Adult Ax & Tx: ABI and RHS

What are the four Criteria for ABI?

1. Impairment of brain function. 2. acquired after birth 3. not genetic or during the birth process, 4. not progressive

What is an acquired brain injury (ABI?)

A brain injury that occurs after birth and effects speech, voice, language, and cognitive communication.

What sort of speech problems appear with ABI?

Apraxia, Dysarthria, Stuttering (1-35%)

What sort of voice problems appear with ABI?

Aphonia, Hyperphonia, Hypophonia (1%)

What kind of language problems appear with ABI?

Aphasia, decreased words and sentences (Stroke: 30-68%, TBI: 2%)

What kind of cog-com problems appear with ABI?

Decreased thinking for communication (75%)

What are possible causes of ABI?

TBI, CVA

Aneurysm, hemorrhage,

Hypoxic ischemic brain injury, Anoxia

Infections (encephalitis, meningitis, lymedisease, etc.)

Intervention effects (Chemo, surgical complications)

(Brain) surgeries, Seizures, Electrocution

What are the principles for experience-dependent neural plasticity?

1. Use it or loose it.

2. Use it and improve it

3. Specificity (be specific in training.)

4. Repetition matters (re-fire neurons to build habits.)

5. Intensity matters (7 days rest, then go hard and fast.)

6. Time Matters.

7. Salience matters (relevant/meaningful)

8. Age matters.

9. Transference (generalizations / carryover)

10. Interfernce (cascade effect. 1 neg exp interferes w/ unlearning unwanted behaviors)

What is right hemisphere syndrome/stroke (RHS)?

A constellation of symptoms related to brain damage as a result of a stroke or other type of damage to the right side of the brain.

What are possible causes for RHS?

Stroke, TBI, TIA, Tumors, Neurological diseases.

What types of problems to people largely face with RHS?

Attention, anosognosia, semantic language, pragmatic language, cog-com, executive function.

Approximately 50% of people with RHS have

cog-com disorders

Of the people with RHS cog-com disorders, 80% receive

inpatient speech-langauge treatment.

What types of attention problems are related to RHS?

Divided attention and selective attention

RHS people experience anosognosia at what levels over time?

17-70% of RHS experience it.

3 days post-stroke: 31%

1 week post-stroke: 18%

6 months post-stroke: 5%

What types of semantic problems appear with RHS?

Suppression and figurative language.

What is suppression related to semantics?

Inhibition of contextually-irrelevant meanings (every part of speech is considered literally.)

What types of pragmatic challenges are associated with RHS?

Conversation (>50% experience it.)

Affect and emotion (40-50%) (flat emotions/expression)

Theory of mind (~68% in one study) (trouble taking another’s perspective.)

At approximately what rate does cognitive/executive function problems appear for RHS/strokes.

Cognition (42-67%), Executive function (75% acute, 67% chronic)

Common deficits associated with RHS are…

Non-linguistic, linguistic, extralinguistic, and apragmatism.

What types of non-linguistic deficits appear with RHS?

Attention deficits: Hyper/hypoaroused or have difficulty sustaining attention especially to the left side (neglect.)

Lack of awareness to surroundings/room.

Visuoperceptual deficits (object recognition, constructional tasks, spatial orientation)

Cognition/executive dysfunction (planning)

Neglect.

With RHS neglect, a pt. often fails to report, respond or orient to stimuli on the ___ side despite motor and sensory capacity to do so.

contralateral (opposite side of where the brain lesion is.)

Neglect may be one manifestation of a larger more generalized ___ impairment.

attentional

Neglect is considered an ____ deficit and not just a perceptual deficit.

Intellectual

With RHS neglect usually resolves.

False - it may persist.

What is egocentric neglect (viewer-centered)?

Where the “left” shifts with the person’s visual focus as they move their head orientation.What is

What is allocentric (stimulus/object-centered) neglect?

The “left” side of objects is neglected regardless of placement in the visual field.

What type of neglect is most common?

Egocentric

Which of the following is likely not a lesion site for left neglect?

inferior occipital lobe

Left neglect subcortical lesions sites include all except

Right gray matter.

How do you evaluate nonlinguistic deficits?

Cancellation

Scanning

Line bisection

Drawing tasks

Oral reading tasks

Writing tasks.

What linguistic deficits are associated with RHS?

Word discrimination

Naming

Word definitions

divergent naming/word fluency

reading and reading comprehension

Writing

Often linguistic deficits with RHS are ___

mild - do not affect communication significantly.

To evaluate RHS linguistic deficits, you perform a

language assessment.

People with RHS extralinguistic deficits may have trouble understanding implied meaning of

complex narratives. I.e. get the gist.

People with RHS extralinguistic deficits may have trouble understanding humor, irony, and

sarcasm.

People with RHS extralinguistic deficits may have trouble expressing their own

intended meaning due to hypo/hyper affect.

People with RHS extralinguistic deficits may struggle to use linguistic cues that convey

emotion, which leaves them seeming monotone.

People with RHS extralinguistic deficits may experience confabulation which is

fabricated, distorted, or misinterpreted memories; difficulty sorting fact from fantasy.

People with RHS extralinguistic deficits may have trouble with understanding…

alternative meanings, expressing emotion, and producing prosody.

People with RHS extralinguistic deficits may struggle with extracting and integrating

bits of information. I.e. getting the gist based on context.

To evaluate RHS extralinguistic deficits

Language sample - check structure and content.

Picture description

Tell a joke and ask pt. to explain why it’s funny.

Apragmatism

A disorder in conveying and or comprehending meaning/intent through linguistic, paralinguistic, and/or extralinguistic modes of context-dependent communication. The context includes the conversational partner, environment, cultural considerations, and goal of the interaction.

Impact of RHS deficits on outcomes, cognitive deficits, unilateral neglect, and anosognosia.

Mortality, functional status on discharge, long term recovery, QOL, dependence in ADLs, length of stay, discharge to dependent setting, participation-level outcomes.

Impact of apragmatism:

Lack of empathy which is very important to spouses, poor reader of non-verbal cues. Weak relation between facial affect discrimination and marital satisfaction.

Why do patients with RH fall through the cracks?

RH strokes have to be more severe before they can be identified as easily as LH strokes. Symptoms may be less recognizable. Anosagnosia may have an impact. Anosodiaphoria (indifference) may impact them getting help.

RH stroke patients are less likes to get to the emergency department within the first

4.5 hour

RH stroke patients are less likely to get clot busting drug treatment than LH strokes

true: however chances double if they show neglect.

RH stroke patients are more likely to undergo longer hospital stays because

they typically arrive at the ED later than patients with LH strokes.

SLPs can talk to families about deficits to watch for things that are…

difficult to notice and hard to identify until they return home.

Social interactions may be different now because of deficits in empathy, humor, and misinterpretations.

Social interactions will uncover deficits better than test scores.