Cognitive Communication Final

Full lecture flashcards

Underserved Groups

Groups of individuals that receive fewer healthcare services and face barriers to accessing care.

Cultural Humility

Recognition of the limitations of one's own cultural perspective and a lifelong commitment to self-reflection and learning about other cultures.

Trauma-Informed Care

Care approach acknowledging trauma's impact, emphasizing safety, trust, choice, collaboration, and empowerment.

Marginalized Groups

Groups and communities that often experience discrimination and exclusion due to unequal power relationships.

Encephalopathy

A general term referring to any diffuse disease of the brain that alters brain function or structure.

Anoxic Encephalopathy

Diffuse brain damage due to complete lack of oxygen, leading to the death of brain cells.

Hypoxic Encephalopathy

Brain injury resulting from a restriction of oxygen to the brain, causing cell death or impairment.

Neuroplasticity

The brain's ability to reorganize itself by forming new neural connections throughout life.

ReNEW

A framework for driving change in cognitive communication: Reinforcement, Novelty, Enhanced Attention, and Well-being.

Dopamine

A neurotransmitter important for reward-guided learning and motivation.

Acetylcholine

A neurotransmitter that enhances attention to stimuli.

Serotonin

A neurotransmitter that modulates perception, cognitive appraisal, and response to emotional stimuli.

Primary Progressive Aphasia (PPA)

A neurodegenerative disorder causing gradual loss of speech and language skills, while general cognitive functions remain relatively intact.

Semantic Variant PPA

PPA subtype with deficits in picture naming, word comprehension, loss of object knowledge, and surface dyslexia/dysgraphia; repetition, grammar, and motor speech are relatively preserved; most like Anomic aphasia

Logopenic Variant PPA

PPA subtype with difficulty in word retrieval in speech and naming, impaired phrase repetition, phonemic errors, but intact single-word comprehension, object knowledge, motor speech, and syntactic processing; most like Wernicke’s aphasia

Nonfluent Variant PPA

PPA subtype: agrammatism/apraxia of speech, syntax comprehension deficit (complex syntax), preserved single-word comprehension & object knowledge; most like Broca’s aphasia

Multiple Sclerosis (MS)

An auto-immune disease that attacks the myelin sheath around nerve fibers of the CNS, leading to scar tissue (sclerosis) that alters or stops messages traveling from the brain and spinal cord.

Parkinson’s Disease (PD)

A neurodegenerative disorder affecting the neurons in the substantia nigra that produce dopamine, leading to symptoms like bradykinesia, tremor, and rigidity of muscles.

Bradykinesia

Slowness of movement, a telltale symptom of Parkinson's Disease

Huntington’s Disease

Hereditary disorder causing neuron breakdown, leading to behavioral, emotional, cognitive changes, and chorea (uncontrollable dance like movements)

Amyotrophic Lateral Sclerosis (ALS)

A rare neurological disease characterized by the deterioration and death of motor neurons, leading to gradual loss of voluntary muscle movements.

Chorea

Uncontrollable dance-like movements common in Huntington's Disease

Shared Decision-Making (SDM)

Collaborative process: healthcare providers, patients, and care partners make informed care decisions together.

Physical Medicine and Rehabilitation (PMR)

Branch of medicine focused on restoring functional ability and quality of life to those with physical impairments or disabilities.

Relationship-Centered Approach

An approach that recognizes decision-making in PMR settings is embedded in interpersonal relationships.

Multidisciplinary Team

A team comprised of various professionals (SDM expert, OT, SLP, PT, family care partners, sociologists, physician) involved in the decision-making process.

Micro-Decision

Small, individual decisions that contribute to a larger decision-making process, broken down into initiation, response, and closure.

Relational Dimensions

Aspects of relationships influencing decisions, categorized as interactional (observable actions) and contextual (experiences, beliefs, values).

Interactional Dimensions

Observable verbal and nonverbal actions like information exchange and collaboration skills.

Contextual Dimensions

Experiences, habits, beliefs, time influences, and perceived value/meaning that shape interactions and decisions.

Social Forces

Invisible cultural, institutional, and professional influences that shape how care decisions are made.

Epistemic Injustice

When care partners’ lived experience is undervalued or ignored in clinical settings.

RCSDM Process Model

Framework analyzing decision-making in rehabilitation, considering micro-decisions, relationships, roles, and social forces.

Institutional Norms

Insurance rules, clinical protocols, and documentation pressures that guide what care is possible.

Dementia

A syndrome with lasting decline in multiple cognitive areas, affecting communication, social skills, work, and daily living activities.

