Neuroscience - Exam 4

Olfactory Pathways

(pic in notebook) LEFT HALF: Limbic system is activated directly That means that the olfactory input has a direct influence on memory, emotional tone, and on stress levels When really stressed out there are lots of things you can do - light candles (calming scents) - lavender, mint, rosemary, pumpkin spice -it provides an effect that is calming Ex: just enough of a smell that it was noticeable but not enough to where someone would say something (only worked until someone noticed it, then productivity went down) -productivity smells would change based on the scent -if it smelled like food - less productive before 12 -productivity unchanged if smell occurred after 2, after lunch -hint of mint - productivity rose 25% (behavior was changed by olfactory environment) -not enough for them to notice it, but enough to affect these areas, these structures reticular formation ANS, hypothalamus neuroedocrine levels, all of these non-cognitive activities could be influenced by scent. Structure that is important to understand is amygdala, structure important for people to notice novel external events - cognitive equivalent of what was in the corner of your eye (what was that? - pay attention to it) - the level of activity in amygdala if normal you will notice things and then discount them as not relevant, but if hpervigilant it would notice even tiny things and then not let them go, this person would look really distracted in a classroom, but this hypervigilance, that change in amygdala is probably associated with syndromes like PTS (PTSD) - probably related to hyperactive amygdala system -in an environment where you need to be more vigilant to be safe - more active, paying more attention -if return to an area where you don't have to be as vigilant - you can't turn that off, heightened level of stress that whole limbic system is involved with, but the actual noticing part is hypervigilent -good likelihood that reduced vigilance, may be what's going on with social aspects of autism, doesn't notice normal social behaviors and cues Hippocampus - part of limbic system and it's the part that is important for encoding and retrieving memories, important for having an experience and turning it into a memory (encoding) and then retrieving a memory ex: useless file cabinet until you find a key - the lock is the hippocampus, allows things to be filed and retrieved, doesn't actually store things Pregnancy and sense of smell - neuroendocrine part probably -documented changing in preference of smell across menstrual cycle - men more stable, women very different. Period just prior to fertility portion of cycle where there's heightened sensitive to all smells, varies with different people, hormonally based change in sensitivity receptors changing, over course of pregnancy those hormonal fluctuations also rise up, morning sickness may be triggered by something like that - environmentally induced, to much smell, smells need to be controlled around pregnant women (knew was pregnant because change in scent) RIGHT HALF: This is the pathway that responds to the beyond threshold smells when you notice is and name it. So you break ammonia capsule under nose and they gasp and heart rate goes up - first part, second part is whoa that's ammonia. Gee it smells like a swimming pool in here - 2nd part. This that's involved in recognizing, naming, identifying smells Put them together you have alerting/arousing on the left and identification/discrimination on the right - just like all other sensory pathways Right involves cognition Not so much on left

Papez Circuit with I/O connections

(pic in notebook) We now know everything is connected! Don't have to memorize. Global view of omg everything is connected to the Papez circuit Any kind of tone - all different parts of brain can contribute to tone problems no matter what kind of tone (stress, emotional) Amygdala connects to almost everything - noticing those things out in the environment cause things to happen This is partly why having a functional amygdala is so important - if working how it is supposed to, it will filter information in environment and what is and is not important to you - won't pay attention to it

Relation of Implicit and Explicit Memory

(pic in notebook) Declarative memory stored in medial temporal lobe (alzheimers and epilepsy issues located here). Implicit memories located in neocortex, striatum, amygadala, etc.) Any one of them may alter performance a little bit but not actually impair memory completely - not impair ability to do the job completely -so that's why memories are so hard to completely erase

Function and cortical regions: Non-dominant hemisphere

-'Conceptual' functions -Intuitive thought -Spatial relations -Emotions -Prosody

Function and cortical regions: Dominant hemisphere

-'Intellectual' functions -Rational thought -Verbal skills -Analytical thinking -Processes having 'components'

Communication and language

-'Language' is a cognitive skill (aphasia) -'Speech' is a motor skill (dysarthria) -Function of dominant hemisphere -Receptive & expressive components -Non-dominant hemisphere plays a role --Prosody: rhythm, intonation

Escalating Activity

-'Reverberating' circuit -Sequential stimuli = amplification of activity -'Stress management' --ability to 'reset' system effectively --alternate strategies if not effective? --negative health consequences include dysfunction related to immune, ANS systems

"Learning" Defined

-A Set of Processes --Events or occurrences that taken together lead to a state of change in behavior --Assume that something has take place to facilitate changes in responding (cellular, systems, behavioral) --What these processes are is not exactly clear

Memory cont.

