ncd midterm

ncd

problem w/ comm as result of damage to brain or other part of nervous system (aphasias, dysarthria, apraxia of speech, right hemisphere disorders, dementia)

where slps treat ncds

school, hospital, home healthcare, rehab facility

cognition

ability to process thought

speech

sounds mouth makes to make words

language

symbol set used to comm meaning (usually verbal, written, sign)

cognition divisions

arousal, orienting, orientation, problem-solving, inferencing, executive functions

arousal

ability to respond to stimuli

orienting

ability to direct attention to stimuli

orientation

ability to know who/where/when you are

problem-solving

ability to choose, apply, evaluate strategy to solve problem

inferencing

ability to interpret overall meaning of details

executive functions

ability to employ lower level cognitive functions to meet goals

working memory

ability to hold finite amt of info for immediate processing + manipulation

declarative memory

ability to remember facts

expressive language

words we assign to ideas to express meaning of our thoughts to others

receptive language

ability to understand spoken + written language

speech

simply sounds mouth makes to produce verbal language

impact of healthy aging on cognition

stays intact: orientation, sustained attention, ltm, procedural memory
slight nonpathological decline: selective attention, stm, episodic memory, declarative memory

impact of healthy aging on language

stays intact: processing functional verbal language, overall comp
slight nonpathological decline: processing of verbal language slows but stays fully functional, reading slows but stays fully functional, word finding of proper names + confrontational naming

impact of healthy aging on speech

speech + voice production stay overall typical

WHO

-biopsychosocial
-approaches comm as basic need + right of all human beings
-all 3 areas should be attended to from 1st day of intervention
-applies to individual that suffers + fam

client-centered approach example

observing the participant + recording naturalistic comm which ensures focus on authentic comm

client-centered approach example 2

analyzing social network to inform social comm approaches + include in therapy

sustained attention

ability to hold attention on single stimulus

selective attention

ability to hold attention on stimulus while ignoring competing stimuli

cns

brain + spinal cord, encased in bone, descending motor tracts send efferent info

pns

nerve tracts that connect rest of body to cns, encased in soft tissue, ascending sensory tracts send afferent info

gray matter

-collection of cell bodies + dendrites
-abundant blood supply
-unmyelinated neurons
-processes + regulates info in cns

white matter

-collection of axons
-covered in myelin sheath
-connects diff areas of nervous system to each other + allows them to comm

lobes

frontal, parietal, temporal, occipital, limbic

frontal lobe functions

motor control, language, higher-order cognitive function

parietal lobe functions

tactile + proprioceptive info, language comp, spatial orientation + processing

temporal lobe functions

auditory, language comp, higher-order visual processing, learning, memory

occipital lobe functions

visual

limbic lobe functions

emo response, drive-related behavior, learning, memory

main subcortical structures

brainstem, cerebellum, thalamus, basal ganglia

main brainstem structures

midbrain, pons, medulla

left hemisphere deficits

-damage to broca’s: knows what one wants to say but cant find right words
-damage to wernicke’s: can’t comp speech w/ own speech being often devoid of meaning

right hemisphere deficits

-comp: can only concretely understand language, unable to recognize faces/expressions, can’t recognize/interpret music
-expression: monotone, flat facial expressions, can’t make music
-can’t understand non-speech sounds
-can’t piece small details (microstructure) to get at big pic (macrostructure)
-visuospatial: can’t perceive depth, distance, shapes, etc
-sustained attention
-selective attention

anterior cerebral blood supply parts

internal carotid arteries: anterior + middle cerebral arteries

posterior cerebral blood supply parts

vertebral arteries: basilar artery: posterior cerebral arteries

sig of blood supply dist to ncds

brain regions responsible for speech depend on adequate oxygen + nutrients thru blood

sig of meninges to ncds

protect brain from infection + trauma

sig of ventricles to ncds

they make + circulate csf which cushions brain + removes metabolic waste from neural tissue

sig of understanding basic neuroanatomy + physio to study ncds

allows correlation of specific lesion locations w/ predictable patterns of comm deficits

etiology: stroke

-ischemic
-hemorrhagic
-transient ischemic attack
-acute vs chronic

etiology: tbi

-falls, assaults, abuse, sports
-closed vs open (penetrating)
-can be secondary damage

etiology: degenerative diseases

ad, parkinson’s, huntington’s, multiple sclerosis

stroke risk factors

cholesterol, cigs, alcohol, male

tbi risk factors

male, > 65, 5 + <, lower se factors

degenerative disease risk factors

fam history, heart disease, age, enviro

stroke incidence

-750k people will have this year (160k will die)
-2/3 survivors will be disabled
-impacts 4/5 fams

tbi incidence

-almost half of all injury deaths
-leading cause of injury death + disability for kids + young adults
-1.5m/year

