Post on 26-Mar-2015
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Unit Nine
Neurological
Disorders in Adults
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Chapter 35
Causes of Neurogenic
Speech, Language, Cognitive,
and Swallowing Disorders
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3
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
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F.A.S.T
• A test to determine if a person is having a stroke:
• F: Face
• A: Arms
• S: Speech
• T: Time
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5
Occlusive Strokes
• Brain is deprived of blood due to blocked artery
• 80 percent of all strokes
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6
Cerebral Embolism
• Fragment of material travels through the circulatory system– Reaches an artery in the brain where it
occludes a blood vessel
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Cerebral Hemorrhage
• Rupture of a blood vessel sending blood into brain tissue
• 20 percent of strokes
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8
Multicultural Considerations
• Risk factors for strokes are generally the same for all ethnic and cultural groups
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9
Recovery from Strokes
• Most recovery occurs in the first weeks and months after a stroke
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10
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
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11
Tumors
• An abnormal growth of tissue that can cause communication and swallowing problems
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Toxins
• Substances that poison or cause inflammation of the CNS
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Chapter 36
The Aphasias
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Aphasia
• A deficit in language processing that may affect all input and output modalities
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Aphasia Classification
• Receptive aphasia (fluent)– Associated with lesions posterior to the
Fissure of Rolando
• Expressive aphasia (dysfluent)– Associated with lesions around Broca’s
area
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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
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Wernicke’s Aphasia
• Fluent aphasia caused by damage to Wernicke’s area in posterior superior left temporal lobe
• See Figure 36-1
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Anomia
• Impaired ability to remember names of people, places, or things
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Paraphasias
• Literal/phonemic– Substitutions of intended sounds for
sounds in words
• Verbal/semantic– Word errors, which may be related to the
intended word
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Paraphasias
• Neologisms – Combining C and V to make new “words”
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Anomic Aphasia
• Persistent and severe difficulty retrieving names
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22
Conduction Aphasia
• Rare syndrome
• Patients have difficulty repeating multisyllabic words, phrases, and sentences
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23
Transcortical Sensory Aphasia
• Fluent aphasia with damage to left posterior temporoparietal region
• Patients have impaired comprehension and naming combined with echolalia
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Language Characteristics of Nonfluent Aphasia
• Relatively good auditory comprehension
• Difficulty initiating speech
• Reduced speech rate
• Effort when speaking
• Abnormal intonation and prosody
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25
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
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Transcortical Motor Aphasia
• Relatively good auditory comprehension
• Speech is nonfluent, agrammatic, and telegraphic
• Damage is to frontal lobe– Not including Broca’s area
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Global Aphasia
• Combination of fluent and nonfluent aphasia
• Usually caused by occlusion of left middle cerebral artery
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Assessment of Aphasia
• Receptive language
• Expressive language
• Nonverbal communication
• Reading and writing
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Standardized Tests
• A variety of standardized tests are available
• Subtests from a variety of tests may be administered due to time constraints
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Principles of Therapy
• Select functional behaviors
• Begin with easier tasks
• Provide feedback
• Train patient to self-monitor and self-correct
• Provide family education
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Approaches to Therapy
• Restorative approach – Focus on improving underlying processes
that are impaired
• Compensatory approach– Provide strategies for persistent deficits
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Chapter 37
Cognitive Disorders
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Cognitive Impairments
• Impaired ability to process and use incoming information
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Cognitive Disorders
• Three most common etiologies:– Right-hemisphere damage (RHD)– Traumatic brain injury (TBI)– Dementia
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Right-Hemisphere Functions
• Arousal and attention
• Orientation
• Visual perception
• Emotional experiences
• Temporal order
• Cognition
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RHD: Visual Spatial Impairments
• Difficulty associating objects that can be seen with their spatial relationships
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RHD: Attention Impairments
• Difficulty staying focused on tasks
• Shifting attention from one task to another
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RHD: Communication• Literal interpretation of language
• Difficulty with social aspects – Turn-taking, topic maintenance
• Naming problems
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Assessment
• Similar procedures to those used with patients with aphasia
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Principles of Therapy
• Focus on functional outcomes:– Attention– Memory– Orientation to time, place, etc.– Pragmatics
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41
Traumatic Brain Injury (TBI)
• Closed Head Injury
• Open Head Injury
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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
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CHI Impairments
• Difficulty concentrating under distracting conditions
• Multitasking
• Attention, memory, and higher level cognitive difficulties
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Open Head Injuries
• Skull and brain are penetrated by impact or projectiles
• Often have significant impairments
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Cognitive Impairments of TBI
• Attention
• Memory
• Orientation
• Reasoning and problem-solving
• Executive functions
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Language Impairment of TBI
• Auditory comprehension
• Anomia
• Pragmatics
• Reading and writing
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Principles of Assessment for TBI
• Many patients may not be immediately testable
• Assessment results one day might differ the next day if patient changes
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Principles of Therapy for TBI
• Environmental control
• Behavioral management
• Orientation therapy
• Cognitive retraining
• Compensatory training
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49
Dementia
• A syndrome caused by acquired neurological diseases that involves intellectual, cognitive, and personality deterioration
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Alzheimer’s Disease
• Most common progressive dementia
• Typically begins after age 65
• Decline in intellect, memory, communication, and personality
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Stages of Alzheimer’s Disease
• Stage I – Mild – Forgetfulness
• Stage II– Moderate – Confusion stage
• Stage III– Severe – Terminal stage
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Assessment of People with Dementia
• People in stages I and II of Alzheimer’s are testable
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Principles of Therapy for People with Dementia
• Maximize current cognitive-linguistic abilities
• Slow the deterioration of those abilities
• Goals must be functional
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Chapter 38
Motor
Speech Disorders
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Motor Speech Disorders
• Neurological impairments affecting the motor planning, programming, neuromuscular control and/or execution of speech
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Dysarthria
• Group of speech disorders – Characterized by weakness in the muscles
that control respiration, phonation, resonation, and articulation
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Myasthenia Gravis
• Chronic fatigue and muscle weakness
• Occurs in females more than males
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Parkinson’s Disease
• Gradual deterioration of nerve centers in the brain
• Speech and swallowing can be affected
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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
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Impaired Respiratory System
• Short inhalations decrease air for speech
• Short phrases
• Inadequate voice loudness
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Impaired Phonatory System
• Breathy voice quality
• Decreased loudness
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Impaired Resonatory System
• Hypernasal resonance is heard in speech
• Decrease in speech intelligibility
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Impaired Articulatory System
• Imprecise articulation of consonants
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Types of Dysarthria
• Spastic
• Ataxic
• Flaccid
• Hyperkinetic
• Hypokinetic
• Mixed
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Assessment of Dysarthria
• Case history/medical history
• Evaluation of the speech systems– Respiratory, phonatory, resonatory,
articulatory
• Instrumental analysis
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Principles of Therapy for Dysarthria
• Maximize the effectiveness, efficiency, and naturalness of communication
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Apraxia of Speech
• Deficit in neural motor planning and programming of articulatory muscles for volunteer movements for speech in the absence of muscle weakness
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Characteristics of Apraxia of Speech
• Variable articulation errors
• Sound substitutions more frequent
• Errors increase with length of utterance
• “Groping” behavior
• “Islands” of fluent speech
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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
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Chapter 39
Emotional and
Social Effects of
Neurological Disorders
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71
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
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72
Emotional Effects
• Self-image/self concept changes
• Families go through the stages of grief
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Social Effects
• Social lives are altered or diminished
• Jobs may be lost
• Financial expenses due to loss of work and cost of medical care