Intern Study Guide

1.
Grand Strand Regional Medical
Speech Therapy Department
Intern Overview Packet & Study Guide

2. Table of Contents
Patient Assessment/Status………….…………………………………………………………2
Aphasia……………………………….………………………………………………………….3
Swallowing Mechanism……………………………………….……………………………..…4
Dysphagia…………………………………………,………………………….……………….5­
7
Cognitive Diagnostic Tests………………………………………………….……………...6­12
Stroke………………………………………………..………………………………………13­1
5
Brain Function & Brain Injury………………………………………………………….….16­23
Vocabulary and Abbreviations……………………………………………………..……..24­29
1

3. Patient Assessment/Status
Level of Consciousness
Awake (A), Alert (A), Oriented (O): Normally a person is awake, alert, and oriented
knowing who they are, where they are, the date, the time, and what has happened or
the current situation. When a patient is assessed in the hospital their level of
consciousness is measured by their AAO on the scale shown below:
AAOX4 The person knows person, place, time and situation.
AAOX3 The person knows person, place and time, but not situation.
AAOX2 The person knows person and place, but not time and situation.
AAOX1 The person knows person, but not place, time and situation.
AAOX0 The person is awake and alert, but is disoriented.
http://www.nols.edu/alumni/leader/02summer/patientassessment.shtml
2

4. Aphasia
Definition
Communication disorder that causes difficulty in speaking, listening, and reading.
Individuals who suffer from aphasia do not decline cognitively and most likely still have
the ability to understand others, but they have difficulty speaking fluently or finding and
saying the appropriate words. There are various causes, symptoms, and types of
aphasia.
Causes:
Stroke, Brain Injury, Neurological Disorder, Dementia
Types:
Expressive/Nonfluent/Broca’s Aphasia: ​The person has difficulty saying exactly what they
want to say however, they know what they want to stay and understand language.
Receptive Aphasia/Fluent/Wernicke’s Aphasia:​ The person has difficulty understanding and
comprehending the meaning of spoken words. The patient can speak fluently but the words
often do not make sense.
Anomic Aphasia:​ These individuals have difficulty with word­finding and have a hard time
saying what they want to say.
Global Aphasia: ​These individuals have difficulty speaking and understanding as well as
inability to read or write. This is the most severe type of aphasia and is often seen immediately
following a stroke.
Primary Progressive Aphasia:​ These individuals slowly lose their ability to read, write, talk,
and understand.
http://www.webmd.com/brain/aphasia­causes­symptoms­types­treatments
3

5. Swallowing Mechanism
Swallowing Stages
1. Oral Phase​: Food is chewed and mixed with saliva to form a bolus. The tongue
is responsible for propelling the bolus from the front to the back of the mouth.
2. Pharyngeal Phase:​ The food has reached the upper throat area and the
following occurs:
a. The soft palate rises
b. The epiglottis closes off the trachea to prevent food from entering the
airway.
3. Esophageal Stage: ​The bolus reaches the esophagus and is propelled down to
the stomach through muscle contractions.
http://www.uwhealth.org/voice­swallow/stages­of­swallowing/11463
4

6. Dysphagia
Definition
Difficulty chewing or swallowing foods or liquids in different phases of the swallowing
process. Poor swallow function can lead to ​aspiration​ which can then lead to
pneumonia making it extremely important to diagnose dysphagia and alter the
individual’s food and liquid intake until swallow function improves.
Common Causes
Stroke, Brain or Spinal Cord Injury, Parkinson’s disease, Multiple Sclerosis, Cerebral
Palsy, ALS, Alzheimer's Disease, Neck Injury, Throat or Mouth Cancer.
Types
Oropharyngeal: ​Difficulty in the initial stage of the swallowing process
● Oral Difficulties
○ Difficulty sucking from a straw
○ Difficulty forming a bolus
○ Difficulty moving the bolus to the back of the mouth
● Pharyngeal Difficulties:
○ Difficulty closing off the airways properly causing food or liquid to move
toward the trachea
○ Difficulty holding food or liquid in the mouth causing food or liquid to reach
the throat before the swallow is triggered.
Esophageal:
● Food or liquid does not reach the stomach properly and often stops in the
esophagus
Aspiration:
When food or liquid enters the airway (trachea) below the vocal folds.
A SLP’s responsibility is to evaluate a patient’s swallow to determine whether or not
they are showing signs and symptoms of aspiration. The patient is given a variety of
liquids and solids of different viscosities and consistencies to determine the safest diet
for the patient. The dysphagia solid and liquid levels are outlined below.
Signs and Symptoms
5

