Neurological Disorders This is an overview to help you with your understanding of neurological disorders.

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.

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.

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

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

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

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

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

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.

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

Toxins Substances that poison or cause inflammation of the CNS

Aphasia

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

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

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

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

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

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.

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

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

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

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

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

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.

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

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

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

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.

Principles of Therapy Select functional behaviors Begin with easier tasks Provide feedback Train patient to self-monitor and self-correct Provide family education

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

Cognitive Impairments

Cognitive Impairments Impaired ability to process and use incoming information

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

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

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

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

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

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

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

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

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.

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

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

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

Language Impairment of TBI Auditory comprehension Anomia Pragmatics Reading and writing

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.

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

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

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”

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

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

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

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

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.

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

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

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

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

Impaired Phonatory System Breathy voice quality Decreased loudness

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

Impaired Articulatory System Imprecise articulation of consonants

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

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

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

Apraxia of Speech Deficit in neural motor planning and programming of articulatory muscles for volunteer movements for speech in the absence of muscle weakness

Characteristics of Apraxia of Speech Variable articulation errors Sound substitutions more frequent Errors increase with length of utterance “Groping” behavior “Islands” of fluent speech

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.

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

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

Social Effects Social lives are altered or diminished Jobs may be lost Financial expenses due to loss of work and cost of medical care