455 Final Exam
Terms in this set (223)
3 major types of cognitive communication disorders
_____ hemisphere used to be considered the "unique flower of human evolution"
This hemisphere used to be considered "subordinate, minor, unconscious"
Roger Sperry dove into right hemisphere damage through the ___ ____
Sperry was working on cutting the ___ ___ to relieve seizures.
Temporal lobe of left hemisphere
Can seizures travel? Where do they often start?
Corpus callousum is a band of ___ matter
Major bridge of communication between left and right hemisphere
Cutting the corpus callousum helped ____ the two hemispheres allowing for investigation of individual function.
Nonlinguistic elements of communication (prosody, facial expression, body lx, emotion)
Math/Visuospatial Skills (localizing targets, identifying figure-ground relationships, perception of depth/distance/space)
Processing melody of music
Assembling small details for perception of a larger picture
Normal right hemisphere functions
Melody and rhythm of speaking
The ____ perceives our two dimensional world and then our ____ creates depth/distance.
Does right cerebral hemisphere damage usually involve language related deficits?
Right hemisphere etiologist include:
The level of deficit in right hemisphere disorder damage depends on ____ and ____ of damage.
We see deficits in right hemisphere disorder in ______.
Comprehension of facial expression
production of facial expressions
Comprehension of prosody
production of prosody
Areas of right hemisphere deficit with affect communication can include:
Inability to recognize faces int he absence of other visual agnosia (face blindness)
Inability to perceive visual stimuli due to damage to the CNS, not damage to optic nerve or eyes
Prosopagnosia is damage is ____ association areas in occipital lobe that are used to process/interpret visual info.
other distinctive feature
Individuals with prosopagnosia may not recognize by faces, but may be able to recognize by
Fusiform face area
What area is more active with looking at faces?
Are those with right hemisphere deficits less able to interpret facial expressions and identify emotions?
Yes (take things literally)
Do individuals with right hemisphere damage have trouble with sarcasm?
Right hemisphere controls ____ side of face
We usually see more expression on left side of face, expect in right hemisphere patients. These patients may display a ____ affect or ___ facial expression
Two components to speech
Parts of prosody
Do individuals with right hemisphere often feel more negative emotions? Are they able to portray those emotions?
big picture notion
Ability to take previous knowledge and experience and apply it effectively to the interpretation of small details
The exchange of communicative information from speaker to listener
Discourse deficits occur when speaker wouldn't use a pronoun or assumes shared knowledge. T/F
Discourse deficits also occur in what population?
don't stop talking
don't give cues to speak
don't give cues they want to speak
Individuals with right hemisphere deficits struggle with turn-taking. how?
Occur in typical conversation
Individuals with right hemisphere deficits struggle with topic maintenance. How?
indicates some knowledge is impaired
an impairment with individual who can only sense details but cannot use those details to infer/put together big picture without some explicit information
Simultagonosia is often due to lesion at what are?
when patient is unable to perceive color
Cerebral achromotopsia is due to ____ or damage to ____
Inability to attend to sensory stimuli from one side of body or environmentally
Side unattended to or unrecognized is the side of the body/environment that is ______ to lesioned hemisphere
when the individual is unable to perceive their own body parts as being part of themselves
Neglected body parts often display weakness or _____
Are body neglect limbs still motorically intact?
Neglect to environment
Mild cases of hemispatial neglect may be known
Yes, but not severe
Can mild cases of hemispatial neglect be cued and assisted?
Severe hemispatial neglect
individuals may be unable to recognize the existence of the neglected world via vision, auditory, and olfactory information
Hemispatial deficits are _____
attention that is used to get and maintain attention over time
attention used to ignore chirping bird in class
selective and sustained
Deficits in _____ and ______ attention may cause individuals with right hemisphere lesions to miss relevant information, be distracted by irrelevant stimuli, and further lose track of what is being spoken of
An individual's inability to recognize/realize they have deficits
Common in any population following disease, surgery, stroke, or trauma, may go unnoticed or masked by other deficits in those with right hemisphere disorders
Belief that loved ones, significant others, or family members have been replaced by imposters who look and sound like the original person
epilepsy, TBI, stroke, or acute lesion to right hemisphere
Capgras delusion occurs in those with:
disconnection of the area of the brain responsible for processing faces and the area of the brain responsible for producing normal emotional response in reaction to seeing the face
The delusional belief that a familiar person is able to take on the guise of another person, at times many other people, and assume their exact appearance
fregola delusion is often accompanied by a degree of
When an individual is perceiving something visually that does not exist
lesions or seizure activity usually in posterior right hemisphere among visual processing areas
Visual hallucinations are due to
Visual and/or auditory perception of some threatening, ominous, or foreboding
Acquired global loss of brain function with slow insidious onset
No (symptom of some disease)
Is dementia a disease itself?
