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Neurological Disorders in Adults

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1 Neurological Disorders in Adults
Unit Nine Neurological Disorders in Adults

2 Speech, Language, Cognitive, and Swallowing Disorders
Chapter 35 Causes of Neurogenic Speech, Language, Cognitive, and Swallowing Disorders

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 Discuss the risk factors for a stroke and warning signs of a stroke.

4 F.A.S.T A test to determine if a person is having a stroke: F: Face
A: Arms S: Speech T: Time Full description of FAST acronym provided in Figure 35-2.

5 Occlusive Strokes Brain is deprived of blood due to blocked artery
80 percent of all strokes

6 Cerebral Embolism Fragment of material travels through the circulatory system Reaches an artery in the brain where it occludes a blood vessel

7 Cerebral Hemorrhage Rupture of a blood vessel sending blood into brain tissue 20 percent of strokes See Figure 35-4.

8 Multicultural Considerations
Risk factors for strokes are generally the same for all ethnic and cultural groups

9 Recovery from Strokes Most recovery occurs in the first weeks and months after a stroke

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 Figure 35-6 shows trauma of a stab wound and hemorrhage.

11 Tumors An abnormal growth of tissue that can cause communication and swallowing problems

12 Toxins Substances that poison or cause inflammation of the CNS

13 Chapter 36 The Aphasias

14 Aphasia A deficit in language processing that may affect all input and output modalities Check the website of the National Aphasia Association.

15 Aphasia Classification
Receptive aphasia (fluent) Associated with lesions posterior to the Fissure of Rolando Expressive aphasia (dysfluent) Associated with lesions around Broca’s area

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 Wernicke’s Aphasia Fluent aphasia caused by damage to Wernicke’s area in posterior superior left temporal lobe See Figure 36-1 Refer to figure 36-1 for sites associated with aphasias

18 Anomia Impaired ability to remember names of people, places, or things

19 Paraphasias Literal/phonemic Verbal/semantic
Substitutions of intended sounds for sounds in words Verbal/semantic Word errors, which may be related to the intended word See examples in text. Students could create other examples.

20 Paraphasias Neologisms Combining C and V to make new “words”
See examples in text. Students could create other examples.

21 Anomic Aphasia Persistent and severe difficulty retrieving names
Sidebar presents strategies for word retrieval.

22 Conduction Aphasia Rare syndrome
Patients have difficulty repeating multisyllabic words, phrases, and sentences

23 Transcortical Sensory Aphasia
Fluent aphasia with damage to left posterior temporoparietal region Patients have impaired comprehension and naming combined with echolalia

24 Language Characteristics of Nonfluent Aphasia
Relatively good auditory comprehension Difficulty initiating speech Reduced speech rate Effort when speaking Abnormal intonation and prosody

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 See Figure 36-1.

26 Transcortical Motor Aphasia
Relatively good auditory comprehension Speech is nonfluent, agrammatic, and telegraphic Damage is to frontal lobe Not including Broca’s area

27 Global Aphasia Combination of fluent and nonfluent aphasia
Usually caused by occlusion of left middle cerebral artery

28 Assessment of Aphasia Receptive language Expressive language
Nonverbal communication Reading and writing

29 Standardized Tests A variety of standardized tests are available
Subtests from a variety of tests may be administered due to time constraints See Figure 36-2 for list of tests.

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 Approaches to Therapy Restorative approach Compensatory approach
Focus on improving underlying processes that are impaired Compensatory approach Provide strategies for persistent deficits

32 Chapter 37 Cognitive Disorders

33 Cognitive Impairments
Impaired ability to process and use incoming information

34 Cognitive Disorders Three most common etiologies:
Right-hemisphere damage (RHD) Traumatic brain injury (TBI) Dementia

35 Right-Hemisphere Functions
Arousal and attention Orientation Visual perception Emotional experiences Temporal order Cognition

36 RHD: Visual Spatial Impairments
Difficulty associating objects that can be seen with their spatial relationships

37 RHD: Attention Impairments
Difficulty staying focused on tasks Shifting attention from one task to another

38 RHD: Communication Literal interpretation of language
Difficulty with social aspects Turn-taking, topic maintenance Naming problems

39 Assessment Similar procedures to those used with patients with aphasia
See Figure 37-1

40 Principles of Therapy Focus on functional outcomes: Attention Memory
Orientation to time, place, etc. Pragmatics

41 Traumatic Brain Injury (TBI)
Closed Head Injury Open Head Injury

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 See Figure 37-2 for diagram of CHI and the contrecoup damage.

43 CHI Impairments Difficulty concentrating under distracting conditions
Multitasking Attention, memory, and higher level cognitive difficulties

44 Open Head Injuries Skull and brain are penetrated by impact or projectiles Often have significant impairments See info on war wounds and the author’s personal story of Vietnam

45 Cognitive Impairments of TBI
Attention Memory Orientation Reasoning and problem-solving Executive functions

46 Language Impairment of TBI
Auditory comprehension Anomia Pragmatics Reading and writing

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 See Figure 37-3 for TBI test batteries.

48 Principles of Therapy for TBI
Environmental control Behavioral management Orientation therapy Cognitive retraining Compensatory training

49 Dementia A syndrome caused by acquired neurological diseases that involves intellectual, cognitive, and personality deterioration

50 Alzheimer’s Disease Most common progressive dementia
Typically begins after age 65 Decline in intellect, memory, communication, and personality See Personal story of “that’s my wife”

51 Stages of Alzheimer’s Disease
Stage I Mild – Forgetfulness Stage II Moderate – Confusion stage Stage III Severe – Terminal stage Personal story of Daisy presented.

52 Assessment of People with Dementia
People in stages I and II of Alzheimer’s are testable See Figure 37-6 or commonly used assessments

53 Principles of Therapy for People with Dementia
Maximize current cognitive-linguistic abilities Slow the deterioration of those abilities Goals must be functional

54 Motor Speech Disorders
Chapter 38 Motor Speech Disorders

55 Motor Speech Disorders
Neurological impairments affecting the motor planning, programming, neuromuscular control and/or execution of speech

56 Dysarthria Group of speech disorders
Characterized by weakness in the muscles that control respiration, phonation, resonation, and articulation See Figure 38-1 for speech dimensions of dysarthria.

57 Myasthenia Gravis Chronic fatigue and muscle weakness
Occurs in females more than males Personal story in this section.

58 Parkinson’s Disease Gradual deterioration of nerve centers in the brain Speech and swallowing can be affected Se side bar on the actor Michael J. Fox

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 Impaired Respiratory System
Short inhalations decrease air for speech Short phrases Inadequate voice loudness

61 Impaired Phonatory System
Breathy voice quality Decreased loudness

62 Impaired Resonatory System
Hypernasal resonance is heard in speech Decrease in speech intelligibility

63 Impaired Articulatory System
Imprecise articulation of consonants

64 Types of Dysarthria Spastic Ataxic Flaccid Hyperkinetic Hypokinetic
Mixed See Table 38-1 for characteristics of these six types.

65 Assessment of Dysarthria
Case history/medical history Evaluation of the speech systems Respiratory, phonatory, resonatory, articulatory Instrumental analysis See figure 38-2 of assessment tools

66 Principles of Therapy for Dysarthria
Maximize the effectiveness, efficiency, and naturalness of communication

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 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 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 See Figure 38-3 fro assessment materials for apraxia.

70 Emotional and Social Effects of Neurological Disorders
Chapter 39 Emotional and Social Effects of Neurological Disorders

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 Emotional Effects Self-image/self concept changes
Families go through the stages of grief See discussion of Kubler-Ross’ stages of grief.

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

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