SLP 150: CVA and Aphasia Quiz #6
Other causes of Impairment
-Dementia -Infections -Brain tumors -Envt'l toxins -Neurological disease -Age and superimposed medical condition
Research at Rancho Los Amigos: Rancho Scale
-Designed to describe the typical status of behavioral recovery of individuals who have had a TBI or are recovering from a coma during inpatient rehab -Assessment involves 8 level ordinal scale that categorizes correspondence to increasingly complex behaviors
With Aphasia, there is problems with words!
-If truly aphasia -Difficulty with BOTH expressive and receptive but to varying degrees
What is being done to prevent Concussions?
-Increased training of coaching -Awareness among the athletes themselves, so they care of themselves -Research and technology in helmets -Stricter protocols for return to play
Traumatic Brain Injury
-Injury to the brain -Caused by an outside physical force hits the head -Something moves the brain within the skull -The head hits something OR something hits the head -Acquired-not born with it -Not caused by a degenerative process like Dementia -Physical &/or cognitive-thinking impairment
The Following groups are at particular risk for TBI
-Males are about twice as likely as females to sustain a TBI -Infants and children aged 0-4 and adolescents age 15-19 years are the 2 age groups at HIGHEST risk for a TBI -Adults aged 75 years and older have the highest rates of TBI-related hospitalization and death
Rest your weary brain (sit in a dark room and rest)
-No sports or physical activity -No school or studying -No playing video games, TV, or texting
Immediate Care
-Remove from play immediately and for rest of game -Perform cognitive test and compare to baseline scores (from before they were hit to after) -Monitor neuro status every 15-30 mins for several hours -If stable, send home with adult for complete rest
Second Impact Syndrome
-Second blow occurs before brain recovered -Breakdown of blood-brain barrier and some swelling -Second hit causes massive swelling and sudden death SIS: repeated mild brain injuries occurring over an extended (i.e., months or years) can result in cumulative NEUROLOGIC AND COGNITIVE DEFICITS -Repeated mild brain injuries occuring within a short period (i.e., hours, days, weeks) can be fatal!
Its not just teenage boys in Football with concussions
-Soccer, boxing, and hockey -Girls susceptible due to reduced neck mass (can have worse injuries)
Wernicke's Aphasia (receptive)
-Speech is fluent but sounds like a different language -Contains incorrect/distorted/nonsense words -Poor awareness of own errors and lack of listener's comprehension -No IDEA that they are doing this
Broca's Aphasia (expressive)
-Speech is nonfluent, labored, halting -"telegraphic speech": just content words, omitting articles, prepositions, etc. -Pausing (knows what they want to say but not coming out) -Comprehension MAY BE RELATIVE STRENGTH -REMEMBER DOES not affect intelligence in Aphasia
Monitoring Patients with TBI
-Understanding with context of the injury, stages of recovery and behavioral symptoms all aid in the expectations of recovery and treatment planning -This also help focus treatment approaches- not unnecessarily treating things that may naturally resolve (transient post-traumatic amnesia, agitation)
What do we see with someone with TBI? It is characterized by:
-changes in levels of consciousness -memory disturbances -Confusion and disorientation (think we're in alaska but in SD) -Neurological signs -Visual field deficits -Hemiparesis (weakness) or other motor dysfunction -Behavior changes
The brain is like a computer because
-controls all body actions and rxns -Receives info from the 5 senses -Tells muscles what to do
How does brain injury happen?
-decrease in Cerebral blood flow -increase in neurotransmitters -subtle but widespread brain injury -brain physio can be altered for hours to years
Principles of Therapy
-involve patient/family in goal-setting -show patient their progress -Be flexible -"Just-right" challenge
If CVA is in RIGHT brain
-left face droop -left arm paralysis -left leg paralysis Trouble with ATTENTION and BEHAVIOR!