-A reconstruction process - pull information from all parts of the brain -Environment thus can greatly influence how and what information is gathered -Strongly related to hippocampal function (this region very susceptible to decreased blood flow, e.g. long-term hypertension) **Environment can also facilitate the memory -if you have distractions it's much harder to study and focus -strongly related to hippocampal function and if it is impaired you will not be putting it in the right place or not as completely or thoroughly or parts don't end up where they belong

Implicit Knowledge

-Accumulates with repetition -Not dependent on conscious processes -Not accessible to conscious recollection -Neural locus is distributed - no single lesion can eliminate task performance entirely **-increases with practice (so you can do it without thinking about it) -declarative does not increase with practice - learn rules and done

Language and cognitive-communicative disorders of adults

-Aphasia -Right hemisphere language syndrome -Language of confusion (TBI) -Language of dementia (AD and others) **Different kinds of communication disorders Aphasia is a general term used in a global way that is not necessarily useful because there are different kinds of language disturbances that are distinct to someone who knows the details from aphasia -reports saying someone has aphasia may not always be correct -for therapy purposes we need to know what kind of aphasia - can the not produce language or can the person understand you? - these are important differences Dementia - qualities of language impairment Same with TBI That are not quite the same thing as aphasia Reason we hear about aphasia a lot is because there are a lot of strokes out there and Stroke = most common cause of aphasia

Related disorders

-Apraxia of speech (motor speech) -Dysarthria (motor speech) -Right hemisphere language syndrome -Primary progressive aphasia -Alzheimer's disease -Hearing loss -Depression

Major aphasic syndromes: Nonfluent aphasias

-Broca's Aphasia -Global Aphasia -Mixed Nonfluent Aphasia -Transcortical Motor Aphasia

Right hemisphere language disorders

-Difficulty with pragmatic aspects of language, which includes talking for too long on a turn, interrupting a speaker, reduced eye contact -Communication deficits resulting from impaired attention (difficulty following the gist of a conversation) -Difficulty making inferences -Difficulty interpreting non-literal language -Difficulty determining relevant from irrelevant info (difficulty determining main ideas)

Basic Principles of Learning for Rehabilitation Scientists

-Do not fool yourself by confounding learning with performance -Fundamental to "learning" is PRACTICE -Practice of tasks/skills forms a large part of "treatment" -The issue of how much feedback to provide during treatment is critical.. **Important: if you think about how your interaction during a therapy session goes, it usually involves you sitting there and providing a lot of feedback, but if you provide too much feedback you're interfering with their learning process. They will be listening to you rather than doing it and self-evaluating or become reliant on your external feedback to perform. You want them to become reliant on self-critical feedback in order to evaluate their performance. You begin with more feedback but taper it off until they can do it on their own.

Explicit Knowledge

-Established in a single exposure -Accessible to conscious recollection -Medial Temporal Lobe **provided have medial prefrontal cortex and frontal lobes can see the consequence that will happen if you do something -not sure about single time learning

Forms of "memory"

-Explicit memory (Declarative) -Implicit memory (Procedural, etc.) -Emotional memory

Factors used to distinguish among the fluent and nonfluent aphasias

-Fluency: fluent vs. nonfluent -Auditory comprehension: good vs. poor -Repetition: good vs. poor NOT USED: reading and writing skills, confrontation naming --- BUT you need to assess reading and writing to determine whether the person has fluent/nonfluent aphasia vs. one of the pure aphasias/alexia with agraphia.

Major aphasic syndromes: Broad categories

-Fluent Aphasia -Nonfluent Aphasia -Alexia with Agraphia -Pure Aphasias **Fluent aphasia - Wernicke's problem Nonfluent aphasia - Broca's problem Alexia with agraphia - inability to read and write - but can speak - problem associated with angular gyrus and supramarginal gyrus - but not with Wernicke's Pure aphasias - relatively rare, but one is called pure word deafness - person can't understand language if it's spoken but they can read and write

Anomic aphasia: Linguistic features

-Fluent and grammatically well formed -Content is high -Inordinate difficulty with word retrieval (on confrontation naming and during conversational speech - more difficulty with less common words) -No literal or verbal paraphasias -Good at producing circumlocutions -Good repetition -Variable reading comprehension and writing **Word finding problems -we all have it - how significant is it - unusual for a person my age -will often beat around the bush - words in the area but not come up with the word - and may people do that in conversation - maybe not that severely

Wernicke's aphasia: Linguistic features

-Fluent speech with normal rate and rhythm -Poor auditory comprehension -Paraphasic errors (phonemic/literal, semantic/verbal); both single- and multi-word -Neologisms -Informational content may be quite low -Written expression parallels oral expression -Reading comprehension parallels auditory comprehension -Poor repetition -Little awareness of deficits

etc..

-Have trouble with language but good with geography --this is because a map is a representational thing (a picture) - engaging both sides of the brain - right side working better than the left, so right side can compensate = same idea of showing a picture, a map is a picture representation of a physical environment and they can actually extrapolate from the map place names- these people can often sing as well (very communicative and emotionally communicative and all can say is yup and nope but he can sign happy birthday - because it has a rhythmic intinational pattern (right side of brain) you don't listen to words or have information content when you sing happy birthday) Ex: horses name in jingle bells - bobtail (bells on bobtail ring) - there is information in the language of the song but because we are focused on the rhythm and intination we don't listen to the words Hard time with reading comprehension

Implicit/Explicit Distinction

-Individuals with Parkinson's Disease demonstrate impaired implicit learning but spared explicit learning -Individuals with amnesia demonstrate spared implicit learning but impaired explicit learning Parkinson's - can talk about doing it but can't do it Alzheimer's and amnesia - can do it, just don't remember they can (one is cognitive activity and one is behavioral activity)

learning defined cont..

-Is not directly observable --Processes that underlie learning are reflected in changes in nervous system function and behavior --Neuroimaging allows a more direct view of nervous system reorganization

learning defined cont...