7. ● ​Coughing after swallowing food or liquid
● Throat clearing after swallowing food or liquid
● ​Difficulty breathing (fast, slow, gurgling lung sounds)
● A change in voice
● Fever (dizzy, sweating, chill)
Dysphagia Diets
Liquids:
● Thin:​ These are liquids of normal or everyday thickness such as:
○ Water
○ Coffee
○ Juice
○ Broth
○ Milk
○ Soda
○ Tea
○ Ice Cream
● Nectar­Thick: ​Mildly Thick
○ These are thin liquids that have been thickened using a nectar thickening
packet
● Honey­Thick: ​Moderately Thick
○ These are thin liquids that have been thickened using a honey thickening
packet.
● Pudding Thick: ​Extra Thick
Solids:
6

8. ● Regular: No restrictions
● Reduced Level 1: Mechanical Soft Diet
○ Easy to chew foods
○ Avoid dry, crunchy, chewy or hard foods
● Reduced Level 2: Pureed Diet
○ Pudding­like consistency; no chewing
○ Anything that is pureed or blended
Evaluation:
❖ To test the patient’s ability to swallow liquids the SLP often gives the patient the
following liquids in the following order. If the patient shows signs or symptoms of
aspiration the SLP will thicken the liquid as listed below:
1. Thin Water
2. Nectar Thickened Water
3. Honey Thickened Water
❖ To test the patient’s ability to chew and swallow solids the SLP often gives the
patient the following food items in the following order. If the patient shows signs
or symptoms of aspiration the SLP will often not test further
1. Reduced Level 2: Applesauce, Pudding
2. Reduced Level 1: Fruit Cup
3. Regular: Graham Cracker, Granola Bar
Further Testing Methods
● Modified Barium Swallow:​ This procedure is performed in radiology and the
patient eats and drinks foods/liquids that are covered in barium paste. The
swallowing process is visible as a video x­ray.
● FEES: Fiberoptic Endoscopic Evaluation of Swallow
● A scope is inserted through the nose and rests near the esophagus. The swallow
can be viewed on a screen while the procedure is done at the patient’s bedside.
http://www.asha.org/public/speech/swallowing/Swallowing­Disorders­in­Adults/#signs
7

9. Cognitive Diagnostic Tests
ROSS Information Processing Assessment Second Edition (RIPA)
● Subtest 1: Immediate Memory
○ “Say these after me: 4­3­7”
● Subtest 2: Recent Memory
○ “How long have you been in the hospital?”
● Subtest 3: Temporal Memory (Recent Memory)
○ “What year is it?”
● Subtest 4: Temporal Orientation (Remote Memory)
○ “What are the days of the week?”
● Subtest 5: Spatial Orientation
○ “What city are you in now?”
● Subtest 6: Orientation to Environment
○ “Who is your doctor?”
● Subtest 7: Recall of General Information
○ “Who is our president?”
● Subtest 8: Problem Solving and Abstract Reasoning
○ “You are driving on the highway and run out of gas. What do you do?”
● Subtest 9: Auditory Processing and Retention
○ “Name as many animals as you can in one minute.”
○ “What are birds, cats, and camels?”
● Subtest 10: Problem Solving and Concrete Reasoning
○ “Does it take longer to put on a hat than shoes?”
ROSS Information Processing Assessment­ Geriatric (RIPA­G)
● Subtest 1: Immediate Memory
○ “Say these numbers after me: 5­2­4­8”
● Subtest 2: Recent Memory
○ “How many children do you have?”
● Subtest 3: Temporal Orientation
○ “What year is it?”
● Subtest 4: Spatial Orientation
○ “Where were you born?”
● Subtest 5: Orientation to Environment
○ “What meals have you eaten today?”
● Subtest 6: Recall of General Information
8

10. ○ “Who was your favorite president?”
● Subtest 7: Problem Solving and Abstract Reasoning
○ “What would you do if you needed to go to the bathroom?”
● Subtest 8: Organization of Information
○ “Name as many animals as you can in one minute.”
○ “What are cats, dogs, birds?”
● Subtest 9: Auditory Processing and Comprehension
○ “Does a sheet go over a blanket?”
● Subtest 10: Problem Solving and Concrete Reasoning
○ What can you do if a piece of food is too large?”
http://overlake.virtual­space.net/SLP/RG.pdf
Galveston Orientation Amnesia Test (GOAT)
The GOAT is administered to measure attention and orientation. The GOAT is often
used to determine whether or not a patient suffers from amnesia after a traumatic brain
injury. A score of 78 or more on 2 consecutive occasions is considered to indicate
post­traumatic amnesia (PTA).
Scoring
76­100: Normal
66­75: Borderline
<66: Impaired
9

