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Exam 1

Terms in this set (43)

WHO-ICF
A system to describe the impact of disease or injury on the body and it's functions, in addition to a patients ability to complete tasks or activities relevant to their personal pursuits.
WHO-ICF Components
Body Structure and Body Function, Activities and Participation, and Contextual Factors such as environmental and personal.
Body Structure and Body Function
Composed of structures of the nervous system, structures of the eye, ear, and related structures, structures involved in voice and speech, musculoskeletal structures related to movement, mental functions, sensory functions, voice and speech functions, and neuromusculoskeletal and movement related functions.
Activities and Participation
Communication, Learning and applying knowledge, self care, general tasks and demands, domestic life, interpersonal interactions and relationships, major life areas such as education, work, and employment, and community, social and civic life.
Contextual Factors
Products and technology, environmental characteristics, support and relationships, attitudes, services, systems and policies, race, age, life experiences, and personality.
How does the WHO-ICF inform and impact our assessment and treatment of clients with aphasia and right hemisphere disorders.
This model informs and impacts our assessment and treatment of clients with aphasia and right hemisphere disorders due to it's ability to characterize the impact of these disorders on the client's lives. It focuses on the various aspects of the disorder and the client that help us gain a good overview of what's happening to the client both physically and mentally. It emphasizes the underlying language and cognitive impairments, communication and cognitive limitations, and the impact they have on the client's quality of life.
Evidence Based Practices (EBP)
The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. It involves the use of incorporating clinical expertise, patient values, and the best available evidence into the clinical decision making process.
Steps of EBP
· Convert the need for information into an answerable question
· Identify the best evidence with which to answer that question
· Critically appraise the evidence
· Apply the results of this appraisal in clinical practice
· Evaluate your performance
How EBP should be applied to our work with people with aphasia and right hemisphere disorders.
EBP's should be applied in our work with aphasia and right hemisphere disorders because they have been tried and tested in the specific area we are researching. It has valid information that can be transferred to our patients so they can receive the best treatment and information possible.
Efficacy
The potential maximum benefit of a treatment
Efficiency
High productivity, a maximum effect for the effort expanded
Both are important because effectiveness can be compared with another treatment to determine which has a more efficient outcome.
Cognition
All processes that we transform, condense, elaborate, store, retrieve and exploit sensory information so that we can understand and interact with our environment.
Language Processing
A part of cognition that supports language comprehension and production.
Attention
A cognitive function allowing for allocation of processing of resources to stimuli or tasks. Example: Cutting coupons and watching TV at the same time; No full focus on either task.
Memory
A cognitive function allowing for individuals to store, retain, and subsequently retrieve processed information. Example: Thinking about the last time you had ice cream and knowing you had banana split last night on the couch with cake.
Executive Function
A cognitive function responsible for generating, planning, selecting, and monitoring goal directed and adaptive responses that in turn create completion of independent, purposeful behaviors. Example: Planning out your day.
Language Neural Bases
Housed in the left hemisphere of the brain. Broca's area has the primary role of language expression. Wernicke's area is on language comprehension. Other areas such as the supramarginal gyrus and angular gyrus contribute to the comprehension of written language.
Cognition Neural Bases
The subcortitical structures play a role in language processing. The thalamus and basal ganglia are involved in cognitive function such as attention, memory, and executive functions.
What are the different symptoms of aphasia?
· Comprehension deficits; phonological analysis, semantic processing, morphosyntactic parsing
· Speech fluency; agrammatism, paragrammatism
· Naming; anomia, paraphasia, neologism, jargon, circumlocution
· Repetition
· Disruptions in written language; agraphia
· Gestural communication
· Pragmatic abilities
What are some concomitant cognitive symptoms that can accompany aphasia?
· Attention problems
· Memory problems
· Executive function problems
Dichotomous
Classifies aphasia based on speech fluency (non-fluent vs fluent aphasia)
and degree of comprehension (receptive vs expressive aphasia). Both of these are behavioral characteristics but they are proposed to be associated with specific lesion sites in the brain.
Connectionist
Classifies aphasia based on both behavioral characteristics and neuroanatomical correlates of the observed behaviors. Adopted by commonly used aphasia diagnostic batteries; Boston Diagnostic Aphasia Examination-3rd edition and Western Aphasia battery revised. Used the most frequently by professionals serving patients with aphasia. Called connectionist due to the assumption that the various aphasic subtypes reflect disruption of specific brain centers or the connections between these centers. Connectionist aphasia types are broca's, wernicke's, global, transcortical motor, transcortical sensory, transcortical mixed (isolation), conduction, and anomic.
What are the hallmark symptoms of right hemisphere disorder?
· Perceptual problems
· Attention problems
· Neglect syndrome; hemi-inattention, hemikinesia, and allesthesia
· Memory problems
· Executive functioning problems; anosognosia
· Communicative symptoms; lexical-semantic abilities and pragmatic and discourse (appreciating humor, comprehending non-literal language, interpreting cues, inferencing)
Neglect Syndrome
A set of attention problems in which patients are slow or inaccurate at reporting, reacting to, orienting to, or seeking out stimuli that are presented contralateral to the side of their brain damage. Patients with RHD will have difficulty presenting to stimuli presented on their left side.