-Is relatively permanent --When you practice and learn a skill, you are not the same as you were before.. ---examples: bicycle riding, swimming --This is a critical distinction...If your patient has "learned" the skill being practiced s/he will be able to demonstrate it... (get better at it with practice, but may not have learned the behavior) (performance is different from learning)

Psychosurgeries

-Lobectomy -Commissurectomy -Hemispherectomy -Cingulectomy - disconnection of cingulate gyrus from rest of the brain, and dorsal portion for procedural memories and anterior for emotional component for things like pain (done to prevent functional impairment due to emotional components - pain coming from thalamic pain syndrome which is not real but it's just enough to affect their behavior) -Prefrontal lobotomy -- vs. electroconvulsive therapy --'One Flew Over the Cuckoo's Nest" **usually because of epilepsy -lobectomy - if done early enough, won't notice, pretty functional (if after age of adolescence it is a devastating surgery to have done) commissurectomy - split brain procedure - no cross communication (buttoning and unbuttoning) - whole point was that there are seizures that begin on one side and progress to the other or involve the whole brain and this stops that -hemispheretomy - extreme - whole cortex on that side removed -prefrontal lobotomy - removal of frontal lobes (bilateral), extreme, realized they didn't need to do that, just needed to cut the fibers above the eyeballs (we don't do this anymore - but we do do electroconvulsive therapy - effective for depression and mental health concerns, usually effective)

Function and cortical regions

-Localization of function -Lateralization of function --dominant hemisphere --non-dominant hemisphere -Neuronal plasticity

Limbic System

-M.O.V.E. -Hippocampus -Amygdala -Limbic cortex (lobe) -- Cingulate gyrus -- Parahippocampal gyrus -- Uncus

Learning vs Performance

-Momentary strength or accessibility of a response (performance) -Underlying habit strength of that response (learning) -A change in performance DOES NOT necessarily imply learning has occurred **Momentary efficiency - practicing/performance part Remembering it and doing it later - that's the learning. True whether physical or cognitive activity

Global aphasia: Linguistic features

-Nonfluent -Extremely limited verbal output (may be limited to a few single words) -Single word output may be a non-word or a real word stereotypic response -Severely impaired repetition -Severely impaired confrontation naming **Global aphasia = Most common Very often will have - Some motor, articulation, swallowing component along with affects of type of stroke they had Have a hard time repeating, producing, pointing, drawing = difficult people to work with because have to work around multiple impairments But they're highly motivated to communicate We worry about safety with this group - because try to walk and will fall because of hemiparesis Term global means big - have not just arm hemiparesis but also leg

Broca's aphasia: Linguistic features

-Nonfluent oral expression that is effortful & slow -Reduced phrase length and syntactic complexity -Agrammatism is common (omission of function words and grammatical morphemes) -Oral expression is described as "telegraphic" -Informational content is often quite high -Difficulty initiating speech -Relatively poor repetition -Good awareness of language difficulty, with resulting high number of attempts at self-correction

Learning and Memory

-Normal role for synaptic plasticity -'Patterns' of activity -Memory as hologram -Limbic arousal influences process -Limited by random neural activity -'Memories' vs. 'Access' -Korsakoff's syndrome -Trauma

Forgetting

-Passive decay of memory trace over time -Active interference by new events --new learning disrupts old learning --The more similar the new and old information, the more severe the interference effect (can forget when something very similar to what you're trying to remember occurs or happens while you're trying to do something (dejavu feeling). new task not good at competing with old task not good at, this conflict causes reduced learning. so as a therapist should we take an old task that's not working right and tweak it or scrap that and move to a different task, revise it, and have them relearn it)

learning defined cont.

-Produces an acquired capability for behavior -New behavior may result from: --Internal changes --Motivation --External conditions (example: may not be able to perform a learned skill when fatigued) --Maturation / Strength

Major aphasic syndromes: Pure aphasias

-Pure Alexia -Pure Agraphia -Pure Word Deafness -Optic Aphasia

Global aphasia: Linguistic features cont.

-Severely impaired written expression -Severely impaired auditory comprehension, but comprehension of material of personal relevance may be fairly good -Remarkably well-preserved ability to understand geographical place names; can indicate them on a map -Severely impaired reading comprehension

H.M. cont.

-Surgery cured the seizure disorder, but.. --Severe amnesia; complete inability to form new memories --Immediate memory intact --Improved IQ (normal range) -Implicated hippocampus and adjacent regions in the formation of declarative memories **No new memories - permanent anterograde amnesia Retrograde still intact - fine memories up to that point Lived in the moment until got distracted from point of conversation and then had to start all over again Would go through same greeting pattern every time doctor left the room to do something quick

What is memory?

-The persistence of learned habits, movements, facts... -The expression of memory can be influenced by: --Attention --Motivation --Fatigue --other factors (drugs, alcohol, environment) **Ability to retrieve what you have learned Affected by a lot of different factors - are you paying attention, do you care enough to do this, are you half asleep or are you awake, what are you doing recreationally at that moment -these are the things you don't do when you're trying to study Sleeping is a really good thing for learning and memory. Study hard and have a good night sleep you will have better memory and learning the next morning -why cramming doesn't work

Characteristics of right hemisphere language disorders

-Unawareness of deficits -Reduced sensitivity to tone of voice and/or reduced ability to convey emotion using tone of voice -Not sensitive to level of shared knowledge between conversational partners -May neglect left side of page - reading comprehension problems will result -May neglect people in left hemi-space

