Ch 16 Cog Communication Disorders

Cognitive communication disorders are ______ problems that occur secondary to _______ impairment

language / secondary

cognitive-communication disorders

Difficulty with any aspect of communication that is affected by disruption of cognition. Impaired ability to process and use incoming information for memory, organization of information, reasoning, judgment, and problem-solving for adequate functioning in activities of daily living, including a person’s work. A diagnostic term that implies a certain set of characteristics apply to a patient.

CCD involves Impaired ability to process and use incoming _______ for member reasoning, judgement, ______ of information, and problem solving

information, organization

most common causes of cog communication disorder

TBI, right hemisphere damage, dementia

challanges of CCD:

• _______changes and impact on ______

• families need substantial support

• nearly ____ million Americans provide ____ family care for a person w/ dementia

• caregivers so _____- vulnerable to cardiac problems, breakdowns

• person might be very young w/ family but can’t work

• social media and email very helpful

  • have to be mointored

• personality/family

• 15/unpaid

• stressed

right hemisphere is important for a_____, e______, o______, s_____ and p_____ communication skills

attention, emotion, orientation, semantic and pragmatic communication skills

patients w/ RHD may struggle with anosognosia and struggle to stay motivated in therapy

decreased awareness of deficits or disabilities often seen in right-hemisphere damage; impairment of an individual’s ability to relate to parts of his body

patient may have difficulties with r______ and ______ solving, a_____, m_____, o____, and ____ functioning

reasoning and problem solving, attention, memory, orientation, and exec functioning

RHD communication impairments can include:

• naming _____

• decreased awarness of _____ subtleties (face, body language)

• flat _____ and monotone

  • irrelevant and inappropiate ____

• categories

• communication

• affect

• comments

In addition to receptive and expressive language impairments, patients with right-hemisphere damage may have difficulty with aprosodia

Difficulty recognizing, interpreting, and conveying prosody (rhythm, pitch, stress, intonation) that is usually secondary to neurological impairment

Patients with right-hemisphere damage often have visual–spatial impairments

Difficulty associating seen objects with their spatial relationships—what is around the objects and the environment; often results in disorientation.

Patients w/ RHD also may have (prosopagnosia)

Difficulty recognizing familiar faces, including family members and famous people.

More RHD challanges:

• violating _____ rules- interrupting, changing _____, not understanding _____

• visual- ______ impairment- get lost easily

• difficulty recognizing familiar _____, even family

  • _____ side neglect

• pragmatics/topics/humor

• spatial

• faces

  • left

what does someone with left side neglect do

write only on right side

TBI is an ______ brain injury caused by _____ physical force

acquired/ external

most common causes of TBI

1. falls

2. struck against object

3. motor vehicle accidents

TBI

• leading cause of death in ppl under _____

• after TBI, 1 in _____ have a permanent disability

  • lifelong c_____ and c____ problems

• 35

• 3

  • cognitive and communicaiton

what is open head injury caused by

skull and brain being penetrated by severe impact or projectiles

• follows a single path

what abuse went up most during covid

elder abuse

most common type of injury in civilian pop

closed head injury

is closed head injury penetrating

no non penetrating

what is closed head injury caused by

severe impact- damage from blunt object

• usually car accident or domestic violence

what is a coup-contrecoup injury

• damage to brain at site of ____

• also the _____ side (brain bouncing around)

• there is tearing of a____ and d____, h_____, etc

damage to the brain at site of impact

• opposite

• axons and dendrites, hemorraging

in a closed head injury hemorrhaging of capillaries and other blood vessles break up the blood-brain barrier which is

A semipermeable membrane barrier that prevents circulating blood in the capillaries and other blood vessels from making direct contact with the cells of the nervous system, but allows oxygen and nutrients to pass through the membrane to supply the nervous system tissue

closed head injuries sometimes result in a coup-contrecoup injury which is

damage to the brain at both the site of impact (coup) and the opposite side (contrecoup), because the brain “flows” and causes intense compression; for example, when an impact to the right frontal area of the skull results in brain damage directly behind the impact and on the opposite side left posterior area

concussion/MBTI caused by:

• ____ to head

• upper body or head s____ or i_____ violently

• _____ are destroyed

  • sometimes but not always accompanied by loss of _____

blow

shaken or impacted

neurons

consciousness

MBTI can have negative impact:

