Final Exam Study Guide Flashcards

Question

What do ischemic strokes generally result from?

Answer 1

a thrombus or embolism

Answer 2

A collection of fat and blood from the diseased artery that narrows it and blocks the flow of blood going to the brain, causing ischemia. A thrombus is stationary.

Answer 3

A blood clot containing arterial debris that travels to a smaller artery and “gets stuck”. The blood flow to that area of the brain is now blocked, causing ischemia.

Answer 4

Hemorrhagic events comprise 20% of strokes and are identified by location and subtype Approximately 20% of all strokes are hemorrhagic. The mortality rate for this type is about 50% if you survive, better outcomes

Answer 5

Intracerebral hemorrhage: deep hypertensive hemorrhage and lobar hemorrhage Extra-cerebral hemorrhage: subarachnoid hemorrhage and other hemorrhages that do NOT occur within the cerebrum, but within the skull.

Answer 6

A blood vessel bursts in the brain causing blood to enter the surrounding tissue. It can be caused by brain herniation, massive edema, use of cocaine or other illicit drugs. It is often due to aneurysms, leukemia, clotting deficiency, diet pills, and brain tumors. If hemorrhage is larger than 3cm, surgery is typically performed to evacuate the hematoma. The majority are due to a ruptured congenital berry aneurysm. Subarachnoid hemorrhage occurs more often in women 50-60 years old.

Answer 7

Assesses the linguistic skills most frequently affected by aphasia, in addition to key nonlinguistic skills, and provides differential diagnosis information Employs a taxonomic (categorical) approach to classification— Pts are assigned to diagnostic categories according to their scores on language subtests The WAB was designed to provide a means of evaluating the major clinical aspects of language function: content, fluency, auditory comprehension, repetition and naming plus reading, writing and calculation ``` Criterion cut scores: Aphasia Quotient Cortical Quotient Auditory Comprehension Quotient Oral Expression Quotient Reading Quotient Writing Quotient Bedside WAB–R scores ``` ``` Two main scores: Aphasia Quotient (AQ) score and Cortical Quotient (CQ) score ``` AQ can essentially be thought of as a measure of language ability, whilst CQ is a more general measure of intellectual ability and includes all the subscales One apraxia (not AOS) subtest Yields aphasia syndrome type

Answer 8

Used to assess verbal fluency--production of individual words under restricting search conditions Client names as many words as they can that start with F, A, and S in 1 minute (1 min per letter) The score is the sum of all admissible words for the three letters (proper nouns, wrong words, variations, and repetitions are not counted as correct)

Answer 9

The book club program was initially developed by Berstein-Ellis and Elman at the Aphasia Center of California (ACC) in 1999 in Oakland, CA. The purpose of Aphasia Book Clubs is to enhance one’s quality of life through social interaction and life participation. In 2004 the ACC received funding to replicate their program at four sites in North America. The Aphasia Center of California’s mission is to combine community service, student training and research, centered around individuals living with Aphasia

Answer 10

Community need After a stroke, people continue to improve over a period of time (years). This can be a slow process for both the patient and the family. Individuals living with Aphasia need to learn compensatory strategies for communicating. Most inpatient rehabilitation is limited to 16-24 days! Outpatient rehabilitation is often only 3-6 months, depending on insurance. Persons with aphasia, their families, and clinicians are searching for low-cost options in the community that are readily accessible to them!

Answer 11

Groups promote interaction and variety of communicative functions or speech acts Groups provide opportunity for wider array of partners = more generalization Groups promote language improvisation Groups improve psychosocial functioning – Benefit of Community Groups are cost effective

Answer 12

Increase pause time/decrease interruptions Do not request known information or ask ‘performance’ questions (e.g., “What’s my name,” or “Tell Mary my name.”) Utilize gestures, writing, and drawing to facilitate successful communication Use what works best for each individual (e.g., the mini whiteboard) Acknowledge that the person knows what he or she wants to say Rephrase or expand what the person has communicated Be patient, and verify topic Acknowledge communication breakdowns (e.g., “That’s not what you meant?”)

Answer 13

Proxemics! Create a seating chart that strategically arranges book club members and volunteers for maximum ease of communication Name tags Start each session by “checking in” with members by reviewing last week’s discussion and taking time for questions Priority: “Does anyone want to start us off today by telling us about something you found especially interesting in this week’s reading?” Based our discussion points off of the chapter highlights PowerPoints or “learning modules” focus on some specifics of the chapter as well as topics that were related to the chapter more broadly As volunteers and facilitators, try to avoid taking on the role of the classroom teacher Weekly worksheets to facilitate understanding: Worksheets completed at home Choose from worksheet A, B, or C (or all three) depending on the level of difficulty the book club member feels comfortable with Always look for communication opportunities between members; try to get members talking to each other “Word of the Day”

Answer 14

Level I-no response: total assistance Level II-Generalized response: total assistance Level III-Localized response: total assistance Level IV-Confused/Agitated: Maximal assistance Level V-confused, inapprpriate, non-agitated: Maximal Assistance Level VI- Confused, Appropriate: Moderate Assistance Level VII- Automatic, Appropriate: Minimal Assistance for Daily Living Skills Level VIII- Purposeful, Appropriate: Stand-By Assistance Level IX- Purposeful, Appropriate: Stand-By Assistance on Request Level X- Purposeful, Appropriate: Modified Independent

Answer 15

Complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive, vestibular or painful stimuli.

Answer 16

Demonstrates generalized reflex response to painful stimuli. Responds to repeated auditory stimuli with increased or decreased activity. Responds to external stimuli with physiological changes generalized, gross body movement and/or not purposeful vocalization. Responses noted above may be same regardless of type and location of stimulation. Responses may be significantly delayed.

Answer 17

Demonstrates withdrawal or vocalization to painful stimuli. Turns toward or away from auditory stimuli. Blinks when strong light crosses visual field. Follows moving object passed within visual field. Responds to discomfort by pulling tubes or restraints. Responds inconsistently to simple commands. Responses directly related to type of stimulus. May respond to some persons (especially family and friends) but not to others.

