Presentation is loading. Please wait.

Presentation is loading. Please wait.

Copyright © 2008 Delmar. All rights reserved. Unit Nine Neurological Disorders in Adults.

Similar presentations


Presentation on theme: "Copyright © 2008 Delmar. All rights reserved. Unit Nine Neurological Disorders in Adults."— Presentation transcript:

1 Copyright © 2008 Delmar. All rights reserved. Unit Nine Neurological Disorders in Adults

2 Copyright © 2008 Delmar. All rights reserved. Chapter 35 Causes of Neurogenic Speech, Language, Cognitive, and Swallowing Disorders

3 Copyright © 2008 Delmar. All rights reserved. 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

4 Copyright © 2008 Delmar. All rights reserved. 4 F.A.S.T A test to determine if a person is having a stroke: F: Face A: Arms S: Speech T: Time

5 Copyright © 2008 Delmar. All rights reserved. 5 Occlusive Strokes Brain is deprived of blood due to blocked artery 80 percent of all strokes

6 Copyright © 2008 Delmar. All rights reserved. 6 Cerebral Embolism Fragment of material travels through the circulatory system –Reaches an artery in the brain where it occludes a blood vessel

7 Copyright © 2008 Delmar. All rights reserved. 7 Cerebral Hemorrhage Rupture of a blood vessel sending blood into brain tissue 20 percent of strokes

8 Copyright © 2008 Delmar. All rights reserved. 8 Multicultural Considerations Risk factors for strokes are generally the same for all ethnic and cultural groups

9 Copyright © 2008 Delmar. All rights reserved. 9 Recovery from Strokes Most recovery occurs in the first weeks and months after a stroke

10 Copyright © 2008 Delmar. All rights reserved. 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

11 Copyright © 2008 Delmar. All rights reserved. 11 Tumors An abnormal growth of tissue that can cause communication and swallowing problems

12 Copyright © 2008 Delmar. All rights reserved. 12 Toxins Substances that poison or cause inflammation of the CNS

13 Copyright © 2008 Delmar. All rights reserved. Chapter 36 The Aphasias

14 Copyright © 2008 Delmar. All rights reserved. 14 Aphasia A deficit in language processing that may affect all input and output modalities

15 Copyright © 2008 Delmar. All rights reserved. 15 Aphasia Classification Receptive aphasia (fluent) –Associated with lesions posterior to the Fissure of Rolando Expressive aphasia (dysfluent) –Associated with lesions around Brocas area

16 Copyright © 2008 Delmar. All rights reserved. 16 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

17 Copyright © 2008 Delmar. All rights reserved. 17 Wernickes Aphasia Fluent aphasia caused by damage to Wernickes area in posterior superior left temporal lobe See Figure 36-1

18 Copyright © 2008 Delmar. All rights reserved. 18 Anomia Impaired ability to remember names of people, places, or things

19 Copyright © 2008 Delmar. All rights reserved. 19 Paraphasias Literal/phonemic –Substitutions of intended sounds for sounds in words Verbal/semantic –Word errors, which may be related to the intended word

20 Copyright © 2008 Delmar. All rights reserved. 20 Paraphasias Neologisms –Combining C and V to make new words

21 Copyright © 2008 Delmar. All rights reserved. 21 Anomic Aphasia Persistent and severe difficulty retrieving names

22 Copyright © 2008 Delmar. All rights reserved. 22 Conduction Aphasia Rare syndrome Patients have difficulty repeating multisyllabic words, phrases, and sentences

23 Copyright © 2008 Delmar. All rights reserved. 23 Transcortical Sensory Aphasia Fluent aphasia with damage to left posterior temporoparietal region Patients have impaired comprehension and naming combined with echolalia

24 Copyright © 2008 Delmar. All rights reserved. 24 Language Characteristics of Nonfluent Aphasia Relatively good auditory comprehension Difficulty initiating speech Reduced speech rate Effort when speaking Abnormal intonation and prosody