What is the LPAA approach to aphasia and why is the statement of values important to you as a clinician?
Life Participation Approach to Aphasia. Aphasia impacts the core of a person, their ability to communicate. By having a holistic approach and social model, we switch our focus to increasing the patients communication participation. Aphasia can't always be cured so by using a treatment approach in this way we can help make communication more accessible and achievable. By increasing this communication access it can help limit the feelings of isolation. This is important for me as a clinician because I can help teach family members and patients how to utilize and implement communication boards, aac, etc into the lives of those impacted by aphasia to help increase the patients communication.
Speech production characteristics in aphasia
· Anomic pause
· Semantic paraphasia
· Phonemic paraphasia
· Anomic circumlocution
· Neologism
· Jargon
· Agrammatism
· Paragrammatism/Empty speech
· Random paraphasia· Indefinite substitution
· Stereotypy
Types of Aphasia
Brocas
Werenicke's
Global
Transcortical motor
Transcortical sensory
Transcortical mixed
Conduction
Anomic
Broca's
Non-fluent language output and relatively spared language comprehension compared to output fluency difficulties
Werenickes
Marked comprehension, naming, and repetition impairments
Global
Significant impairments in all language modalities and functions (comprehension, fluency, naming, repetition)
Transcortical Motor
Similar to Broca's in regards to fluency, comprehension, and naming. Spoken output is generally more fluency with fewer errors than spontaneous verbal output
Transcortical Sensory
Poor comprehension and fluent speech
Transcortical Mixed/Isolation
Similar to global. Exhibit notable impairments in comprehension, fluency, and naming but retain the ability to repeat at a level not predicted by the severity of their other language deficits
Conduction
Disproportionately severe deficits during repetition
Anomic
Isolated impairment of naming with fluent speech and good comprehension
What are the major arteries that provide blood flow to the brain?
The carotid arterial system and the vertebrobasilar arterial system.
What is the importance of the Circle of Willis to our course?
The Circle of Willis connects the carotid and vertebrobasilar arterial systems. It provides collateral circulation that helps compensate for a blockage in one of the major cerebral arteries. For example if there is a occlusion of the left internal carotid artery that in turn is reducing flow through the left middle and anterior cerebral arteries, the right carotid and basilar artery can provide alternate sources of blood flow via the anterior communicating artery and the left posterior communicating artery.
Ischemic Stroke
87% of strokes
Deficiency in blood flow to the brain due to an artery blockage
Small ischemic stroke may be called lacunar stroke - small penetrating arteries that supply blood to structures deep in the brain and result in a small area of brain damage
Infarct is an area of dead brain tissue
2 types of blockages; thrombosis and embolus
Thrombosis is buildup of atherosclerotic or fatty plaque on an artery that provides blood flow to the brain
Embolus is a clot formed or a piece of fatty plaque breaks off from elsewhere in the circulatory system and then travels to block off a smaller artery that supplies blood to the brain - usually faster onset
A lot of stroke causes aren't determined so they're called thromboembolic
TIA is a transient ischemic stroke which is a smaller precursor to an ischemic stroke - A small and temporary disruption of blood flow to the brain usually caused by small emboli that briefly became lodged in the cerebral vasculature prior to being broken up
Hemorrhagic Stroke
13% of strokes
Occurs when an artery bursts and causes blood to escape and flood surrounding brain tissue
Buildup of blood is called a hematoma - dangerous because the pool of blood can displace and compress adjacent brain tissue, arteries, or cranial nerves
Often associated with aneurysms, arteriovenous malformations, or hypertension
Aneurysm is a weak or thin spot on a blood vessel that causes the vessel to dilate or balloon
Arteriovenous malformation (AVM) is a defect in the communication links between arteries and veins and consequently results in weakened arterial walls.
Hemorrhagic strokes are often characterized by where they occur such as intracerebral hemorrhage - blood invades tissues in the brain
What type of treatment is available for stroke?
· Recognizing the symptoms; Dizziness, confusion, severe headache, one sided numbness or weakness, slurred speech
· If ischemic, patient may be candidate to receive drug treatments designed to reverse or minimize permanent brain damage; Ex. rTPA must be used within 3 hours of stroke to break up blood clot by speeding up the body's natural clot dissolving process
· Surgery to remove or disrupt the clot
· Use of neuroprotective agents to protect brain tissue directly adjacent to the infarct; Still under development
1. What is meant by 'Counting what Counts'?
It means that we need to focus on more than just the symptoms of aphasia. We need to also focus on what is important to that person and how we can improve the areas of their life that are important to them.
What is the A-FROM? How does it relate to WHO-ICF?
A-FROM is a broad, non-prescriptive conceptual approach to outcome measurement that takes account of the impact of aphasia on life areas deemed important by people with aphasia and their families. It was developed with key concepts from WHO-ICF. Many focus groups and clinicians commented that WHO-ICF was hard to understand and difficult to use ICF into daily assessments. This feedback was used to make A-FROM from WHO-ICF but in a more user friendly, easier to understand way by simplifying concepts and narrowing the focus.
What are the four A-FROM domains?
Aphasia severity, Participation, Environment, Personal and Life with Aphasia are the four domains.
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