COSI 357 Midterm: Patient Perspective and Neuroanatomy

What is special about the WHO framework?

• Creates a foundational concept of how this thing is impacting this person's daily life 

  • The whole point of our profession is to know what's going on so we can treat it and help people do what they want in their daily lives

What is the first step of treating someone as an SLP?

Fully understanding why someone is experiencing what they are and behaving they way they are is the first step to treating someone as an SLP

Understand how something is affecting everyday life → how something affects someone may be different than how it affects someone else

What are compensatory vs restoratory interventions?

• Compensatory: do we come up with compensatory strategies like leaving post it notes —> try to compensate for what is missing or going on 

• Restoratory: do we treat them and try to restore/fix what is going on 

  • Typically we do a combo of both unless late stage of something in which case we would do compensatory

What is the biopsychosocial approach?

• Biopsychosocial approach 

  • Multifaceted approach to viewing a patients disease

• Approach communication as “a basic need and right of all human being” 

  • If they are having problems with communication it is our job to fix that 

• All 3 areas should be attended to from the first day of intervention 

  • Bio, psycho, social 

• Applies to both the individual that suffers from aphasia as they family members 

  • Our care does not stop with our patient it extends to their family as well 

  • Consult with family 

What is the main question we ask based on the biopsychosocial approach? What influences do we also look at?

• How is this disease affecting their activity and participation?

• Ex: dementia → how it affects neuroanatomy and physiology → how it affects what they want to do

• Environmental factors and personal factors influence all of this 

  • Environmental factors: socioeconomic status, familial support and home

  • Personal factors: education level, motivation, psychological issues that require help

Why do we want to have a client centered approach?

• We want to have a client centered approach to our treatment → we want our patients to be choosing what they do → if there is something they are interested in we do that → listen to them 

  • What are your goals and what do you want to be able to do?

What is the experience of illness?

• Stage 1: Uncertainty 

  • Suspecting something is going on but uncertain of what exactly it is and others in your life are also observing something but are keeping an eye on it 

• Stage 2: Disruption

  • There is something going on and you need help 

• Stage 3: regaining self

  • Understanding what is going on and trying to preserve the self 

• Stage 4: regaining wellness 

  • Taking charge, set goals, and be yourself again through this illness process

Central Nervous System

Central Nervous System (CNS)
• Brain and spinal cord
• Encased in bone
• Descending motor tracts send efferent information (from brain to body)

Peripheral Nervous System

Peripheral Nervous System
(PNS)
• Nerve tracts that connect the rest of the body to the CNS
• Encased in soft tissue
• Ascending sensory tracts send afferent information (from body to brain)

Gray vs white matter

Gray matter
• AKA: nuclei* & cortex
• Collection of cell bodies & dendrites
• Abundant blood supply

• Unmyelinated neurons
• Processes and regulates information in the CNS
• Found in the cortex, cerebellum, thalamus, basal
ganglia, and spinal cord.

______________
White matter
• AKA: tract, fasciculus, funiculus,lemniscus, & peduncle
• Collection of axons
• Lipid covering, myelin sheath, gives white appearance

• Axons of neurons covered in a white sheath of a
protein and fatty substance called myelin
• Myelin insulates the axons of neurons to allow electrical
impulses to be conducted(~100 meters/second)
• Connects different areas/structures of the nervous
system to one another and allows them to
communicate

Describe the cerebral hemispheres?

• Made up of ridges (gyri) and valleys (sulci)
• Folded tissues allow more neural tissue to be packed into a smaller space
• Rests on top of the brain stem
• Originating our highest/most complex cognitive functions
• Cerebral cortex
• Surface tissue of the cerebrum
• 5 hemispheres

What role does the frontal lobe play in speech?

Inferior frontal gyrus has 3 parts important for language & cognition

Pars Orbitalis
• Most anterior

Pars Triangularis
• Wedge-shaped

Pars Opercularis
• Most posterior

Triangularis and Opercularis = brocas area

What are the four functional areas of the frontal lobe?

