The case of mister mg-Psych 340
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The case of mister mg-Psych 340

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  • •Mister M.G. is 63 year old right handed male who drives a tram as an occupation. He has had high blood pressure for several years and 14 years prior to the incident in this case he suffered a coronary occlusion, which is the partial or complete obstruction of blood flow in a coronary artery. (“LOSS OF MENTAL IMAGERY: A CASE STUDY,” 1980).
  • Early morning while preparing to go to work mister MG suffered an attack of severe giddiness that was accompanied by a headache. Shortly after, the attack he realized that he was not able to read. His wife took him to the Doctor and he was Three days later he developed a slight right hemiparesis a neurological examination also disclosed dysphasia and right-sided homonymous hemianopia.
  • Due to the descriptions of the case the patient seems to have had a left hemispheric stroke. Typical signs of this type of stroke are: Paralysis on 1 or both sides of your body, falling toward your right side, lack of awareness of the right side of your body, trouble speaking, reading, writing, or understanding language, changes in mood or the ability to pay attention or solve problems. ("Left Hemispheric Stroke", 2013). A stroke occurs when blood cannot flow to your brain. The left hemisphere (side) of your brain controls the right side of your body. It also controls your speech and language abilities. The after effects of a left hemisphere stroke on the brain: right-sided weakness (right hemiparesis) or paralysis (right hemiplegia) and sensory impairment, problems with speech and understanding language (aphasia), visual problems, including the inability to see the right visual field of each eye (homonymous hemianopsia), impaired ability to do math or to organize, reason, and analyze items, behavioral changes such as depression, cautiousness, and hesitancy, impaired ability to read, write, and learn new information, memory problems.
  • A CT scan of the patients brain showed an area of reduced density involving the lower mesial region of the left occipital lobe and part of the juxtaventricular structures of the left temporal lobe with possible inclusion of the hippocampus. The left Sylvain fissure and trigon were markedly enlarged. An area of decreased density was also apparent in the upper portion of the left cerebellar hemisphere, extending to the midline. (“LOSS OF MENTAL IMAGERY: A CASE STUDY,” 1980).
  • After his attack of giddiness and headache a short while later he could no longer read. Three days later he developed a slight right hemiparesis, or weakness on the right side. People who experience hemiparesis can have difficulty moving their legs and arms, walking, and might also have a loss of balance. Due to this, performing everyday activities such as dressing, eating, grabbing objects, or using the bathroom can be more difficult. Loss of abilities related to a stroke or hemiparesis depend upon the area of the person's brain that has been damaged. A neurological examination of the patient also showed Dysphasia, which is also referred to as aphasia. Those suffering from dysphasia have difficulty in comprehension of reading and language, semantics, complex grammatical structure, and word problems in math ("Dysphasia", 2011).
  • It was also discovered that Mister MG had right-sided homonymous hemianopia. The patient was not initially aware of his vision deficit on the right side, but his wife realized something was not right and he returned to the doctor with this symptom that was deemed related to the prior incident. Those with homonymous hemianopia often bump into things on the side of the visual field defect. To the affected individual it is not that they see half the world as blank or a dark area often they don’t realize that something is wrong. The missing half of their vision simply does not exist, so it is difficult to know it is missing. That is why the patient didn’t realize there was a problem although it may have started with the onset of the first symptoms("Homonymous Hemianopia", 2009).
  • Not necessarily sensory, but quite notable and important to the other senses of the body, this patient lost his ability to form mental images inside his head. Imagery can be understood as echoes, copies, or as images of previous experience in their past. Although imagery does plays a pivotal role in memory (Yates, 1966; Paivio, 1986) and motivation (McMahon, 1973). Picture naming was impaired as the patient could name only 7 out of 20 pictures of familiar objects. Object naming was normal. He said he was able to identify the pictures he could not name; accurately pointing to pictures named by the examiner. Writing of single letters to dictation showed no errors, but he could only read 8 letters out of 10. Writing of syllables, words, meaningless words and sentences was moderately impaired, with the rate of errors ranging from 10 to 30. It is possible that these errors were at least partly due to the slight paresis of the right upper limb and to the inability to check his own writing. Reading of syllables and words was severely impaired with 45 and 80 errors respectively. The reading of meaningless words and of sentences was impossible. (“LOSS OF MENTAL IMAGERY: A CASE STUDY,” 1980).
