LDA Quiz #4

semantic PPA

-Difficulty understanding words• -Difficulty following basic directions• -Difficulty labeling objects• -Difficulty listing objects in categories• -Speech remains fluent• -May use a lot of non-specific words(this, that, it, thing)• -May exhibit surface dyslexia (read word based only on phonetic pronunciation rules)• -Intact repetition

common symptoms PD

- Tremor - Slowed movements - Rigid muscles - Impaired posture - Impaired balance - Mood changes - Voice changes - Dysphagia - Cognitive impairment

Access to AAC can be fluid depending on:

-Activity• -Positioning• -Time of day• -Fatigue• -Level of motivation• -Skill acquisition

bulbar onset ALS

-Approximately 30% of individuals present with bulbar onset ALS (Wijesekera &Leigh, 2009)• -Bulbar changes affect speech (dysarthria) and swallowing (dysphagia)

spinal onset ALS

-Approximately 70% of individuals present with spinal onset ALS (Wijesekera &Leigh, 2009)• -Presents with muscle weakness and atrophy in limbs and trunk• -Nearly 85% of patients with spinal-onset ALS, however, exhibit bulbar changes as the disease progresses

components of AAC assessment

-Assessment of the individual's participation patterns and communication needs• -Assessment of environmental supports and opportunity barriers• -Assessment of the individual's capabilities and access barriers• -Planning and implementation of intervention with the individual who requires AAC and the communication partners• -Evaluation of the effectiveness of the intervention and follow-up as required

parkinson's disease

-Chronic, progressive neurodegenerative disorder of the central nervous system that belongs to a group of conditions called motor system disorders -Direct result of the loss of cells in a section of the brain called the substantia nigra, a basal ganglia structure located in the midbrain

Motoric Deficits in Parkinson's Disease

Starts gradually, increases in severity - Tremor at rest - Impaired balance - Rigidity or stiffness of legs and trunk - General slowness of movement - Bradykinesia - Stooped posture Progress to difficulty with walking, talking, and completing other simple tasks

short term memory

activated memory that holds a few items briefly -tends to be affected first

mild cognitive impairment

intermediate (preclinical) state between the cognitive changes associated with healthy aging and the pathological changes that accompany AD

multi-modal communication

method of communicating using a variety of methods, including verbal language, sign language, and different types of augmentative and alternative communication (AAC) - Describes all the different ways we employ in communicating with each other, every day.• - This may be via spoken language, texting, tweeting, emailing, handwriting, body language, & gesturing, or by using a communication device

declarative memory

things you know that you can tell others

diffuse axonal injury

traumatic shearing forces leading to tearing of nerve fibers in the white matter tracts

Glasgow Coma Scale

typically administered in the field, at the scene of the crash, or in the emergency room to obtain a rapid clinical picture of the patient

MS symptoms

-Numbness or weakness in arms/legs• -Balance problems, unsteady gait• -Vision problems• -Fatigue• -Chronic Pain• -Dizziness• -Dysarthria• -Dysphagia• -Cognitive impairment

logopenic PPA

-Difficulty with word retrieval and labeling objects• -Understanding of single words remains relatively intact• -Speech contains frequent hesitations and pauses• -Use circumlocutions and non-specific words• -Impaired repetition• -May exhibit phonemic paraphasias• -Grammar is relatively intact• -Difficulty with auditory memory as disease progresses

Considerations for Intervention for MS

-Due to stage of life at diagnosis, important to focus on compensatory strategies for work -Simulated household management tasks might also be helpful -Teach strategies and practice their use during phases of remission -Driving might be a concern

Effects of AD on Language Comprehension

-Impaired auditory comprehension at the discourse level• -Respond appropriately to simple, concrete questions until the middle stages of the disorder• -Impaired ability to draw inferences from written material and to answer questions based on content

partner independent communicator

-Initiates communicative interactions with others frequently and independently• -Uses both natural modalities andAAC strategies to communicate• -Recognizes communication breakdowns and supplements with AAC• -Displays relatively good pragmatic behaviors during conversational interactions• -Has relatively good comprehension skills• -No significant fine or gross motor deficits that impacts access to the device

partner dependent communicator

-Needs assistance from a partner to initiate and maintain communicative interactions• -Requires support for use of AAC• -May not search for ways to communicate w/o prompts• -Does not consistently recognize errors in communication• -May have difficulty using symbols of any kind• -May not engage in appropriate turn-taking during conversation• -May require support for comprehension and/or expression of messages

