Neurologically Based Communication Disorders Flashcards

Question

Which PPA is associated with these characteristics? - Slow speech, with word-finding pauses but NO agrammatism - moderate naming difficulties in the early stages - Severe difficulty repeating phrases and sentences - Behavioral changes - Impaired sentence comprehension

Answer 1

lvPPA (logopenic)

Answer 2

nfvPPA (nonfluent)

Answer 3

Refers to a group of neurological disorders that include hypokinesia, tremors, and muscle rigidity. Possibly due to both genetic and environmental factors.

Answer 4

Alzheimer's

Answer 5

Frontotemporal dementia

Answer 6

When symptoms are worst at night. Alzheimer's disease sometimes has this syndrome.

Answer 7

Lewy body dementia

Answer 8

Vascular dementia

Answer 9

Dementia associated with TBI

Answer 10

Dementia associated with multiple CVAs

Answer 11

Wernicke-Korsakoff syndrome

Answer 12

Offer intervention that will help slow the progression of dementia, sustain communication and other skills to the extent possible, improve daily communication and living skills. Helping family members is also a major concern.

Answer 13

Early stages: Communication, memory, behavioral management Late stages: providing communication with caregivers

Answer 14

True. AIDS, encelopathy or Creutzfeldt-Jakob disease can cause dementia.

Answer 15

Parkinson's disease

Answer 16

Parkinson's disease

Answer 17

Huntington's disease

Answer 18

Huntington's disease

Answer 19

Management of daily activities, memory and communication skills - Ex. Establishing simple routine, keeping phone numbers and possessions in specific place, carrying card or wearing bracelet with names, phone numbers of caregivers, external cues to improve memory and behavior (memory wallet), writing down information when memory begins to fail Communication training - Ex. Improving or sustaining basic, functional communication skills as long as possible, caregiver and family involvement in communication training is crucial

Answer 20

Left neglect; reduced awareness of the left side of the body and generally reduced awareness of stimuli in the left visual field

Answer 21

Comprehension of single words Comprehension of spoken sentences Discourse comprehension

Answer 22

Semantic feature analysis

Answer 23

Target reading skills are selected based on Ax of premorbid reading skills and current need for reading. - Survival reading skills (reading letters, menus, bank statements and maps) - Reading newspapers, books and letters - Reading and comprehension of printed words - Reading and comprehension of phrases and sentences - Reading and comprehension of paragraphs and extended material

Answer 24

Target writing skills are selected based on Ax of premorbid writing skills and current need for writing. - initially writing functional words (ex. name, family member's name) - Writing short functional lists (grocery list) - Writing short notes, reminders, addresses, etc. - Filling out forms - Writing letters

Answer 25

Progressive/degenerative nervous system disease that affects nerve cells in the brain and spinal cord, causing loss of muscle control Neurologically based speech disorders will worsen overtime

Answer 26

Rapid onset of symptoms; denervation of muscles, which causes weakness, with expected improvement given treatment. Recovery time is generally 3 years. Neurologically based speech disorders will: mostly improve given ongoing intervention

Answer 27

Dysarthria is considered the most common communication disorder in those with MS. It is typically mild, with severity of dysarthria symptoms related to neurological involvement Neurologically based speech disorders will: likely remain stable with ongoing treatment of disease, worsen later on in life expectancy

Answer 28

A chronic autoimmune disorder in which antibodies destroy the communication between nerves and muscle, resulting in weakness of the skeletal muscles - lesions occur at neuromuscular junction Neurologically based speech disorders will: likely worsen as disease progresses

Answer 29

A rare, progressive, genetic disorder characterized by excess copper stored in various body tissues, particularly the liver, brain, and corneas of the eyes. Prognosis depends on time of diagnosis and ongoing treatment. Causes tremor, involuntary movements, lack of coordination, and muscle rigidity Neurologically based speech disorders will: worsen overtime

Answer 30

Resuls in visuospatial deficits, visual (left) neglect, denial and poor awareness of impairment (anosognosia), prosodic, inferencing, and discourse deficits, sustained and selective attention deficits.

Answer 31

Neuroactive medications: dosage timing may affect observations made during assessment. Sedatives: lethargy may influence communication function Antihypertensives, antihistamines, diuretics: may affect vocal quality.

