Advanced exam 2: Aphasias, Right Hemi, TBI

Communication disorders associated with RHD

-Semantics & Pragmatics

-Prosody

-Cognitive aspects related to attention, perception, orientation, agnosia, neglect

Etiologies of RHD

-CVA

-Tumors

-Trauma

-TBI

-Other neurological diseases

Communication

-Propagnosia (facial recognition)

-Understanding/expressing facial expressions

-Anosognosia (lack of insight)

-Prosody

-Inferencing (literal)

-Discourse (exchanging convo, topic maintenance, etc)

Attention

-Left neglect: cannot attend to left side

-Sustained attention

-Selective attention: choosing what to hear

-Divided attention: being able to go from one thing to another

Neglect

Defined as a failure to report, respond or orient to stimuli to the side opposite to the brain injury

-Typically related to lesions in the parietal lobe

-Related to stroke, tumours, trauma, or degenerative disorders

-Contribute to any sensory modality in isolation or cominantion

-Can affect safety & communication

Affect and emotional deficits that RHD may show

-Difficulty understanding/identifying emotions

-Emotions depicted in pictures/stories

-Emotional tone of voice

-Demonstration own emotions (inappropriately or at the wrong time)

Coprolalia

-Involuntary brief stereotypical vocal tics

-LaPoints research found this was consistent across languages anf cultures

-Therapy includes medical management (antipsychotics) and behavioural intervention

-SLP cannot fix this with therapy, but can work on in sessions

Informal testing of RHD

-Prosopagnosia: photos, family members

-Facial affect: recognize/do facial expresssions

-Prosody: phrase, alter stress/pitch to change meaning

-Inferencing: images (season example)

-Discourse: conversation, see if they turn take, listen etc

-Neglect: drawings, food on plate, ask to grab something on left

-Attention (4 kinds)

Treatment for RHD

-Giving strategies/cues to make them successful during activities

Closed head injury

without breaking the skull

-Acceleration-deceleration head injuries

-Focal damage (frontal/temporal) and overall damage from contrecoup injury including brainstem

-Impact-based injuries, struck by object moving, so skull is pressed inward

example= concussion

Open head injury

Skull is opened

-Often associated with assaults

-Focal damage

-Damage depends on site of lesion/size

example = gunshot wound

Secondary risks

-Intracranial pressure

*cerebral edema

*traumatic hydrocephaleus: difficulty reabsorbing old CSF while producing new

-Traumatic Hemorrhage

*intracerebral: within brain

*subdural: dura matera and arachnoid

*epidural: dura mater and skull

*hematoma

Generalized picture of TBI

-presents to the hospital

-confused, disoriented, minimally consious

-hooked up to ventilator an/or has a tracheostomy

(SLP would want to look at swallowing and communication)

Motor deficits

-Planning/execution for production of speech and swallowing

Motor speech disorders (apraxia/dysarthria)

Swallowing (dysphagia)

Altered states of consiousness

-Coma

-Vegetative state- minmally responsive but not cognitively aware

-Persistent vegetative states lasts more than 4 weeks

-Minimally conscious

*follow simple commands

*respond to y/n questions

*intelligible utterances

*purposeful behaviour

Common cognitive linguistic deficits TBI

Memory

Executive functioning

What does executive functioning entail

-Attention

-Initiation

-Shifting and adjusting within an activity

-Self monitoring and self control

-Goal setting

-Sequencing

-Planning and organization

-Problem solving

Assessment of TBI

-Common standardized assessments:

Brief test of head injury

Cognitive-linguistic quick test

ross information processing assessment

Assessment- arousal

Coma scales

-glasgow coma scale: eye opening, motor, verbal responses

-ranchos los amigos levels of cognitive functino scale

Assessment orientation

-may use standardized test or screen (mini mental state examination, SLUMS, MOCA)

-Ask questions! whats your name, what time is it, where are you

Assessment- memory

-Long term memory: personal questions during interview

-Visual memory: drawings (be careful), objects in field of choice

-Immediate recall/short term memory: word list retention (unrelated)

Models of cognitive rehabilitation

1. direct instruction- emphasizes specific skills

1. strategy-based instruction: emphasizes self-monitoring and monitoring one's own thinking

3. combined model: reinforcement and modeling

*restorative vs compensatory

Treatment of TBI- arousal

-Sensory Stimulation Therapy : minimal research

visual

auditory

olfactory

tactile

gustatory

(no patient participation)

Treatment of TBI- attention

-Will mirror therapy for attention deficits in L and R hemi disorders

What types of attention to target?

Sustained, selective, alternating, divided

Types of attention

sustained: focus on one thing

selective: choose a stimulus to focus on

alternating: back and forth between tasks

divided: attending to multiple things at once

Treatment for TBI- problem solving

-dependent on current capabilities of patient (severity, age etc)

-hierarchy of concrete, simple tasks and increase complexity

-functional tasks of daily living (bathroom, cooking, make bed, pay bills)

Treatment for TBI- memory, restorative

Restorative - spaced retrieval

-for remembering info

-increase time in between when sucessful

-decrease time if not sucessful

Treatment for TBI- memory, compensatory strategies

internal: visualizing, rehearse in mind

external: list, rehearse out loud

Working memory strategies

-decrease length of instructions

-dont talk too fast

-breakdown tasks

-increase automaticity

-use functional tasks vs worksheets (good for motivation)

Treatment for TBI- orientation

external aids: clocks, calendars, photos

*changes every day so it can be hard to teach. provide resources for the patient

Treatment for TBI - others

-Safety and reasoning

-Planning and organization

-Inferencing

*focus on cognition and language because both hemis can be affected

3 ways to improve aud comp

-limit background noise

-minimal options

-high frequency words

3 ways to promote verbal expression

-manipulative objects

-extra time to process

-high frequency words

-phonemic cues