Acquired Exam 1

CNS

brain and spinal cord

PNS

cranial and spinal nerves

neurons

basic structural and functional unit of nervous system (sensory, motor, inter)

axons

projections from cell body carrying impulses

dendrites

receiving impulses

glial cells

provide support, nutrition, and maintenance for neurons

gray matter

process information

white matter

transmit information

white myelin sheath around axon

bundles of axons in CNS

* pathways or tracts
* Ex: arcuate fasciculus

bundles of axons in PNS

* nerves
* Ex: spinal nerves, cranial nerves

projection fibers

to and from cortex to brainstem/spinal cord (corona radiata)

association fibers

to and from region of same hemisphere (arcuate fasciculus)

commissural fibers

from one hemisphere to the other (corpus callosum)

ascending nerve fibers

sensory, afferent (body to CNS)

descending nerve fibers

motor, efferent (CNS to body)

skull protects…

brain

vertebrae protects…

spinal cord

protective membranes

dura mater, arachnoid mater, pia mater

cerebrospinal fluid

reduces impact for brain

cerebrum includes

* cerebral hemispheres
* cortex
* subcortical structures

basal ganglia

motor coordination

thalamus

sensory and motor relay center

limbic structures

pleasure, mating, feeding, emotions, memory, learning, motivation, fight or flight

sulci

groove or fissure

gyri

ridges or bumps

cerebellum

* Crucial connections to cortical and subcortical structures, brainstem, and spinal cord
* Responsible for balance and smooth motor coordination

brainstem

* consists of the midbrain, pons, and medulla
* Responsible for autonomic functions (breathing, swallowing, heart rate)
* Origin of the cranial nerves (except I and II)

blood gets to the brain via

* carotid arteries
* vertebral arteries

external arteries

face and neck

internal carotid (ACA and MCA)

brain

vertebral arteries

* Join to form the basilar artery
* Posterior cerebral arteries (PCA)

dorsal horn

sensory info to brain

ventral horn

motor info from brain

somatic nervous system

* sensation
* motor movements

autonomic nervous system

* self regulation
* sympathetic
* parasympathetic

sympathetic

fight or flight

parasympathetic

returns body to normal state

How many cranial nerve pairs?

12

How many spinal nerve pairs?

31

spinal nerves C3, C4, C5

innervate the diaphragm

dermatomes

an area of skin that is mainly supplied by a single spinal nerve

Trigeminal - V

A mixed nerve that innervates the jaw and tongue; important for speech and chewing

Facial - VII

mixed nerve for sensation of taste and motor control of the facial muscles; important for facial expression and salivation

Vestibulocochlear - VIII

sensory nerve that is needed for hearing and balance

glossopharyngeal - IX

mixed nerve with sensory input from tongue and motor control of the pharynx for salivation and swallowing

Vagus - X

Mixed nerve innervating heart, lungs, and digestive system. Sensation and motor control in the larynx and pharynx important for phonation, soft palate movement, and swallowing,

spinal accessory - XI

motor nerve that innervates muscles of the pharynx, soft palate, head, and shoulders

hypoglossal - XII

motor nerve controlling muscles of tongue

aphasia

* acquired disorder of language
* caused by damage to the left hemisphere
* affects all language modalities

etiologies of aphasia

* stroke (most common)
* tumor
* trauma
* infection
* degenerative disease

ischemic stroke

occluded blood vessel in brain

thrombosis

narrowing/hardening of arterial walls

embolism

thrombotic material breaks off; stops blood flow upstream

transient ischemic attack (TIA)

temporary ministroke (1-24 hours)

hemorrhagic stroke

bleeding in brain

subarachnoid

bleed between the surface of the cerebrum and the skull

intracerebral

blood vessel IN brain ruptures

cerebral aneurysm

weakening and rupture of arterial wall

arteriovenous malformation

rupture of tangled blood vessels

binary classification

fluent vs nonfluent

CVA in anterior branches of MCA

nonfluent aphasia

CVA in posterior branches of MCA

fluent aphasia

broca’s aphasia fluent or nonfluent?