Answer 32

Confrontation naming (word-finding) and generative naming may decline but not so to the extent that it interferes with communication Language comprehension may be affected if information is complex and presented rapidly Main effects on language are secondary to slower processing and poorer attention

Answer 33

Associated with aphasia No definite predictions concerning its length or extent Maximum improvement in first 3 months Probably continues for at least 6 months In global aphasia, probably starts later, lasts longer; likewise in severe TBI (not in hypoxic injury) At this point, several aphasia studies have looked at spontaneous recovery in absence of treatment All support statistically significant improvement in first weeks after stroke

Answer 34

Patient status depends on medical factors For stroke, type of stroke and extent of brain damage Hemorrhage patients (if they survive) begin spontaneous recovery later, improve more than patients with thromboembolic strokes. True of cortical and subcortical stroke For other ABI, recovery depends on extent of axonal vs. neuronal damage Symptoms may evolve rapidly

Answer 35

Left hemisphere: stroke and aphasia

Answer 36

Frontal lobe: TBI and CCD Right hemisphere: right-hemisphere pathology and RHD Mesial temporal lobes: neurodegeneration and dementia

Answer 37

Behavioural and cognitive symptoms. Delirium—an acute state of confusion associated with temporary, but reversible, cognitive impairments (Mahendra & Hopper, 2013) Age-related memory decline Other conditions that have inconsistent symptoms or are temporary and/or treatable, including: infections (e.g., urinary tract infection [UTI], meningitis, syphilis); toxicity (e.g., drug-induced dementia, toxic metal exposure); vitamin B-12 deficiency; metabolic disorders (e.g., kidney failure); hormonal dysfunction (e.g., thyroid problems); and pseudodementia due to psychiatric disorders (e.g., depression, generalized anxiety disorder, schizophrenia, mania, conversion disorders

Answer 38

Not: syntax, grammar, phonological processing, and word retrieval. Yes: semantic processing, discourse processing (including narrative), prosody, and pragmatics. Can also impact other cognitive domains including attention, memory, and executive functioning. Other impairments include anosagnosia (reduced awareness of deficits) and visual neglect, which can affect spoken and written language. Can have a significant affect in social and vocational settings.

Answer 39

In a very small proportion of right-handed individuals, the language centers are located in the right hemisphere of the brain, rather than in the left hemisphere. In these individuals, damage to the right hemisphere may result in symptoms of aphasia similar to those normally associated with a left hemisphere lesion.

Answer 40

Assessment should include determining relevant life participation needs and discovering competencies of clients → client should be directly involved in treatment planning Clinicians are equally as interested in assessing how the person with aphasia does with support along with assessing language and communication deficits.

Answer 41

Explicit goal of enhancing life participation Supporting all those affected by aphasia - i.e. offering service to immediate family Targeting both personal (internal) and environmental (external) factors Emphasis placed on the availability of all services at all stages of aphasia

Answer 42

A-FROM is a framework for measuring aphasia outcomes It is a user-friendly version of the ICF that is specific to aphasia In contrast to the ICF, it does not emphasize “body structures and functions” However, it does emphasize participation, activity, environment, and personal factors The overlapping circles in this model show explicit interaction between all four factors

Answer 43

Generally the acute phase is not a good time to do an assessment as things can change rather quickly. Most studies support statistically significant improvement in the first weeks after stroke.

Answer 44

Informal conversation assessment (instead of standardized assessment) Each day, you can ask the same questions and document changes that could help give strategies to staff. Other functional language assessment activities: - Reading get well cards - Study and fill in hospital menus - Use a write board to write families names - Name objects around the room - Present commands to be followed - Check yes/no comprehension and response type - Track comprehension in conversations

Answer 45

1) Acknowledge the competence of the person 2) Reveal competence: This both helps the person with aphasia understand you better (getting the message in) and enables the person with aphasia to express themselves better (Getting the message out)

Answer 46

Help the person feel respected and treated as an intelligent adult. Acknowledge their fears and frustrations Speak naturally, using an adult tone of voice.

Answer 47

Facilitators - family support, availability of communication partners able to provide communication support to persons with aphasia in daily interactions, personal motivation to return to prior level of function, desire for greater communication independence, ability and willingness to use compensatory techniques and strategies, including AAC.

Answer 48

Lack of regular and willing communication partners who are able to provide communication support to the person with aphasia in daily interactions, reduced confidence in one’s ability to communicate with familiar and unfamiliar speakers, cognitive deficits, visual and motor impairments, other comorbid chronic health conditions.