Answer 18

Alert and in heightened state of activity. Purposeful attempts to remove restraints or tubes or crawl out of bed. May perform motor activities such as sitting, reaching and walking but without any apparent purpose or upon another's request. Very brief and usually non-purposeful moments of sustained alternatives and divided attention. Absent short-term memory. May cry out or scream out of proportion to stimulus even after its removal. May exhibit aggressive or flight behavior. Mood may swing from euphoric to hostile with no apparent relationship to environmental events. Unable to cooperate with treatment efforts. Verbalizations are frequently incoherent and/or inappropriate to activity or environment.

Answer 19

Alert, not agitated but may wander randomly or with a vague intention of going home. May become agitated in reponse to external stimulation, and/or lack of environmental structure. Not oriented to person, place or time. Frequent brief periods, non-purposeful sustained attention. Severely impaired recent memory, with confusion of past and present in reaction to ongoing activity. Absent goal directed, problem solving, self-monitoring behavior. Often demonstrates inappropriate use of objects without external direction. May be able to perform previously learned tasks when structured and cues provided. Unable to learn new information. Able to respond appropriately to simple commands fairly consistently with external structures and cues. Responses to simple commands without external structure are random and nonpurposeful in relation to command.

Answer 20

Constraint Induced Language Therapy (CILT) aka Constraint Induced Aphasia Therapy (CIAT) CILT was developed for patients with chronic, stroke-induced Aphasia. It was developed in 2001 from the physical therapy technique of Constraint Induced Movement Therapy. This is where the patient, who tends to overuse their “good arm” due to a hemi, have their “good arm” tied to their body for 90% of the day, to prevent use of it. Therapy is intensive, but much research has shown that it is effective. This concept was taken and employed using a language perspective

Answer 21

Constraint: ONLY VERBAL communication is allowed. NO compensatory nonverbal communication strategies may be used. Forced Use: you MUST communicate by only talking Massed Practice: Therapy occurs 2-4 hours per day

Answer 22

Therapy basically looks like a modified version of Go Fish

Answer 23

SRT is a memory training procedure in which participants are trained to perform newly taught procedures, recognize newly taught stimuli, or remember to do something at a designated time, with gradually increasing time intervals between training and performance. Forms of Spaced Retrieval Include: Semantic memory (remembering facts, names of people, objects, etc…) Procedural memory (remembering to perform some action--e.g., getting out of a chair, swallowing techniques) Prospective memory (remembering future appointments, activities, or tasks) Recent episodic memory (remembering recent personal events--e.g., one’s birthday, a dinner party)

Answer 24

to perform SRT several functional targets are selected then one target is focused on at a time until maintenance level is achieved the SLP asks a question to elicit the target if the client answers correctly, increase the time interval and ask the question again. if the answer is incorrect, provide immediate correction and ask the question again at the last correct time interval.

Answer 25

SRT should help a person with dementia recall trained information for up to several months after training. SRT will not improve generalized memory function. Selecting specific and functional targets is key for the client to obtain improved independence.

Answer 26

Pt. will (action) with ___% accuracy with (amount of assistance) by (time frame)

Answer 27

Pt. will copy simple single words (e.g., 3-5 letters), with 80% accuracy with min. assistance.

Answer 28

Pt. will follow simple/basic 2 step commands (e.g., point up, then touch your nose) with 80% accuracy with min. assistance.

Answer 29

Pt. will read at the single/compound sentence level, with 80% accuracy with mod. assistance.

Answer 30

- Given a colored photo, Pt. will match single/simple sentences in a field of 3 (f/3), with 90% accuracy given occasional assistance. - Given a (novel/complex/abstract paragraph), Pt. will answer multiple choice concrete questions from a field of 3, with 90% accuracy, with min. assistance. - Pt. will independently use learned compensatory strategies to engage in two way conversation with an unfamiliar communication partner during six turn-taking events with 80% accuracy with min. assistance. - Using the non-dominant (L) hand, the patient will independently formulate and write at the single/simple sentence level with 90% accuracy with minimal assistance by July 2015.

Answer 31

- Cortical - subcortical - mixed

Answer 32

Changes in cerebral cortex

Answer 33

- Alzheimer's | - PPA (primary progressive aphasia)

Answer 34

- Dementia is a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment. - Consciousness is not clouded. Impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behavior, or motivation. - Dementia produces an appreciable decline in intellectual functioning, and usually some interference with personal activities of daily living, such as washing, dressing, eating, personal hygiene, excretory and toilet activities.

Answer 35

- Memory failure - Disorientation - Lapses in judgment - Difficulty performing activities of daily life - Difficulty performing mentally challenging tasks - Misplacing things - Apathy and loss of initiative - Changes in mood

Answer 36

- fastest growing and most expensive disease - Affects more women than men - 3 microscopic changes in brain neurons: neurofibrillary tangles, neuritic plaques, and granulovaculoar degeneration - Tx: tranquilizers, antidepressants, Cognex and Aricept - 1st symptoms: memory lapses, faulty reasoning, poor judgment, disorientation, mood changes - Language less affected than cognition

Answer 37

- changes in basal ganglia, thalamus, and brain stem - Motor impairments (tremors and gait) - volitional movement impairments - first signs of dementia appear months to year after appearance of motor impairments (as disease progresses) - Cortical function impairments occur in the later stages - Motor impairments are evident in the early stages - Most SDs are delayed consequences of extrapyramidal system disease and reveal volitional movement impairment - Assess and tx for speech impairments - Screen for cognitive involvement & dysphagia

Answer 38

- Parkinson's - Huntington's - Progressive Supranuclear Palsy - AIDS

Answer 39

- Weak voice - Reduced vocal loudness - Speech rate increases/reduced articulation - Rapid, stuttering-like repetitions of syllables, words, and phrases - Micrographia is common - Drooling/swallowing, middle stages - Vocabulary, syntax, and grammar are preserved until late stages - Most individuals die within 15-20 years of onset

Answer 40

- Affects more men than women and appears between 50-65 - Caused by deterioration of dopaminergic neurons in basal ganglia and brain stem - 60% of these neurons are destroyed and 1st symptoms emerge: resting tremor, pill rolling, muscle rigidity, slowness, diff. initiating movement - Primary treatment: levodopa (L-dopa)

Answer 41

- disturbances of movement including muscle rigidity, tremor, slowness/abolition of movements, and loss of balance.

