double vision that prevents the two eyes from fixating on the same point.
drooping of eyelid caused by paralysis
abnormal, involuntary movement of the eyes
blindness in one-half of the visual field (B59-61)
blindness in the lateral visual field for both eyes
blindness in the same (right or left) half of the visual field in each eye.
blindness in different halves of the visual field in each eye.
the presence of a small region of intact vision near the center of a visual field
a spontaneous and uncontrollable movement in response to a stimulation (B64)
elicited by touching, stroking, or brushing the surface of body parts; includes gag reflex, swallow reflex, corneal reflex, and plantar flexor reflex.
Deep reflex (tendon or deep tendon reflex):
elicited by tapping or suddenly stretching muscles or tendons, which causes contraction of the muscle whose tendon is tapped or stretched, i.e. knee-jerk reflex (patellar reflex).
Pathologic superficial reflexes (primitive reflexes)
the Babinski reflex, palmar grasp reflex and the sucking reflex.
the tension remaining in a relaxed muscle or muscle group (B65)
abnormally high levels of tension in resting muscles
abnormally high levels of tension in resting muscles caused by upper motor neuron damage; feels hard to the touch and resists stretching
resistance of muscles to movement in any direction; hard to the touch and resists active and passive movement
abnormally low levels of muscle tension in resting muscles
decrease resistance to passive movement, can be hyperextended.
disease of muscles (B66)
suffix denoting paralysis (B66)
paralysis or severe weakness of one limb
paralysis of both limbs on the same side
paralysis of both legs
paralysis of all four limbs
suffix denoting weakness
abnormal and involuntary muscle movements
complete loss of sensation
temporary disturbance of consciousness lasting from a few minutes to several days; patient engages in normal activities of daily life but later does not remember events; seen in combination with psychiatric illness and epilepsy (rare).
Grand mal (tonic-clonic) seizures
massive discharge of neurons in the brain causing contraction of of almost all muscles in the body followed by a series of intermittent clonic jerks; lasts an average of 1-3 minutes and never remembered by patient. (B, p. 77)
Petit mal (absence) seizures
characterized by a loss of consciousness that lasts only a few seconds; patient usually does not fall but may stare, stop moving and talking, drop things, or move his or her head and limbs aimlessly and involuntarily during the seizure. (B, p. 77)
-Impaired comprehension and production of language, usually caused by damage in the language-competent brain hemisphere (brookshire; 2)
-Language deficits due to traumatic brain injury or damage/lesions in language-specific area
-Impaired speech production, usually caused by damage in nerves controlling muscles involved in speech or damage in the speech muscles (brookshire; 2)
Apraxia of speech
-a label for several syndromes characterized by difficulty carrying out volitional movement sequences in the absence of sensory loss or paralysis sufficient to explain the difficulty. (brookshire; 314)
-Motor planning difficulties
Ischemic Stroke (also called occlusive stroke)
-occurs when an artery is blocked and part of the brain loses its blood supply.
-Ischemic strokes may be caused by thrombosis or embolus
Hemorrhagic Stroke (also called cerebral hemorrhage)
-caused by rupture or leakage of cerebral blood vessels.
Thrombosis (thrombotic stroke)
an artery slowly is occluded by a plug of material accumulating at a fixed location.
Embolism (embolic stroke)
an artery abruptly is occluded by material that moves through the blood and blocks the artery.
Other causes of brain damage other than CVA
•Infections and toxins
•Nutritional and metabolic disorders
Primary-originating in the brain, most often affect the cerebrum or cerebellum
Secondary intracranial tumors
originating elsewhere and migrating to intracranial locations
side effect of very high intracranial pressure by which the brain shifts across structures within the scull.
A condition by which the cerebral ventricles are enlarged, either as a result of increased pressure in the ventricles or as a result of brain atrophy (shrinkage).