Answer 49

Verb Network Strengthening Treatment (VNeST) Semantic Feature Analysis

Answer 50

Focuses on verbs, encouraging participants to think of the people who perform the actions (agents) and the objects or people the actions are performed on (patients). Connections to nouns will strengthen all the words in the mental network around the verb Does not use pictures as it is meant to activate the mental images and words in the brain and encourage flexible thought Evidence that findings generalize beyond the words work on in therapy Effective in mild to moderate-severe aphasia. Goal: To promote sentence production and connected speech

Answer 51

Based on the principles for spreading activation theory (SAT). If we are thinking about the word in terms of semantic category (e.g. how it is used, features, where it is found), we can help the PWA with word retrieval by activating associated words with their neural networks to reach the target word. Enables patients to use and practice circumlocution to help move conversation forwards, even if the target word is not found. May be effective for words PWA have not used previously with this approach. Also demonstrated that the effects of using this approach are generalizable: PWA who have practice this approach for certain words have more success with word-finding for words that are semantically related to the words they practice with than they have with words not semantically related. May be effective in training communication partners in learning what questions to ask when the client is struggling to find a word.

Answer 52

1) Graphic organizer is shown to PWA with a picture of the object in the centre (see below for image) 2) The PWA tries to name the item in the picture (move on regardless of response) 3) Ask each of the questions around the picture, writing the correct answers as they’re discussed. Give clues when needed. (Keep going even if they name the object) 4) The PWA tries to name the picture again. If they can’t say it on their own, have them repeat after you.

Answer 53

Receiving information the client and family want to share with you Giving information Clarifying attitudes, beliefs and emotions Providing options for changing behaviours

Answer 54

Response elaboration training. Designed to help clients with non-fluent aphasia increase the amount of information they share about a topic and the length of their utterances. Relies on clinician responses and prompts to model and promote increased verbal expression. Considered an informal training program and involves incidental learning and positive reinforcement for correct responses. Focuses on content rather than form.

Answer 55

Present a picture scene to the client. Prompt the client for a response (e.g., “Tell me about this picture”, “What does this remind you of?”, “Tell me what is happening”) Repeat what the participant had said, and reinforce it (e.g. “Man… great that’s a man”. Ask the client to elaborate on what they had said from Step 1 using wh-questions. Reinforce the client’s utterance from Step 3 then model a phrase/sentence which combines the client’s productions from Steps 1 and 3 (e.g., “ Right, shaves, Man shaves”). Provide a model of the combined production again, and request the client to repeat it. Take away the picture, wait ~5 seconds, bring the picture back and ask the client again to describe the picture.

Answer 56

Reading and writing stimulation. This approach aims to develop a systematic, client-specific hierarchy of massed reading and writing practice. This involves considering various aspects of reading difficulty, including length, relative frequency of words, ability to use context and prior knowledge, as well as the client’s current level of independent reading comprehension. Considerations for writing difficulties: - Commonness of spelling - Relative frequency of words Example: 1. Copy single short relevant words with reference photo, onto dashed lines (one line per letter) 2. Copy single short relevant words with reference photo, onto one long line 3. Write single short relevant word from relevant photo 4. Copy longer relevant word, or two short relevant words with reference photo, onto dashed line (one per letter) 5. Copy longer or pairs of words onto long line 6. Write longer relevant word, or two short relevant words from reference photo

Answer 57

Oral reading for language in aphasia (ORLA) Aim is to improve reading comp. by providing practice in grapheme to phoneme conversion The backing idea is that as oral reading becomes more fluent, the reader can focus on comprehension. It focuses on reading full sentences rather than single words with the goal of also improving intonation and prosody. Levels: - Level 1. Simple 3-5 word sentences at a first grade reading level. - Level 2. 8-12 words that may be single sentences or two short sentences, at a third grade reading level - Level 3. 15-30 words, divided into 2-3 sentences, at a sixth grade reading level - Level 4. 50-100 words comprising a 4-6 sentence simple paragraph

Answer 58

SLP uses a whiteboard to write a sentence (4 words in length) SLP reads the stimulus out loud SLP reads stimulus aloud to patient with SLP and patient pointing to each word SLP and patient read allowed together, with patient continuing to point to each word SLP adjusts rate and volume Steps above are repeated twice more. For each line or sentence, the SLP states a word for the patient to identify Pt reads stimulus aloud with SLP reading aloud as needed

Answer 59

Melodic intonation therapy. This approach is effective for improving production of words and phrases in multiple aphasia profiles and improving the intelligibility of dysarthric speech. Hierarchy (see below from image): Level 1 & 2: 1. Humming 2. Unison intoning 3. Unison intoning with fading 4. Immediate repetition 5. Response to question Level 3: Delayed repetition Level 4: Fading into normal prosody. Key components: intensive, structured language requirements, exaggerated tone/intonation, choral/unison singing/intoning, repetition.