PPA characteristics

-Patients with PPA have focal damage to a relatively small area of the brain• -Healthy areas of the brain can help support language improvement• -In early stages, cognition is relatively unaffected so patients can benefit from learning compensatory strategies -May be able to continue working using compensatory strategies during mild stages• -As PPA progresses, other cognitive functions are affected including memory, reasoning, attention, and behavior/personality• -Patients with agrammatic PPA may have dysphagia and problems with motor skills• -Patients eventually require assisted living or long-term care• -Patients may benefit from AAC• -Family members and caregivers can be taught supportive strategies• -Average life expectancy after diagnosis is 8-12 years

Dynamic Assessment in Indiv. with Dementia

-Present information in multiple modalities (printed text, verbal) -Administer tests without time limits• -Include multiple trials before assessing task performance• -Present stimuli multiple times using fixed or spaced repetition to assess effects on recall.• -Data from dynamic assessment is particularly important in determining the ability to learn and ability to benefit from a variety of cues

nonfluent PPA

-Speech appears effortful and labored• -Speak in short sentences that lack complexity• -Speech sounds disfluent with possible sound/syllable/word repetitions• -May interject fillers "uh, um"• -Difficulty with verb tenses, pronouns, and other grammar elements• -Reduced rate of speech• -Difficulty with word order• -Less difficulty labeling objects than in other types• -Single word comprehension is relatively intact• -May exhibit motor planning difficulties similar to apraxia of speech

Snoezelen Therapy

-multisensory stimulation program -stimulates the primary senses (sight, hearing, touch, taste, and smell) -limited data on positive outcomes

cognitive changes PD

1. 50-80% of individuals with PD will eventually develop dementia - Average length of time from diagnosis to onset of dementia is 10-15 years 2. Cognitive changes may include: - Impaired attention - Decreased processing speed - Difficulty with abstract reasoning and mental flexibility - Difficulty with planning and sequencing - Impaired recall - Difficulty with word retrieval - Impaired visuospatial skills - Impaired initiation

cognitive changes in MS

1. An estimated 50-65% of people with MS will develop cognitive changes - May be one of the first symptoms 2. Common cognitive changes: - Decreased processing speed - Memory impairment - Difficulty with attention - Difficulty with planning and organization - Difficulty with visuospatial skills - Decreased verbal fluency - Poor emotional regulation 3. Cognitive changes are primary reason that people with MS must leave the workforce - Cognitive changes are less likely than other symptoms to resolve completely during a remission 4. Patients may be taking steroids, muscle relaxants, or other medications that worsen cognitive symptoms 5. Severity tends to be mild-moderate

dysarthria in MS

1. Dysarthria is considered the most common communication disorder in individuals with MS - Typically mild severity 2. Results from disturbances in motor control of the 4 speech mechanism - Impaired articulation, speaking rate, intelligibility, speech fluency

SLP role in dementia management

1. Educating others on the needs of persons with dementia and the role of SLPs in diagnosing and managing cognitive communication and swallowing disorders associated with dementia• 2. Diagnosing cognitive-communication disorders associated with dementia• 3. Develop treatment plans and provide treatment to maintain an individual's cognitive communication and functional abilities• 4. Monitoring cognitive-communicative status to ensure appropriate intervention and support throughout the course of the underlying disease

communication deficitis PD

1. Impairment in cognitive function may result in: - Deficits in high level language skills - Deficits in comprehension of complex sentence structure - Difficulty in constructing grammatically-correct sentences. - Decreased conversational fluency 2. Reduction of vocabulary diversity and increase word perseverations 3. Reduction in the pragmatic communication skills 4. Reduced motivation to communicate