Mild Cognitive Impairment (MCI)

A pre-dementia state; a transition between normal aging and dementia. Self report issues with memory that are confirmed by a family member, measurable changes in memory but no difficulties with ADL; most frequently report severity of TBI

Criteria for Diagnosing MCI

Memory problems, measurable memory impairment on standardized testing, and no impairments in reasoning, general thinking skills, or ability to perform ADLs.

Two Types of MCI

Includes Amnestic (single or multiple domain) and Non-amnestic (single or multiple domain).

Major Neurocognitive Disorders

Significant cognitive decline that disrupts independence in ADLs.

Mild Neurocognitive Disorders

Evidence of modest cognitive decline that DOES NOT interfere with independent completion of ADLs.

Early Stage Dementia Symptoms

Difficulty with finances, disorientation, memory issues, complex tasks, recent event awareness, conversation, and mild anomia.

Middle Stage Dementia Symptoms

Increased disorientation, memory loss, impaired semantic memory, reduced attention, visuospatial and executive dysfunction, requiring ADL assistance, with word-finding difficulties, agitation, and impaired literacy skills.

Late Stage Dementia Symptoms

Severe disorientation and cognitive decline; significantly reduced communication, potentially including muteness, perseveration, echolalia, and palilalia.

Common Forms of Dementia

Includes Alzheimer's, Vascular, Lewy Body, Frontotemporal, Huntington's, Korsakoff's, Creutzfeldt-Jakob, and AIDS-related dementias.

Alzheimer's Disease (AD)

The most common cause of dementia, accounting for 60% to 80% of all dementia diagnoses.

AD: Earliest Appearing Symptoms

Symptoms include deficits in episodic and working memory, attention, executive function, and language/communication affecting word retrieval and discourse.

Vascular Dementia (VaD)

Caused by ischemic or hemorrhagic cerebrovascular disease, cardiovascular disease, or circulatory disturbances that damage brain areas vital for memory and cognitive functions; dementia related

Diagnosis of VaD

Requires cardiac/vascular conditions, cerebrovascular disease linked to dementia onset, neurological signs, and imaging evidence of lesions.

Dementia with Lewy Bodies (DLB)

Biologically related to PD. Both share Lewy bodies, abnormal clumps of alpha-synuclein.

DLB: Symptoms

Persistent visual hallucinations, visuospatial impairment, sleep disturbance, fluctuating attention, gait imbalances, reduced speech rate, and executive function impairments.

Frontotemporal Lobar Degeneration (FTLD)

A heterogenous group of rare neurodegenerative disorders that result in significant impairments of behavior, personality, language, and movement.

Frontotemporal Lobar Degeneration (FTLD) Variants

Behavioral variant (bvFTD), Semantic variant (sv-PPA), Nonfluent/agrammatic variant (nf-PPA), Logopenic variant (lv-PPA).

Korsakoff's Syndrome

Cognitive decline from thiamine deficiency due to chronic alcohol abuse, affecting memory and causing confabulation.

Creutzfeldt-Jacob Disease

Rare, rapid, degenerative viral disease with misshapen protein destroying brain cells, causing quick cognitive-linguistic and coordination loss.

Role of the SLP in Dementia

Screening, assessment, diagnosis, treatment, and research of dementia-based communication disorders.

Areas for Screening in Dementia/MCI

Review medical history, assess hearing, vision, speech/communication, screen for depression, evaluate cognitive function and mobility/balance.

Screening Tools for Cognitive Impairment

Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), Montreal Cognitive Assessment (MoCA), and Saint Louis University Mental Status (SLUMS) Exam.

Goals of Comprehensive Assessment in Dementia

Identify disorders, document abilities, establish a baseline, assess factors, provide info, and determine intervention candidacy.

Standardized Assessment for Dementia

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Dementia Rating Scale (DRS-2), Cognitive Linguistic Quick Test (CLQT), Arizona Battery for Communication Disorders of Dementia (ABCD), Western Aphasia Battery-Revised (WAB-R).

Standardized Tests for Functional Assessment in Dementia

Communication Activities of Daily Living (CADL-3), Functional Linguistic Communication Inventory (FLCI).

Broad Types of Interventions for Dementia

Pharmacological and Non-pharmacological.

Behavioral Interventions in Dementia

Direct interventions are when persons with dementia themselves participate in compensatory programs. Indirect interventions involve training caregivers, modifying the environment, and developing therapeutic activities.

Evidence-Based Features of Successful Interventions for PWD

Effective interventions for persons with dementia (PWD) include repetitive learning, active engagement, cognitive exercises, error reduction, attention enhancement, relevant stimuli, structured cues, creative tasks, and community involvement.

Spaced Retrieval Training (SRT)

A shaping paradigm for facilitating recall of information or procedures.

Memory Books and Memory Wallets

Collections of pictures, phrases, and words associated with familiar people, places, and events.