Answer 60

This is a client-centered strategy that focuses on functional communication. The client will identify daily situations where a script would be beneficial (e.g. ordering a coffee, talking on the phone, going shopping). The clinician moves through various steps to build the client’s independence with the script, targeting one short sentence at a time. The underlying principles for this approach is the lexical-semantic approach, which focuses on improving output content at the discourse level by focusing on meaningful segments rather than single words, and the instance theory of automatization, the belief that automatic processing is fast and effortless and that memories are formed with repeated exposure to a consistent task, like the script.

Answer 61

The client will attend to the clinician modeling the first sentence of the script with the clinician. The client and clinician say the sentence together. - Substep = if they struggle, break it down and blend it together. The clinician fades support at the end of the sentence (begin by saying the sentence together, and the client finishes the sentence on their own). The client reads the sentence off a cue-card independently. The client says the sentence independently without the cue card.

Answer 62

Partner training Environmental modifications Metacognitive strategy training Identity mapping External aids Cognitive training software

Answer 63

This involves providing strategies for communication partners to help facilitate transmission and receiving of information. This approach focuses on adapting the environment/ situation to facilitate communication. Heavily ICF focused as it emphasizes the environment/ personal factors in order to identify barriers/facilitators to communication. Key aspects: - Educating on communication challenges individual may experience - Identifying communicative behaviours that disrupt communication and working to mitigate them. - Providing structured training in the behaviours that support successful interactions. Examples: Learning effective listening and speaking skills Asking positive questions Learning how to keep conversation going with turn taking. Supportive conversation training (similar to training provided for clients with aphasia).

Answer 64

Take the idea of identity and provide a way of collaborating with a client to identify an alter ego based on someone/ something that they admire (see below table for an example map). This approach focuses on the client’s values and personal heroes, and creates goals that center around everyday activities. Key Steps: - Talking to client about desirable activities to identify their personal centre- their hero - Discussing facts about their hero and associations with the client’s own life. - Talk about relevant associations with being their hero. - Talk about goals associated with being their hero. - Talk about how the client would feel if they were able to achieve those goals. - Talk about various actions and action strategies that would be necessary/useful in achieving these goals.

Answer 65

Memory Training (Spaced retrieval, errorless learning, vanishing cues) Environmental and Partner Supports (discussed in interventions for ABI listed above + brief description listed below) LEEPs

Answer 66

A method used to teach new information and skills to people with memory problems. The goal is for the person to remember and recall information over long amounts of time. Steps: 1) Identify the information, habit, or skill you want the person to remember and how they will be cued to remember (eg. walk in the door (cue), hand the keys on the hook (response). 2) Practice the cue-response pair over longer and longer time intervals. First show the cue-response, then give the cue and ask for the response, keep increasing the time between each cycle. 3) If the person gives the wrong response or struggles to remember, stop them immediately. Show the correct pair and have them produce the response, then return to the last time interval. 4) Generally stop at a 16 minute interval. 5) At the end of every session, add up the number of errors and correct responses. If errors > correct responses, the pair is not the best fit for the person and needs to be changed. 6) The goal is considered learned when the cue is presented to the person first thing the next day and they give the correct response.

Answer 67

The clinician uses cues and instructional strategies to minimize the chance of the client making errors. Based on the idea that to learn and retain new information, persons with memory deficits should engage in “errorless” practice with the new information. Declarative memory deficits prevent self-monitoring and correcting of responses during training; therefore errors during training must be inhibited by now allowing a time delay before the response and not prompting with a hierarchy of cues, (i.e not allowing for the incorrect response). Has been shown to be effective in several studies, more so than errorful learning. Idea is that you interrupt prior to the person making a mistake. Often used in conjunction with other methods.

Answer 68

Another way to conduct errorless learning that is designed for more complex information or behaviours. The client is provided with enough information to provide the correct response on the initial trial. Over several successful trials, the information is gradually withdrawn and the client is required to respond with fewer cues. If the client finds this difficult, cues are added and then faded.

Answer 69

Severity of impairment (are they capable of benefiting from a group setting?) Funding: - Do they have insurance? - What is going to be the best use of their money and time? Are there other issues that are more pressing to address? - Swallowing or motor issues - Other serious medical complications that may be of higher priority Living arrangements: - Location - Access to transportation - Mobility - Comfort with technology Self-awareness of impairments