who uses AAC

1. Individuals who are unable to verbally communicate or those who verbally communicate unintelligibly/ineffectively• 2. This can include individuals with:• - Autism, TBI, cerebral palsy, genetic syndromes, intellectual disability, stroke, ALS, Guillain-Barré syndrome• 3. Individuals with apraxia, dysarthria, and/or aphasia• 4. Most AAC users are multi-modality or total

disease course of MS

1. Relapsing-remitting: Symptoms appear(sometimes suddenly), temporarily worsen, and then go into period of remission• - Accounts for 80-85% of cases 2. Primarily Progressive: Gradual onset of symptoms and steady progression of disease without remissions 3. Secondary Progressive: Occurs when relapsing-remitting disease type becomes a steady progression without remission• - An estimated 50% of relapsing-remitting cases will become secondary progressive

Considerations for Intervention with PD

1. Teach compensatory strategies as early as possible - Why? Provides patients opportunities to learn these strategies when cognitive deficits are mild 2. Research suggests better success with external memory aids than internal strategies - Strategies for swallowing safety - Compensatory strategies for speech clarity 3. Since procedural memory may be impaired, teach visual cues and/or written steps for functional tasks 4. Due to average age of onset: simulated work tasks might be less common, might focus more on hobbies and household management

direct access to AAC

1. direct access: -Pointing• -Touching/Pressing• -Eye gaze• -Computer Mouse• -Head Pointing

indirect access to AAC

2. indirect access -scanning

dysarthria in ALS

ALS patients usually have a mixed dysarthria (spastic-flaccid) Characterized by: - Impaired articulation - Slow laborious speech - Imprecise consonant production - Hypernasality

Effects of AD on Language Production

Anomia is common (even in the early stages)• Reduced and increasingly irrelevant, tangential content• Retain the ability to correct misinformation• Reduced complexity of written language

assessment team AAC

Assessment and intervention requires a team approach: -Family members/caregivers -PT, OT -Neuropsychology Children: -Education team Adults: -Employers -Co-workers -Nursing personnel

AAC & AT

Augmentative and Alternative Communication; Assistive Technology

irreversible dementia

Dementia of the Alzheimer's Type• Dementia of the Parkinson's Type• Vascular Dementia (multi-infarct)• Frontotemporal Dementia

reversible dementia

Depression• Vitamin deficiency (e.g. B12 deficiency)• Thyroid disease• Infections• Medication/drug interactions• Renal failure• Congestive heart failure• Diabetes

Evaluation of Functional Communication

Designed for clients with moderate to severe dementia, the Functional Linguistic Communication Inventory is useful in evaluating: -Greeting and naming - Answering questions - Writing - Sign comprehension - Object-to-picture matching - Word reading and comprehension - Following commands

reminiscence therapy

Discussing past activities and experiences with another individual or group -highlights the distant past -use objects that have become obsolete

continuum of AAC support

Enhance• - Enhance auditory comprehension Provide• - Provide a means of expressing preferences, needs, and personal information Serve• - Serve as a word or phrase bank for more complex topics Assist• - Assist as a tool for both spoken and written language Enable• - Enable an individual's participation with more independence across environments

cause of PD

Exact cause is unknown, but thought to be a combination of genetic and environmental causes - Males are more likely to be diagnosed with PD - Exposure to pesticides and certain toxins increases risk

dysarthria PD

Individuals with PD develop hypokinetic dysarthria with symptoms including: - Reduced loudness - Variable speech rate - Imprecise articulation - Harsh and breathy voice quality Treatment protocols - Lee Silverman Voice Treatment - Speak Out

assessment AAC

Goal: develop a clinical profile of capabilities and needs• Formal standardized assessment of language• Allows for classification of aphasia type• Cognitive assessment Assessment of the Individual's Capabilities• -StandardizedAssessment• -Dynamic Assessment• -Assessment of Symbol Representation• -Assessment of Cognitive Processes• -Assessment of Motor Capabilitiesac

progression of PD

Gradual worsening of symptoms over a period of years (progresses through 5 predictable stages)

axonal shearing

Gray and white matter move at different speeds due to their relative weight (the white matter is denser than the gray matter), causing this type of injury as a result of acceleration/deceleration

clinical criteria for MCI

Memory complaints (corroborated by informant) -Objective evidence of memory impairment (for age and education level) -Intact overall cognitive function -Normal activities of daily living- -Absence of other symptoms of dementia (impaired judgment)

