3. Head rotation 4. Head tilt 5. Supraglottic swallow 6. Super supraglottic swallow 7. Mendelsohn maneuver

Question 35

List 6 Low-Risk Feeding Strategies

Answer 35

1. Make sure its the correct type of food 2. Minimize distractions 3. Bed at 90 degrees, neck slightly flexed 4. Mouth care before eating to remove bacteria 5. Use metal teaspoons, do not use plastic! 6. Slow rate of feeding 7. Make sure to fully swallow the bolus 8. Preform mouth care and remove all food debris 9. Observe for 30mins to check for any signs and symptoms 10. Keep him upright to clear esophagus and reduce reflux 11. Document his food and liquid intake also if any issue raises

Question 36

Complications of Malnutrition Post-Stroke 🔑

Answer 36

1. Decreased response to physiotherapy. (Low therapy adherence) 2. Increased length of stay. (Always on bed, now he developed bed sore) 3. Greater risk of bedsores and UTIs. 4. Lower Barthel Index scores at 1-4 months. (Poor outcome)

Question 37

How to tell patient is underweight? Malnourished? 🔑

Answer 37

Body Mass Index (BMI) value less than 18.5 is considered to be underweight.

Question 38

Assessment of Swallowing Post Stroke at Time of Admission.

Answer 38