Major aphasic syndromes: Fluent aphasias

-Wernicke's Aphasia -Conduction Aphasia -Anomic Aphasia -Transcortical Sensory Aphasia

Motor cortex

-broca's area -prefrontal cortex -frontal eye field -premotor cortex -primary motor cortex **On the production end you have Broca's area Broca's area is right in front of the ideational, praxis, motor planning, coming with behavioral motor plan. Same aspect of behavior, but related to communication This is where you're coming up with how do you take the words that you're thinking about, the thoughts that you have, and turning them into language Brocas area - responsible for turning any form of communication into an external event (writing, gestural systems, speech) Communication does not equal speech!! Communication - anything involving the understudying of a symbolic content or production of intentful meaning to someone else Frontal eye fields - part of brain that are responsible for controlling the movement of the eyes (in a directed volitional way), right by SMA they involve cross-hemispheric communication so both eyes looking at same thing at the same time, and next to part of brain that's responsible for interpreting, reading, writing, or involved with communication. Part of brain that directs what are your eyes looking at. Ex: reading a textbook -this frontal eye field related to communication system is pretty important

Cortical areas supporting communication

-broca's area -supramarginal gyrus (writing) -angular gyrus (reading) -wernicke's area

continued.

-girls not good at math because don't get enough early practice and can feel successful at it Language is a cognitive skill Failure of language to communicate = aphasia Aphasia - failure of language Speech - motor skills, movement of the muscles - dysarthria --swallowing clinic, muscle control of oral cavity - more dysarthria Working with kids who stutter -need to distinguish is it a motor or cognitive problem, or problem with both? Expressive and receptive aphasia: -receptive - (aka fluent aphasia) - the output, produce lots of words that may or may not be connected or have meaning, they don't' understand rules, concepts, or conversation that they're hearing. This is a Wernicke's area problem. Responsible for interpreting language but they don't understand language, can produce it just fine, but might not know what was just said to them -expressive - (aka non-fluent aphasia) - can understand what's being said but can't produce language in a fluent manner. Frequently one word utterances or a sentence that's missing all the little connector words. Just has the main words, and might not be the correct form of the word - so might not use past tense

H.M.

-hit by bicycle at 9 years old -surgery at 27 years bilateral resection of: - hippocampus - amygdala - uncus **Canadian person who was hit by a bike when 9 years old Started having significant seizures When 27 - realized two sources of epilepsy (one on left and one on right) Removed the small area of the brain on both sides - cured him But also removed his ability to make memories

Major aphasic syndromes: Alexia with Agraphia

-in a category by itself!

Cortex

-language -communication -cognition

Sensory cortex

-primary somatosensory cortex -wernicke's area -"reading" -secondary visual cortex -primary visual cortex -primary auditory cortex **If look at sensory side of brain: Back end of lateral sulcus just above temporal lobe is Wernicke's area Angular gyrus - responsible for reading (behind Wernicke's area) Supramarginall gyrus - responsible for writing (just above wernicke's area and angular gyrus) When we talk about communication disorders we are talking about speech (related to motor production - movement of tongue, the lips, the breathing to support speech - that's all motor speech), communication is the delivery of intent - using words to tell me what you think - this does not necessarily have to be speech - could be writing, gestural systems (ASL), or speech. The ability to take a symbol and turn it into intentful communication is what Wernicke's area does for auditory language and that's what the angular gyrus does for written language and what the supramarginal gyrus is the beginning of the output of the writing, how you take reading and put it into writing. This information is on the receiving end

H.M. and Implicit Learning

-recognize person in mirror but shocked that it was him Given star - have you seen this before? No. Take pencil and draw it within the lines with non-dominant hand, count how many times cross inner or outer boundary -gradually get better -get better more quickly the next day Every day he could do the task better each day - but would continue to answer he had never seen it before Unable to recognize that he knows the rules (failure of explicit memory) but able to perform (characteristic of certain kinds of dementia) (implicit memory) Therapists: most will be explicit issues/declarative

Memory and Trauma

-retrograde amnesia --loss of memory prior to event (pic in notebook) -Anterograde amnesia --loss of memory of and after the event (pic in notebook) Both may occur together! - common, but may vary over time **2 forms of amnesia: Retrograde: From the point of the trauma backwards in time, more significant the trauma, the further back in time the memory is lost. Consolidation process is interfered with. Don't usually remember the trauma of the event. Ex: last memory is picking up keys off counter - crash on way to work -process of consolidation isn't an instant save - it takes time, so if it's a big event you can lose a lot of memories (days, weeks) Anterograde: loss of events that have occurred since the time of the injury, forward in time until now Ex: talk to person that was in car accident, they say I haven't seen you in a while, and the doc says I was here yesterday but they don't remember -in the moment and experiencing it, not being laid down as a memory -because of disordered processing, everything is functioning but not the right way -inability to form new memories even though the world is going on around them. Power goes out on computer and has to reboot - things still going on in the world but computer doesn't know it When talking about amnesia- one or both could be happening. Generally, the more significant the injury the more likely it is that anterograde amnesia will be present and the more likely that the time before and after injury will be extended. Lose memories from farther back and take longer for them to make new memories - get back to normal if something isn't encoded - it won't be remembered

continued...