Answer 42

- Dysarthria - Dysphagia - Final stages: Mute, incontinent and profoundly demented

Answer 43

inherited degenerative neurologic disease

Answer 44

There is no cure, only medication to control movement, emotional, and psychological effects Appears between 40-60 years 1st symptom: involuntary movements

Answer 45

Progressive Supranuclear Palsy

Answer 46

- Rare; 1 in 20,000 adults in U.S. - Begins between 50 and 80 - No known tx

Answer 47

Caused by neuronal loss, neuronal abnormalities, and proliferation of glial cells through the brain cell and basal ganglia Progression: Pt loses vertical and lateral eye movements, limbs become stiff and rigid, dysarthria, and dysphagia

Answer 48

- dysarthria, - speech is slow, - repetitions, - reduced vocal loudness, - language remains intact, - mutism is common in very late stages

Answer 49

depression & dementia

Answer 50

Paralysis of muscles responsible for downward gaze, rigidity of neck muscles, facial muscle weakness

Answer 51

- Complex signs/symptoms - Weakens the immune system - AIDS Dementia Complex (HIV encephalopathy) - 70% of persons w/ AIDS develop AIDS dementia complex - Infection causes pathologic changes in subcortical white matter and basal ganglia (eventually reaching the cortex)

Answer 52

extrapyramidal pathology (weakness, slowness, rigidity, dyskinesia) and later symptoms reveal cortical involvement (declined perception, memory, intellect, language)

Answer 53

- early stages may reveal mildly reduced word retrieval, - later speech is dysarthric and labored, - eventually reduced to single words.

Answer 54

- Vascular dementia - Lewy Body Dementia - Frontotemporal dementia (FTD) - Behavioral- variant FTD (bvFTD) - Pick's disease (confirming) - PPA (Primary progressive aphasia)

Answer 55

- Important cause of dementia in adults - 2nd only to AD! - Dx is complicated and controversial - Pure vascular dementia is relatively uncommon; majority have both AD and VD - Most common type: Multi-infarct dementia - Lacunar state - Multiple cortical infarcts - Binswanger’s disease (rare; caused by multiple infarcts in subcortical white matter)

Answer 56

- Usually after 75 years of age - males > females - one of the most common progressive dementias, accounting for 10% yo 15% of all cases, behind Alzheimer’s.