Reverse Psychology
-left side of the brain controls to right of our body -right side of the brain controls the left side of our body
Concussion Symptoms
-mild concussion may involve no loss of consciousness (feeling "dazed") or a very brief loss of consciousness (being "knocked out") A severe concussion may involve prolonged loss of consciousness with a delayed return to normal -dizziness -nausea -dazed feeling -visual symptoms -Irritability
General Philosophy of TBI care
-must go through all stages to recover -Longer time in early stages =poorer prognosis for full recovery -May take 6 mos to 2 years or more
Our brain has 2 networks
-nerves which carry messages -blood vessels which carry food (oxygen)
Studies on HS athletes
-pre/post season data taken -cognitive tests and imaging studies -shows changes in athletes brains
If CVA is in LEFT brain
-right face droop (OT, PT, help involved) with eating, swallowing, etc -Right arm paralysis -Right leg paralysis Trouble with LANGUAGE!
Signs of Stroke
-sudden numbness of face, arm, and leg, esp on one side of the body! -sudden confusion, trouble speaking or understanding -sudden trouble seeing in or both eyes -sudden trouble walking, dizziness, loss of balance or coordination -sudden severe headache with NO known cause
Rancho levels of Cognitive Functioning
1-8, 1 is the worst, and 8 they can do on their own with little assistance
Aphasia is
Acquired communication disorder > impairs ability to process language > BUT does NOT affect intelligence -can affect difficulty understanding, reading, speaking, and writing -It is Language Disability by Brain injury
Areas Tested for CVA
Auditory Comprehension Verbal expression Speech production Reading Writing
Global Aphasia
BOTH severe expressive and receptive aphasia -little or no verbal output -little or no understanding -no reading or writing -Life expectancy might not be long -Side of their body can be affected COMPLETELY left side and may go into the other side as well -Not able to communicate bc it is hard, huge counseling Loss of words, not intellect
Ever-narrowing network
Brain is only 2% of total body weight but receives 15-20% of body's blood supply
Concussion in Sports: How to reduce head injuries in US
Concussion is a violent jarring or shaking that results in a disturbance of brain function The term concussion describes injury to the brain from impact to the head, concussion results from CLOSED-head type of injury By def, a concussion in NOT a life-threatening injury, but it can cause both short-term and long-term problems
Traditional Definition of Concussion
Concussion: Mild TBI= blow to the head, temporary symptoms and not life-threatening Differentiated from Severe TBI: usually multiple injuries, associated with major accidents long-lasting effects
Progression of TBI
Deficits in arousal and consciousness > basic attention and anterograde amnesia (what happened immediately before the injury) > higher level attention, memory, executive functioning, processing speed , insight and social awareness
No time to WASTE! Time lost is brain lost (FAST)
Facial Weakness Arm and leg weakness Speech problems Time is critical
Uses of Rancho Scale
Facilitates recovery > assists with rehab plan > predicts outcomes (help family know, do they need to be at home or at the center?)
Evaluation for CVA
History Interview Observation Testing
At-risk populations for TBI
Individuals across the lifespan! Anyone can have brain injuries
The left side of the brain pertains to...
Language
Severity of Glasglow
Mild is greater than 13, moderate is 9-12, and severe is less than 8 However, this doesn't predict outcome b/c scoring immediately. This can talk about much care you might need in the future
Brain needs time to recover after first blow...
More likely to get hurt again> brain more susceptible to further injury> reflexes, vision, balance impaired
So what is Traumatic Brain Injury called?
Neuro Trauma, TBI, ABI, BI, Head Injury (open and close), Concussion
What nourishes our brain?
Oxygen! Blood carries oxygen from heart to brain via arteries. Everything we do requires oxygen!
General Duties of the Brain
Plan and execute motor activities happen in FRONT of the brain. If damaged, fluency problems! Hearing and making meaning happens in the BACK of the brain
Therapy Settings
Support Group Day Program Outpatient Clinic Inpatient hospital Rehab center Nursing home Home health
However, what does the rancho scale NOT tell us?
The speed at which progression from level to level will occur cannot be predicted (can't tell how the patient will get better) -Level of plateau cannot be predetermined -rancho scales are only descriptive of behavior -patient may skip levels or stop at one particular level
Dysarthria
Think WEAKness, speech muscles are weak and dyscoordinate, slurred, whispered or mumbled
TIA: Transient Ischemic Attack (mini stroke)
This is a WARNING stroke -Symptoms occur rapidly, then resolve within a few minutes -Blockage is temporary, then dissolves -No permanent injury to the brain!