Predominant consequence of dementia
Two types of short term memory
Two types of long term memory
If you have someone's phone number and need to remember it until you get to your phone, you are using
Type of memory being engaged constantly to understand words, phrases, etc
Short term memory isn't necessarily impaired in dementia but is not as
3 types of declarative memory
Impairment to this type of memory impact ability to understand the meaning of things
Memory where it is hard to find word to express meaning
Memory of different events of life
Dysarthria and apraxia focus on speaking and language while dementia focuses on _____
In speech communication, you have to have a _____. Speech production can be done by itself
The success or failure of speech ______ is solely determined by speaker.
The success of failure of speech ______ is determined by speaker AND listener/s.
Memory that naturally works that we don't think about
Acquired global loss of brain function with slow insidious onset
Dementia is a ____, not a disease
Verbal/written expressive and receptive language
Recognition/identification of objects
Inability to execute motor activities
Abstract thinking, judgment, and execution of complex tasks
DSM Iv defines dementia as memory loss plus one additional deficits in an area below that affects ADLS:
Sudden disturbance in consciousness or change in cognitive ability that fluctuates throughout the course of the day
Dementia has ____ progress while delirium is ____
Mild cognitive impairment
Changes that are significant enough to not be within normal spectrum of changes with age but not severe enough to affect ADLs
Decreased ability to concentrate
Decreased word finding abilities
Decreased short-term memory
Difficulty following detail heavy conversations/writings
Symptoms of Mild cognitive impairment
In normal aging, language remains intact while there is a slight decline in
In normal aging, sustained attention remains intact while there is a slight decline in
In normal aging, divided attention skills intact during simple tasks while decline in ____ Tasks
In normal aging, _____ time is overall slowed
In normal aging, long-term memory and procedural memory are intact while ___ and ____ memories are reduced
Cortical dementia that is most common cause etiology of dementia
Alzheimer's is associated with damage to
Progressive and fatal disease with no known treatments to stop or slow progression
Onset of Alzheimer's is usually after
Neuropathology includes presence of
General neuronal atrophy
shrinkage of cortex and widening of ventricles
(always inclusion bodies)
Alzheimer's neuronal atrophy occurs with
clinical signs, autopsy, or Pittsburgh (PiB) Compound test
Alzheimer's is diagnosed with
Where the tau protein and microtubule have become tangled
Neufibrillary tangle the neuron eventually
Neurofibrillary tangles only happens with ______ cells
results from a protein amyloid that is usually broken up in the brain but because of some disease process that we are not sure of
these plaques interrupt communication between neurons which is how we form and retrieve memories
What two impairments must be present to manifest Alzheimer's?
Neurons of the brain are dying and the brain volume is getting smaller. When you lose brain volume, the fluid of the brain then takes that space. What area takes that space?
Gray matter is the
When gray matter dies, does the whole neuron die?
White matter is a
First area affected by neurofibrillary tangles
Three stages of Alzheimer's disease
Motor function retained
Short-term memory loss, word finding difficulties, comprehension of verbal language deficits, and personality changes
Early stage lasts 2 years on average
Early stage of Alzheimer's
Negative impact on ADLs and reliance on others
More severe memory loss, attention deficits, dramatic personality changes, visuospatial and visuoconstructive deficits, and expressive language deficits
May experience wanderlust, sundowner syndrome, disorientation, and confusion
Mid stage lasts from 4 to 10 years
Mid stage of Alzheimer's damage
Manifestation of symptoms getting worse over course of day
Loss of motor function
May become nonambulatory, bedridden, incontinent, and unresponsive
Memory, cognition, and expressive language deficits are profound
May cause muteness and dysphagia
late stage of Alzheimer's
Degeneration of frontal and temporal lobes
Alzheimer's and frontotemporal dementia are both ____ types of dementia
Progressive Nonfluent Aphasia
Frontotemporal dementia includes
Dementia resulting from progressive degeneration of frontal and temporal lobes
personality changes, antisocial and inappropriate behavior, memory loss in absence of language deficits
Pick's disease is characterized by
Neuropathology for Pick's disease
Hyperkinetic movement disordered produced as hyperkinetic dysarthria
Huntington's disease is a ___ dementia
personality, cognition, language, and emotion
Huntington's disease can cause changes in
production of mutant Huntington protein that creates degeneration of basal ganglia, hippocampus, substantia nigra, and Purkinje cells of pons
Where is neuropathology in Huntington's?