Infections and toxins
-Major bacterial infections: bacterial meningitis and brain abscess
the pia, arachnoid, and CSF become infected with bacteria, causing inflammation, swelling, and fluid exudate from the meninges.
caused by introduction of bacteria, fungus, or parasites into brain tissues from a primary infection site elsewhere in the body. Primary sources of infection are the nasal sinuses, middle ear, or mastoid cells in 40% of cases.
caused by the introduction into the nervous system of substances that inflame or poison nerve tissue, may be caused by drug overdoses, drug interactions, bacterial toxins (tetanus, botulism, dipheteria), or heavy metal poisoning (lead, mercury).
common causes of CNS dysfunction, but rarely cause isolated communication disorders.
e.x. Severe hypoglycemia may cause deterioration of cerebral function, leading to confusion, stupor, or coma.
Rare in the US, but cause CNS dysfunction and may occasionally generate cognitive-communicative impairments. (Wernicke's encephalopathy)
5 levels of alertness (attention)
•Sustained Attention (vigilance)
•Attention In Daily Life
typically is assessed with strings of computer-presented auditory or visual stimuli, presented over relatively long and purposely monotonous intervals.
selective attention typically is assessed with a paper-and-pencil cancellation tasks by which the test taker must scan printed arrays of numerals, letters, or symbols and cross out or circle each occurrence of a designated target
tests of alternating attention require the test taker to change attentional focus in response to changing task requirements.
divided-attention tests come in two forms; one form is when the test taker retains information in memory while performing mental operations on the information. The other form is having divided attention tests (dual-task format) that requires the test taker to perform two concurrent tasks.
Attention In Daily Life
most tests of attention call on cognitive processes in addition to attention (visual search, scanning, tracking, short-term memory, and appreciation of verbal or mathematical concepts).
The divisions of memory
very brief storage of stimulus traces in modality-specific form. Information cannot be manipulated or maintained by rehearsal
limited capacity. Information decays in a few seconds unless consciously maintained by rehearsal
contemporary replacement for the concept of short-term mmemory. Active working space in which components of cognitive processes are temporarily stored.
long-lasting storage of information. Information in long-term memory decays slowly, if at all.
memory for past experiences, events, and information.
memory for what we know about things
Memory for past events that are specific to a time and place
Organized knowledge of the world, including knowledge gained in educational settings
Knowledge of how to perform behavioral routines learned in the past
remembering to remember - remembering to carry out previously scheduled actions
simplest word-comprehension tests require the patient to point to body parts or objects in the environment; tests patient's ability to comprehend single words and simple spoken directions.
test could include having patient pointing to one or more items in sets of pictures, objects, or body parts or have the patients manipulate objects or body parts (ring the bell, close the box, and give me the key.)
Sentence Comprehension and Comprehension in Daily Life
Items in most sentence comprehension tests are not very representative of what adults experience in daily life. Listeners in daily life usually need only remember the gist of sentences and not their verbatim form, and they don't have to remember the gist for more than a few seconds. A way to test this is to tell the client directions to activities of daily living and have them perform the actions in their life.
Comprehension of Spoken Discourse
A way to test this is to have paragraphs read aloud by the examiner followed by spoken questions about the paragraph directed to the listener. (use short story-like narratives)
(literal paraphasia)-hautch/watch, gum/gun
• Phonetic dissolution - fan (nasal)/fan, ten (dental),/ten
• Verbal Paraphasia - clock/watch, lock/key
• Neologistic - tudo/watch, mara/key
• Circumlocution - temperature/thermometer, cutting/scissors
• Stereotype - bisabee/bisabee, aye aye aye?