Challenges Faced by TBI Survivors in Healthcare

Often lack specialized rehab services and face access barriers due to communication issues, medical conditions, and limited awareness.

Special Considerations for Clinicians Working with TBI Survivors

Expertise in cognitive communication, collaboration, complex symptoms, and real-life assessment is essential for clinicians working with TBI survivors.

Memory Impairments After TBI

Impairments in short-term and long-term memory, declarative, procedural, visual, and verbal memory, with difficulty storing and retrieving declarative information.

Post-Traumatic Amnesia

The time between injury and recovery of continuous memory (ability to remember events for a 24-hour period).

Anterograde Amnesia

Inability to create new memories after the incident, leading to difficulty recalling recent events while long-term memories remain intact.

Retrograde Amnesia

Loss of memories created prior to the TBI incident.

Awareness Deficits in TBI

TBI can cause awareness deficits (intellectual, emergent, anticipatory) in up to 97% of individuals, hindering rehabilitation.

Theory of Mind

The ability to perceive another individual’s perspective; may be related to impaired self-awareness in TBI.

Speech and Language Impairments in TBI

Apraxia, dysarthria, and mutism are common speech impairments; Aphasia, word-finding deficits, and linguistic processing issues are common language difficulties.

Memory Interventions for TBI

External memory aids and internalized strategies aimed at acquisition, application, and adaptation.

Internalized Strategies for Mild Memory Impairments

Visual imagery, verbal rehearsal, storytelling, or mnemonics, spaced retrieval techniques.

Executive Function Intervention Approaches

Metacognitive strategy instruction, training strategic thinking, and multitasking instruction are examples

Discourse Deficits in TBI

Problems in narrative and conversational discourse, social disconnection, and reduced awareness.

Challenges in Narrative and Conversational Discourse

inferences, quantity and quality of expressed language, and recognition of alternative meanings may affected

Pragmatic Goals in TBI Treatment

Increasing awareness of listener needs, improving use of social conventions, and reducing Theory of Mind deficits.

Augmentative and Alternative Communication (AAC)

Strategies used by people with TBI to meet communication needs, ranging from simple choice-based systems to complex voice output systems.

AAC Strategies - Early Stage

Simple choice-based systems and eye gaze or direct selection are examples.

AAC Strategies - Middle Stage

Written Choice Communication Strategy and simple voice output for basic information

AAC Strategies - Late Stage

Alphabet board for supplemented speech with familiar listener, Text-to-speech for unfamiliar listener

Group Treatment for TBI

Supports cognition and communication, focusing on intervention of skills, counseling, education, or psychosocial support.

Focus of Group Treatment

Sociolinguistic groups, transition groups, and maintenance groups.

Traumatic Brain Injury (TBI)

An acquired injury to the brain due to an applied force that results in widespread damage to cortical and subcortical structures.

Penetrating Head Injury (Open)

External force passes through the skull, results in brain tissue destruction (e.g., missile, gunshot, knife).

Non-Penetrating Head Injury (Closed)

Head trauma without skull penetration; examples include motor vehicle accidents, falls, and Diffuse Axonal Injury (DAI).

Varied Nature of TBI

Diverse TBI population with varying medical issues, unclear diagnosis, and symptom severity.

Etiologies of TBI

Falls, motor vehicle accidents, injuries during sporting activities, gunshots, knife-stabbing wounds, military injuries.

Risk Factors for TBI

Pre-existing medical conditions, heart disease, high blood pressure, mental illness, previous head injury, substance abuse, gender, age and socio-economic conditions.

Rotational Forces in TBI

Occurs when the vector of force does not pass through an object's center of gravity causing a rotation of the object around its center of gravity.

Deceleration Injuries (Diffuse Axonal Injury)

Abrupt stop causes brain to impact skull, leading to coup/contrecoup injuries and axonal shearing.

Secondary Blast Injury

Caused by objects set into motion, like flying debris or structural collapse.

Mild Brain Injury (mTBI)

GCS > 12; Loss of consciousness/confusion < 20-30 min; Post-traumatic amnesia < 24 hours; Hospital stay < 48-72 hrs.

Functional Recovery

Return to baseline levels of performance in daily activity.

Pre-Injury Risk Factors for Prolonged mTBI Symptoms

Lower education, female gender, lower military rank, previous TBI/neurological events, history of learning disability, personal/family history of migraine or behavioral health concerns.

Neurophysiology of Concussion

Ionic imbalance causes potassium to leave cells and sodium/calcium to enter, resulting in toxic synapses and slowed communication.

Neurophysiology of Concussion (Energy Consumption)

Initial hyperactivity with rapid energy use, followed by decreased blood flow and hypometabolism.