11.
http://scale­library.com/pdf/Galveston_Orientation_Amnesia_Test.pdf
Montreal Cognitive Assessment Test (MOCA)
The MOCA is used as a quick screening tool for mild cognitive dysfunction. The test
takes about 10 minutes to administer.
Scoring:
26­30: Normal
Assesses:
● Attention and Concentration
● Executive Functioning
● Memory
● Language
● Visuoconstructional Skills
● Conceptual Thinking
10

12. ● Calculations
● Orientation
http://www.parkinsons.va.gov/Consortium/MoCA.as​p
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13. Mini­Mental State Examination (MMSE):
The MMSE is used to measure cognitive impairment and often used for dementia. The
MMSE is best used to follow progress over time and notice change due to treatment.
The test takes approximately 5­10 minutes to administer.
Scoring:
15 and below: Absolute Dementia
20 and below: Dementia
21­25: Borderline
26>: Normal
Assesses​:
● Registration
● Attention and Calculation
● Recall
● Language
● Ability to Follow Commands
● Orientation
12

14. Stroke
Definition:​ A stroke occurs when one of the arteries that supplies blood to the brain is blocked.
This alters or inhibits blood flow to the brain causing brain malfunctions and alterations. A stroke
normally happens on one side of brain which affects coordination and control of the opposite
side of the body.
Overview of the Effects of a Stroke
❖ Dysphagia: Swallowing difficulty
❖ Dysarthria
➢ Mild­ Slurred Speech
➢ Severe­ Inability to coordinate speech; cannot be understood
❖ Hemiparesis: Weakness or paralysis on one side of the body
❖ Memory Problems
❖ Loss of Judgement
❖ Increased Impulsivity
❖ Loss of Sensation
❖ Vision Problems
❖ Difficulty with thinking, attention, learning, comprehension
❖ If the stroke occurs on the right side of the body:
➢ Paralysis or loss of coordination and function on the left side of the body
➢ Vision problems and difficulty
➢ Quick, abrupt behavior
➢ Memory loss
❖ If the stroke occurs on the right side of the body:
➢ Paralysis or loss of coordination and unction on the right side of the body
➢ Speech/language problems
➢ Slow behavior
➢ Memory loss
Types
TIA:​ Transient Ischemic Attack/Mini­Stroke
● A TIA occurs when blood flow to the brain is only blocked for a short amount of time
causing temporary problems.
Ischemic Stroke​: Occurs when an artery in the brain is blocked
● Embolic:​ A blood clot forms somewhere outside of the brain, but eventually travels to
the brain and blocks an artery.
● Thrombosis: ​A blood clot forms in an artery that is directly supplying blood to the brain.
Hemorrhagic Stroke​: Occurs when a blood vessel in the brain bursts
● Intracerebral: ​Occurs when a blood vessel bursts and bleeds into brain tissue causing
decline in this area of the brain
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15. ● Subarachnoid:​ Occurs when a blood vessel bursts near the brain and then leaks into
the space between the brain and the skull.
http://www.allinahealth.org/Health­conditions­and­treatments/Health­library/Patient­education/U
nderstanding­Stroke/Effects­of­stroke/Physical­effects­on­either­side­of­the­brain/
The link below provides more information on strokes and their effect on the body and
function.
https://www.stroke.org/sites/default/files/resources/ExplainingStrokeBrochure.pdf
NIH Stroke Scale
Assesses:
● Consciousness
● Brain Function
● Vision
● Sensation
● Movement
● Speech
● Language
Scoring:
0= No Stroke
1­4= Minor Stroke
5­15= Moderate Stroke
15­20= Moderate/Severe Stroke
21­42= Severe Stroke
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16.
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17. The Brain
Brain Sections
● Cerebrum​: The largest part of the brain that is responsible for majority of the
brain’s function.
○ Divided into 4 Lobes:
■ Frontal Lobe​: Self­awareness, creative thought, problem solving,
intellect, judgement, reasoning, behavior, attention, abstract
thinking, physical reactions, coordinated movements, smell,
personality, decision making
● Broca’s Area​: Language processing and comprehension,
speech
■ Parietal Lobe​: Visual function, language, reading, internal stimuli,
tactile sensation, and sensory comprehension
● Sensory Cortex​: Receives information relayed from the
spinal cord related to the position of body parts and their
movement.
● Motor Cortex: ​Monitors and controls movement throughout
the body
■ Temporal Lobe​:Visual and auditory memories, speech and hearing
capabilities, behavior, and language.
● Wernicke’s Area: ​Controls expressive language
■ Occipital Lobe:​ Controls vision
● Cerebellum:​ Regulation and coordination of movement, posture, and balance
● Limbic System:​ Controls and relays emotions
○ Amygdala: Helps the body respond to emotions, memories, and fear
○ Hippocampus: Controls learning memory and the conversion of temporary
memories into permanent memories
○ Thalamus: Controls attention span and sensations.
● Brainstem:​ Controls basic life functions; heart rate, blood pressure, breathing
○ Midbrain
○ Pons
○ Medulla Oblongata
● Spinal Cord:​ Carries messages between the brain and the rest of the body.
● Blood Vessels:​ Carry blood to the brain
http://www.md­health.com/Parts­Of­The­Brain­And­Function.html
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18.
Brain Injury
Brain Injury Types
● Traumatic Brain Injury:​ Change in brain function caused by an external force
○ Falling, motor vehicle accident, object penetrating skull
● Non­Traumatic Brain Injury​: Caused by an illness or disruption/lack of oxygen
flow to the brain
○ Strokes, aneurysms, cardiac arrest, drowning, tumors, infections
Possible Effects of Brain Injury
● Frontal Lobe
17