• at work

• in ____ relationships

• ppl may need a lot more r____ than before

• if ____ lobe damage, problems with m____, f_____, multi____, ____ functioning

  • may be more irritable, a_____, depressed, un____

• family

• rest

• frontal/ memory, focus, executive

• anxious, unmovtivated

premorbid

wellness or functioning of a patient before significant illness or injury

even when head injuries are mild, often lead to long lasting subtle impairments called

post concussion syndrome

what is PCS and signs

concussion symtoms for mor ethan 3 months

• headache, dizzy, sleep disturbance, attention problems, etc

chronic traumatic encephalopathy

A degenerative brain disease caused by repeated brain traumas (particularly contact sport–related concussions and military personnel exposed to blasts) that results in degenerative brain disease in later life that may include headaches, mood disorders, cognitive difficulties, difficulties with speech and language, aggressive behavior, dementia, and suicidal ideation.

What is chromic traumatic encephalopathy caused by

repeated mild brain traumas (esp. concussions in contact sports)

when do CTE problems begin

around 8-10 years old after one experiences repeated concussions (why not seen in kids/adolescents)

what are early symptoms of CTE

dizzy, headache, impaired attention

challanges of CTE:

• _______ challenges

• _____ behavior, poor ______

  • in late stages: slurred _____, s____ problems, progressive d_____, slower muscular ___

• memory

• erratic/poor

• speech, swallowing, dementia, movements

how is CTE diagnosed

only definitively through brain autopsy

what is dysarthria

slurred speech

in war wounds why are open head injuries more common and more extensive

bullets

what is polytrauma

A medical term describing the condition of a person who has been subjected to multiple traumatic injuries, such as a serious head injury, severe burns, lacerations, bone fractures, and post-traumatic stress disorder (PTSD).

multiple wounds all over the body- blast injuries

PTSD

A set of symptoms after exposure to a psychologically extreme traumatic stressor that involves intense fear, horror, or helplessness; symptoms include persistent reexperiencing of the traumatic event or events, avoidance of stimuli associated with the trauma, and symptoms of increased arousal (hypervigilance)

Many patients with severe TBIs are initially in a comatose (coma) or semicomatose state, which is related to the severity of impairments

1. A prolonged period of unconsciousness in which a patient has minimal, if any, purposeful responses to stimuli.

2. Partially conscious; not completely aware of sensations and stimuli.

TBI assessments:

• difficulties with reading and ____, ______ comprehension, word ____

• P____ (social skills)

• saying _____ things, in______

• interpreting _____ language like making inferences

• reading and writing, auditory, word finding

• pragmatics

• inappropiate

• abstract

TBI cognitive impairments-difficulties with:

• O_____: time, place, person/situation

• M_____: acquiring and retaining info

• A_____

• R_____ and problem ____

• E_____ functioning

• orientation

• memory

• attention

• reasoning and problem solving

• executive functioning

Computed tomography (CT) scan

A radiographic technique to visualize body tissue not able to be seen on standard X-ray images; formerly called computerized axial tomography (CAT) scan

Magnetic resonance imaging (MRI)

An imaging study that does not expose patients to radiation and often provides images with sharper detail than those from computerized tomography (CT) scans. Medical imaging based on the resonance of atomic nuclei in a strong magnetic field.

Mental status examination

A structured interview and observations conducted by a psychologist or neuropsychologist of a patient’s orientation, attention, concentration, memory, language comprehension and expression, visual–spatial skills, abstraction abilities, general cognitive functioning, and insight into problems to provide direction for cognitive-communication rehabilitation that is typically provided by a speech language pathologist

Cognitive impairment TBI symptoms continued:

• examine _____ discourse (storytelling)

• evaluate impact of ______ challenges on ____ of life

• evaluate ability and willingness to use _____ strategies

• ask: does person lack awareness of their disability?

• narrative

• communication on quality of life

• compensatory strategies

Intervention for Persons w/ TBI:

• team work is _____! usually PT, OT, SLP, psychologist, social workers, doctor

  • must adrdress b_____ disorders due to dis____

critical

• behavorial disorders tue to disinhibition

goals for TBI therapy

1. improve phsycial, cog, and psychosocial functioning

2. foster i______

3. faciliate ______ into community

Tx: regain lost ____, compensate for ____ damaged

1. improve phsycial, cog, and psychosocial functioning

2. foster independance

3. faciliate intergration into community

treatment: regain lost skills, compensate for abilites damaged

Cognitive rehabilitation

Individualized programs focused on specific cognitive areas (e.g., improving memory and language processing) to help brain injured individuals restore abilities or compensate for cognitive deficits to promote independent functioning in daily living.

cognitive rehab:

• apps on phones and ipads help w/ m____ and o_____

  • focus on ____ attention, m____, j____, social ______, ____ function

memory and organization

• increasing, memory, judgement, social communicaiton, exec, function

what is usually outcome for TBI

continue to have impairments and difficulties in various areas on a long-term basis, and sometimes for rest of their lives

Right-hemisphere syndrome

Damage to the right hemisphere of the brain that may result in impairments of attention; visual–spatial abilities; orientation to person, place, time, and purpose; emotions; cognition; subtle to overt communication problems; and left-side neglect.

what is dementia caused by

progressive nuero disease

senility

A medical term that refers to the normal loss of cognitive functioning with advanced age.

vascular disease dementia

atherosclerosis in the brain develops from deposits of fat and other debris that form on the inside of arteries and partially or completely block the flow of blood

Multi-infarct dementia is caused by

multiple small strokes

frontotemporal dementia

degeneration of frontal lobes of the brain

how is hearing loss and dementia related

seniors w/ hearing loss are significantly more likely to develop dementia over time

dementia is intellectual, cognitive, com_____, be____, and per_____ deterioration

communicative, behavioral, and personality deteroration

in dementia patient shows significant decline from previous level of performance in areas like m____, l____, a____ etc

• defectis interfere w/ carrying ____ of daily living

memory, language, attention, etc

• activites

we won’t use the term senility but instead

mild age related cognitive decline

normal loss of cog. function w/ advanced age

brains resilience:

ability to cope with ____ damage while still functioning ____

incerasing / adequatly

cognitive reserve

The brain’s resilience, its ability to cope with increasing damage while still functioning adequately; the brain’s ability to improvise and find alternate ways to accomplish a task

what is cog reserve based on

education , new learning, new experiences

higher cog reserve: those w/ _____ education, cog complex and challanging ____

advanced, progessions

Alzheimer’s disease is a ________ disease that causes progressive ____

• many cases related to _______ factors that cause microscopic changes to both ____ and _____ matter resulting in _____ atrophy

neurological/ dementia

• genetic/ gray,white/ cerebral

what age does alzheimer’s usually begin

after age 65

what is alzheimer’s characterized by

• decline in ______

• _____ disorientation

• del_____

• _____ changes

• ____ impairments

• memory

• intellect

• delusisons

• personality

• communication

cortical atrophy

Shrinkage and wasting away of cortical tissue that is common in dementia.

why would someone not show they have alzheimers

large cog reserve

alzheimer’s disease

dementia of alzheimers type

why does alzheimer’s occur more in women

they live longer

cog/ intellectual impairments severe enough to interfere w/ s_____ or _____ functioning

social or occupational

dementia diagnosis made by

physicians and psychologists

what do SLP evaluate for in dementia

language, cognition, swallowing

Preclinical Alzheimer’s Disease

individuals have measurable brain changes that indicate the earliest signs of Alzheimer's disease (biomarkers—e.g., lab and neuroimaging indicators), but they have not yet developed symptoms such as memory loss.

mild cognitive impairment

s cognitive decline greater than expected for an individual's age and education level but that does not interfere noticeably with activities of daily living.

dementia therapy goals

max current _____

_____ progression

• consouling the ____ is key

max current abilites

slow progression

• family

Stage 1: _____ Alzheimer’s

• disorientation

• lost while driving on ____ streets

• impaired ____ memory

• putting items in ____ placs

• mood ____

• may take out fursteration and ____ on fam and colleagues

• familair

• working

• inapporiapte

• swings

• anger

Stage 2: moderate-middle

• inapporiate public____

• outburst of anger and _____

• increase loss of ____ memory

• dimished _____

• meaningless and ____ convo

• loss of reading and wriritn

• inapporiate public behavoir

• outburst of anger and aggressive

• increase loss of working memory

• dimished voca

• meaningless and empty convo

• loss of reading and wriritn

stage 3: severe-late stage:

• max assistance for

• minimal / no ____, or ____ communication

• difficultry reg others or ____

• difficultyyr chewing and ____

  • average life span after diagnosesis _____

• ADL

• memory, verbal

• self

• swallowing

• 4-7 years

Board and care home:

A homelike environment where there may be a few to several elderly or physically impaired individuals residing, and meals, laundry, and other services are provided.

Residential care facility

A fairly large complex of small “apartments” where individuals or couples live that provides communal dining, and various services (e.g., security, trips to the mall, and outings).

Custodial care

Services and care of a nonmedical nature (e.g., bathing, feeding, toileting) provided long term, usually for convalescent and chronically ill patients.