Answer 57

``` - visuospatial abilities language - attention - working memory - executive functions similar to the impairment of person with Alzheimer's dementia, but with memory somewhat better preserved ```

Answer 58

- There are multiple subtypes - Leads to tissue shrinkage and reduced function in the brain's frontal and temporal loves, which control planning and judgement; emotions, speaking and understanding speech; and certain types of movement - FTD was once considered rare, but it's now thought to account for up to 10 to 15 percent of all dementia cases, but less common than Alzheimer's disease, vascular dementia and Lewy body dementia - In those younger than age 65, FTD may account for up to 20 to 50 percent of dementia cases. People usually develop FTD in their 50s or early 60s, making the disorder relatively more common in this younger age group

Answer 59

- Behavioral-variant FTD (bvFTD) - Semantic dementia - Pick's disease - PPA (primary progressive aphasia)

Answer 60

- Hyperoral behaviors include overeating, dietary compulsions, in which the person restricts himself to eating only specific foods (such as a certain flavor of Lifesaver, or eating food only from one fast food restaurant) or attempts to consume inedible objects. Patients may consume excessive amounts of liquids, alcohol and cigarettes. - Stereotyped and/or repetitive behaviors can include re-reading the same book multiple times, hand rubbing and clapping, humming one tune repeatedly or walking to the same location day after day. - Personal hygiene habits deteriorate early in the disease progression, as the person fails to perform everyday tasks of bathing, grooming and appropriate dressing. Hyperactive behavior is exhibited by some patients, and can include agitation, pacing, wandering, outbursts of frustration and aggression. - Hypersexual behavior can range from a preoccupation with sexual jokes to compulsive masturbation. - Impulsive acts can include shoplifting, impulsive buying and grabbing food off another person’s plate.

Answer 61

- Apathy or indifference toward events and the surrounding environment can be marked by reduced initiative, and lack of motivation. - Lack of insight into the person’s own behavior develops early. The patient typically does not recognize the changes in his or her own behaviors, nor do they exhibit awareness or concern for the effect these behaviors have on the people around them, including loved ones. - Emotional blunting develops early in the course of the disorder, and is manifested as a loss of emotional warmth, empathy and sympathy, and development of what appears to be indifference toward other people, including loved ones. - Mood changes can be abrupt and frequent

Answer 62

Symptoms similar to those seen in Parkinson disease. Among bvFTD patients, the term “parkinsonism” is used to distinguish the fact that they do not have Parkinson disease, though they do exhibit some of these symptoms. Symptoms include: decreased facial expression, bradykinesia (slowness of movements), rigidity (resistance to imposed movement) and postural instability

Answer 63

Language difficulty. - due to the disease damaging the left temporal lobe, an area critical for assigning meaning to words. The language deficit is not in producing speech but is a loss of the meaning, or semantics, of words. At first, you might notice someone substituting a word like "thingy" for more unusual words, but eventually a person with SD will lose the meaning of more common words as well. - People speak easily, but their words convey less and less meaning. They tend to use broad general terms, such as "animal" when they mean "cat." Language comprehension also declines

Answer 64

- a rare form of progressive dementia, typically occurring in late middle age and often familial, involving localized atrophy of the brain. - Changes in personality, and emotion are first signs

Answer 65

- a language disorder that involves changes in the ability to speak, read, write and understand what others are saying. It is associated with a disease process that causes atrophy in the frontal and temporal areas of the brain, and is distinct from aphasia resulting from a stroke. - slow, insidious onset - people lose their ability to generate words easily, and their speech becomes halting, "tongue-tied" and ungrammatical. Ability to read and write also may be impaired.

Answer 66

Communication Effectiveness Index

Answer 67

Is a rating protocol for communication partner to respond to. Family members rate their loved ones ability in day-to-day situations- either “not at all able to” or “as able as before stroke”. Assesses severely aphasic adults’ functional communication

Answer 68

- Broca's | - Global

Answer 69

- Anomia - Phrase length: 0-5 words per breath unit - relatively good auditory comp. - relatively poor repetition - agrammatism/telegraphic speech - effortful articulation, disrupted prosody - phonemic paraphasias are common

Answer 70

- Profound anomia - virtually no speech output - very poor auditory comprehension - may have stereotypical utterances (real word or nonsense syllables)

Answer 71

Wernicke's Transcortical sensory Transcortical Motor Conduction Aphasia Anomic Aphasia

Answer 72

Notable anomia poor auditory comprehension Prosody WFL Articulation WFL Phonemic, semantic, neologistic paraphasias empty content may have jargon press of speech/logorrhea

Answer 73

Severe anomia poor auditory comprehension relatively good repetition skills reduced flow of output due to anomia but preserved articulation and prosody preserved grammar empty content (e.g., “thing” for target word) Semantic paraphasias more often than phonemic paraphasias perseveration common

Answer 74

Impaired initiation of verbal output anomia short phrase length good auditory comprehension good repetition in comparison to speech output unable to generate full sentences

Answer 75

Anomia Fluent output with normal average phrase length (e.g., 9 words or more) Speech may contain delays in word finding, self corrections auditory comprehension is good repetition is worse than self-formulated speech

Answer 76

Word finding problems across tasks phrase length could be WNL-but completely empty speech delays for word retrieval auditory comprehension and repetition relatively intact use of nonspecific terms, circumlocutions paraphasias usually of semantic type

Answer 77

language is less affected than cognition, memory, and intellect in early stages

Answer 78

slow, insidious onset Lose ability to generate words easily speech is halting “tongue tied” & ungrammatical ability to read & write also may be impaired

Answer 79

speak easily, but words convey less & less meaning use broad general terms such as “animal” when they mean “cat” language comprehension also declines

Answer 80

weak voice reduced vocal loudness speech rate increases/reduced articulation rapid, stuttering-like repetitions of syllables, words, and phrases micrographia is common drooling/swallowing, middle stages vocabulary, syntax, and grammar are preserved until late stages

Answer 81

Dysarthria Dysphagia Final Stages: Mute & profoundly demented

Answer 82

dysarthria speech is slow repetitions reduced vocal loudness language remains intact mutism is common in very late stages

Answer 83

Early stages may reveal mildly reduced word retrieval late speech is dysarthric and labored eventually reduced to single words

Answer 84

Diminished Speech Prosody - lack normal variability in pitch & loudness - speech sounds monotonous/devoid of emotion - reduced spontaneity & variety in nonverbal movements that typically accompany speech (e.g., head nod/gestures) - slower than normal speech rate - reduced emphatic stress in phrases/sentences - diminished pitch variability (restricted intonations, failure to distinguish between questions/assertions) - Many of the same individuals who fail to communicate emotion via speech prosody also fail to appreciate emotions conveyed by others’ speech prosody and facial expression thereby suggesting an underlying affective impairment Anomalous Content & organization of connected speech -excessive, confabulatory, and sometimes inappropriate -connected speech (assess using narrative production, story retell tasks) connect speech often described as: excessive, rambling, repetitive, irrelevant, tangential, digressive, inefficient -use more words but produce less information - narratives are: fragmented, lack cohesion, overall theme or point, focus on incidental details, fail to establish relationships among events, insert tangential comments, permit personal experiences/opinions to intrude into their narratives Impaired comprehension of narratives & conversations Pragmatic Impairments - turn-taking, topic maintenance, social conventions, and eye contact - may begin/end conversations abruptly - poor at obtaining and/or maintaining eye contact - talk excessively & without regard for their listener - difficulty staying on topic - Interject irrelevant, tangential, and inappropriate comments - Fail to make conversational repairs - insensitive to rules governing conversational turn-taking