1. Fluent or non-fluent 2. Good comprehension - do you have the sense that they actually understand what you're saying, (more complex than if they can understand the word) can they follow through and do what you're asking 3. Repetition - repeat after me, how fast should we be producing the words, how fast should they be responding, what is typical and what is not, varies a little bit Speech/language pathologist - important for diagnostic part but that matters to us because it's important when doing interactions with that person with everything else -if they are having trouble processing language for whatever reason - the faster you speak, more complex words you use, more alluding language used - the more frustrated they will become -need to know how to slow our speech down In the social environment if you are the person who is the other half of the conversation and you're conversation partner isn't responding - most people will try to fill the silence with words. But in this situation it is actually better to not say anything and just give them time to think - really hard to do. "Confrontation" naming - when you take a card and ask what does that word say? Here's a card, do what it says. - not used often - not good to distinguish among the various aphasias. It becomes frustrating to the person by adding to the complexity

Papez Circuit (pic in notebook)

Accessing memories requires hippocampus - getting memories out of storage, it knows where it put all the pieces Ex: what was that guy's name? Name starts with an S.. Oh it's George. = access problem - hippocampus allows us to find the pieces in the correct place Ex: front hall closet, and go why am I here? Oh I was on my way to the fridge. -a motor plan got you to a point where you opened a door but in wrong context (hippocampus keeps you on right path, the "G" file not the "S" file) (more going on, amps it up - increases activity) Circuit: no obvious direct pathway, but because of what they do and how they work they must be somehow connected. The AN of thalamus (affect) - cingulate gyrus (emotional component of memories) - parahippocampal gyrus - hippocampus - (fornix - bundle of axons) - connect to mammillary bodies of hypothalamus (which have a direct connection mamalothalamic pathway back to the thalamus. This s not an input /output, it's a circuit - we call it a reverberating circuit - that means activity in any one of these different areas will produce activity in the whole circuit. What happens then is if each of these different areas are connected with other parts of the brain then each is increasing the circuit even more (more inputs = self-stimulating circuit) Hippocampus - persevered thoughts, memories, and perceived ongoing stress then this is where we think the disordered stress regulation takes place. Keep pumping up level of activity in circuit each time there are additional inputs Ex: little things through the day and each thing goes wrong - each one of those events is annoying but it's the piling of each that makes you go ballistic

Broca's aphasia

Accompanying Deficits: -Apraxia of speech -Hemiplegia (contralateral to lesion; arm more than leg) -Mild dysarthria Site of Lesion: -Broca's area plus surrounding area (structural imaging data) -Decreased glucose metabolism throughout the left hemisphere and some areas of the right hemisphere (PET data)

Anomic aphasia

Accompanying Deficits: -Can vary depending on the site of lesion Site of Lesion: -Temporo-parietal junction -Temporo-parietal lesion, extending into the angular gyrus -Second temporal gyrus -Frontal lobe lesions

Global aphasia

Accompanying Deficits: -Other cognitive deficits such as impaired problem-solving ability -Apraxia of speech -Gestural apraxia -Contralateral hemiplegia (arm more than leg) -Volitional performance deficit -Homonymous hemianopia Site of Lesion: -Usually a large left hemisphere lesion involving the frontal, temporal, and parietal lobes **Can't do gestural actions Can't communicate the word anymore or with speech or writing Good positivity will have large visual field gone (contralateral homonymous hemianopia) -OT cares about this so they can move through environment

Wernicke's aphasia

Accompanying Deficits: -homonymous hemianopia Site of Lesion: -Posterior portion of the first (superior) temporal gyrus (Wernicke's area) -Supramarginal and angular gyri in addition to above

"brain is only body part that gets less gray and wrinkly as you age"

After adolescence - your brain is same size and shape for rest of life until starts to diminish as you get older

continued..

Aphasia usually has other problems too Most common: apraxia - Aphasia is related to language Apraxia - is related to the production of speech, inability to produce speech -have trouble producing language and when they can they have articulation problems and you cant' understand what they are trying to say -apraxia of speech can occur separately from aphasia, but most often because they are a similar distribution of blood vessels - they often co-occur Dysarthria - inability to articulate clearly Dysphagia - swallowing disorders (safety concern - they could aspirate and die) (specialty focus for OT - often with infants) - stroke client will be evaluated by speech/language pathologist for swallowing If left hemisphere is dominant for language and where all language processing takes place, doesn't mean language won't be affected if right hemisphere has a stroke -you may still be able to understand and produce spoken language but it would not be rich, total, or melodic. You would not be able to interpret sarcasm or produce sarcastic speech - the intinational/emotional/unspoken social commentary that actually goes with what is being said becomes a problem for these people- they are very literally, this is something to consider when working with these patients (need to say exactly what you mean, no alluding or metaphorical speech) Primary progressive aphasia - neurological disorder related to basal ganglia and extrapyramidal systems (not the cortex). These are the people who process pretty well but the words come out too fast. These are the people who speak at same rate as your auctioneer. Reasonably articulated but really fast. Have fast forward on. And it gets worse. As the progressive disorder continues they get faster and faster until not understandable Alzheimer's disease and other dementias - going to affect communication because of the cognitive, social, and memory component. Not necessarily the language per say but the communication. They may not be good at social cues in language conversation which is largely turn taking. They can't do this well. (if only talk about themselves, interrupt, over-talk) person is not turn talking properly that would be an appropriate concern Hearing loss - just aren't processing the language Depression - global affects, may not be turn taking because they don't want to

continued....

