Day 5 Flashcards
(83 cards)
1
Q
In the 18th century it was
believed that aphasia was caused by a ________________ (Johann Gesner 1738-1801)
A
congestion of the nerve ducts
2
Q
__________ was practiced in the 19th century
A
Phrenology
3
Q
20th century –___________ believed language is localized to specific areas in the brain.
A
localizationists
4
Q
Define: aphasia
A
impairment of language affecting the production or comprehension of speech and the ability to read or write
5
Q
(More, less) people have aphasia than other common conditions, including cerebral palsy, multiple sclerosis, Parkinson’s disease, or muscular
dystrophy.
A
More
6
Q
_________ is a leading cause of long-term disability.
A
Stroke
7
Q
There are at least __________ people in the USA with aphasia.
A
1,000,000
8
Q
2 fathers of aphasia
A
Paul Broca and Carl Wernicke
9
Q
Paul Broca
A
French neurologist who, worked with a patient with limited speech and impaired language due to
brain damage to a specific area. These clinical features are now identified with Broca’s aphasia.
10
Q
Carl Wernicke
A
Such as Broca’s area and Wernicke’s area
11
Q
2 structures in the specific :eloquent cortex”
A
Broca’s area and Wernicke’s area
12
Q
Many now believe (mostly from fMRI and PET data) that language should be viewed as __________. Why?
A
Neural networks. During imaging studies, many areas light up when
performing language tasks
13
Q
White matter pathways carry information to/from ____________.
A
the “eloquent” cortex
14
Q
Cognitive areas impact what 4 cognitive-linguistic functions?
A
attention, memory, impulse control, initiation
15
Q
Blue lobe (largest) at forehead/front region
A
frontal
16
Q
Pink lobe at bottom middle region
A
temporal
17
Q
Green lobe at top middle region
A
parietal
18
Q
Orange/red small lobe in back
A
occipital
19
Q
10 primary structures of the cerebral cortex
A
- Central sulcus (Fissure of Rolando)
- Lateral sulcus (Sylvian fissure)
- Primary Motor cortex • Primary Sensory Cortex • Broca’s area • Wernicke’s area • Supramarginal gyrus • Angular gyrus • Primary visual cortex • Primary auditory cortex
20
Q
Central Sulcus (Fissure of Rolando)
A
divides frontal and parietal lobes.
21
Q
Lateral Sulcus (Sylvian Fissure)
A
divides frontal and temporal
lobes.
22
Q
Primary Motor Cortex- define and location
A
AKA precentral gyrus Sends motor information to contralateral body (in frontal lobe)
23
Q
Primary Sensory Cortex - define and location
A
AKA postcentral gyrus Receives sensory information from contralateral body (in parietal lobe)
24
Q
Broca’s Area- define and location
A
Motor programming for speech production (in frontal lobe)
25
Wernicke's Area- define and location
Comprehension of oral
| language (in temporal lobe)
26
Supramarginal gyrus- define and location
Symbolic integration for writing (in parietal lobe)
27
Angular gyrus- define and location
Symbolic integration for reading (in
| parietal lobe)
28
Primary visual cortex (define and location)
Receives visual information for seeing (in occipital lobe)
29
Primary auditory cortex (define and location)
Receives auditory information for hearing (in temporal lobe)
30
Perisylvian Zone- aka, lesion implications
aka Lateral fissure, lesions in this area can result in language disturbances
31
Largest cortical vascular territory- most important implications for speech/language
Middle cerebral artery
32
Wernicke-Geschwind process of reading aloud
Primary visual cortex --> angular gyrus --> Wernicke's area --> Broca's area --> Primary motor cortex
33
Wernicke-Geschwind process of Verbal repetition
Primary auditory cortex --> Wernicke's area --> Broca's Area --> Primary motor cortex
34
What stroke location/cerebrovascular artery has most implies aphasia
Left hemisphere, MCA
35
Define: White matter
bundles of myelinated axons that are interconnected
36
Define: Arcuate fasciculus
white matter pathway that connects Broca and Wernicke's areas
37
Clinical features of Broca's aphasia
Relatively good auditory comprehension ▫ Nonfluent speech with short sentence length ▫ Increased effort in speaking ▫ Agrammatism (lack of “little words”) ▫ Poor repetition and naming
38
Neurological location often associated with Broca's aphasia
Broca’s area AND surrounding white/gray matter
39
Clinical features of Wernicke's aphasia
Poor auditory comprehension ▫ Fluent speech/normal sentence length ▫ Lack of meaning in speech ▫ Paraphasias (jargon) ▫ Poor repetition and naming
40
Neurological location often associated with Wernicke's aphasia
Wernicke's area in the temporal lobe
41
Clinical features of global aphasia
▫ Poor auditory comprehension ▫ Nonfluent/limited speech
▫ Poor naming and repetition
▫ Comprehension of pictures and gestures are typically better than auditory comprehension
42
Neurological location often associated with global aphasia
Larger area of damage including both Broca and Wernicke areas
43
Which types of aphasia have poor auditory comprehension?
Wernicke's and Global
44
Which types of aphasia have non-fluent speech?
Broca's and Global
45
Commonality between Global, Wernicke, and Broca
Poor naming and repetition
46
Which type of aphasia involves more awareness of their deficits?
Broca's aphasia
47
Which type of aphasia is the most severe in characteristics and implications?
Global aphasia
48
Are lesion sizes/locations variable between patients?
