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Unit 09 Neurological Disorders in Adults

Unit 09 Neurological Disorders in Adults






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  • Discuss the risk factors for a stroke and warning signs of a stroke.
  • Full description of FAST acronym provided in Figure 35-2.
  • See Figure 35-4.
  • Figure 35-6 shows trauma of a stab wound and hemorrhage.
  • Check the website www.aphasia.org of the National Aphasia Association.
  • Refer to figure 36-1 for sites associated with aphasias
  • See examples in text. Students could create other examples.
  • See examples in text. Students could create other examples.
  • Sidebar presents strategies for word retrieval.
  • See Figure 36-1.
  • See Figure 36-2 for list of tests.
  • See Figure 37-1
  • See Figure 37-2 for diagram of CHI and the contrecoup damage.
  • See info on war wounds and the author’s personal story of Vietnam
  • See Figure 37-3 for TBI test batteries.
  • See Personal story of “that’s my wife”
  • Personal story of Daisy presented.
  • See Figure 37-6 or commonly used assessments
  • See Figure 38-1 for speech dimensions of dysarthria.
  • Personal story in this section.
  • Se side bar on the actor Michael J. Fox
  • See Table 38-1 for characteristics of these six types.
  • See figure 38-2 of assessment tools
  • See Figure 38-3 fro assessment materials for apraxia.
  • See discussion of Kubler-Ross’ stages of grief.

Unit 09 Neurological Disorders in Adults Unit 09 Neurological Disorders in Adults Presentation Transcript