19. ○ Difficulty making decisions, focusing attention on tasks, planning tasks
and problem solving.
○ Easily distracted
○ Stubborn
○ Personality changes
○ Difficulty maintaining socially appropriate behavior
○ Repeats the same action or words over and over without realizing it
○ Mood swings
○ Word finding problems
● Parietal Lobes
○ Difficulty with hand­eye coordination
○ Inability to recognize touch sensation on the opposite side of the body
○ Right Side
■ Difficulty drawing
■ Lack of awareness of certain body parts
○ Left Side
■ Difficulty naming objects, doing math problems, writing words
● Temporal Lobes
○ Memory problems
○ Changes in sexual interest
○ Aggressive behavior
○ Right Side
■ Difficulty recognizing faces, understanding spoken words,
recognizing music
■ Persistent talking
○ Left Side: Wernicke’s Area
■ Inability to read or understand what someone is saying
● Occipital Lobe
○ Difficulty in vision, locating objects, recognizing colors, reading and writing
○ Inability to recognize words or accurately see objects
*For further information seek Grand Strand Regional Medical Center: Guide to Brain
Injury
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20. Right vs. Left
Injury to Right Side
● Difficulty in understanding language, speaking
● Depression and anxiety
● Impaired logic
● Inability to sequence events
● Decreased control over the right side of body
Injury to Left Side
● Visual impairment
● Inattention to left side of body
● Altered creativity
● Loss of big picture type thinking
● Decreased control of left side of body
http://brainmadesimple.com/left­and­right­hemispheres.html
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21. Diagnosing Severity of Brain Injury
Glascow Coma Scale​: Estimates and categorizes the outcome of brain injury based on
motor, verbal, and eye opening responses.
Eye Opening Response
• Spontaneous­­open with blinking at baseline ​4 points
• To verbal stimuli, command, speech ​3 points
• To pain only (not applied to face) ​2 points
• No response ​1 point
Verbal Response
• Oriented ​5 points
• Confused conversation, but able to answer questions ​4 points
• Inappropriate words ​3 points
• Incomprehensible speech ​2 points
• No response ​1 point
Motor Response
• Obeys commands for movement 6 points
• Purposeful movement to painful stimulus 5 points
• Withdraws in response to pain 4 points
• Flexion in response to pain (decorticate posturing) 3 points
• Extension response in response to pain (decerebrate posturing) 2 points
• No response 1 point
Categorization:
Coma: No eye opening, no ability to follow commands, no word verbalizations (3­8)
Severe Head Injury­­­­GCS score of 8 or less
Moderate Head Injury­­­­GCS score of 9 to 12
Mild Head Injury­­­­GCS score of 13 to 15
http://www.cdc.gov/masstrauma/resources/gcs.pdf
20