Will manifest as a difficult/inability to remember episodes in life
Will manifest as a difficulty to remember the meaning objects have
Frontal and temporal lobe activity with some parietal lobe
These are areas that are involved with semantic memory
Frontal lobe (left hemi, lots of broca's area)
Where is damage in progressive confluent aphasia?
Huntington's is a dementia is what kind of movement disorder?
hippocampus (memory), basal ganglia (movement)
What two areas have degeneration in Huntington's?
Can't test until 40/50's and people have already have kids (passing on gene)
What dementia can you test for? Why is It still occurring?
How many stages of Huntington's are there?
motor symptoms of chorea, emotional problems,
difficulty concentrating, memory problems,
difficulties with executive functioning,
Stage one and two of Huntington's
hyperkinesias that interfere with speech production
Training on AAC for future loss of verbal and written expression
Stages two, three and four of Huntington's
full dependence on others,
high risk of aspiration,
and use of AAC devices to communicate
Stage 5 of Huntington's disease
In stage of Huntginton's, they are more like ____ pts
Mixed dementia caused by small ischemic strokes within the cortex, subcortex, or both
cortex, subcortex, or both
Mixed dementia can occur in what areas?
Memory loss, aphasia, apraxia of speech, difficulties with executive functioning that occur more suddenly
Vascular dementia is characterized by multiple cognitive deficits such as?
Hyperactive reflexes and weakness are present in what dementia?
What dementia has acute onset followed by stepwise progression of degeneration
small or unnoticed ischemic strokes
Neuropathology of vascular dementia
area of brain that has died as a result of stroke
3 subtypes of vascular dementia
Vascular dementia caused by many usually small infarcts to various areas of the brain
Damage to cortex and sub cortex occurs in this vascular dementia
Vascular dementia is the result of small recurrent ischemic strokes to cortex
Cortical multi-infarct results in damage to
Vascular dementia result of multiple subcortical thrombotic ischemic strokes in the brain stem, basal ganglia, and other subcortical structures
Lacunar state is a vascular dementia where damage has occurred in
Lewy body Disease
Results in neuropathological changes in the brain due to presence of Lewy bodies in cell body of neurons
Lewey body and parkinsons' disease are the same
Characterized by motor abnormalities such as rigidity, tremor, slowness of volitional movement, and cognitive deficits
Where is damage in Parkinson's?
What chemical does substantia nigra produce?
loss of dopamine producing cells in substantia nigra as a result of Lewy bodies
Neuropathology of Parkinson's
motor abnormalities at rest, bradykinesia, mask-like facial expressions, difficulty initiating movements for speech, festinations, paresthesia, micrographia, and akinetic movement
Characteristics of Parkinson's
Medical treatment for Parkinsonian symptoms
induced dyskinesias (choreiform involuntary movements affecting the face, head, neck, trunk, and extremities)
on/off effects (The rapid changes in motoric ability induced by fluctuations in the concentration of L-Dopa in the blood plasma)
Side effects with chronic use of levodopa
Dementia with Lewy bodies
dementia where there is a combination of overall decrease of volitional movement and difficulty initiating motor movement alongside cognitive deficits
deterioration of cortex and subcortex due to Lewy bodies
Neuropathology in Lewy bodies
serious or potentially life-threatening levels of physical injury
motor vehicle and traffic accidents,
being struck by an object,
Etiologies of tbi
Under the age of four
Above the age of 75
Users of alcohol or recreational drugs
Of lower socioeconomic status
Previous sufferers of TBI
Law enforcement or military personnel
Most at risk populations
Closed head injuries
Forms of trauma causing brain damage that do not break the skull open or penetrate the cerebral meninges surrounding the brain
When a person's body (and brain) is moving very fast (accelerating) through space and then comes to a sudden abrupt stop (decelerates)
Damage from acceleration-deceleration closed head injury
When front of head is hit making skull hit brain (pushing brain backwards), results from acceleration of head
When brain hits back of skull from front of head hit, deceleration component
anterior-inferior portions of the frontal lobes and temporal lobes as well as posterior portion of occipital lobes, cerebellum, and brain stem
What areas are damaged in coup contra-coup?
