Presentation on theme: "Neurological Disorders in Adults"— Presentation transcript:
1Neurological Disorders in Adults Unit NineNeurologicalDisorders in Adults
2Speech, Language, Cognitive, and Swallowing Disorders Chapter 35Causes of NeurogenicSpeech, Language, Cognitive,and Swallowing Disorders
3Strokes (CVAs) Third leading cause of death in United States Average age of stroke is 67 yearsStrokes cause brain damage due to a disruption of blood flowDiscuss the risk factors for a stroke and warning signs of a stroke.
4F.A.S.T A test to determine if a person is having a stroke: F: Face A: ArmsS: SpeechT: TimeFull description of FAST acronym provided in Figure 35-2.
5Occlusive Strokes Brain is deprived of blood due to blocked artery 80 percent of all strokes
6Cerebral EmbolismFragment of material travels through the circulatory systemReaches an artery in the brain where it occludes a blood vessel
7Cerebral HemorrhageRupture of a blood vessel sending blood into brain tissue20 percent of strokesSee Figure 35-4.
8Multicultural Considerations Risk factors for strokes are generally the same for all ethnic and cultural groups
9Recovery from StrokesMost recovery occurs in the first weeks and months after a stroke
10Traumas 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 areaFigure 35-6 shows trauma of a stab wound and hemorrhage.
11TumorsAn abnormal growth of tissue that can cause communication and swallowing problems
12ToxinsSubstances that poison or cause inflammation of the CNS
14AphasiaA deficit in language processing that may affect all input and output modalitiesCheck the website of the National Aphasia Association.
15Aphasia Classification Receptive aphasia (fluent)Associated with lesions posterior to the Fissure of RolandoExpressive aphasia (dysfluent)Associated with lesions around Broca’s area
16Language Characteristics of Fluent Aphasia Auditory and reading comprehension impairmentsSpeaking rate of 100 to 200 words per minuteNormal articulationSyntactic errorsLittle content or meaning
17Wernicke’s AphasiaFluent aphasia caused by damage to Wernicke’s area in posterior superior left temporal lobeSee Figure 36-1Refer to figure 36-1 for sites associated with aphasias
18AnomiaImpaired ability to remember names of people, places, or things
19Paraphasias Literal/phonemic Verbal/semantic Substitutions of intended sounds for sounds in wordsVerbal/semanticWord errors, which may be related to the intended wordSee examples in text. Students could create other examples.
20Paraphasias Neologisms Combining C and V to make new “words” See examples in text. Students could create other examples.
21Anomic Aphasia Persistent and severe difficulty retrieving names Sidebar presents strategies for word retrieval.
22Conduction Aphasia Rare syndrome Patients have difficulty repeating multisyllabic words, phrases, and sentences
23Transcortical Sensory Aphasia Fluent aphasia with damage to left posterior temporoparietal regionPatients have impaired comprehension and naming combined with echolalia
24Language Characteristics of Nonfluent Aphasia Relatively good auditory comprehensionDifficulty initiating speechReduced speech rateEffort when speakingAbnormal intonation and prosody
25Broca’s Aphasia Nonfluent aphasia Site of lesion in lower posterior region of the left frontal lobe in the premotor cortexPatient may have right-sided weakness or loss of movementSee Figure 36-1.
26Transcortical Motor Aphasia Relatively good auditory comprehensionSpeech is nonfluent, agrammatic, and telegraphicDamage is to frontal lobeNot including Broca’s area
27Global Aphasia Combination of fluent and nonfluent aphasia Usually caused by occlusion of left middle cerebral artery
28Assessment of Aphasia Receptive language Expressive language Nonverbal communicationReading and writing
29Standardized Tests A variety of standardized tests are available Subtests from a variety of tests may be administered due to time constraintsSee Figure 36-2 for list of tests.
30Principles of Therapy Select functional behaviors Begin with easier tasksProvide feedbackTrain patient to self-monitor and self-correctProvide family education
31Approaches to Therapy Restorative approach Compensatory approach Focus on improving underlying processes that are impairedCompensatory approachProvide strategies for persistent deficits
33Cognitive Impairments Impaired ability to process and use incoming information
34Cognitive Disorders Three most common etiologies: Right-hemisphere damage (RHD)Traumatic brain injury (TBI)Dementia
35Right-Hemisphere Functions Arousal and attentionOrientationVisual perceptionEmotional experiencesTemporal orderCognition
36RHD: Visual Spatial Impairments Difficulty associating objects that can be seen with their spatial relationships
37RHD: Attention Impairments Difficulty staying focused on tasksShifting attention from one task to another
38RHD: Communication Literal interpretation of language Difficulty with social aspectsTurn-taking, topic maintenanceNaming problems
39Assessment Similar procedures to those used with patients with aphasia See Figure 37-1
40Principles of Therapy Focus on functional outcomes: Attention Memory Orientation to time, place, etc.Pragmatics
41Traumatic Brain Injury (TBI) Closed Head InjuryOpen Head Injury
42Closed Head Injury (CHI) Most common type of TBISkull receives impact and may be fractured but it is not penetratedTwo-thirds classified as “mild” with no loss of consciousness (LOC) or less than 30 minutes LOCSee Figure 37-2 for diagram of CHI and the contrecoup damage.