22. Ranchos Los Amigos Scale​: Used to determine the patient’s level of activity following
brain injury by measuring levels of awareness, cognition, behavior, and environmental
interaction.
● Level 1: ​No reaction ​­ The brain­injured person is unconscious. They appear to
be sleeping. They do not react to any stimuli. This comatose state can last for
seconds, minutes, hours, days, weeks or months.
● Level 2: ​Generalized reaction ​­ The brain­injured person will react but
inconsistent and without purpose. The reaction is often broad body movement or
garbled words and the reaction is usually the same regardless of what the
stimulus is. The first reaction is usually to deep pain.
● Level 3: ​Localized reaction​ ​­ The brain­injured person is improving. They will
react more specifically to different stimuli but the reaction is different each time.
For example, they may occasionally turn their head in the direction of a speaker's
voice. They may have a vague awareness of their body. They may sometimes
follow simple commands such as "close your eyes" or "squeeze my hand".
● Level 4: ​Confused/Agitated​ ​­ The brain­injured person has become very active
but they are not yet able to understand what's going on. The behavior might
become bizarre. They might cry out or try to remove the feeding tube. They may
be hostile and uncooperative but they are not acting out of anger or fear. This is
a reaction to their confusion.
● Level 5: ​Confused/Inappropriate​ ​­ The brain­injured person has become less
agitated. They react to simple commands in a more consistent manner. If the
commands are more complicated, they get confused and react incorrectly. They
may become agitated if they are in a noisy or "busy" environment. They will not
take the first step. They will react best to body aches and pains, to their own
comfort and to close family members. Memory is severely damaged and they are
unable to learn new information. At this level, they are in danger of "wandering
off."
● Level 6: ​Confused/Appropriate​ ​­ Things are looking up. The brain­injured
person is motivated but still depends on others to lead the way. Reactions will be
more appropriate. If they are uncomfortable, they will complain. They are
beginning to recognize therapy staff and are much more aware of self and family.
They can easily follow simple directions. Memory of the past has improved
greatly but memory of recent events is still damaged.
● Level 7: ​Automatic/Appropriate​ ​­ The brain­injured person seems to act
appropriately in the hospital and at home. They know who they are, where they
are, the date and time. All seems well but things are still not completely right.
They go through daily routines automatically like a robot. Although they can
dress, wash and feed themselves without help, they need guidance to stay safe.
21

23. Judgment and problem­solving skills are still damaged and they cannot make
realistic plans for the future.
● Level 8: ​Purposeful/Appropriate ​­ At last! The brain­injured person remember
show the past fits with the future. They are independent and can function well in
society. They may still have some difficulty with reasoning, judgment and
learning, especially in high stress, unusual or emergency situations. They may be
actively involved in a vocational rehabilitation program, learning a new way to
live.
http://www.mc.vanderbilt.edu/documents/traumasurvivors/files/The%20Rancho%20Los
%20Amigos%20Scale.pdf
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24. Vocabulary
● AAC​ (Augmentative and Alternative Communication): All forms of communication
other than oral speech.
○ Aided AAC​: Rely on the user’s body to convey the message such as body
or sign language
○ Unaided AAC​: Requires the use of tools or equipment in addition to
gestures or body language ranging from paper/pencil to communication
boards, or electronic devices to create messages.
● Agnosia​: Inability to recognize objects when using a specific sense such as
visual, auditory, and touch
● Agraphia​: Inability to produce written language
● Amnesia​: Loss of memory due to brain injury, shock or illness.
○ Anterograde: ​Loss of memories that were formed before the injury.
○ Retrograde: ​Loss of ability to form new memories after the injury.
○ Post Traumatic Amnesia: ​State of confusion immediately following
traumatic brain injury. During PTA the individual cannot store new events
in memory or remember events that occur after the injury and is often
confused and disoriented.
● Anosognosia​: The denial or unawareness of one’s neurological deficits
● Aphasia​: Difficulty understanding, speaking, reading, and writing while cognitive
function is normally intact. Normally caused by damage to the left side of the
brain
Types:
○ Expressive:​ Have trouble speaking and writing; also known as ​Broca’s
Aphasia
■ Only able to say 1 or 2 words at a time
■ Have trouble thinking of the words they want to say
■ Leave words out of sentences
■ Have problems spelling
■ Have trouble putting together sentences that make sense
○ Receptive:​ Have trouble reading and understanding; also known as
Wernicke’s Aphasia
■ Only able to follow simple directions
■ Trouble following a conversation
■ Need to have information repeated
■ Need visual or touch cues to help them understand
■ Have trouble understanding what they read
23