Answer 85

Olfactory Smell Assessment: - Ask client if s/he has noticed any change in his/her sense of smell - Clinician: Use soap, coffee, cloves, vanilla - Don’t use a harsh order (e.g., ammonia) as this will stimulate the intranasal pain endings of CN V, rather than assessing CN 1 - Directions: Have the client/patient close both eyes, clinician occludes (“close”) one nostril/nare, and client should gently inhale to smell the scent. - Assess both nares separately.

Answer 86

Optic Nerve Controls central and peripheral vision Assessment: - Test: Visual acuity, color vision, visual fields - Test one eye at a time; if client usually wears glasses then use them - Obtain a reading sample from client/patient (e.g., hospital menu, newspaper) - Ask client to identify colors - Have the client count how many fingers you are holding up—6 inches in front of him/her - Test peripheral vision one eye at a time. - Cover one eye and ask the client to look at your nose - Move your index fingers to check the superior and inferior fields one at a time - Ask the client to note any movement in the peripheral visual fields

Answer 87

Oculomotor Nerve Controls pupillary constriction Eye movement Assessment: - Dim the lights, bring the light of the penlight from the outside periphery to the center of each eye, and note the response. - Use an mm chart to describe pupil size; descriptions such as “small” or “medium” are too subjective - Check where the eyelid falls on the pupil. If it droops, note that the pt has ptsosis.

Answer 88

Trochlear Nerve Acts as a pulley to move the eyes down—toward the tip of the nose. Assessment: -Instruct the patient to follow your finger while you move it down toward his/her nose.

Answer 89

Trigeminal Nerve - Innervates the forehead, cheek and jaw - Sensations of touch, pain, temperature from face, and head, chewing, swallowing Assessment: - Sensory fibers has 3 branches - Check sensation in all three areas using soft/dull object (cotton swab): - Check both sides (e.g., left and right) / Keep pressure firm and consistent across all trials! - Ophthalmic nerve: forehead, eyes, and nose - Stroke above eyebrow - Maxillary nerve: upper lip, mucosa, maxilla, upper teeth, cheeks, palate and maxillary sinus - Stroke the upper lip in upward movement toward cheekbone) - Mandibular Nerve: anterior 2/3 of tongue, mandible, lower teeth, lower lip, part of the cheek, and part of external ear - Stroke between lower lip and chin in an upward movement toward cheekbone; compare sides of tongue (anterior and medial) for sensitivity - Test the motor function of the temporal and masseter muscles by assessing jaw opening strength: - Ask client to open mouth, clench teeth (pterygoids), and open jaw against resistance - Palpate the area - Unilateral paralysis of CN V shows deviation of jaw to side of lesion AND inability to force jaw to side opposite of the lesion - Bilateral upper motor neuron lesions result in limited jaw movement (reduced ROM and slow movement)

Answer 90

Abducens Nerve Controls lateral eye movements Assessment: - Ask the client to look toward each of YOUR ears, one at a time. - Have him/her follow your fingers through the six “cardinal fields of gaze” - Note any twitching or nystagmus of the eye - Definition: “involuntary eye movement”

Answer 91

Facial Nerve - Controls facial movements and expression - Taste anterior ⅔ - Somatosensory information from ear - Lacrimation & Salivation Assessment: - Assess client’s face “at rest” for facial symmetry - Ask him/her to perform the following movements: - Wrinkle forehead - Close eyes, tightly - Smile - Pucker lips - Show his teeth - Puff out cheeks and hold. - Are the movements symmetrical?

Answer 92

Vestibulocochlear Controls hearing & balance Assessment: - Rub your fingers together by client’s ears; perform one at a time. - We do not test vestibular function. - If client reports: - Tinnitus or dizziness—refer to neurologist and/or audiologist

Answer 93

Glossopharyngeal Nerve Cranial nerves IX and X, which innervate the tongue and throat (pharynx and larynx) are checked together. Assess the sense of taste ⅓ posterior portion of the tongue Somatoseensory information from tongue, tonsils, pharynx Controls some muscles for swallowing Assessment: - Observe pt’s ability to swallow by noting how he/she handles secretions - Ask the client to open his/her mouth and say AHHHHHHHHHH - Use a penlight - The uvula should be in the midline, and the palate should rise.

Answer 94

Vagus Nerve Autonomic visceral functions, heart rate, glands, digestion See CN IX for assessment

Answer 95

Accessory nerve Controls neck and shoulder movement Assessment: - Ask client to raise his shoulders against your hands to assess the trapezius muscle - Ask client to turn his head against your hand to assess the sternocleidomastoid muscle

Answer 96

Hypoglossal nerve Innervates the tongue Assessment: - Ask the client to protrude (“protrude”) his/her tongue; - Tongue should be at midline - Inspect for signs of atrophy (unilateral LMN lesion; side of lesion will appear shrunken/atrophied) - UMN involvement – tongue deviates to the side opposite of lesion (due to contralateral control) - Bilateral damage – client is unable to protrude the tongue beyond the lips - Look for fasciculations or fibrillations (tiny ripples). WFL – “some ripples may be present” - `Check for strength and mobility including lingual protrusion, elevation, lateralization

Answer 97

* Headaches * Nausea & vomiting * Memory loss * Emotional lability * Dizziness * Vision problems * Sleep disturbances

Answer 98

Moving object strikes head Moving head strikes object Penetrating & nonpenetrating injuries

Answer 99

Skull fracture/meninges torn High velocity: rifle bullets, military projectiles Carries foreign material into brain Low velocity: bullets from shrapnel—often less fatal (20-40% cause death)

Answer 100

Closed Head Injury/Meninges remain intact Linear acceleration injuries (coup & contracoup) Shaken baby syndrome, whiplash Focal damage to meninges and brain tissue Angular acceleration injuries (blows to the head, causing it to move away from point of impact) Twisting and shearing tend to be concentrated at boundaries between gray and white matter Tissue damage, bleeding and swelling affect major nerve fiber tracts

Answer 101

treatment is dependent on Rancho levels

Answer 102

Early Treatment programs: Drill activities stimulate and enhance mental processes Current Treatment programs: Functionally oriented treatment Cognitive: rehabilitation-restorative or compensatory Behavior Management: Control problem behaviors and enhance desired behaviors Medications: Prescribed to control agitation/restlessness, improve alertness/attention, manage depression, diminish psychotic symptoms, and control seizures. Sensory Stimulation: Common for comatose patients Component Training: Repetitive drill activities for attention, memory, problem solving Crosson’s Model: Intellectual, emergent, and anticipatory awareness Prigitano & Klonoff: Unawareness (puzzled when told of limitation; direct effect of BI) and denial (angry when told of limitations; coping strategy)

Answer 103

* Brain tumors * Aneurysm * Infection/virus * Anoxia * Surgery * Chemo/radiation * Substance abuse * Meningitis * Stroke

Answer 104

**Highly Variable** Decreased ability to initiate an activity without help Decreased ability to concentrate and pay attention to what’s important Decreased orientation Increased confusion and disorganized thinking Increased impulsiveness Decreased memory Left neglect Decreased visual perception Decreased cognition Denial and defensiveness Changed personality Decreased social skills Decreased clearness of speech Self-absorbed Insensitive Rambling in speech

Answer 105