25 Copyright © 2008 Delmar. All rights reserved. 25 Brocas 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

26 Copyright © 2008 Delmar. All rights reserved. 26 Transcortical Motor Aphasia Relatively good auditory comprehension Speech is nonfluent, agrammatic, and telegraphic Damage is to frontal lobe –Not including Brocas area

27 Copyright © 2008 Delmar. All rights reserved. 27 Global Aphasia Combination of fluent and nonfluent aphasia Usually caused by occlusion of left middle cerebral artery

28 Copyright © 2008 Delmar. All rights reserved. 28 Assessment of Aphasia Receptive language Expressive language Nonverbal communication Reading and writing

29 Copyright © 2008 Delmar. All rights reserved. 29 Standardized Tests A variety of standardized tests are available Subtests from a variety of tests may be administered due to time constraints

30 Copyright © 2008 Delmar. All rights reserved. 30 Principles of Therapy Select functional behaviors Begin with easier tasks Provide feedback Train patient to self-monitor and self- correct Provide family education

31 Copyright © 2008 Delmar. All rights reserved. 31 Approaches to Therapy Restorative approach –Focus on improving underlying processes that are impaired Compensatory approach –Provide strategies for persistent deficits

32 Copyright © 2008 Delmar. All rights reserved. Chapter 37 Cognitive Disorders

33 Copyright © 2008 Delmar. All rights reserved. 33 Cognitive Impairments Impaired ability to process and use incoming information

34 Copyright © 2008 Delmar. All rights reserved. 34 Cognitive Disorders Three most common etiologies: –Right-hemisphere damage (RHD) –Traumatic brain injury (TBI) –Dementia

35 Copyright © 2008 Delmar. All rights reserved. 35 Right-Hemisphere Functions Arousal and attention Orientation Visual perception Emotional experiences Temporal order Cognition

36 Copyright © 2008 Delmar. All rights reserved. 36 RHD: Visual Spatial Impairments Difficulty associating objects that can be seen with their spatial relationships

37 Copyright © 2008 Delmar. All rights reserved. 37 RHD: Attention Impairments Difficulty staying focused on tasks Shifting attention from one task to another

38 Copyright © 2008 Delmar. All rights reserved. 38 RHD: Communication Literal interpretation of language Difficulty with social aspects –Turn-taking, topic maintenance Naming problems

39 Copyright © 2008 Delmar. All rights reserved. 39 Assessment Similar procedures to those used with patients with aphasia

40 Copyright © 2008 Delmar. All rights reserved. 40 Principles of Therapy Focus on functional outcomes: –Attention –Memory –Orientation to time, place, etc. –Pragmatics

41 Copyright © 2008 Delmar. All rights reserved. 41 Traumatic Brain Injury (TBI) Closed Head Injury Open Head Injury

42 Copyright © 2008 Delmar. All rights reserved. 42 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

43 Copyright © 2008 Delmar. All rights reserved. 43 CHI Impairments Difficulty concentrating under distracting conditions Multitasking Attention, memory, and higher level cognitive difficulties

44 Copyright © 2008 Delmar. All rights reserved. 44 Open Head Injuries Skull and brain are penetrated by impact or projectiles Often have significant impairments

45 Copyright © 2008 Delmar. All rights reserved. 45 Cognitive Impairments of TBI Attention Memory Orientation Reasoning and problem-solving Executive functions

46 Copyright © 2008 Delmar. All rights reserved. 46 Language Impairment of TBI Auditory comprehension Anomia Pragmatics Reading and writing

47 Copyright © 2008 Delmar. All rights reserved. 47 Principles of Assessment for TBI Many patients may not be immediately testable Assessment results one day might differ the next day if patient changes

48 Copyright © 2008 Delmar. All rights reserved. 48 Principles of Therapy for TBI Environmental control Behavioral management Orientation therapy Cognitive retraining Compensatory training

49 Copyright © 2008 Delmar. All rights reserved. 49 Dementia A syndrome caused by acquired neurological diseases that involves intellectual, cognitive, and personality deterioration