25. ■ Say words that don’t make sense but don’t know that others can’t
understand them.
○ Global​: Have trouble with speaking, writing, reading, and understanding
● Aphonia: ​Loss of voice
● Apraxia:​ The inability to perform a movement or sequence of movements
despite intact sensation and understanding of the task; difficulty controlling mouth
to speak clearly
○ Mix up sounds in words
○ Say the wrong sounds
○ Say words and sounds differently each time
○ Struggle to say sounds
● Articulation:​ Producing speech sounds
● Aspiration: Inhaling of a liquid or object into the airway
○ Signs and Symptoms
■ Coughing after swallowing food or liquid
■ Throat clearing after swallowing food or liquid
■ Difficulty breathing (fast, slow, gurgling lung sounds)
■ A change in voice
■ Fever (dizzy, sweating, chill)
● Ataxia​: Lack of coordination fine and gross motor activity
● Bolus:​ Mass of food prepared by the mouth for swallowing (after chewing).
● CABG: ​A surgical procedure that improves and restores normal blood flow to the
heart for people with coronary heart disease.
● Cerebrovascular Accident: ​Decreased blood flow to the brain caused by a
blocked artery that results in the death of brain cells, also known as a stroke.
● Cerebral Palsy​: Neurological disorder that permanently affects body movement,
muscle coordination, and balance.
● Cognitive­Communication Disorders: ​Problems with memory, reasoning,
problem­solving, and attention
● Dysarthria: ​Slurred quiet speech caused by muscle weakness
● Dysphagia​: Difficulty chewing and swallowing food and drink
● Esophageal Dysphagia​: Occurs when foods or liquids do not reach the stomach
properly commonly caused by the backing up of stomach acid into the
esophagus due to reflux problems making it harder for the esophagus to pass
foods to the stomach.
● Oropharyngeal Dysphagia: ​Difficulty with the initial stage of the swallowing
process resulting problems moving food from the front to the back of the mouth.
● Dysphasia:​ Impairment of speech due to brain damage.
● Dyspnea:​ Shortness of breath
24

26. ● Edema: ​Medical term for swelling or when blood vessels release fluid into nearby
tissues
● Embolus:​ A blood clot that has been carried in the bloodstream and eventually
lodges into a blood vessel in a new location to cause a stroke
● Encephalopathy:​ General term for brain disease or brain damage; symptoms
include memory loss, altered mental state, personality changes, dementia,
seizures, or coma.
● Endotracheal Intubation: ​A procedure in which a tube is placed into the trachea
through the mouth or nose to support breathing and open the airway to give
oxygen.
● Fluoroscopy​: X­ray study of moving body structures; used to watch a patient’s
swallow.
● Hematoma: ​The collection of blood outside of the vessel most commonly due to
damage to the vessel wall. These look like bruises under the skin but can also
happen in places that are not visible.
● Hemorrhage: ​An escape of blood from a ruptured blood vessel; rapid,
uncontrollable loss of blood.
● Brain Hemorrhage: ​Localized bleeding in the brain due to the bursting of an
artery in the brain. This causes swelling in the brain and increases the pressure
in the brain, which kills brain cells.
● Hydrocephalus: ​Abnormal accumulation of cerebrospinal fluid in the brain that
causes it to swell. It can lead to brain damage and physical, developmental, and
cognitive impairments.
● Hyperlipidemia: ​High number of lipids or fats, most commonly referred to as
high cholesterol
● Infarct​: An area of dead tissue resulting from lack of blood supply
● Ischemic Stroke:​ Occurs when blood vessels connected to the brain are
clogged or blocked. A clot forms and blocks the flow of blood to certain areas of
the brain causing the stroke to occur.
● Labial​: Pertaining to the lips.
● Language​: Words we use and understand
● Larynx​ : Valve structure between the trachea (windpipe) and the pharynx (the
upper throat) that is the primary organ of voice production
● Lesion​: A region or zone of an organ or tissue that has suffered damage.
● Lingual: ​Pertaining to the tongue
● Modified Barium Swallow:​ The use of videofluoroscopy to evaluate a patient’s
swallow.
● Multiple Sclerosis (MS): ​A disease of the central nervous system affecting the
brain and the spinal cord.
25