Damage to the right parietal lobe (typically after stroke)

Answer 106

Attentional Activities: Sustained, selective, alternating, and divided attention—drills including paper and pencil tasks (e.g., cancellation, mazes, etc…) Impulsivity: Use of stop and go signals Impaired reasoning and problem solving: Identify a problem, think of several possible solutions, evaluate the feasibility and potential consequences of each solution, choose the best solution, apply it, evaluate the results. Affective communication/Prosody: show individual pictures of faces expressing various emotions, replace by card which carry names of emotions Reading: Colored vertical lines, colored dots, rulers placed at the left margin, use of finger, verbal cues Pragmatics: Videotape, cues to improve eye contact, turn-taking rules, structured practice (e.g., games in small groups), PACE

Answer 107

Exaggerated forms of: Memory failure Disorientation Lapses in judgment Difficulty performing ADLs Difficulty performing mentally challenging tasks Misplacing things Apathy and loss of initiative Changes in mood

Answer 108

changes in the cerebral cortex (alzheimer's disease)

Answer 109

changes in the basal ganglia, thalamus, and brain stem ( e.g., parkinson's disease and vascular dementia)

Answer 110

caused by changes in cortical and subcortical structures Normal pressure hydrocephalus Creutzfeldt-Jakob Disease (“Mad cow Disease”) Late stages of ALS, MS Brain tumors and chronic SDH if chronic elevation of intracranial pressure Bacterial or viral infections of the brain (e.g., meningitis, encephalitis) Hemodialysis (secondary to kidney failure… dialysis dementia)

Answer 111

It can be managed and slowed with medication, but there isn’t really any treatment

Answer 112

Symptoms of depression may mimic symptoms of dementia: cognitive impairments, loss of appetite, difficulty sleeping, social withdrawal, and apathy. Pseudodementia has an identifiable onset, with rapid symptom development. True dementia has an insidious and gradual onset with slow symptom development. Persons with pseudodementia make little effort to perform clinical tests. Person with true dementia (in early stages) try hard to prove themselves adequate on tests. The test performance of person with pseudodementia is highly variable from test to test and day to day, even on test of equivalent difficulty. The test performance of person with true dementia is consistent across tasks and test occasions.

Answer 113

A type of subcortical dementia. No cure exists, and all medication is to alleviate symptoms. The first symptom usually seen is involuntary movements. Results in cognition and communication deficits. Dysarthria, and dysphagia are common. In final stages: mute, incontinent, and profoundly demented.

Answer 114

The formation of amyloid plaques and neurofibrillary tangles are thought to contribute to the degradation of the neurons (nerve cells) in the brain and the subsequent symptoms of Alzheimer's disease.

Answer 115

These are microscoping changes in brain neurons, and primary markers of Alzheimer’s Disease. They are insoluble twisted fibers found inside the brain's cells. These tangles consist primarily of a protein called tau, which forms part of a structure called a microtubule. The microtubule helps transport nutrients and other important substances from one part of the nerve cell to another. In Alzheimer's disease, however, the tau protein is abnormal and the microtubule structures collapse.

Answer 116

One of the hallmarks of Alzheimer's disease is the accumulation of amyloid plaques between nerve cells (neurons) in the brain. Amyloid is a general term for protein fragments that the body produces normally. Beta amyloid is a protein fragment snipped from an amyloid precursor protein (APP). In a healthy brain, these protein fragments are broken down and eliminated. In Alzheimer's disease, the fragments accumulate to form hard, insoluble plaques.

Answer 117

o A type of Alzheimer’s, characterized by a slow, insidious onset. PPA begins very gradually and initially is experienced as difficulty thinking of common words while speaking or writing. PPA progressively worsens to the point where verbal communication by any means is very difficult. The ability to understand what others are saying or what is being read also declines. In the early stages, memory, reasoning and visual perception are not affected by the disease and so individuals with PPA are able to function normally in many routine daily living activities despite the aphasia. However, as the illness progresses, other mental abilities also decline.

Answer 118

Failure to respond to people, sounds, objects on the left side of body Attend only to right in self care activities Failure to move or attend to the left side of the body Bump into walls and doorways on left Reading only the right side of printed materials Displaced writing/drawing to the right side of a page Diminished/poor awareness of deficits Disinterested/lack of participation in rehab

Answer 119

Short utterances that lack emotional inflection Lack of prosody Characteristic of RHS

Answer 120

traumatic hemorrhage subdural hematomas subarachnoid hematomas intracerebral hematomas

Answer 121

Cuts, bruises, twisting, and shearing forces in the brain cause bleeding (hemorrhages) and accumulations of blood (hematomas). Auto accidents, falls, sports injuries

Answer 122

Accumulations of blood beneath dura mater (above the arachnoid) MVA most common 60% or greater mortality rate

Answer 123

Rupture of pial vessels within subarachnoid space May go for years without overt symptoms

Answer 124

Caused by rupture of blood vessels inside the brain

Answer 125

cerebral edema traumatic hydrocephalus elevated intracranial pressure alterations in the blood-brain barrier

Answer 126

Accumulation of fluid due to trauma, anoxia, infection, inflammation

Answer 127

Swelling of brain tissues sometimes compresses passages through which CSF circulates among ventricles and into subarachnoid space

Answer 128

Most dramatic and deadly consequence of TBI is pressure buildup inside the skull most frequent cause of death from TBI Ischemic Brain Damage Most BI pts sustain ischemic brain damage Most prominent in severe head injuries

Answer 129

Passage of normally excluded substances into the brain may contribute to accumulation of fluid and swelling of brain tissues (cerebral edema)

Answer 130

“loss of the abstract attitude” Failure to appreciate the abstract or implied meaning of events, situations, language, or visual images. Difficulties with figurative language, idioms, metaphors, humor, sarcasm, problem solving, and another’s point of view

Answer 131

normal or slightly lowered levels of consciousness but impaired orientation can be caused by many factors, including nutritional deficiencies, dementing illness, drug or alcohol intoxication or withdrawal, endocrine disturbances, nutritional disorders, infections, cerebrovascular disorders, head trauma, and psychiatric illness. Acute confusional states are transitory, but a period of confusion may evolve into a more circumscribed but longer lasting syndrome. For example, a stroke patient may exhibit confusion immediately after the stroke, with the confusion gradually clearing, leaving the patient not confused but with a language specific (or other) deficit.

Answer 132

Comprehensive test used widely in the United States Has 9 subtests (quick test) Tells type of aphasia and severity level

Answer 133

Word retrieval for milder cases of aphasia Tests confrontation naming 60 items Not culturally sensitive Some items are outdated

Answer 134

A type of Alzheimer’s, characterized by a slow, insidious onset. PPA begins very gradually and initially is experienced as difficulty thinking of common words while speaking or writing. PPA progressively worsens to the point where verbal communication by any means is very difficult. The ability to understand what others are saying or what is being read also declines. In the early stages, memory, reasoning and visual perception are not affected by the disease and so individuals with PPA are able to function normally in many routine daily living activities despite the aphasia. However, as the illness progresses, other mental abilities also decline.

Answer 135