nonfluent

wernicke’s aphasia fluent or nonfluent?

fluent

conduction aphasia fluent or nonfluent?

fluent

global aphasia fluent or nonfluent?

nonfluent

anomic aphasia fluent or nonfluent?

fluent

transcortical aphasia fluent or nonfluent?

fluent (sensory) or nonfluent (motor)

4 primary parameters used in traditional aphasia classification

* Fluency
* Auditory comprehension
* Naming
* repetition

Broca’s aphasia speech and language characteristics

*Nonfluent, agrammatic* (grammar and syntax are not correct), naming difficulties (anomia), impaired repetition, impaired reading and writing; often have motor speech difficulties (dysarthria or apraxia of speech); *relatively intact auditory comprehension*

Wernicke’s aphasia speech and language characteristics

*Fluent speech (“empty speech” with paraphasias and neologisms- not saying an actual word)*, impaired naming, impaired repetition, impaired reading and writing, *impaired comprehension*

conduction aphasia speech and language characteristics

Fluent speech, some naming trouble, relatively intact comprehension, some reading and writing difficulties, *impaired repetition*

global aphasia speech and language characteristics

Severely nonfluent with severely impaired naming, repetition, comprehension, reading and writing

anomic aphasia

Fluent spontaneous speech with good articulation, syntax, phrase length, and prosody. Auditory comprehension and repetition may be mildly impaired. Mild reading and writing deficits. *Primary symptom is word-finding difficulty (anomia).*

broca’s

nonfluent speech, relatively good comprehension

wernicke’s

fluent speech, poor comprehension

conduction

poor repetition compared to spontaneous spoken production and auditory comprehension abilities

global

all language abilities severely impaired

anomic

fluent with good comprehension; intermittent trouble with word retrieval

subcortical aphasia

damage to thalamus or basal ganglia, more like anomic, have trouble with naming, semantic errors

primary progressive aphasia

gradual onset and continued decline in language abilities; progresses into dementia; not caused by an acute neurologic event

substitution

anymay → anyway

transposition

emeny → enemy

addition

abrout → about

omission

drug → dug

neologisms

spoon → shlurfa

semantic paraphasia

chair → table

prognosis

likelihood for improvement

factor affecting prognosis for improved language function

* Time since onset of neurological damage
* Location and severity of damage/lesion
* Type or characteristics of aphasia
* Progress in treatment
* Age
* Motivation
* Support of family/caregivers
* Medical history

quality of life assessments for aphasia

* Assess patients and caregivers
* How do they see aphasia affecting participation in daily life?
* What emotional and social effects? Depression? Social Isolation?

aphasia treatment guidelines

* Treat the person with aphasia in an age-appropriate fashion
* Keep language clear and simple
* Use supports such as pictures are written language along with your spoken language
* Work on what is important and meaningful to the patient
* Incorporate the patient and family into goal setting
* Teach the patient to use their strengths to help compensate for weaknesses

restorative treatment approach for aphasia

aim to directly improve language abilities that are damaged

compensatory treatment approach for aphasia

target ways to work around language weaknesses; focus on teaching strategies and skills

Ex: AAC

social treatment approach for aphasia

focus on functional interaction and communication with others; focus on psychological aspects of aphasia

cog-comm disorder is usually used when referring to

* Right Hemisphere Disorder
* Traumatic Brain Injury (TBI)
* Dementia

Communication in these cog-comm individuals is impaired largely due to impaired cognitive abilities in the areas of:

* Attention
* Memory
* Executive function

right hemisphere normal function: attention and perception

* Sustained, selective, divided, and alternating attention
* Perception of the “whole” instead of the parts
* Perception of spatial information
* Facial recognition

right hemisphere functions

* attention and perception
* emotion
* facial expression
* visuospatial skills
* extralinguistic communication

right hemisphere damage

damage to the right cerebral hemisphere of the brain that results in a collection of symptoms related to cognition and communication

common etiologies of right hemisphere damage

* Right cerebral hemisphere CVA (stroke)
* TBI
* Tumors
* Infections
* Degenerative diseases