(phonemic error) fliers/wrench, telepon/thermometer
Give an example of part-word paraphasia
fan (nasal), ten (dental)
Give an example of Neologistic paraphasia
bisabee/bisabee, aye aye aye
Reasons for referral/ significant history
case history, chart review
Ask what day/year/time it is
word to picture matching
having them repeat words and sentences
Pictures: name the dog, broom, desk etc
have them read words and sentences
Rating of connected speech
fluency, word finding, phrase length, take MLU
test letters and words to dictation, have them copy words
Broca's aphasia: Lesion
Lesion: Posterior inferior frontal lobe
Brocas aphasia: Fluency
Fluency: Nonfluent telegraphic speech
Broca's aphasia: Speech
Speech: phonetic dissolution (fragmented)
Broca's aphasia: Word retrieval
Word retrieval: Fair but misarticulated
Broca's aphasia: Repetition
Repetition: Labored, misarticulated, telegraphic
Broca's aphasia: Comprehension
Comprehension: fair to good
Wernicke's aphasia: Lesion Location
Lesion location: Posterior superior temporal lobe
Wernicke's aphasia Fluency
Wernicke's aphasia: Speech
Verbal (semantic) paraphasia
Wernicke's aphasia: Word Retrieval
Poor, with verbal paraphasias
Wernicke's aphasia: Repetition
Fluent, verbal paraphasia; grossly restricted retention span
Wernicke's aphasia: Comprehension
Conduction aphasia: Lesion Location
Conduction aphasia: Fluency
Conduction aphasia: Speech
Literal (phonemic) paraphasic
Conduction aphasia: Word Retrieval
Fair, with literal paraphasias
Conduction aphasia: Repetition
Fluent, literal paraphasia; some restriction of retention span
Conduction aphasia: Comprehension
Fair to good
Anomic aphasia: Lesion Location
Temporal parietal lobe
Anomic aphasia: Fluency
Anomic Aphasia: Speech
Verbal (semantic paraphasia)
Anomic Aphasia: Word Retrieval
Fair, with verbal paraphasia
Anomic Aphasia: Repetition
Anomic Aphasia: Comprehension
fair to good
Transcortical motor: Lesion location
Anterior, Superior frontal lobe
Transcortical motor: Fluency
Transcortical motor: Speech
Transcortical motor: Word retrieval
Variable with delays in imitation
Transcortical motor: Repetition
Good but delays in imitation
Transcortical motor: Comprehension
a.k.a anterior isolation syndrome
posterior isolation syndrome
Transcortical sensory: Lesion
Posterior, superior parietal lobe
Transcortical sensory: Fluency
Transcortical sensory: Speech
Transcortical sensory: Word retrieval
Transcortical Sensory: Repetition
Transcortical Sensory: Comprehension
Literal, verbal paraphasia, verbal stereotypes
Global: Word Retrieval
Poor, literal, verbal paraphasia; grossly restricted retention span
Six Reading Subtests
Oral reading of words
Oral reading of sentences
Single word comprehension
Comprehension of printed sentences
Comprehension of printed text
match the card with stimulus
Oral reading of words
read aloud words on cards
Oral reading of sentences
read aloud sentences on cards
Single word comprehension
word to picture matching from a group of 3
comprehension of printed sentences
yes/no questions (do eggs come from chickens?)
Comprehension of printed text
match card to photo
Generating automatized sequences
writing over-learned sentences (alphabet)
copy geometric forms, symbols, letters, printed words etc
Writing to dictation
follow a letter to word sentence progression in dictation
Writing self formulated material
write sentences describing function of everyday objects
What factors might produce incorrect answers on reading and writing tests?
Administration of test
is an electrically excitable cell that processes and transmits information by electrical and chemical signaling, made up of cell body, axon and terminal, can be sensory or motor
supports neurons and nerve fiber tracts may serve other functions like regulating fluid level, removing foreign substances, and participating in brain metabolism
are the branched projections of a neuron that act to conduct the electrochemical stimulation received from other neural cells to the cell body
is a junction that permits a neuron to pass an electrical or chemical signal to another cell
thin white fatty substance that covers the axon. electrical insulation that facilitates the transmission of nerve signals down to axon
consists of neurons and glial cells
composed of primarily myelinated axons
tubular projection that carries information away from the cell body and connects with the dendrites of other neurons
bundles of axons within white mater
three membranes that enclose the CNS
Central Nervous System
Brain, cerebellum, spinal cord
Peripheral nervous system
nervous system outside the skull and vertebrae
List the 3 major fissures of the brain
Longitudinal cerebral fissure
Central cerebral fissure (Rolandic)
Lateral cerebral fissure (Sylvan)
List the 5 major gyri of the brain
Middle temporal gyrus
provide initial impetus for overt behaviors
plays an important role in language and audition
important for somesthetic sensation, sensory
connect adjacent regions
List 4 ventricles
Components of the brainstem
Midbrain- eye movement
Pons- balance and hearing plus eye movement
Medulla- balance and hearing
Important for integration and coordination of volitional movements
Describe what a motor pathway in the spinal cord does
carries signals away from the brain, controls motor movement of trunk and limbs, muscles of the head and neck, and muscles responsible for quick movements, modulates heart rate and other autonomic functions
Describe what a sensory pathway in the spinal cord does
carry sensory information to the brain, pain, temperature, and awareness of body/limb position, touch.