ad incidence

-1 in 8 americans 65+
-40-50% of people > 85 likely meet criteria
-5th leading cod for 65+

parkinson’s incidence

-2nd most common neurodegenerative disorder
-.3% of pop
-1% of > 60

huntington’s incidence

-~30k currently diagnosed

als incidence

-~30k people currently diagnosed

ms incidence

-~400k people currently diagnosed

stroke pathophysiologic changes

cell death + swelling, metabolic reactions, inflammatory reactions

tbi pathophysiologic changes

neuro-toxicity, hematoma, astrocyte swelling, vascular dysregulation

ad pathophysiologic changes

-temporal + frontal lobes, hippocampus
-neurofibrillary tangles + neuritic plaques

aphasia

acquired comm disorder that impairs person’s ability to process language but does not affect intelligence. impairs ability to speak + understand others, most people experience difficulty reading + writing

language modalities

comp: listening + reading. production: speaking + writing

language components

syntax (form), semantics (content), pragmatics (use)

dominant paradigm: classical associative connectionist paradigm

-specific brain parts are responsible for discrete language behaviors
-discrete areas share info w/ each other thru dedicated pathways
-oversimplifies complexity of aphasia presentation
-application: activating pathways to target, strengthening weakened connections thru repeated practice + multi-modal stimulation

dominant paradigm: neoclassical connectionist model of aphasia

-posterior language areas = language comp center
-anterior language areas = speech motor reps
-area of connection = arcuate fasciculus
-too simple
-application: targeting specific impaired pathway, predicting strengths, using alternative routes when routes are damaged

brown’s microgenetic theory

-holistic tradition
-dynamic across time in short + long term
-errors made by people demonstrate earlier learned language phenomena
-hard to test w/ behavioral measure
-application: target depth of breakdown, errors show which stage is disrupted

cognitive neuropsych model

-language is broken down into discrete components that function on their own
-have been valuable for clinical decision making
-weakness: basic principle of language function after injury is identical to normal language function
-application: identify specific impaired part

computational models

-attempt to more clearly identify connection btwn modules identified in cognitive neuropsych models
-lesions can be introduced to disrupt connections 
-application: strengthen weakened networks thru repeated activation of damaged pathways, using intact connections to support weak ones

aphasia classification system: fluent/nonfluent

-from clinical observation
-parameters: speaking rate, prosody, articulation, phrase length

aphasia classification system: boston diagnostic

-from classical associative connectionist model
-based on idea of disconnection btwn broca + wernicke via arcuate fasciculus damage
-3 key areas:
—severity of comp deficit
—linguistic features of spontaneous verbal expression
—repetition ability compared to spontaneous expression
-parameters: articulatory agility, phrase length, grammatical form, melodic line

aphasia classification system: schuell

-from empirical testing

-unitary language disorder that can also include deficits in sensory, motor, cognitive domains
-no lesion location assumptions
-no modality/process-specific considerations

broca’s

-left frontal lobe
-AGRAMMATISM (across language domains)
—predominance of nouns/verbs
—no function words, inflectional endings
-relatively intact auditory comp
-less repetition
-impaired word finding

transcortical motor aphasia

-front top left frontal lobe
-reduced quantity, variety, elaboration
-reduced syntactic complexity
-intact repetition
-auditory comp spared

global aphasia

-broca + wernicke + insular areas
-severe language impairment across all modalities
-poor comp + minimal production
-may have some intact automatic speech, singing
-may try non-verbal cues

wernicke’s aphasia

-back high temporal lobe
-POOR AUDITORY COMP, JARGON, PRESS FOR SPEECH
-unawareness of output
-phonemic, semantic paraphasias
-neologisms

conduction aphasia

-parietal lobe
-LEVEL OF IMPAIRED REPETITION DISPROPORTIONATE TO RELATIVELY INTACT COMP + SPONTANEOUS SPEECH
-anomia
-occasional phonemic paraphasias w/ increased length + complexity
-more awareness of production errors than wernicke’s

transcortical sensory aphasia

-bottom left temporal lobe
-similar to wernicke but w intact repetition

anomic aphasia

-left parietal lobe
-difficulty finding + using words
-uses general terms
-pauses
-may have intact comp

thalamic aphasia

left mediodorsal thalamic nucleus, anomia, variable phase length, variable auditory comp, relatively good repetition

anterior capsular/putaminal aphasia

anterior limb of internal capsule and/or anterior putamen, anomia, variable phrase length (best 6-8 words), relatively good comp + repetition

posterior capsular/putaminal aphasia

anomia, variable phrase length, poor auditory comp + repetition

primary progressive aphasia

-isolated language deterioration w/ relative preservation in other cognitive skills
-insidious onset, gradual progression, prolonged course