``` Enables the examiner to quantify cognitive-linguistic deficits, determine severity levels for each skill area, and develop rehabilitation goals and objectives. The RIPA-2 provides quantifiable data for profiling 10 key areas basic to communicative and cognitive functioning: • Temporal Orientation (Recent Memory) • Temporal Orientation (Remote Memory) • Immediate Memory • Recent Memory • Spatial Orientation • Orientation to Environment • Recall of General Information • Problem Solving and Abstract Reasoning • Organization • Auditory Processing and Retention ``` The study sample included 126 individuals with traumatic brain injury in 17 states. The sample was representative of TBI demographics for gender, ethnicity, and socioeconomic status.

Answer 136

Often used for patients suffering from dementia. Uses a person’s past experiences and present behaviors. Focus on the remaining abilities of the persons taking into account of the person’s past and present strengths, interests, and difficulties.

Answer 137

Is used for naming deficits that occur with aphasia It can be used on PWA and also in the classroom or private clinic (for CH with language deficits) It enhances lexical retrieval after training with cues; has 6 semantic features for naming pictures: • Group: what group does it belong to? • Use: what is the purpose of it? • Action: what does it do? • Properties: what are its physical properties? • Location: where is it found? • Association: what does it remind you of? Activities: • Present picture and ask client to name it • Ask client to provide verbal response for each semantic feature (fruit, grows on tree, is round, can eat it) • After naming semantic features, ask client to name object again

Answer 138

Is a rating protocol for communication partner to respond to. Family members rate their loved ones ability in day-to-day situations- either “not at all able to” or “as able as before stroke”. Assesses severely aphasic adults’ functional communication.

Answer 139

Comprises the area from the central sulcus to the anterior limit of the cerebral cortex just dorsal and posterior to the bone case of the eyes.  The posterior portion of the frontal lobe consists of the precentral gyrus - specialized for control of movement.   The frontal lobes make us conscious of our actions and thoughts.

Answer 140

Loss of simple movement Loss of ability to spontaneously interact Loss of flexible thinking and problem solving Perseveration Inability to focus on a task Mood Changes Changes in personality and social behavior Inability to speak Inability to sequence complex movements

Answer 141

Located inferior to the Sylvain Fissure (the lateral sulcus) and continues back to the Occipital lobe. The left temporal lobe contains Wernicke’s area, important for language comprehension. This area has connections to Broca’s area (in left frontal lobe), important for speech production. The temporal lobes house the primary and secondary auditory cortex and are involved in auditory sensation and perception. Auditory stimuli are transformed for comprehension of language in the temporal lobes. Hearing, some visual perception, and categorization skills are dependent, in part, on the temporal lobes. The temporal lobes are also primary sites for projections from the thalamic nuclei.

Answer 142

Prospagnosia: Difficulty recognizing faces Difficulty understanding spoken words Poor selective attention for verbal and visual information Short-Term memory loss Interference with long-term memory Increased or decreased interest in sexual behavior Inability to categorize objects Logorrhea: Persistent talking/press of speech Increased aggressive behavior

Answer 143

Located between the occipital lobe and the central sulcus (the Rolandic Fissure) and superior to the temporal lobe The most anterior region to the post-central gyrus This is the main area of termination for axons carrying information for the sense of touch Sensations from the body are represented at various parts of the post-central gyrus The parietal lobes receive and evaluate most sensory information including touch, pressure, pain, temperature, and taste. They help us identify objects by sensation of touch.

Answer 144

Inability to attend to more than one object at a time. Alexia: problems with reading Agraphia: Difficulty writing words Word Blindness: inability to recognize words Dyscalculia: difficulty with math and arithmetic concepts Difficulty drawing objects Difficulty knowing left from right Lack of awareness of specific body parts Unilateral neglect Inability to focus visual attention Difficulties with eye-hand coordination Impaired perception of touch Difficulty with goal directed movements Difficulty with the functional manipulation of objects (non-motoric)

Answer 145

Located at the most posterior part of the cerebral cortex. This lobe is the primary target for projections from the thalamus and receives sensory information from fibers in the eyes. The retina gets visual input from light, shapes, and shading. This input is then transmitted through the optic nerve to the thalamus and then to the primary visual cortex in the occipital lobe. If the visual cortex is damaged, it can lead to blindness or a visual field cut (hemianopsia). Damage to left occipital region impairs vision in the right visual field. A small area of damage can lead to a small blind area, called a scotoma. Secondary association areas are important to visual processing and transmit stimuli to other parts of the brain for analysis. These areas are important to visual processing in order to recognize objects and discriminate features.

Answer 146

Visual field cuts Difficulty locating objects in the environment Difficulty recognizing drawn objects Inability to recognize movement of an object in space Difficulty identifying colors Visual illusions or inaccurately seeing objects Word blindness or inability to recognize words Difficulties with reading and writing

Answer 147

The cerebellum does not initiate or integrate motor activity. It controls and performs online correction of planned movements. The cerebellum regulates balance and posture and coordinates movements for fine-motor tasks such as speaking.

