Study Notes on Aphasia and Right Hemisphere Disorders

Online class has two different sections.
- Students are separated by days of attendance (some on Monday, others on a different day).
Voice Disorders class does not occur on Monday or Tuesday.
Class frequency: once a week.

Discussion of a book portraying Birmingham, documenting changes over time.
- The book contains photographs showcasing then and now comparisons.
- Personal experience: lived in Birmingham during the twenties; possesses a near-native understanding of the area.
- Book used to prompt discussions about observations and experiences in Birmingham.

Two clinical sessions reviewed with students:
1. First session focused on a male patient with expressive language deficits, specific challenges in word retrieval despite fluent speech.
2. Second session involved a male patient displaying traditional Broca's aphasia, with cognitive functions preserved.

Patient exhibited high verbal expression but struggles with precise word finding.
- Came in very talkative and intelligent.
- Despite expectations, the patient struggled with picture naming tasks, indicating a significant expressive deficit.
- This scenario illustrates how a patient can have fluent speech but underlying expressive difficulties.

Patient presented a classic case of Broca’s aphasia:
- Common presentation in aphasia (4 out of 5 cases typically present similarly).
- This patient retained cognitive abilities such as driving and performing math functions post-stroke.
Discussion questions on perceived difficulty of being students in observational roles during therapy sessions.
- Many students likely viewed the therapists as experienced due to visible progress and troubleshooting that had occurred in prior classes.

Therapy session planning for patients with aphasia involves knowledge of previous lesson plans, but the challenge is effectively cuing patients for success in therapy activities.
Hierarchy of cues for assisting in language retrieval was previously taught,
- Strongest to weakest cues: rhymes with, phonetic cues, semantic cues.
Emotional and financial limitations of therapy duration and frequency, with insurance often determining the extent of therapy open to patients.
- Empathy for patients as therapy can provoke emotional distress due to confronting their deficits.

Critical to manage the emotional state of patients undergoing therapy for aphasia.
- Engagement in therapy can be taxing, as it requires confronting personal deficits, leading to fatigue or potential trauma.
Validating the emotional impact of therapy and exploring the potential for trauma during these experiences.

Research-identified that some patients tolerate high failure rates, while others become frustrated and disengaged with even modest failure rates.
Recognizing the balance of providing adequate challenge without overwhelming patients is key to successful therapy sessions.

Class discussion transitioned to right hemisphere disorders, questioning prior slides for clarity and understanding.
Importance of right hemisphere tests:
- Example: Mini Inventory for Right Brain Injury, assessing visual processing, emotional recognition, etc.
Mentioned testing methods and criteria concerning left vs. right hemisphere impacts.
Naming functional deficits associated with right hemisphere impairment, including issues with visual scanning, recognition tasks, emotional perception, etc.

Suggested practices from ASHA for therapy targeting cognitive impairments.
- Use positive stimuli to elicit emotional responses and avoid situations that might provoke negative emotions.
- Adapt therapy pacing and strategies based on patient engagement and emotional stability.
Considerations when communicating with patients include minimizing figurative language early in therapy to enhance understanding of direct language.

Exploring functional applications and practical strategies in therapy.
- Breaking down complex tasks into smaller steps for better understanding and practice.
- Emphasis on safety and supervision for impulsive patients (e.g., right hemisphere stroke patients).

Evaluations like line bisection or cancellation tasks to determine the extent of neglect.
Use potential real-world settings or rehabilitation during therapy for more accurate assessment of deficits.

Traditional approach: Visual scanning therapy is particularly focused on neglect rehabilitation.
- Process described where patients learn to engage with neglected spaces through guided activities.
Alternative methods introduced:
- Edginess task, using physical engagement to help patients locate objects within their neglected space.

Techniques for instructing patients to engage with their neglected field.
Use of physical objects (e.g., baking pans) to teach spatial awareness over repeated trials.

Understanding and dealing with disorientation in patients unable to perceive their deficits.
- Techniques for addressing denial of deficit through structured contracts and setting up tasks to showcase difficulties.
- Caution regarding potential emotional fallout from confronting deficits during therapy.

Utilizing video feedback as a tool for patients to recognize deficits.
- Careful consideration due to the potential for emotional distress while navigating patient’s perception of their condition.
Approaches to social skill training, emotion recognition, and pragmatic language in therapy for those with right hemisphere deficits,
- Includes explicit teaching methods mirroring styles used for children with autism.

Summarized overall therapy strategies for right hemisphere and TBI patients include gradual progression from basic tasks to more complex contextual applications, leveraging structure initially before easing into variability as recovery progresses.
Noted similarities in approached therapies for different cognitive deficits, highlighting interdependencies and shared challenges.
Last points on course calendar, assignments, and upcoming classes repeated for clarity, ensuring student understanding of expectations moving forward.