Rancho Levels of Cognitive Functioning
Top of the scale 3: need high level of assistance, can't do anything Middle range of the Rancho scale: still confused but doing things for themselves, can inconsistently respond to commands from you Last level patients are getting back to getting things done on their own, doing things they should be doing, correctly and appropriately
Younger Kids (It is not true that younger kids are less susceptible!)
We frequently see the cognitive and emotional recovery is slower in younger kids because they are in the process of developing
It is important for SLPs because we are in charge when seeing the student athletes with post-concussive syndromes
Your caseload might include these clients, and you must be able to recognize cognitive and behavioral changes that impact learning and life skills
Ischemic Stroke
a clot blocks blood flow to an area of the brain, aka stopped and we need oxygen for our BRAINS
Expressive Aphasia (Broca's)
affects production of their language
Cerebrovascular Accident (CVA: stroke)
arteries can be BLOCKED or Burst there are 2 types
Causes for TBI
automobiles, pedestrians, bikes, and motor bikes, gunshot wounds, combat, domestic violence, assault and child abuse (shaken baby syndrome) falls, industrial, sports and recreation
Cumulative effects of Pro-Athletes
behavior and mood changes age 35 > cognitive memory loss age 59 > Dementia, ALS, Parkinson's, depression
Hemorrhagic Stroke
bleeding occurs inside or around brain tissue and the tissue dies off
Structural Brain damage
brain changes show up on MRI despite normal cognitive tests -MRIs of soccer players who didn't report concussion differ from those of swimmers -Any kind of concussion due to their sport, what's showing is that the brain itself is changing, even though it doesn't show up immediately
Receptive Aphasia (Wernicke's)
comprehension of their language
Our nerves bring info from..
different parts of the body to the brain and sends instructions from brain to muscles and they are rapid electrical signals
Glasgow Coma Scale
done first by paramedic, done again in ER -Testing behavior at the time of the injury. This is used for physical response from stimuli from the outside to see how aware the patient is and what kind of control they have of their body, and speech/cognition. Eye opening, motor response and verbal response (more points you get on the glasgow coma scale, the better you are! 6 means obeys commands
Parts of the Brain: 4 lobes
frontal lobe (responsible for thinking, memory, personality, motor activity and speech and language) Parietal lobe Occipital love (language that is visually based) Temporal lobe (auditory comprehension) Brainstem and cerebellum
Simple Concussion
in a simple concussion, the person the symptoms gradually resolve and the patient returns to normal function in 7-10 days
Aphasia is a language disorder
language: what you want to say -finding words -knowing vocab -forming sentences -interpreting meaning Speech: how you say it -controlling the muscles of the mouth and throat to produce it
Right CVA
may do well on verbal tasks, but fail to execute, reduce poor problem solving and judgement, poor interpersonal skills, visual deficits, dysarthria, denial of deficits VISUAL neglect: visual pathways are impacted, cant see thru left side since right is affected
Apraxia
motor-planning deficit, you KNOW what you want to say but you cant control and sequence the muscles to produce it. THIS is an acquired event aka stroke
TB Injury may be....
open (head injury) or closed (skull is not fractured but brain is moved around) High or low speed > focal or diffuse
Caution of Recovery of Head Trauma
some will plateau at certain stages (stop for a while and gain some new skills) -Seem to get worse before getting better Rancho scale helps.... us know where they are at any moments, how we can work best with them, and how we can develop our treatment plan. BUT we really cant plot how a person will recover from a TBI
TBI
something hits or enters the head ? causes sudden acceleration or deceleration of the brain
Complex Concussion
symptoms persist and thought processes are affected. Patients with repeated concussions
If CVA is in right brain...
we see left face droop, left arm paralysis, and left leg paralysis -Trouble with ATTENTION AND BEHAVIOR
If CVA is in left brain...
we see right face droop, right arm paralysis, right leg paralysis Trouble with LANGUAGE!
Stroke mechanisms
when comparing the two arteries in the picture: One normal and other is by Atheroslcerosis, which is filled with plaque and can block artery and blood flow. Also when a bubble forms on an artery and pops, blood flow can hit the brain and cause dead brain tissue =if blood vessels are affected in any way, can mess with the nerves who carry messages