Difficulty producing speech - apraxia Different patterns of motor speech, motor behavior (opposite arm), and inability to produce language Lesion in area 45 was found in these patients - always on left side of the brain If you use a part of your brain a lot or are born with innate characteristics, then a certain part of your brain would be used and produce a bump - old way of thinking - so they would feel your head for things - this was how Broca's was discovered - wanted to disprove phrenology

Examples of implicit skills

Driving a car with a manual transmission Walking with an assistive device or prosthesis, or following neurologic injury Riding a bicycle. **Finger tutting: itsy bitsy spider (hand motions associated with music) -can you describe this song? - yes. When did you learn this? - little kid Difference between describing and doing Describing - explicit learning (rule based do this, then that, part of performance) Implicit learning/memory - is the doing of it without having to explain it You can learn how to do it and not be able to do it automatically Automatically - useful functional way

Memory Formation

Encoding --> Storage --> Retrieval -an impairment can occur at any of these stages, or at more than one stage! **Telephone number - remember just long enough to dial it in - only in short-term memory Only 9 digits because 10 is what most people can remember in that short-term pattern 16 - you will have to look it up halfway through (each stage can be interfered with and alter the ability to perform) the first arrow = hippocampus - part of limbic system responsible for translating an experience into a memory and retrieving the memory from the storage location (not the actual memory itself)(both arrows?) hippocampus is a problem if it won't let you file things away or take them out. -often message to hippocampus is just misdirected (trying to think of someone's name) busy looking in S file for guy with hawaiian shirt, not in the correct G file - happens more when you're under stress, when multitasking activities are going on, when you get older (worrying about dementia)

Brodmann's areas

If you understand how language works, you understand how the brain works - most complex things we do Another complex thing we do is respond appropriately in social environments such as: Changing rules, flexible rules, complex rules, rules that are not obvious to someone who isn't in that environment. If not part of cultural setting you don't know all the rules sort of thing Behavior and communication - 2 really complex things that we do

(cont)

Immediate - vaporizes - there until power goes out, haven't saved it - it's gone Short-term - may persist a tad longer, a few moments, starting to become a memory but not solid yet Long-term - permanent, after consolidation taken place, called back a day, week, month later. relatively clear detail wise, edges haven't worn off yet Remote - memories from childhood long time ago, general impression memories, used a lot, pretty smooth, think they're pretty clear but details are kind of lacking Emotional memory - you have the emotion associated with the memory, emotion is the main component. Remember how you felt when you did something but might not remember all the details Together = elements of common memories

etc.

Large lesion right above optic radiations when the lesion goes deep it takes out visual pathway and causes contralateral homonymous hemianopia - not aware of this problem -missing everything from the left over -pictures will work better cause that engages both sides of the brain and the right side is intact, both sides do pictures and therefore the right side can maybe compensate --a common communication strategy for those with aphasia = letter board, picture board, etc. to carry with them to help them communicate Book called "Rules" Use letter boards to help understand them -they're not writing, they're pointing - but for Wernicke's probably using a picture board

notes:...

Lizzie Gordon - rhyme Took an axe Gave her mother forty whacks When she saw what she had done She gave her father 41 Ax murder came from her (trialed for killing her family) Important for OT - recognize that everyone you're working with has by nature some level of functional stress - our job it to help them manage that stress (candle, meditation, teaching other strategies, cognitive-behavioral therapy) to help manage stress so in a functional/useful place to participate in intervention -negative health consequences with persistent stress - weakened immune system -physiological responses to high stress

cont

Localization of function: PMC, postcentral gyrus, primary somatosensory cortex - where sensory information like pain, touch, pressure portions of body are received. Area 5 and 7 are where patterns of touch are understood. If this part is impaired then that function will be impaired. Memory is a distributed function, different parts of the brain that do different parts of memory and when all working together you have a memory. If part of brain is impaired that memory will be degraded in some way but will still have the memory (just not as detailed or as useful) Localization of function is the one we normally think of When we talk about communication in particular - we are talking about lateralization of function -the ability to communicate in most of us is lateralized to the left side of the brain -even if left hand dominant, probably still left brain dominant for communication (almost all of us - left side of brain controls the understanding and production of language) Wernicke's area by definition must be referring to part of the left cortex - because it's responsible for interpreting language (area 22) (communication has to be on the left side of the brain) Have a right side area 22 - not Wernicke's area -right side of brain doesn't do language -area 22 is related to communication, not in the interpretation of language, but the right side of the brain is responsible for the ability to understand intination and meaning from the tone of language (the melodic aspect of language is called- prosody) the right side is responsible for interpreting prosody in language. Ex: when someone speaks a different language - can't understand the language but know that it is language being produced - the prosody is a big clue that something is going on and it's probably language -Language has melody, there are rules about language that your brain will listen to and say hey that's language. The prosody, initination, is a big clue that something's going on and it's probably language Wernicke's area on and hyper-activated - very on when listening to a different language -trying to put rules of what it knows about language into that foreign language trying to understand -if had to interpret all day long you will be exhausted -doesn't work in a noisy, but not language environment -works if listening all day, but even more if listening to another language -bilingual children will have a harder time producing language, not understanding because has so many different rules -but better able to grab other languages later on because they have a more flexible understanding of the rules Dominant hemisphere for language - almost always the left Right side of hemisphere is responsible for - prosodic intinational aspects of language. Not just understanding of intination and melody but also production of it Problems with right side area 22 - difficultly with interpreting melodic aspects of language, and sarcasm Ex: go jump off a bridge - well why would I do that? Area 45 broca's area (there is a left and a right side) - left side area is called broca's area, right side is called right side area 45 Brocas -responsible for turning thoughts that you have into communication Right side -ability produce intination/melodic language Neuronal plasticity: takes place predominantly in grey matter of the brain (particularly in the cortex and cerebellum (kind of)) this is the unmyelinated areas where neurons have membrane that is exposed to the membrane of other neurons, not insulated by myelin. Therefore, those contact points can develop into synaptic contacts. The more synapses you have the more flexible connections you have the more patterns that can be generated through Mutual co-activation of these adjacent cells. More synapses you have, the more options you have for complex brain behavior. Through exposure and experience and learning we trim away some of those synapses (80%), if you can preserve those synapses during that very early age as you age, you have more options for complex patterns of activity later in life. Those who learned a new language (or second or third) or musical instruments earlier in life have more grey matter than people who are monolingual or don't play and instrument and more than people who pick it up later in life Therapists adjust synapses or adjust patterns of activations by practice, through experience, through exposure - increasing the synapses or changing the patterns of their activation Early experiences and more synapses available longer - helps preserve cognition as they get older How many do you lose before you have an impairment? - depends on how many you had to start with