27. ● Muscle Atrophy​: The loss of muscle ability due to underuse or neglect.
● Myalgia​: Muscle pain
● Nasal Emission​: Airflow through the nose, usually audible and indicative of an
incomplete seal between the nasal and oral cavities
● Necrosis​: Death of most or all of the cells in an organ or tissue
● Paraesthesia​: An abnormal tingling/numbness (pins and needles) sensation
usually in upper and lower extremities
● Paresis​: Muscle weakness.
● Parkinson’s Disease:​ A progressive disease that disrupts movement.
Symptoms include tremors, slowed movement impaired posture and balance,
decreased ability to perform automatic movements, speech and writing changes.
● Perseveration:​ Repetition of a particular response (word or phrase) and
repeatedly bringing up a topic that is no longer appropriate
● Phonics​: The relationships between written letters and their spoken sounds
● “Phone” spelled with a /ph/, not an /f/ as in “fone”
● Phonological Awareness:​ Awareness of individual sounds in spoken words as
well as how those sounds go together and how they can be changed to make
new words
● Phonology:​ How speech sounds go together/follow patterns to make words
● Speech:​ How we say sounds and put them together into word
● Thrombus​: A blood clot that forms within the vascular system.
● Tracheostomy:​ A procedure done to create an opening in the trachea to provide
an airway and remove lung secretions. Often used in patients who have an
object blocking the airway, or lack of ability to breathe.
● Total Parenteral Nutrition (TPN): ​All nutritional needs are met through an IV or
intravenously.
Abbreviations:
● A/P: anterior­posterior
● A&O: alert and oriented
● ad lib: as much as needed
● ADL: activities of daily living
● ARDS: acute respiratory distress syndrome
● bm: bowel movement
● BS: breath sounds
● c: with
● C/O: complaining of
● c/o: complains of
● CA: cancer
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28. ● CABG: coronary artery bypass grafting
● CN: cranial nerves
● CNS: central nervous system
● COLD: chronic obstructive lung disease
● COPD: chronic obstructive pulmonary disease
● CP: chest pain
● CPAP: continuous positive airway pressure
● CSF: cerebrospinal fluid
● CVA: cerebrovascular accident
● CXR: chest x­ray
● DAI: diffuse axonal injury
● DAT: diet as tolerated
● DC: discharge
● DJD: degenerative joint disease
● DM: diabetes mellitus
● DNR: do not resuscitate
● DOA: dead on arrival
● DOE: dyspnea on exertion
● DVT: deep venous thrombosis
● DX: diagnosis
● ECG: electrocardiogram
● EMT: eyes, motor, verbal response
● ENT: ears, nose, throat
● ETT: endotracheal tube
● FTT: failure to thrive
● FU: follow­up
● FVC: forced vital capacity
● Fx: fracture
● HA: headache
● HBP: high blood pressure
● HO: history of
● HOB: head of bed
● HPI: history of present illness
● HTN: hypertension
● Hx: history
● LLL: left lower lobe
● LLQ: left lower quadrant
● LML: left middle lobe
● LOC: level of consciousness
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29. ● LP: lumbar puncture
● LUL: left upper lobe
● LUQ: left upper quadrant
● MVA: motor vehicle accident
● NAD: no active disease
● NAS: no added salt
● NG: nasogastric
● NKA: no known allergies
● NPO: nothing by mouth
● NT: nasotracheal
● OPPT: oriented to person place and time
● PMH: previous medical history
● PO: by mouth
● PRN: as needed
● Pt: patient
● PTA: posttraumatic amnesia
● qd: everyday
● RLL: right lower lobe
● RLQ: right lower quadrant
● RML: right middle lobe
● ROM: range of motion
● RUL: right upper lobe
● RUQ: left upper quadrant
● RV: residual volume
● Rx: treatment
● s: without
● s/s: signs and symptoms
● SCI: spinal cord injury
● SOAP: Subjective, Objective, Assessment, Plan
● SOB: shortness of breath
● Sx: symptoms
● TLC: total lung capacity
● TPN: total parenteral nutrition
● TV: tidal volume
● Tx: treatment
● UGI: upper gastrointestinal
● VC: vital capacity
● VO: verbal or voice disorder
● VSS: vital signs stable
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30. ● WF: white female
● WM: white male
● WN: well nourished
● WNL: within normal limits
● yo: year old
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