Primary motor cortex
• Precentral gyrus
• Origin of descending motor pathways

Premotor and supplementary motor cortex
• Just anterior to 1º motor cortex; motor control

Broca’s area
• Opercular & Triangular parts; language

Prefrontal cortex
• Remainder of frontal lobe; higher-order cognitive function

Describe the parietal lobe

• Postcentral gyrus corresponds to primary somatosensory cortex
(tactile & proprioceptive information)
• Inferior parietal lobule involved in language comprehension
• Remainder involved in spatial orientation & processing

Describe the temporal lobe

• Primary auditory cortex (superior surface)

• Wernicke’s area (posterior portion of superior temporal gyrus) - language comprehension

• Inferior surface involved in higher-order visual processing

• Most medial part involved in learning and memory (actually limbic lobe)

Describe the occipital lobe

• Exclusively concerned with visual function
• Primary visual cortex - calcarine sulcus
• Remainder is visual association cortex

Describe the limbic lobe

• Responsible for emotion (big reason why is the amygdala)

• Drive related behavior (motivation, goal setting)

• Learning and memory → hippocampus is located here

What are some examples of left hemisphere deficits that can result from something like a TBI or Stroke?

• Primarily responsible for expressive and receptive language

• Broca’s area

  • Inferior-posterior region of frontal lobe

  • Finding words to express meaning

  • Damage leads to Brocas Aphasia

    • know what they want to say but cannot find the right words to use

    • usually intact receptive language

• Wernicke’s area

  • Posteriorly located along the superior marginal
    gyrus of temporal lobe

  • Interpreting meaning of spoken words

  • damage to wernicke’s area leads to wernicke’s aphasia

    • unable to comprehend speech with their own speech being often devoid of meaning

What are some examples of right cerebral hemisphere deficits?

Responsible for prosody, facial expression, melody and rhythm aspects of language comprehension

Responsible for prosody, facial expression, melody and rhythm aspects of language expression

Deficits:

• Perception of environmental sounds

  • Inability to understand non-speech sounds

    • door slamming or birds singing

• Visuospatial Processing

  • inability to perceive depth, distance, shapes etc

• Sustained Attention

  • inability to attend to single stimulus

• Selective Attention

  • inability to ignore unimportant stimuli when attending to the important stimuli

• Macrostructure

  • Inability to piece small details (microstructure) to arrive at the big picture (microstructure)

    
    
    

Describe the subcortex

• Responsible for functions usually beneath the level of awareness

  • Refines motor plans

  • Regulates heartbeat, breathing, arousal, and
    sleep/wake cycle

  • Coordinates viscera and digestive system

• Primary structures of the subcortex

  • Brainstem

  • Cerebellum

  • Thalamus

    • internal capsule: contains most fibers from cortex to deep structures

  • Basal Ganglia

    • motor control

What makes up the diencephalon?

Thalamus
• Nuclear mass
• Almost all informationcpasses through

Hypothalamus
• Major visceral control center

Epithalamus
• Most dorsal division
• Information going to other parts of the brain travels through here

Subthalamus
• Involved in motor control

What are the vegetative functions of the brainstem?

Vegetative Functions:

• respiration

• cough and gag reflex

• pupillary response

• swallowing reflex

What does the midbrain do?

relay center for auditory, visual and sensory/motor information

What is the function of the pons?

mainly relays information to cerebellum; mediates motor function at an unconscious level

What is the function of the medulla?

Pyramids
• Motor tracts carrying descending motor information

Pyramidal decussation
• Cross-over point for motor information

Inferior Olives
• Sensory information to the cerebellum

Discuss cranial nerves

• Cranial nerves are considered part of the PNS
• Their cell bodies are considered part of the CNS
• Begin exiting the brain at the level of the midbrain and lead all the way down the medulla

Discuss the functions of the cerebellum

3 functional areas
Anterior lobe
• Involved in coordination of leg movements

Flocculonodular lobe
• Eye movements and postural adjustments to gravity

Posterior lobe
• Coordination of voluntary movements

Circle of Willis

• Connection of the ICA, ACA, and PCA of both sides
• Forms an anastomosis at the base of the brain
• Normally little flow through the Circle of Willis due to
equalized pressure
• ACA pressure = PCA pressure; no flow in communication
arteries
• If one vessel is occluded - other vessels may provide critical
flow
• Individual variability in vessel size and temporal
characteristic of occlusion determines amount of collateral
flow

what mechanisms protect the CNS?

• Skull and vertebral column
  • Provide structural support

• Meninges
  • Stabilize the shape & position of nerve tissue

• Cerebral spinal fluid within the meninges
  • Provide buoyancy which diffuses various forces

What are the three meninges?

1. Dura

2. Arachnoid

3. Pia

What are the spaces within the meninges?

1. epidural space

2. subarachnoid space

3. subdural space

Discuss the ventricles

• Core of neural tube forms cavities in the brain - called
ventricles
• Ventricles are filled with CSF
• Produced by choroid plexus
• Ventricle system is continuous

• 4 ventricles
• 2 lateral ventricles
• 3rd ventricle
• 4th ventricle