50 Copyright © 2008 Delmar. All rights reserved. 50 Alzheimers Disease Most common progressive dementia Typically begins after age 65 Decline in intellect, memory, communication, and personality

51 Copyright © 2008 Delmar. All rights reserved. 51 Stages of Alzheimers Disease Stage I –Mild – Forgetfulness Stage II –Moderate – Confusion stage Stage III –Severe – Terminal stage

52 Copyright © 2008 Delmar. All rights reserved. 52 Assessment of People with Dementia People in stages I and II of Alzheimers are testable

53 Copyright © 2008 Delmar. All rights reserved. 53 Principles of Therapy for People with Dementia Maximize current cognitive-linguistic abilities Slow the deterioration of those abilities Goals must be functional

54 Copyright © 2008 Delmar. All rights reserved. Chapter 38 Motor Speech Disorders

55 Copyright © 2008 Delmar. All rights reserved. 55 Motor Speech Disorders Neurological impairments affecting the motor planning, programming, neuromuscular control and/or execution of speech

56 Copyright © 2008 Delmar. All rights reserved. 56 Dysarthria Group of speech disorders –Characterized by weakness in the muscles that control respiration, phonation, resonation, and articulation

57 Copyright © 2008 Delmar. All rights reserved. 57 Myasthenia Gravis Chronic fatigue and muscle weakness Occurs in females more than males

58 Copyright © 2008 Delmar. All rights reserved. 58 Parkinsons Disease Gradual deterioration of nerve centers in the brain Speech and swallowing can be affected

59 Copyright © 2008 Delmar. All rights reserved. 59 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

60 Copyright © 2008 Delmar. All rights reserved. 60 Impaired Respiratory System Short inhalations decrease air for speech Short phrases Inadequate voice loudness

61 Copyright © 2008 Delmar. All rights reserved. 61 Impaired Phonatory System Breathy voice quality Decreased loudness

62 Copyright © 2008 Delmar. All rights reserved. 62 Impaired Resonatory System Hypernasal resonance is heard in speech Decrease in speech intelligibility

63 Copyright © 2008 Delmar. All rights reserved. 63 Impaired Articulatory System Imprecise articulation of consonants

64 Copyright © 2008 Delmar. All rights reserved. 64 Types of Dysarthria Spastic Ataxic Flaccid Hyperkinetic Hypokinetic Mixed

65 Copyright © 2008 Delmar. All rights reserved. 65 Assessment of Dysarthria Case history/medical history Evaluation of the speech systems –Respiratory, phonatory, resonatory, articulatory Instrumental analysis

66 Copyright © 2008 Delmar. All rights reserved. 66 Principles of Therapy for Dysarthria Maximize the effectiveness, efficiency, and naturalness of communication

67 Copyright © 2008 Delmar. All rights reserved. 67 Apraxia of Speech Deficit in neural motor planning and programming of articulatory muscles for volunteer movements for speech in the absence of muscle weakness

68 Copyright © 2008 Delmar. All rights reserved. 68 Characteristics of Apraxia of Speech Variable articulation errors Sound substitutions more frequent Errors increase with length of utterance Groping behavior Islands of fluent speech

69 Copyright © 2008 Delmar. All rights reserved. 69 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

70 Copyright © 2008 Delmar. All rights reserved. Chapter 39 Emotional and Social Effects of Neurological Disorders

71 Copyright © 2008 Delmar. All rights reserved. 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

72 Copyright © 2008 Delmar. All rights reserved. 72 Emotional Effects Self-image/self concept changes Families go through the stages of grief

73 Copyright © 2008 Delmar. All rights reserved. 73 Social Effects Social lives are altered or diminished Jobs may be lost Financial expenses due to loss of work and cost of medical care


Download ppt "Copyright © 2008 Delmar. All rights reserved. Unit Nine Neurological Disorders in Adults."

Similar presentations


Ads by Google