Med speech final modules 5 and 6

How was the term delirium first used?

-as a medical term
-occurring during fever or head trauma.

Is delirium a disease?

no

What is delirium?

-a collection of symptoms that are used to describe a transient and reversible syndrome
-that is acute and fluctuating

Delirium is an acute or sub-acute decline in _______ and _______

cognition and attention

Delirium is a ________ and ________ _________ for hospitalized patients

common and severe problem

delirium can cause ________ _______

perceptual impairments

What are some perceptual impairments?

-illusions
-hallucinations
-delusions

With delirium do you assess attention or memory?

attention

Delirium can often be traced to one or more underlying etiologies such as...

•Severe or chronic illness (worsening of liver or lung disease)
•Acute onset of illness (CVA, trauma)
•Medications
•Infection
•Alcohol or drug withdrawal
•Surgery
•Changes in metabolic balance (such as low sodium)•Complications from a fall

What is an easily recognizable type of delirium?

hyperactive delirium

What are the types of delirium?

-hyperactive delirium
-hypoactive delirium
-mixed delirium

What is hyperactive delirium?

-Restlessness
-agitation
-hyper vigilance
-rapid mood changes
-hallucinations/delusions
-refusal to cooperate with care

When assessing delirium, what is the first thing you should do?

make sure to give them glass, hearing aids, and dentures

Who most often has hyperactive delirium?

patients after TBI

What are some features of hypoactive delirium?

-lethargy
-sedation
-abnormally drowsy

Do people with hypoactive delirium response to questions slowly or quickly?

slowly

Do people with hypoactive delirium show spontaneous movement?

they show little spontaneous movement

Who is hypoactive delirium most common in?

the elderly

Hypoactive delirium is often misdiagnosed as a form of _________

dementia

What is mixed delirium?

•Has features of both hypoactive and hyperactive delirium
•Switch back and forth

What should you promote with patients with delirium?

good/healthy sleep habits (bedtime / wake-up times)

What is one way to help a patient remain calm and well-oriented?

-white-boards with day/date/where they are
-have a backlit clock in every room

What is meta-cognitive awareness training also called?

Rehab diaries

What syndromes/diseases is Meta-Cognitive Awareness Training used for?

delirium and dementia

What is meta-cognitive awareness training used for?

To improve awareness and use of compensatory strategies

What are things that should be included in Meta-cognitive awareness training?

•Patient's task
•Prediction
•Estimating performance
•Internal distractions/ inhibitors
•External distractions/ inhibitors
•Compensatory strategies
•Insight
•Actual performance
•Result

Delirium is a risk factor for future ________
Because Those who experienced delirium have increase _________ ___________

-dementia
-brain atrophy

What is dementia?

a neurodegenerative disorder with progressive loss of cognitive abilities

What are the main types of dementia?

*-Alzheimer's*
*-Lewy Body*
-Vascular
-frontotemporal

How common Alzheimer's disease?

-the most common type of dementia
-70% of cases

How can Alzheimer's be differentiated from delirium?

-insidious slow onset
-preservation of attention in the early stages.

How common is Lewy Body Dementia?

-the less common than Alzheimer's
-15% of cases

Why does Lewy body dementia mimic delirium?

-fluctuating course
-inattention

Delirium
Onset:
Course:
Attention:
Alertness:

-acute
-fluctuating
-always inattentive
-may be drowsy (hypoactive) or restless (hyperactive)

What does cognitive testing usually show with delirium?

-Impaired across all domains due to inattention
or
-mainly in executive function

What is a informal cognitive test for delirium that you could do?

-arranging the days of the week
-ask the steps in an event

Lewy body dementia
onset:
course:
attention:
alertness:

-insidious
-fluctuating, progressive
-periods of inattention
-drowsy

What does cognitive testing usually show with Lewy Body Dementia?

-Impaired mainly in executive function
-impaired in visuospatial domains early in disease

What type of dementia is common in people with parkinsonism?

lewy body dementia

Alzheimer's Disease
onset:
course:
attention:
alertness:

-insidious
-progressive decline
-attentive in early to moderate stages
-usually restless/agitated

What does cognitive testing usually show with Alzheimer's disease?

Impaired mainly in delayed recall early in the disease

With delirium, the patients usual fluctuate from their usual behavioral patterns by either __________ or __________

timing or severity

Delirium is associated with ________

precipitants

What are precipitants (causes) of delirium?

-change in medications
-infections
-hospitalization
-etc

With lewy body dementia how long to do the fluctuations last? Do they follow a pattern?

-may last hours or days
-does not follow a pattern (unlike sundowning).

Explain the fluctuations with lewy body dementia

-delirium like
-spontaneous alterations in cognition
-incoherent speech
-variable attention
-staring or zoning out

With lewy body dementia are the fluctuations due to a precipitating factor?

no

What questions do you ask to discriminate between fluctuations of lewy body dementia and Alzheimer's?

ask questions about:
-daytime drowsiness
-lethargy
-staring into space
-episodes of disorganized speech

What is sundowing? Who is it most common in?

-a pattern of worsening neuropsychiatric symptoms
-in the afternoon/evening hours
-in patients with Alzheimer's

Are all types of dementia progressive?
What does how quickly dementia progresses depend on?

-Yes
- the individual

During the later stages of dementia most people will become increasingly frail, becoming...

totally dependent on others

What are characteristics of individuals with dementia?