Taste and the Tongue (pic in notebook)

New flavor: umami (glutamates) Taste is considered to be 50% or less (maybe only 20%) of what we say are flavors, most of what we perceive as flavors is actually the olfactory system 5 flavors of taste: salty, sweet, bitter, sour, and umami (meatiness, why MSG is added to food, increases meatiness flavor) -Mono-sodium G means glutamate - precursor for glutamine, which is a neurotransmitter, hypersensitive to it can cause migraines Also explains behaviors -when you take a pill, toss your head back when put the pill in, want it to move as fast as you can. People put it on front because most pills coating are sweet, even if not coated they won't taste bitter cause that's not where you would perceive it. If bitter pill get caught at back of your throat, it landed in that bitter region just in front of the epiglottis -if don't want to have a bitter pill taste, you should take it with milk, yogurt, etc. cause it covers it up -pill in straw at back of cat's throat - pill hits back and reflex to swallow

etc....

Not sensitive and may neglect bullet points very important -may neglect left side of the page of a book -not seeing everything we are presenting to them -not good at turn taking -this gives appearance of trying to dominate the convo or ignore the other person - in society this will affect their social interactions - OT help with this **KNOW THIS SLIDE WELL** Yes no questions, rephrase things - length of time they remember the conversation will be shorter because so many other things going on Reduce length and complexity - short clear not multistage - just really simply - bullet points helpful Strategies: -ask yes/no questions -paraphrase periodically during conversations -reduce duration and complexity of conversations -use gestures to emphasize important points -establish a topic before beginning the conversation -don't speak for the client or over them - don't let other people do that either -being patient! - is the hardest part but you need to do it -so hard for these people to get the words out of their mouth

Olfactory Cortex

Olfactory information doesn't have to go through the thalamus to get to the cortex Important for therapist to understand Can actually activate the cortex May not use that activation to say I smell a rose, but that's the pathway that activates through the limbic system (memory, etc.) - so it's really important One of the strategies that people employ when working with comatose patients, trying to maintain or tone level of activity to externally influence the activity of the cortex - if thalamus not working, provide them with smells, this causes cortical activity (or it can, it's a strategy) Other side of that story - frequently when one has a TBI you can't filter out that stimuli, so when it's a strong smell it doesn't go away, we become nose-blind to it, but they don't - one of the things therapists can do is form a calming olfactory environment to limit that exposure to disinfectant smell These are the kinds of things that won't occur to brain surgeon But to the OT - we can manipulate those factors - may or may not make a difference, but it's better than having no options

notes

Other half of memory is forgetting - this is not a passive process, it's active, we purposefully forget things, not consciously, brain just says we don't need it The forgetting process can be interfered with by new information -if being taught a pattern and someone comes in and says that's not right, you have competing information, then becomes actually ______. This happens in clinics as well. Finish what you're doing until person knows it well enough to be modified in a different way. Should teach them more than one way to do something, but not when they're first learning People who can't forget things: can't forget certain categories of those things. It is important to them for some reason. Savant - don't have capacity for typical functions, usually has significant cognitive/social other behaviors Photographic memories: not a good explanation, only for certain categories of certain things (written or sound, not both) (**if you practice how to keep memories then you would get good at it but people don't take the time to do this) Remembering EVERYTHING is not typical behavior - don't' have ability to forget so it interferes with other aspects of typical functions (learning disabilities, social problems, etc.)

Memory

Protein synthesis is necessary for short term memory to be converted to long term memory This takes time (and perhaps sleep) and is called Consolidation (this is why cramming for exams doesn't work) **Memory is the ability to retrieve rules, learning, and modify them to what is currently going on Basis of this is protein synthesis - true memory formation takes place when there is time for protein to change in synapses in the cells that are involved with limbic system and involved with making the memory - this takes time, there is a period of time when the memory is vulnerable, as you're learning the memory consolidation is what takes place as that memory is hanging out and getting practiced becomes real -term paper that happens when you haven't saved it yet and your computer glitches and poof it's gone. So when you actually save it - that is consolidation

cont..

