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

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