Evaluation of Communication in Clients with AD

Medical History• Hearing Screening• Screening for Visual Impairments• Screening for Depression• Subjective Report of Memory Problems

amnesic MCI

Memory loss is the most prominent symptom Most common and most likely to be associated to conversion to AD

predictors of recovery from TBI

Post-traumatic amnesia, premorbid intelligence, age at time of injury and duration of coma

spaced retrieval training

Presentation of new or previously known information that must be recalled over increasingly greater intervals of time -helpful for patients to follow a series of steps

Montessori-Based Intervention

Provide meaningful stimulation and purposeful activities• Promote learning through procedural memory processes - reduce demands on episodic and working memory - Tasks are segmented into component parts - Individuals learn each component in sequence with external cues to reduce errors (minimize the risk of failure)• Individuals with mind AD may function as group leaders - Draw satisfaction from leadership role

modeling

This intervention is when the communication partner uses AAC in conjunction with spoken input

eye tracking/eye gaze

This type of technology used to help individuals with severe deficits navigate and select responses from a screen with their eyes

AAC intervention

Three components:• 1. Selection and personalization of AAC to provide effective means of communication• 2. Instruction in the necessary strategies and skills that the individual requires to communicate effectively via AAC• 3. Instruction of family members and other important communication partners -AAC Modeling -Explicit Instruction -Milieu or Incidental -TeachingStrategy Instruction

Alzheimer's disease

a progressive and irreversible brain disorder characterized by gradual deterioration of memory, reasoning, language, and, finally, physical functioning

semantic memory

a network of associated facts and concepts that make up our general knowledge of the world -atrophy of temporal lobe -picture naming and category fluency affected -not as much difficulty with language

ALS 3 phase intervention model-late phase

adapt and accomodate -after initial AAC intervention until the time of the individual's death -modifications in AAC supports are needed to accommodate the changing communication needs -common for those with ALS to be using eye gaze at this time to communicate due to the significant motor deficits they have at this stage -It is important that the person with ALS is able to communicate effectively and independently at this phase for them to be able to maintain quality of life as well as ensuring they are able to make important end-of-life decisions

ALS

amyotrophic lateral sclerosis -a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord -Approximately 95% of people with ALS are unable to speak by the time of their deaths, they commonly require the use of AAC supports to meet their communication needs -Dysarthria results from the weakness and spasticity observed inindividuals with ALS

ALS 3 phase intervention model-middle stage

assess, recommend, implement -time of referral for AAC assessment until AAC supports are selected -speaking rate is the standard for determining when to refer for an AAC assessment -an individual with ALS should be referred for an AAC assessment when their speaking rate approaches 125 words per minute -the individual with ALS will participate in the AAC evaluation by providing information related to their current and future communication needs. -Clinicians must provide education and assessment recommendations related to AAC in addition to recommendations related to assistive technology (AT) and environmental control unit (ECU) supports

moderate AD

impaired: -Semantic memory - Attention - Working memory - Episodic memory - Executive function Spared: -procedural memory

voice output switches

big mac, little mac, talking brix -Voice output switches are a quick, easy way to provide a patient with communication.• -Can quickly program to personalize a message• -Can be helpful for initial introduction to use of switches as a means of communication

middle stage dementia

challenges become more apparent -increase memory loss -increase difficulty with orientation of time and space -difficulty with communication -issues with personal care -increase issues with handling complicated tasks like shopping and household chores -increase changes in mood and behavior; may display inappropriate behavior

cognitive changes ALS

cognitive changes may include: -Executive function impairment with difficulties with reasoning, judgment, inferencing, planning - Much less common for those with ALS to have memory impairment Recent studies suggest that upto 50% of ALS patients demonstrate mild to moderate cognitive and/or behavioral impairment and up to 20% of ALS patients meeting criteria for dementia -Cognitive and behavioral impairment in ALS can vary widely from one person to another

early onset dementia

commonly seen as part of normal aging by public and clinicians -memory loss -difficulty with words -issues with time -issues with finding their way in familiar places -issues with handling complicated tasks -difficulties with handling money -changes in mood and behavior

low tech AAC

communication board, low-tech eye gaze, tech talk, picture exchange communication board -voice output switches

semantic dementia

condition in which there is a general loss of knowledge for all concepts -a loss of picture naming and category fluency