Answer 148

aka Central Sulcus Persons with fluent aphasia have damage to the central sulcus and they speak smoothly and with little effort The central sulcus is a prominent landmark of the brain, separating the parietal lobe from the frontal lobe and the primary motor cortex from the primary somatosensory cortex.

Answer 149

The medulla is an enlargement of the top of the spinal cord. It contains both ascending and descending nerve tracts and nuclei of cranial nerves that are important for speech motor control and swallowing. These include phonation, articulation, and velopharyngeal closure.

Answer 150

The pons is located superiorly to the medulla and inferiorly to the midbrain. It contains nuclei for the trigeminal (V) abducens (VI), facial (VII), and vestibulocochlear (VIII) nerves. It is the ‘bridge’ to the cerebellum. It helps control breathing and sleep. It is part of the reticular activating system which is important for alertness and arousal.

Answer 151

Medulla and pons contain cells of the reticular activating system--crucial for arousal and sleep. The brainstem connects the cerebral cortex to the spinal cord and regulates primary life functions including: Breathing, respiration, swallowing, blood pressure, and eye movements. Regulation of heart rate, vomiting, salivation, sneezing, coughing, and gagging.

Answer 152

The middle cerebral artery is the largest cerebral artery It supplies most of the lateral cortex and outer brain surface, internal capsules, and most of the basal ganglia. The superior branch supplies the orbitofrontal and prefrontal cortex, and the inferior branch supplies most of the temporal regions

Answer 153

• Inconsistently oriented to person, time and place. • Able to attend to highly familiar tasks in non-distracting environment for 30 minutes with moderate redirection. • Remote memory has more depth and detail than recent memory. • Vague recognition of some staff. • Able to use assistive memory aide with maximum assistance. • Emerging awareness of appropriate response to self, family and basic needs. • Moderate assist to problem solve barriers to task completion. • Supervised for old learning (e.g. self care). • Shows carry over for relearned familiar tasks (e.g. self care). • Maximum assistance for new learning with little or nor carry over. • Unaware of impairments, disabilities and safety risks. • Consistently follows simple directions. • Verbal expressions are appropriate in highly familiar and structured situations.

Answer 154

• Consistently oriented to person and place, within highly familiar environments. Moderate assistance for orientation to time. • Able to attend to highly familiar tasks in a non-distraction environment for at least 30 minutes with minimal assist to complete tasks. • Minimal supervision for new learning. • Demonstrates carry over of new learning. • Initiates and carries out steps to complete familiar personal and household routine but has shallow recall of what he/she has been doing. • Able to monitor accuracy and completeness of each step in routine personal and household ADLs and modify plan with minimal assistance. • Superficial awareness of his/her condition but unaware of specific impairments and disabilities and the limits they place on his/her ability to safely, accurately and completely carry out his/her household, community, work and leisure ADLs. • Minimal supervision for safety in routine home and community activities. • Unrealistic planning for the future. •Unable to think about consequences of a decision or action. • Overestimates abilities. • Unaware of others' needs and feelings. • Oppositional/uncooperative. • Unable to recognize inappropriate social interaction behavior.

Answer 155

• Consistently oriented to person, place and time. • Independently attends to and completes familiar tasks for 1 hour in distracting environments. • Able to recall and integrate past and recent events. • Uses assistive memory devices to recall daily schedule, "to do" lists and record critical information for later use with stand-by assistance. • Initiates and carries out steps to complete familiar personal, household, community, work and leisure routines with stand-by assistance and can modify the plan when needed with minimal assistance. • Requires no assistance once new tasks/activities are learned. • Aware of and acknowledges impairments and disabilities when they interfere with task completion but requires stand-by assistance to take appropriate corrective action. • Thinks about consequences of a decision or action with minimal assistance. • Overestimates or underestimates abilities. Acknowledges others' needs and feelings and responds appropriately with minimal assistance. • Depressed. • Irritable. • Low frustration tolerance/easily angered. • Argumentative. • Self-centered. • Uncharacteristically dependent/independent. • Able to recognize and acknowledge inappropriate social interaction behavior while it is occurring and takes corrective action with minimal assistance.

Answer 156

• Independently shifts back and forth between tasks and completes them accurately for at least two consecutive hours. • Uses assistive memory devices to recall daily schedule, "to do" lists and record critical information for later use with assistance when requested. • Initiates and carries out steps to complete familiar personal, household, work and leisure tasks independently and unfamiliar personal, household, work and leisure tasks with assistance when requested. • Aware of and acknowledges impairments and disabilities when they interfere with task completion and takes appropriate corrective action but requires standby assist to anticipate a problem before it occurs and take action to avoid it. • Able to think about consequences of decisions or actions with assistance when requested. • Accurately estimates abilities but requires stand-by assistance to adjust to task demands. • Acknowledges others' needs and feelings and responds appropriately with stand-by assistance. • Depression may continue. • May be easily irritable. • May have low frustration tolerance. • Able to self monitor appropriateness of social interaction with stand-by assistance.

Answer 157

Able to handle multiple tasks simultaneously in all environments but may require periodic breaks. • Able to independently procure, create and maintain own assistive memory devices. • Independently initiates and carries out steps to complete familiar and unfamiliar personal, household, community, work and leisure tasks but may require more than usual amount of time and/or compensatory strategies to complete them. • Anticipates impact of impairments and disabilities on ability to complete daily living tasks and takes action to avoid problems before they occur but may require more than usual amount of time and/or compensatory strategies. • Able to independently think about consequences of decisions or actions but may require more than usual amount of time and/or comepensatory strategies to select the appropriate decision or action. • Accurately estimates abilities and independently adjusts to task demands. • Able to recognize the needs and feelings of others and automatically respond in appropriate manner. • Periodic periods of depression may occur. • Irritability and low frustration tolerance when sick, fatigued and/or under emotional stress. • Social interaction behavior is consistently appropriate.

Final Exam Study Guide Flashcards

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