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