Performance on this type of task can distinguish individuals with AD from individuals with semantic dementia

confrontation naming or category fluency

Contact-sports players who suffer concussions over the course of their athletic careers are at an increased risk of developing this disorder later in life

dementia

late onset dementia

dependence and inactivity increases, challenges become very noticeable -unable to recognize people and items that were familiar to them -no awareness of space and time -increase need for personal care -difficulty understanding surroundings and situations -issues with mobility; swallowing and continence can occur -behavioral changes may occur

Simulated Presence Therapy (SimPres)

emotion-oriented approach -Aims to reduce levels of anxiety and challenging behaviors - Play audio voice recordings of the individual's close relatives - Research has found that simulated presence therapy improves agitated and withdrawn behaviors in patients with moderate to severe dementia of the Alzheimer type (Bayles et al., 2006)

semantic memory (long term)

facts and general knowledge

mild AD

impaired: -Attention - Working memory - Episodic memory - Executive function Spared: -procedural memory -semantic memory

severe AD

impaired: -Procedural memory - Semantic memory - Working memory - Episodic memory - Attention - Executive function

ALS 3 phase intervention model-early stage

monitor, prepare, support -From initial diagnosis through referral for an AAC assessment - clinicians are monitoring speech for changes, screening for any cognitive decline, and obtaining recordings for voice and message banking for future AAC use -clinicians to be educating and counseling the patient and their family on the expected changes to come related to speech and swallow as part of the ALS diagnosis -70% of patients presenting initially with spinal onset while 30% of patients present with bulbar onset -In the early phase, individuals with spinal-onset ALS may not have speech changes present, however those with bulbar-onset ALS may present with mild changes in speaking rate at the time of diagnosis, so this phase may be very short for them -nearly 85% of patients with spinal-onset ALS exhibit bulbar changes as the disease progresses

MS

multiple sclerosis -The body's immune system attacks the myelin sheath that protects nerve fibers in the brain and spinal cord, which disrupts the signal transmission• -Exact cause is unknown• -Average age of onset is between 20-40 years old

variants of PPA

nonfluent semantic logopenic

PPA

primary progressive aphasia -neurodegenerative disorder that gradually impairs a person's ability to speak or comprehend language -Subtle onset with symptoms slowly progressing over a period of years -Memory and reasoning remain intact in the early stages -Symptoms often start when people are in their 50's

Figuratively, you could say that individuals with this deficit "can't see the forest because of the trees," but they would not be able to understand what you mean

right hemisphere disorder

types of memory

semantic short term long term

Individuals with this deficit present with gradual deterioration of conceptual knowledge associated with bilateral temporal atrophy

semantic dementia

high tech AAC

speech generating devices -Novachat 5, 8, 10 -Accent 1000 -Tobii eye gaze system *less likely to be available in ICU*

types of ALS

spinal onset ALS bulbar onset ALS

episodic memory

the collection of past personal experiences that occurred at a particular time and place

long term memory

the relatively permanent storage of information -declarative (episodic and semantic)

memory books

useful for reminiscence therapy -Contain factual information that is personally relevant• -Information is presented with pictures and written words to reduce demands on impaired episodic and working memory systems and recruit recognition and the ability to read aloud• -Positive outcomes: (Improved topic maintenance, Decreased repetitiveness, Fewer ambiguous statements)

unaided

uses no equipment -Nonverbal means of natural communication -Sign language (ALS or signed English), gestures, body language, pointing, blinking, facial expressions

aided

uses some type of equipment/external support -Low tech: (Writing, pictures, communication board) -High tech: (Speech generating device) (SGD)