43CHI Impairments Difficulty concentrating under distracting conditions MultitaskingAttention, memory, and higher level cognitive difficulties
44Open Head InjuriesSkull and brain are penetrated by impact or projectilesOften have significant impairmentsSee info on war wounds and the author’s personal story of Vietnam
45Cognitive Impairments of TBI AttentionMemoryOrientationReasoning and problem-solvingExecutive functions
46Language Impairment of TBI Auditory comprehensionAnomiaPragmaticsReading and writing
47Principles of Assessment for TBI Many patients may not be immediately testableAssessment results one day might differ the next day if patient changesSee Figure 37-3 for TBI test batteries.
48Principles of Therapy for TBI Environmental controlBehavioral managementOrientation therapyCognitive retrainingCompensatory training
49DementiaA syndrome caused by acquired neurological diseases that involves intellectual, cognitive, and personality deterioration
50Alzheimer’s Disease Most common progressive dementia Typically begins after age 65Decline in intellect, memory, communication, and personalitySee Personal story of “that’s my wife”
51Stages of Alzheimer’s Disease Stage IMild – ForgetfulnessStage IIModerate – Confusion stageStage IIISevere – Terminal stagePersonal story of Daisy presented.
52Assessment of People with Dementia People in stages I and II of Alzheimer’s are testableSee Figure 37-6 or commonly used assessments
53Principles of Therapy for People with Dementia Maximize current cognitive-linguistic abilitiesSlow the deterioration of those abilitiesGoals must be functional
55Motor Speech Disorders Neurological impairments affecting the motor planning, programming, neuromuscular control and/or execution of speech
56Dysarthria Group of speech disorders Characterized by weakness in the muscles that control respiration, phonation, resonation, and articulationSee Figure 38-1 for speech dimensions of dysarthria.
57Myasthenia Gravis Chronic fatigue and muscle weakness Occurs in females more than malesPersonal story in this section.
58Parkinson’s DiseaseGradual deterioration of nerve centers in the brainSpeech and swallowing can be affectedSe side bar on the actor Michael J. Fox
59Amytrophic Lateral Sclerosis Rapidly progressive degeneration of motor neurons that run from the brain to the muscles for control of movementMales affected more than females
60Impaired Respiratory System Short inhalations decrease air for speechShort phrasesInadequate voice loudness
61Impaired Phonatory System Breathy voice qualityDecreased loudness
62Impaired Resonatory System Hypernasal resonance is heard in speechDecrease in speech intelligibility
63Impaired Articulatory System Imprecise articulation of consonants
64Types of Dysarthria Spastic Ataxic Flaccid Hyperkinetic Hypokinetic MixedSee Table 38-1 for characteristics of these six types.
65Assessment of Dysarthria Case history/medical historyEvaluation of the speech systemsRespiratory, phonatory, resonatory, articulatoryInstrumental analysisSee figure 38-2 of assessment tools
66Principles of Therapy for Dysarthria Maximize the effectiveness, efficiency, and naturalness of communication
67Apraxia of SpeechDeficit in neural motor planning and programming of articulatory muscles for volunteer movements for speech in the absence of muscle weakness
68Characteristics of Apraxia of Speech Variable articulation errorsSound substitutions more frequentErrors increase with length of utterance“Groping” behavior“Islands” of fluent speech
69Assessment and Therapy of Apraxia of Speech Evaluation of the speech systemsPrimary goal of therapy is to maximize effectiveness, efficiency, and naturalness of communicationSee Figure 38-3 fro assessment materials for apraxia.
70Emotional and Social Effects of Neurological Disorders Chapter 39Emotional andSocial Effects ofNeurological Disorders
71Emotional and Social Effects Entire family is affected by a strokeFamily systems theory is applicable to clients and families when a neurological disorder has occurred
72Emotional Effects Self-image/self concept changes Families go through the stages of griefSee discussion of Kubler-Ross’ stages of grief.
73Social Effects Social lives are altered or diminished Jobs may be lost Financial expenses due to loss of work and cost of medical care