SPECIFIC Cog/Comm 2 Midterm

Attention Components

sustained, selective, inhibition and cog control, bandwidth and working memory, managing distracters

Selection

Ability to attend to one aspect of a situation or stimulus and ignore others

Capacity limitation

only so much information can be consciously attended to, or held and manipulated in memory

Resource Allocation Theory

flexible pool of resources allocated to various cognitive processes, closely related to working memory

Focused attention

basic ability to attend

Sustained attention

maintaining focus over time

Selective attention

maintaining focus in the presence of distraction

Alternating attention

shifting focus back and forth between tasks

Divided attention

“multi-tasking”

Managing external distractions:

modify environment

Managing internal distractions

write it down, come up with a plan

Memory Components

 long-term memory (explicit and implicit), Short-term memory, sensory memory

Sensory memory

traces of sensory input that persist only briefly, allows us to select what to pay attention to next

Short-term memory

 maintaining information for seconds or minutes

Working memory

capacity for maintaining and actively manipulating information

Long-term memory

maintaining information over days to years

Two major branches of LTM

declarative and nondeclarative

Declarative

knowledge you can consciously access (episodic memory and semantic memory)

Episodic memory

memory for events involving contextual information (your 18th birthday party)

Semantic memory

world knowledge, memory for facts independent of learning context (the name of the president)

Nondeclarative

knowledge you can’t consciously access (procedural memory, classical conditioning)

Procedural memory

learning motor or automatized cognitive skills (riding a bike)

Classical conditioning:

pairing of potent with otherwise neutral stimulus

Prospective memory:

remembering to remember

Learning Principles:

errorless learning, effortful retrieval, massed vs. distributed practice

Executive Function

ability to complete high level cognitive tasks involving planning, attention control, cognitive flexibility, and self-regulation

Traditional Approaches to Aphasia Classification:

Boston Classification System, proposes an anatomic/lesion correlation

Pros of aphasia classification:

• provides important historical context

• Tied to vascular syndromes and useful for neurologists especially early in acute recovery phase

• Still in common use clinically based on common aphasia assessments

• Provides a helpful learning framework/structure

Cons of aphasia classification

not every client is a 1:1 mapping of lesion site to deficits seen, aphasia typically presents as more gray than black and white depiction of symptoms

Wernicke’s Aphasia

fluent output, poor comprehension, poor repetition, well-articulated speech without distortions, normal prosody, long, syntactically varied utterances, reduced awareness

Broca’s aphasia

nonfluent output, good comprehension, poor repetition, effortful speech, distorted articulation, short phase length, agrammatic

Global aphasia:

nonfluent output, poor auditory comprehension, poor repetition, may have varied often neologistic output or recurrent stereotypy.

Anomic aphasia:

fluent output, good comprehension, good repetition, circumlocution and semantic paraphasias may be the predominant error types

Components to Aphasia Assessment

Comprehensive language assessment

Functional communication assessment

Motor speech screening/assessment

Cognitive screening

Evaluation of psychosocial consequences of aphasia

Comprehensive language assessment example/goal

CAT, goal is to characterize function of language system, relative strengths and weaknesses, identify presence of impairment and severity, may need to perform more specific assessments to determine language subsystems that are impaired

Functional communication assessment example/goal

natural or structured observation, goal is to describe real-world expressive and receptive level of function, including use of alternative and multi-modal communication approaches

Motor speech screening/assessment example/goal:

Oral mechanism exam, observe AMRs, SMRs, 5 subsystems of speech production and comprehensibility

Cognitive screening example

Ravens (non-linguistic) or CLQT, characterize deficits/strengths relating to attention, memory, and executive function

Evaluation of psychosocial consequences of aphasia example/goal:

ACOM (the aphasia communication outcome measure), goal is to identify how the patient feels about their aphasia and its impact on their life

Aphasia treatment current best practice recommendations:

• Screen all stroke survivors for communication disorders

• Assess language, communication, and psychosocial impact and document an aphasia diagnosis if present

• Provide accessible information tailored to individual and language needs

• Respond to diversity

• Use collaborative goal setting working with SSwA and their family

• Provide language therapy

• Provide communication partner training

• Screen all SSwA for anxiety and depression

• Connect and reintegrate

• Discharge safely

Four main types of intervention/treatment approaches:

• Restorative

• Compensatory

• Counseling

• Education

Restorative Treatment Approach example/explanation

directly improve language function via drilling, structured therapy, lots of repetition and practice, example-SFA

Compensatory Treatment Example/Explanation:

training self-cueing, and other communication strategies for people with aphasia and communication partners, communication is the goal, flexible, example-AAC

Counseling and other types of emotional support

Addressing the emotional impact of aphasia, helping to promote psychological flexibility and resilience, example-peer support groups

Education treatment approach

gain a better understanding of what does and doesn’t work helps PWA and caregivers work with the aphasia as it is, empowering

Tx: Communication Partner Training (identify active ingredients, Tx targets, and mechanism of action)

Active Ingredients: Clinician provides guidance of strategies, providing feedback, co-develops appropriate strategies for the dyad, participates in role-playing to practice strategies

Tx Targets: To improve function communication, participation, and well-being of the person with aphasia

Mechanism of action: combination of declarative learning as well as observing and doing through communication activities, reflection, coaching, and opportunities for reenactment

Tx: Script Training (identify active ingredients, Tx targets, and mechanism of action)

Active Ingredients: Therapist helps PWA develop a script focusing on utilizing functional and personally relevant topics, SLP writes the script with input, scripts are trained one phrase at a time, new pieces of the script are added once previous pieces are mastered

Tx Targets: To produce a specific item in a complete sentence embedded in a dialogue, automatically retrieve and fluently produce appropriate pieces of the scripts, improve everyday conversation

Mechanism of action: Instance theory of automatization, suggests that automaticity is achieved by retrieving memories of complete, context-bound, skilled performances. Automaticity of language may result from intensive practice with the use of multimodal cuing promoting errorless learning

Types of cortical dementias

Alzheimer’s Disease

Lewy body disease

Vascular Dementia

Frontotemporal dementia

  Pathophysiology (e.g., conceptual model of proteinopathies)

Risk Factors, Accumulation of lesions, neurodegeneration, cognitive decline

Risk Factors for Dementia

non-modifiable: genetics, age; modifiable: vascular risk factors, head injury, low education, poor hearing, depression, social isolation

Accumulation of lesions

extracellular proteins: Amyloid (AD); intracellular proteins: Tau (AD, FTD), Synuclein (LBD, PDD, MSA), TDP-43 (FTD), FUS (FTD), PrPSc (Prion disease)

Neurodegeneration

synaptic loss, neurinflammation, neuronal death, glial reaction

Cognitive decline:

memory, visuospatial function, language, executive function, social cognition,  complex attention

PPA subtypes:

nonfluent/agrammatic, semantic, logopenic

Nonfluent/agrammatic variant PPA

agrammatic production, apraxia of speech

Semantic variant PPA:

single word comprehension impairment, impaired confrontation naming

Logopenic variant PPA:

Impaired word retrieval in spontaneous speech and confrontation naming, impaired repetition of sentences and phrases

Why classify PPA?:

Much stronger evidence from psychometric and neurobiological perspectives, each variant is associated with different patterns of underlying atrophy etiology