COMD modules 7 Cognitive Disorders

Right Hemisphere Dysfuncation

Damage tends to be focal, eg from a stroke

Traumatic Brain Injury (TBI)

damges tends to be diffuse

Right Hemisphere Dysfunction

Result from neurological damage to the right cerebral hemisphere, typically caused by a stoke

• Symptoms are quite different to what is typically seen in a left hemisphere stroke. Why? 

• Right hemisphere stroke can still cause dysarthria due to damage to the motor cortex 

• Right hemisphere stroke are slightly less common than left hemisphere  stokes 

• Right hemisphere typically processes non-linear spatial and visual information

Left Neglect

impairment of response to stimuli on the patient left 

• May co exist w/ visual field cut 

• Think of at least two safety implications of this 

Perceptual Impairments 

• Anosgnosia: denial of illness (poor insight)

• More difficulty with spatial than temporal orientation 

Recognition and expression of emotion 

• Typical presentation is a flat affect 

• Can fail to appreciate change in emotional tone 

Attentional Impairments 

• Difficulty focusing, maintaining attention, and shifting attention 

• Difficulty determining what is and what is not important

Communication Symptoms:Diminished speech prosody

• Slower than normal speech rate, robot-like quality

• Reduced emphatic stress in phrases and sentences

Communication Symptoms: Anomalous content and organization of connected speech

• Speech is often excessive, confabulatory, and inappropriate

• Narratives are fragmented, lack cohesion, don’t seem to have a point, focus on incidental details, fail to link events, insert tangential comments, and permit personal experiences and opinions to intrude

Communication Symptoms:Impaired comprehension of narratives

• Difficulty with implied meanings, often concrete interpretations only

• Interpret metaphors and idioms literally

Communication Symptoms:Pragmatic impairments

• Begin and end conversations abruptly

• Talk excessively and without regard for their listener

TBI

neurological damage to the brain resulting from the impact of external forces

• Can be caused by direct or indirect trauma, injury may be penetrating or non-penetrating (closed head), damage is typically diffuse

TBI: Primary Injury

• skull fracture

• contusions/hemorrhage

• concussions

• lacerations

• diffuse axonal injury

TBI: Secondary Injury

• Ischemia

• Hypoxia

• Hypo/Hypertension

• Cerebral Edema

• Elevated Intracranial Pressure

• Hypercapnia

• Meningities

• Seizures

Neuro-Cognitive Consequences of TBI

variety of behavioral, physical, sensory, language, and swallowing deficits

Orientation

person, place, time, purpose, confusion

Memory

Short-term/working memory, post-traumatic amnesia

TBI Treatment: External aids

computer, smartphones, calendars, timer, checklist

TBI Treatment: Internal Aids

mnemonics, visual imagery, encoding, association, chucking

Best Prognostic Indicator

rapidity of emergence from post-traumatic amnesia: this indicates the severity of the ongoing injury

Rancho Level: Early

I-II

Rancho Level: Middle

IV-VI

Rancho Level: Late

VII-X

GOAT

Orientation

SCATBI

Standardized Test

Compensatory Treatment

Accommodations and/or Modifications may be needed

Restoration Treatment

Focuses on the function to achieve the highest level of independent functioning