List 3 inter-hemispheric commissures and describe function
Corpus collosum-facilitates interhemispheric communication
Anterior commissure-serves to connect the two amygdala
Posterior commissure- smaller importance in communication debated
List 3 important fasciculi
List the 3 major arteries to the brain
8 major arteries of the brain
Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery
Anterior communicating artery
Posterior communicating artery
Circle of Willis
provides blood flow to the two anterior, two middle, and two posterior cerebral arteries via the basilar and internal carotid arteries encircles optic chiasm and pituitary gland at the base of the brain
M: Eye movement, pupil constriction, lens shape
M: Eye movement
S: Sensory info from face and mouth
M: Signals for chewing
M: eye movement
M: Facial expression, Tears, Saliva
S: hearing and equilibrium
S: oral cavity
M: Swallowing, Saliva secretion
Sensory and motor signals to many internal organs, muscles and glands
XI Spinal Accessory
M: oral cavity, neck, shoulder muscles
M: tongue muscles
discrete voluntary skilled movements, especially of the distal parts of the limbs
support voluntary movement and help control posture and muscle tone
Frontal association cortex
Parietal association cortex
Temporal association cortex
Primary cortical areas
Auditory: inferior to the Sylvan fissure, posterior region of upper temporal gyrus
Visual cortical area
posterior of brain, on occipital lobe
inferior anterior portion of frontal lobe
post central gyrus
diagrams that show how neurons are distributed for the primary motor cortex and the primary somatosensory cortex
Slow (3-5 cycles per second) appears during volitional movement, or is accentuated by it caused by cerebellar pathology or toxicity/medications
Moderate rate (4-6 cycles per second) present when muscles are at rest, diminishes or disappears during volitional movement, extrapyramidal disease, especially Parkinson's disease, sometimes caused by heavy metal poisoning
Quick irregular muscle contractions occurring involuntarily and unpredictably in different muscle groups, basal ganglia or extrapyramidal pathology, caused by hereditary diseases, drug toxicity, anoxia, cerebrovascular disorders
Slow, sinuous, writhing movements. May move from muscle group to muscle group, increases with emotional tension, disappears during sleep. Pathology affecting basal ganglia and extrapyramidal system, drug toxicity, anoxia
Sustained involuntary contractions of muscle groups, often causing postural distortion (torsion, spasms) pathology affecting basal ganglia and extrapyramidal system, drug toxicity; anoxia
Abrupt , rapid nonrythmic twitching movements of individual muscle groups. often large enough to cause movement of limbs or other body parts. Extrapyramidal disease metabolic disorders, infection disease.
Rapid, irregular, small twitching movements of small groups of muscle fibers does not cause overt movement but can be seen by dimpling or rippling of skin over affected muscles. Occasional fasciculations are common in normal persons may be caused by degenerative diseases of anerior horn cells, spinal nerve compression, peipheral nerve disease
Microscopic contractions of small groups of muscle fibers. Occassional fibrillations are common in normal persons may be caused by primary muscle disease, anterior horn cell disease, spinal nerve disease.
TIcs (habit spasms)
Stereotypic behaviors (blinking, coughing, throat clearing, etc) appearing when the individual is under stress. Not known to be related to nervous system pathology.
occur in the blood vessels in the meninges the bleeding is on the outside of the brain.
bleeding in the brain tissue
symptom of aphasia where substitution of a word by a sound, an incorrect word, or unintended word
the act of inventing a word or phrase
numbness or tingling sensation