SPLH 850: Cognitive-Linguistic Disorders of Adults | Final Exam

Suppression Deficit Hypothesis

A theory that states that in RHD, the suppression of unwanted meanings is impaired

• People with RHD can activate “distant” meanings, but then they can’t suppress the unwanted meanings (so multiple meanings are competing)

Example of Suppression Deficit

A topic is brought up, such as “coffee", and then the brain activates all things/memories related to that topic

• Individuals with RHD can’t suppress what they don’t need to say or talk about in a conversation

• Therefore, they typically say everything that comes to mind and have difficulty suppressing

Activation Deficit Hypothesis

Inefficiency or inability to activate “distant” meanings/features of words

Example of Activation Deficit

Indirect Approaches

• Redundancy

• Short/simple language

• Reorienting implicitly

• Talk slower than usual

• Multimodal input

• Limit number of conversational partners

• Pleasant voice

• Use proper nouns rather than pronouns

• Reduce # of prepositions in a sentence

Not quizzing!

Rancho Los Amigos Scale (RLA)

Neuroanatomy of Attention Processing by Left and Right Hemispheres

Normal

• Right hemisphere attends to both sides of space

• Left hemisphere attends to only the right side of space

Right Hemisphere Lesion (Left Neglect)

• Occurs when there is a Right CVA

• Right hemisphere visual field stops working; therefore, the brain only processes objects in the right visual field (Not the left)

Left Hemisphere Lesion

• Occurs when there is a Left CVA

• Left hemisphere visual field stops working; however the right hemisphere can compensate, therefore, both the left and right visual fields process objects in both fields

  • Less common, less severe

Left neglect is…

NOT a vision deficit

Left neglect is…?

NOT denial

+Left neglect is…

Inattention to the side contralateral to the lesion

Why are computer-generated tasks and websites not recommended for therapy?

Research findings are that the patient gets better at their attention for the computer-generates TASK, not necessarily attention in general - it does not generalize!

Look at InterActAbility Training

Apply findings from non-treatment literature to your treatment needs

Coma

Consciousness: None

Sleep/Wake: Absent

Motor Function: Reflex and postural responses only

Auditory Function: None

Visual Function: None

Communication: None

Emotion: None

Vegetative State

Consciousness: None

Sleep/Wake: Present

Motor Function: Postures or withdraws to noxious stimuli; occasional non-purposeful movement

Auditory Function: Startle; brief orienting to sound

Visual Function: Startle; brief visual fixation

Communication: None

Emotion: None; reflexive crying or smiling

Minimally Conscious State

Consciousness: Partial

Sleep/Wake: Present

Motor Function: Localizes noxious stimuli; reaches for objects; holds or touches objects in a manner that accommodates size and shape; automatic movements (e.g., scratching)

Auditory Function: Localizes sound location; inconsistent command following (evidence of language functioning)

Visual Function: Sustained visual fixation; sustained visual pursuit

Communication: Contingent vocalization; inconsistent but intelligible verbalization or gesture

Emotion: Contingent smiling or crying

DoC - What to do next and why?

Using Literature from Other Populations

1) Is my patient sufficiently similar?

2) Is the nature of my client’s cognitive impairment similar?

3) Are there coexisting cognitive impairments that may interfere?

4) Is it feasible to apply the intervention in my setting?

5) What are the expected benefits and costs of this treatment?

6) Is the treatment consistent with the patient’s own preferences, values, and expectations?

Goal Attainment Scale

+2: Much better than the expected outcome

+1: Better than expected outcome

0: Expected outcome

-1: The patient’s current level of functioning

-2: Lower than the patient’s current level of functioning