Diffuse axonal shearing
When brain pulls backwards, axons are torn off from neurons. They are being stretched too far
Injury to the brain that occurs as a result of stationary head being impacted by a moving object, exerts compressive forces to the area of brain
May bruise and tear surface of brain
Open head TBI
Injury that penetrates the skull into the brain
Open head injury results in ___ damage.
hypoxia (reduced oxygen)
anoxia (complete absence of oxygen)
Increased intracranial pressure results in
Swelling of brain tissue that may occur following trauma to the brain, may cause increased intracranial pressure
Brain is unable to reabsorb old cerebrospinal fluid while still producing fresh cerebrospinal fluid
Traumatic hydrocephalus is when the ___ stop absorbing
Bleeding of blood vessels as result of trauma
_____ hemorrhage is traumatic hemorrhage within the brain
_____ hemorrhage is hemorrhage that occurs between dura mater and surface of brain
_____l hemorrhage is hemorrhage that occurs between the dura mater and the skull
Gathering of blood outside of blood vessel following hemorrhage
1. Loss of oxygen to brain areas that would receive it
2.. Blood brain barrier breached exposing to toxic substances
3. Hematoma developed (lesion occupying space)
3 types of traumatic hemmorages
Seizures that occur consequently to TBI
Shaken baby syndrome
Most common cause of TBI and death in children
Diffuse axonal shearing,
subdural hematoma may occur
Things occurring from shaken baby syndrome
Experienced by modern military personnel as result of exposure to explosion from IEDs
Used to describe various types of trauma experiences by soldiers following IED blast
Primary level damage
Result of shock wave created by explosion from barotrauma that can affect eyes, brain, and air and fluid-filled organs of abdomen
This level of military TBI damage creates barotrauma from pressure wave
In primar level of military damage, the _____ are more susceptible
level of military damage resulting from flying debris and bomb fragments
Tertiary level damage
Level of military tai damage resulting form physical displacement of the body by force of wind or shock wave
Quaternary level damage
Military level damage resulting from trauma created by the blast not due to primary, secondary, and tertiary mechanisms; examples include inhalation of toxic gases, smoke, or dust or burns sustained to body
Are adolescent males/females are greater risks for sports-related TBIs in contact sports?
Chronic trauma encephalopathy (CTE)
Degenerative disease of the brain caused by repeated head trauma that manifests as dementia, confusion, memory loss, headache, depression, and excessive aggression
IN CTE, can you diagnose on behaviors? How can you diagnose?
Age at which first concussion was experienced
What is the defining factor of CTE?
Period of confusion following impact without loss of consciousness
• Mild and transient or severe and persistent
• Chronic headache
• Wording finding deficits
Cognitive symptoms of a concussion
There feelings of concussion affect the ability to self-monitor
Why do concussion symptoms go unrecognized by pts?
Severe gross and fine motor movement deficits,
bilateral paresis/paralysis, contralateral hemiplegia
abnormal muscle tone
Swallowing disorders and motor speech disorders such as apraxia of speech,
ataxic dysarthria, or
combination of the four may often be present
What are motor deficits in TBI?
Hypo/hyper (could be associated with abnormal muscle tone) basal ganglia area essentially
What motor deficits don't individuals with TBI exhibit?
In middle of brain
Why is basal ganglia usually not affected in TBI?
Orientation, attention, memory, problem solving, inferencing, personality changes, impulsivity, emotional lability, lack of motivation, and underestimation of deficits
Cognitive deficits in TBI
Period of unconsciousness lasting more than six hours with individual is unable to be awakened and is unresponsive to sensory stimuli
Person is minimally responsive to stimuli but lacking consciousness and cognition
Minimally conscious state
Person displays inconsistent but definite behavioral signs of consciousness
Persistent vegetative state
Vegetative state continues longer than four weeks
Combination of retrograde and anterograde memory loss in those who recover from comas and vegetative states
loss of memory for things and events before coma
Describes memory loss of events and situations that happen AFTER coma when patents awakens
inappropriate sexual advances, inappropriate statements at inappropriate times,
loss of awareness of social
and cultural conventions,
and more subtle changes such as preferences in food and music
Examples of personality changes in TBI
Limbic system (four f's)
What system is in charge of personality changes?
Language deficits depend of ____ and ___ of damage to brain
Deficits often associated with closed head TBI
Specific language and cognitive deficits more generalized with closed/open head TBI
Open head injuries are associated with more ____ brain damage
Close head injuries are associated with more ___ brain damage.
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