  • At a follow up examination Four months later, his writing to dictation was almost normal and the patient had only some difficulties with meaningless words. His picture naming capabilities had improved, but only slightly. He could name 11 pictures out of 20. He made only very few, if any, errors in reading single letters and syllables. He was hesitant in reading words but he was 100% accurate. In contrast, when reading meaningless words he was still considerably impaired. He was also incapable of reading sentences. (“LOSS OF MENTAL IMAGERY: A CASE STUDY,” 1980).The patient’s loss of mental imagery did not seem to be solely based in the visual modality. He complained of no longer being able to imagine odors, tastes or sounds. He was no longer able to hum even the most popular tunes. Although, when asked to identify a tune hummed by the experimenter, his was quick to answer and accurate.
  • While there is no specific therapy named in the case study for the patient, there is plenty of research, therapy and rehabilitation suggested for individual with specific issues caused from strokes. According to "National Institute of Neurological Disorders And Stroke" (2013), “there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and post-stroke rehabilitation” (Is There Any Treatment?). Post-stroke rehabilitation deals with helping individuals overcome disabilities from the stroke damage. Medication or drug therapy is probably the most common treatment for stroke. Although the most popular classes of drugs used to prevent or treat stroke are antithrombotic (antiplatelet agents and anticoagulants) and thrombolytic ("National Institute of Neurological Disorders and Stroke", 2013). Physiatrists are doctors who specialize in rehabilitation. People who have experienced a stroke require the care of a health care provider who is familiar with current practices, but seek new treatment and new treatments. A physiatrist is a person who can help to manage the rehabilitation process of someone who has experienced a stroke. Physical therapists are specialized in treating disabilities related to large movement and can help with endurance, strength, and range of motion problems. Occupational therapists can help people who have experienced a stroke with daily living and fine motor skills.
  • •Medical science has created, or is looking into, some promising new treatments for people with hemiparesis that can also help people who have experienced a stroke to improve movement in their legs and arms after the initial stroke. Electrical stimulation is something that has been used in the treatment of hemiparesis to strengthen the affected limb while improving their range of motion. The procedure involves placement of small electrical pads on the muscles of the person's weakened limb and applying a small electrical charge to help the muscles contract as the person works to make it move. Researchers are examining cortical stimulation. This involves electrical stimulation is given to the area of the person's brain called the, 'cortex,' to find out if it can improve the person's arm and hand movement. The procedure is performed by placing a tiny electrode on the membrane covering the person's brain. The electrode sends a tiny electrical current to the person's brain while the person performs rehabilitation exercises. At this time, the therapy is only targeted toward people who have some level of movement in their wrist and fingers. Sufferers of hemiparesis learn new ways of moving and using their legs and arms. There is potential, with immediate therapy, for people who experience hemiparesis to eventually regain movement. There are a number of professionals involved in rehabilitation for hemiparesis.
  • As time passes Dysphasic people may recover to some extent. Many learn to adapt to their situation. Speech therapy can be used to improve communication. Adaptation techniques such as talking slowly, repeating things, using gestures or drawings, and avoiding noisy areas are all ways of coping with the disorder ("Dysphasia", 2011).