-memory loss
-deficits in communication
-loss of mobility
-loss of control of bowl or bladder
-puzzling behaviors

Do people with dementia sometimes have occasional experiences of sudden flashes of recognition?

yes

When someone has dementia, they may live in a time form their past. What might they search for?

people or objects from that time

That is all the info for module 5! you are doing so good!

Onto module 6!!

What are the three types of brain lesions/ distributions that may result in brain injury?

-focal lesions
-multifocal lesions
-diffuse lesions

What is a distribution?

where the lesion is

Acquired brain injuries can be _______ to ______ in severity

mild- severe

What are the types of Acquired brain injuries or the underlying pathologies?

-non-traumatic
-traumatic

What are focal lesions? give example

-restricted to one area
-stroke
-tumors
-brain abscesses
-focal trauma/penetrating injury (gunshot wound)

What are multifocal lesions? give example

-multiple, distributed occurrence
-MID (multiple strokes) or TBI

What are diffuse brain injuries? Give examples

-rotational or diffuse axonal injury (DAI) TBI
-hypoxia
-metabolic or infectious brain issues

Where is the damage with a diffuse brain injury?

at the level of the neuron

How do you classify a brain injury?

-TBI classification
-GCS score
-Duration of coma
-length of post traumatic amnesia (PTA)

What is a traumatic ABI?

injury caused by external force

What are examples of traumatic ABI?

*-falls* - most common
-assaults
-MVA
-sports and rec
-Acute Head Trauma /Shaken Baby Syndrome
-Gun Shot Wound
-work-related
-physical abuse/violence
-military actions

What are the two primary mechanisms of traumatic ABIs?

-impact
-inertia

In relation to Traumatic ABIs what does inertia mean?

brain is in motion and body is not moving

In relation to Traumatic ABIs what does impact mean?

contact

What are the two subcategories of traumatic ABIs?

-open (penetrating) head injury
-closed (non-penetrating) head injury

What are examples of non-traumatic brain injuries?

•CVA (ischemic/embolic or hemorrhagic)
•Infectious disease
•Seizure disorders
•Electric shock
•Tumors
•Metabolic disorders (insulin shock, kidney function)
•Anoxia (near-drowning, strangulation, choking)
•Toxins (carbon monoxide poisoning)

Who diagnosis a ABI?

-physician

What is an acquired brain injury diagnosed based on?

patient report

What is the patient report based on? How is it found?

-clinician presentation
-brain imaging studies

What is important to note about mTBIs brain imaging studies?

they typical look normal

Deficits of TBIs are managed and diagnosed by a team of professionals including...

-SLPs
-audiologists
-doctors
-nurses
-neuropsychologists
-OTs
-PTs
-social workers
-employers
-teachers
-neuroscientists
-nutritionist

What type of team are ABIs usually managed by?

interdisciplinary

TBIs due to impact can be ______ or _______

open or closed

Where is the injury with a TBI that is closed due to impact?

At the level of the brain tissue you will see

What are the types of injuries that you would see in a closed TBI do to impact?

-Lacerations
-contusions (bruises)
-intracerebral hemorrhage to the brain (focal injuries)

Closed TBI injuries due to impact can include _______ __________ _________
What does that mean?

-coup-contre-coup
-initial blow/event, subsequent blow/event

Can closed TBIs due to impact include Diffuse axonal injury?

yes

What are open TBIs due to impact?

Breach of meninges or skull

What does an open TBIs due impact result in?

focal injuries (hematomas or hemorrhage)

What are TBIs due to inertia?
What can it be the result of?

-non-impact injuries
-acceleration-deceleration forces

What are the two scales used to assess after a TBI?

-Ranchos Los Amigos
-Glassgow Come Scale

What does Ranchos los amigos assess?

cognitive functioning

What does Glassgow coma scale assess? In what setting is it used

-conscious level in response to different stimuli
-used in acute care settings

GCS
What are the eye response scores?

4 = eyes open spontaneously

3 = eye opening to verbal commands

2 = eye opening to pain

1 = no eye opening

GCS
What are the verbal response score?

5 = orientated

4 = confused, but answer on topic

3 = inappropriate answer or words

2 = incomprehensible sounds

1 = no verbal response

GCS
What are the motor response scores?

6 = obeys commands

5 = localizes to pain

4 = withdrawals from pain

3 = flexion to pain

2 = extension to pain

1 = no motor response

What are the three levels of severity of an ABI/TBI?

-mild
-moderate
-severe

Are mild ABI/TBIs life threatening?

not usually, but effects can be serious

How long does alteration of consciousness (AOC) usually last with an mTBI?
Is there loss of consciousness with an mTBI?

-from the moment of accident to 24 hours
-brief or no LOC

What are symptoms of an mTBI?

-vomiting
-Head Ache
-sensitivity to light and sound

Are there neurological signs with a moderate ABI/TBI? what are they?

-yes
-skull fracture
-bleeding
-bruising

What is a GCS score for a moderate ABI/TBI?

9-12

What is the GCS for an mTBI?

13-15

With a severe ABI/TBI how is structural imaging?

normal or abnormal

What are some common physical symptoms of ABI?

•Dizziness and balance issues
•Weakness (paresis, paralysis)
•Nausea, vomiting, vertigo
•Headaches
•Changes in vision and visual processing
•Changes in hearing and auditory processing
•Sleep disturbances
•Fatigue
•Seizures
•Sensory issues (sound and light sensitivity, issues with taste, smell and touch)