  • Unit Nine Neurological Disorders in Adults
  • Chapter 35 Causes of Neurogenic Speech, Language, Cognitive, and Swallowing Disorders
  • Strokes (CVAs)
    • Third leading cause of death in United States
    • Average age of stroke is 67 years
    • Strokes cause brain damage due to a disruption of blood flow
  • F.A.S.T
    • A test to determine if a person is having a stroke:
    • F: Face
    • A: Arms
    • S: Speech
    • T: Time
  • Occlusive Strokes
    • Brain is deprived of blood due to blocked artery
    • 80 percent of all strokes
  • Cerebral Embolism
    • Fragment of material travels through the circulatory system
      • Reaches an artery in the brain where it occludes a blood vessel
  • Cerebral Hemorrhage
    • Rupture of a blood vessel sending blood into brain tissue
    • 20 percent of strokes
  • Multicultural Considerations
    • Risk factors for strokes are generally the same for all ethnic and cultural groups
  • Recovery from Strokes
    • Most recovery occurs in the first weeks and months after a stroke
  • Traumas
    • Leading cause of death in people under 35 years
    • One-half to two-thirds caused by motor vehicle accidents (MVA)
    • Frontal lobe is most commonly damaged area
  • Tumors
    • An abnormal growth of tissue that can cause communication and swallowing problems
  • Toxins
    • Substances that poison or cause inflammation of the CNS
  • Chapter 36 The Aphasias
  • Aphasia
    • A deficit in language processing that may affect all input and output modalities
  • Aphasia Classification
    • Receptive aphasia (fluent)
      • Associated with lesions posterior to the Fissure of Rolando
    • Expressive aphasia (dysfluent)
      • Associated with lesions around Broca’s area
  • Language Characteristics of Fluent Aphasia
    • Auditory and reading comprehension impairments
    • Speaking rate of 100 to 200 words per minute
    • Normal articulation
    • Syntactic errors
    • Little content or meaning
  • Wernicke’s Aphasia
    • Fluent aphasia caused by damage to Wernicke’s area in posterior superior left temporal lobe
    • See Figure 36-1
  • Anomia
    • Impaired ability to remember names of people, places, or things
  • Paraphasias
    • Literal/phonemic
      • Substitutions of intended sounds for sounds in words
    • Verbal/semantic
      • Word errors, which may be related to the intended word
  • Paraphasias
    • Neologisms
      • Combining C and V to make new “words”
  • Anomic Aphasia
    • Persistent and severe difficulty retrieving names
  • Conduction Aphasia
    • Rare syndrome
    • Patients have difficulty repeating multisyllabic words, phrases, and sentences
  • Transcortical Sensory Aphasia
    • Fluent aphasia with damage to left posterior temporoparietal region
    • Patients have impaired comprehension and naming combined with echolalia
  • Language Characteristics of Nonfluent Aphasia
    • Relatively good auditory comprehension
    • Difficulty initiating speech
    • Reduced speech rate
    • Effort when speaking
    • Abnormal intonation and prosody
  • Broca’s Aphasia
    • Nonfluent aphasia
    • Site of lesion in lower posterior region of the left frontal lobe in the premotor cortex
    • Patient may have right-sided weakness or loss of movement
  • Transcortical Motor Aphasia
    • Relatively good auditory comprehension
    • Speech is nonfluent, agrammatic, and telegraphic
    • Damage is to frontal lobe
      • Not including Broca’s area
  • Global Aphasia
    • Combination of fluent and nonfluent aphasia
    • Usually caused by occlusion of left middle cerebral artery
  • Assessment of Aphasia
    • Receptive language
    • Expressive language
    • Nonverbal communication
    • Reading and writing
  • Standardized Tests
    • A variety of standardized tests are available
    • Subtests from a variety of tests may be administered due to time constraints
  • Principles of Therapy
    • Select functional behaviors
    • Begin with easier tasks
    • Provide feedback
    • Train patient to self-monitor and self-correct
    • Provide family education
  • Approaches to Therapy
    • Restorative approach
      • Focus on improving underlying processes that are impaired
    • Compensatory approach
      • Provide strategies for persistent deficits
  • Chapter 37 Cognitive Disorders
  • Cognitive Impairments
    • Impaired ability to process and use incoming information
  • Cognitive Disorders
    • Three most common etiologies:
      • Right-hemisphere damage (RHD)
      • Traumatic brain injury (TBI)
      • Dementia
  • Right-Hemisphere Functions
    • Arousal and attention
    • Orientation
    • Visual perception
    • Emotional experiences
    • Temporal order
    • Cognition
  • RHD: Visual Spatial Impairments
    • Difficulty associating objects that can be seen with their spatial relationships
  • RHD: Attention Impairments
    • Difficulty staying focused on tasks
    • Shifting attention from one task to another
  • RHD: Communication
    • Literal interpretation of language
    • Difficulty with social aspects
      • Turn-taking, topic maintenance
    • Naming problems
  • Assessment
    • Similar procedures to those used with patients with aphasia
  • Principles of Therapy
    • Focus on functional outcomes:
      • Attention
      • Memory
      • Orientation to time, place, etc.
      • Pragmatics
  • Traumatic Brain Injury (TBI)
    • Closed Head Injury
    • Open Head Injury
  • Closed Head Injury (CHI)
    • Most common type of TBI
    • Skull receives impact and may be fractured but it is not penetrated
    • Two-thirds classified as “mild” with no loss of consciousness (LOC) or less than 30 minutes LOC
  • CHI Impairments
    • Difficulty concentrating under distracting conditions
    • Multitasking
    • Attention, memory, and higher level cognitive difficulties
  • Open Head Injuries
    • Skull and brain are penetrated by impact or projectiles
    • Often have significant impairments
  • Cognitive Impairments of TBI
    • Attention
    • Memory
    • Orientation
    • Reasoning and problem-solving
    • Executive functions
  • Language Impairment of TBI
    • Auditory comprehension
    • Anomia
    • Pragmatics
    • Reading and writing
  • Principles of Assessment for TBI
    • Many patients may not be immediately testable
    • Assessment results one day might differ the next day if patient changes
  • Principles of Therapy for TBI
    • Environmental control
    • Behavioral management
    • Orientation therapy
    • Cognitive retraining
    • Compensatory training
  • Dementia
    • A syndrome caused by acquired neurological diseases that involves intellectual, cognitive, and personality deterioration
  • Alzheimer’s Disease
    • Most common progressive dementia
    • Typically begins after age 65
    • Decline in intellect, memory, communication, and personality
  • Stages of Alzheimer’s Disease
    • Stage I
      • Mild – Forgetfulness
    • Stage II
      • Moderate – Confusion stage
    • Stage III
      • Severe – Terminal stage
  • Assessment of People with Dementia
    • People in stages I and II of Alzheimer’s are testable
  • Principles of Therapy for People with Dementia
    • Maximize current cognitive-linguistic abilities
    • Slow the deterioration of those abilities
    • Goals must be functional
  • Chapter 38 Motor Speech Disorders
  • Motor Speech Disorders
    • Neurological impairments affecting the motor planning, programming, neuromuscular control and/or execution of speech
  • Dysarthria
    • Group of speech disorders
      • Characterized by weakness in the muscles that control respiration, phonation, resonation, and articulation
  • Myasthenia Gravis
    • Chronic fatigue and muscle weakness
    • Occurs in females more than males
  • Parkinson’s Disease
    • Gradual deterioration of nerve centers in the brain
    • Speech and swallowing can be affected
  • Amytrophic Lateral Sclerosis
    • Rapidly progressive degeneration of motor neurons that run from the brain to the muscles for control of movement
    • Males affected more than females
  • Impaired Respiratory System
    • Short inhalations decrease air for speech
    • Short phrases
    • Inadequate voice loudness
  • Impaired Phonatory System
    • Breathy voice quality
    • Decreased loudness
  • Impaired Resonatory System
    • Hypernasal resonance is heard in speech
    • Decrease in speech intelligibility
  • Impaired Articulatory System
    • Imprecise articulation of consonants
  • Types of Dysarthria
    • Spastic
    • Ataxic
    • Flaccid
    • Hyperkinetic
    • Hypokinetic
    • Mixed
  • Assessment of Dysarthria
    • Case history/medical history
    • Evaluation of the speech systems
      • Respiratory, phonatory, resonatory, articulatory
    • Instrumental analysis
  • Principles of Therapy for Dysarthria
    • Maximize the effectiveness, efficiency, and naturalness of communication
  • Apraxia of Speech
    • Deficit in neural motor planning and programming of articulatory muscles for volunteer movements for speech in the absence of muscle weakness
  • Characteristics of Apraxia of Speech
    • Variable articulation errors
    • Sound substitutions more frequent
    • Errors increase with length of utterance
    • “Groping” behavior
    • “Islands” of fluent speech
  • Assessment and Therapy of Apraxia of Speech
    • Evaluation of the speech systems
    • Primary goal of therapy is to maximize effectiveness, efficiency, and naturalness of communication
  • Chapter 39 Emotional and Social Effects of Neurological Disorders
  • Emotional and Social Effects
    • Entire family is affected by a stroke
    • Family systems theory is applicable to clients and families when a neurological disorder has occurred
  • Emotional Effects
    • Self-image/self concept changes
    • Families go through the stages of grief
  • Social Effects
    • Social lives are altered or diminished
    • Jobs may be lost
    • Financial expenses due to loss of work and cost of medical care