  • Dysphasia. (2011). Retrieved from http://www.ayushveda.com/healthcare/dysphasia.htm Effects of stroke. (n.d.). Retrieved from http://www.medicalcenter.osu.edu/patientcare/healthcare_services/stroke/effects/pages/index.aspx Homonymous hemianopia. (2009). Retrieved from http://www.nanosweb.org/i4a/pages/index.cfm?pageID=3289 Homonymous hemianopia. (2013). Retrieved from http://• Cite your source http://www.uptodate.com/contents/homonymous-hemianopia
  • Left Hemispheric Stroke. (2013). Retrieved from http://www.drugs.com/cg/left-hemispheric-stroke.html LOSS OF MENTAL IMAGERY: A CASE STUDY. (1980, February ). Neuropsychology, Vol. 18 (), 435 to 442. Thomas, N. J. (2010). Sanford Encyclopedia of Philosophy. Retrieved from http://plato.stanford.edu/entries/mental-imagery/

The case of mister mg-Psych 340 The case of mister mg-Psych 340 Presentation Transcript

  • The Case of Mister MG Case Study Evaluation Psychology 340 05/24/2013 Manon Doll •Learning Team Assignment Barbara Bradley Jennifer Sheldrake Kelsey Powers Michael Hunter
  •  63 year old  Right Handed Male  Documented High Blood Pressure for several years  Prior history of Coronary Occlusion
  • Incident Morning attack of giddiness and headache Inability to read Three days later developed slight right hemiparesis Neurological examination also disclosed dysphasia and Right-sided homonymous hemianopia. View slide
  • Signs of stroke 1. Right-sided weakness (right hemiparesis) 2. Sensory impairment  Speech  Vision  Numbness View slide
  • • Reduced density involving the lower mesial region of the left occipital lobe • Possible inclusion of the hippocampus • Left Sylvain fissure and trigon were markedly enlarged • Decreased density was also apparent in the upper portion of the left • Cerebellar hemisphere
  •  Weakness on right side, right hemiparesis. a. Right-sided hemiparesis involves injury to the left side of the person's brain, which is the side of the brain controlling speech and language.  Dysphasia a. Dysphasia, also referred to as Aphasia, is a partial or complete impairment of the ability to communicate resulting from brain injury.
  •  Right-side homonymous hemianopia  Homonymous hemianopia is a visual field defect involving either the two right or the two left halves of the visual fields of both eyes. It is caused by lesions on the opti-tract ("Homonymous Hemianopia", 2013)
  • Initial exam  Loss of ability to form mental images  Picture naming impaired  Object naming normal  He could identify the pictures he was not able to name pointing to pictures as named by examiner  Write single letters to dictation, but could not read8 out of 10 letters  Reading of syllables and words was severely impaired with 45 and 80 errors respectively.  The reading of meaningless words and of sentences was impossible.
  • Follow up visit four months after incident  Writing to dictation almost to normal  Picture naming capabilities had improved, but only slightly. He could name 11 pictures out of 20.  Few, if any, errors in reading single letters and syllables  Hesitant in reading words but he was 100% accurate  In contrast, when reading meaningless words he was still considerably impaired  Incapable of reading sentences.  All other modalities of mental imagery affected also. Patient complained of no imagination of sounds, tastes, or smells
  • Rehabilitation from strokes  Physiatrists-doctors who specialize in rehabilitation.  Physical therapists -are specialized in treating disabilities related to large movement and can help with endurance, strength, and range of motion problems.  Occupational therapists –help people with daily living and fine motor skills
  • Hemiparesis Rehabilitation  Electrical Stimulation- placement of small electrical pads on the muscles of the person's weakened limb and applying a small electrical charge to help the muscles contract as the person works to make it move.  Cortical Stimulation-electrical stimulation to the area of the brain called the cortex by placing a tiny electrode on the membrane covering the brain. The person performs rehabilitation exercises while the stimulation is given. (Left Hemispheric Stroke (2013)).
  • Rehabilitation and Therapy Dysphasia Speech therapy can help improve communication Time helps the Dysphasic sufferer recover to some extent without any therapy Many learn to Adapt to the situation with slower speech, repetition, or using gestures, and avoiding noisy areas (Dysphasia, 2011).
  •  Dysphasia. (2011). Retrieved from http://www.ayushveda.com/healthcare/dysphasia.htm  Effects of stroke. (n.d.). Retrieved from http://www.medicalcenter.osu.edu/patientcare/healthcare_servi ces/stroke/effects/pages/index.aspx  Homonymous hemianopia. (2009). Retrieved from http://www.nanosweb.org/i4a/pages/index.cfm?pageID=3289  Homonymous hemianopia. (2013). Retrieved from http://• Cite your source http://www.uptodate.com/contents/homonymous- hemianopia
  •  Left Hemispheric Stroke. (2013). Retrieved from http://www.drugs.com/cg/left-hemispheric-stroke.html  LOSS OF MENTAL IMAGERY: A CASE STUDY. (1980, February ). Neuropsychology, Vol. 18 (), 435 to 442.  National Institute of Neurological Disorders and Stroke. (2013) Retrieved from http://www.ninds.nih.gov/disorders/stroke/stroke.htm