YES!
49
Define: Conduction aphasia
repetition is primary impairment
50
Define: transcortical aphasia
repetition is intact
51
Define: subcortical aphasia
damage is in subcortical structures such as thalamus, internal capsule, basal ganglia
52
Define: crossed aphasia
Right handed with right hemisphere stroke
| resulting in aphasia
53
Define: primary progressive aphasia
Focal dementia impacting language functions first
54
2 important aphasia clinical resources
Aphasia simulation, ASHA practice portal
55
Movement over the past decade to focus on the ______, or _____ model.
Person, social.
56
4 considerations of social model
Life participation is the ultimate goal
▫ Important to assure treatment generalizes to real life
▫ Social supports are important
▫ Communication partner training is included in treatment
57
6 communication tips for clinicians
• Minimize background noise when speaking • Make sure you have the person’s full attention
before you start
• Get on the person’s level and communicate face to face
• Acknowledge that this person is smart and has something to contribute to the conversation
• Speak slower but in a natural way
• Give the person time to speak
58
4 cognitive constructs
speed of processing, memory, executive functions, attention
59
2 types of memory- define each
```
Episodic memory (long-term, autobiographical)
Working memory (simultaneous storage and manipulation)
```
60
3 types of executive functions
Resistance to interference, Inhibition of distractions
Manipulating information, Planning & strategizing
Multi-‐tasking
61
2 types of attention- define
Sustained- focus on one activity for a long period of time
| Selective- ability to focus on one thing when other distractions are present
62
Impacts of speed and memory on assessment and treatment
Introduce yourself and tell them why you are there every single time. make a lot of lists, be direct of split into 2 sentences
63
Function of hippocampus
central switchboard where all aspects (taste, smell, sight, sounds, etc). come together and are integrated into one mental representation.
64
Speed relationship with pathology and age
Speed much worse with pathology and worse with age
65
Episodic memory- details vs. larger picture, locations that cause worse damage to episodic memory
Gist memory is good, details may be hazy
| – VERY impaired if damage to hippocampus or white matter leading to hippocampus
66
Working memory- aging, locations that cause worse damage to working memory
Somewhat limited in healthy aging – Even worse if significant frontal lobe damage
67
Executive function- aging, locations that cause worse damage to executive function
Somewhat impaired in aging
• Active inhibition of distractions
• Multi-‐tasking • Much worse with frontal & parietal lobe damage
– Mostly intact in aging: Planning & strategizing, understanding cause & effect
68
2 other disorders that cause impaired executive function in at least some patients- explain
ALL get impaired with TBI
• Diffuse damage to white matter, especially connections within frontal lobe and to/from frontal lobe
– Impaired in dementia (but different types of dementia will affect different abilities at different times)
69
Attention relies on integrity of _______________ that go from frontal lobes to parietal lobes to basal ganglia
(bidirectionally)
large cortical networks (loops)
70
Aging has minor effects on sustained attention, but may impact __________ a bit more . Why?
selective attention. Related to inhibition, but inhibition is active suppression of distraction, selective attention is more basic FOCUSing ability.
71
Attention is Seriously impaired in ______, with any kind of _______ or ________ damage.
TBI, frontal lobe or basal ganglia
72
Impacts of attention on assessment and treatment
Make sure TV is off and no other distractions before you ask them to concentrate. Make a lot of lists. Shorter more varied assessment. More frequent breaks. Positive reinforcement. Physical activity.
73
3 mitigating factors
education, pain and infection, sensory impairment
74
Education effects, considerations
Education & learning experiences build neural connections, give a buffer so that normal function can be maintained .
• Every day performance used to be much higher, but can still perform “within normal limits” even with age-‐related changes • Greater education has been found to predict better recovery (and sometimes amount of functional deficits) in some studies.
Hard to see if highly educated have memory issues because were so incredibly well-performing before that they still may perform normally on memory tests.
75
Pain and infection effects
Can magnify apparent cognitive impairment. – Normal function returns when condition is resolved
76
Visual impairment effects, considerations, solutions
Considerations: glass, macular degeneration; do as many auditory tasks as possible, has effects on written or picture-based assessment
77
Define- cognitive reserve
how much more you have beyond the required functioning for everyday tasks
78
Hearing impairment effects, considerations, solutions
Hearing aids on, and batteries properly installed/functioning? Use written or picture based communication.
79
Hypothesis about visual and hearing impairments
Long-term uncorrected visual and hearing impairments may have effects on cognition- less input to that cortex, those parts of the brain get taken over by other functions
80
6 parts of a bedside exam or general assessment
```
Introductions
Item naming
Orientation questions
Multi-‐step Commands
Oral-‐Mech exam
Swallowing Exam
```
81
10 primary considerations in thinking about changes in neural bases of communication throughout the lifespan
* Speed of processing • Episodic memory
* Working Memory • Inhibition • Multi-‐‐tasking • Attention • Education
* Pain • Visual impairment • Hearing impairment
82
6 populations that demonstrate possible cognitive impairment as compared to normal adults
```
Mild Cognitive Impairment
Alzheimer & other dementias
Parkinson’s disease
Following Stroke
Young Adult with TBI
Children
```
83
6 things that individual differences in cognitive abilities and history
(education, sensory impairments, pain levels) can impact
Cognition at assessment
Ability to understand instructions Response to treatment
Probability of completing “homework” Expectations of improvement
Awareness of their own deficits