Result from different source of presses Your best client will be the one who is self-motivated - one who will put in the time, wants to get better The most frustrating will be the person who doesn't care or put in the effort -this means if you're directing the intervention, doing it for them, they're not going to learn, they're going to not be able to do the behavior on their own when they need to do it - they have to be motivated and we have to figure out how to motivate them (might be harder than the doing of the intervention)

Review lecture:

Review lecture: -if you lose Heschle's gyrus on one side you will still be able to hear - if you lose Broca's area on one side you will have non-fluent aphasia -Middle cerebral artery feeds both lateral sides of the brain - block left = global aphasia (only on left side, global part is the left hemisphere overall - Broca's impaired in front, Wernicke's impaired in the back - both fluent and non fluent aphasia - motor, sensory, and auditory? cortex between -motor problems with arm and leg (leg less), right arm impaired, right side of face (muscles of articulation) - even if could speak would be difficult to understand - worry for health and safety is - swallowing and chewing impairment - aspirate Block right = right hemispheric aphasia Right side of brain = still able to communicate and come up with words, but lose the big picture - trouble signing probably Left side = comes up with the word, comes up with the meaning, comes up with the best word to convey the meaning -pure Broca's and pure Wernicke's is pretty unusual **taste - not a single nerve and a large part of it is actually smell Complaining about food being tasteless or not having much flavor - may not be taste that is a problem - could be olfactory -common after TBI that olfactory bulb has been damaged - reduced sense of smell - food not as tasty -as OT enhance the flavor - spicy

Memento

Starring: Guy Pearce as Leonard: when you get to the end of the movie you understand the beginning of the story (works from the middle out) - unable to form new memories, develops strategies to keep him informed of past events - as he's doing it he's fine, if distracted away, he forgets - uses polaroid pictures.

Attention and Performance

Stroop Task **Used to evaluate your ability to be flexible in thinking Read the word - not the color Say the color of the ink - not the word Little kids do well on this - can't read Older people - just don't care anymore

cont.

Taking events and turning them into some form of assessable memories Teaching person how to preserve function in a way that is useful to the intervention - may be different from how they used to do it - what you're doing through practice is changing brain's activity on a cellular basis so that it becomes more efficient so it's easier so they can achieve the goals they want to achieve -That learning needs to be assessable to them later - not always the case Ex: You can know that you can do something or you can do something and not know you can do it

notes:.

These systems we don't think about them but they change basic motivational behaviors, if can't smell, not going to want to eat, stuff doesn't taste good cause can't taste or smell - not going to eat, food too salty - not going to eat Limbic system: Neglected part of the brain unless you care about motivation and other behaviors Accepted term is MOVE - Motivation, Olfactory, Visceral activity, Emotional tone 4 F's Fundamental activities that allow you to behavior You don't think about these things (emotional tone, reproductive behavior, olfactory input) though - but it pays attention to them as you're behaving. It takes in the world and converts them to memory and give you a basis for understanding how the world works Hippocampus - encoding and retrieval Amygdala - noticing behaviors -once you have a memory, where is it? If you have a stroke in somatosensory cortex you wont' be able to feel things, if in visual - you wont see things Stroke in limbic system - you won't destroy memory. You will change memory, change the quality of the memory, but depending on where that injury, lesion, tumor, or problem occurs you have different types of memories Cingulate gyrus - (part of midline cortex just above corpus collosum (c shaped structure) responsible at anterior end for interpreting emotional memories. Not storing - interpreting, just adding emotions to a memory or experience. Sot of the crest, middle of c shaped portion at midpoint, most related to storing of memory of motor patterns - probably where you store those complex motor behaviors. Parahippocampul gyrus - posterior end of cingulate gyrus and runs down and continues to curve around and ends up around the hippocampus and thalamus. (controversial views on what it does) Uncus - defined as the midline portion of the temporal lobe. This is the part where the temporal lobe is curving around the bottom of the brain and it's the very tip near the optic chiasm of the temporal lobe. Medial aspect of the temporal lobe which is a lateral surface structure. Uncus is responsible for probably social memories, complex amorphous memories (memories that aren't tied to things like math or rules about how to drive - relatively less clear rules like how to behave) embarrassing memory of what you did when you were 12 is probably stored here. Limbic system is a system, not a single structure. That means if one part of system is impaired in its function the other pats may or may not be. You may lose aspects of a memory but not lose the entire memory, you may retrieve parts of a memory but not able to retrieve the entire memory - this explains a lot about memories themselves

notes:

These two systems are closely related One sensory one not Olfactory very primitive Limbic is usually left to psychology class cause it does learning and memory Both important for OT to understand because what you're doing in any kind of intervention revolves around that person's ability to learn and make new memories, teach them a new task, revive or modify and old task - all of these involve the limbic system **the limbic system is not just involved with memory, it does emotional tone and distress response - critical for OT to understand -can't manipulate/intervene much, but they are seeing us because they are already in a high state of stress, so even if chronic condition they may be in an elevated stress level, so need to break through this in order to have an effective therapy We tell them to do something and we can't and we get frustrated High stress level, giving them something to make them more stressed, given them something to recognize their initial stress and try to lessen that would be helpful

Still not implicit learning..

Turn the handlebars so that the curvature of the bike's trajectory is proportional to the angle of its imbalance, divided by the square of its speed **also not helpful

etc...

Very literal, have the words Don't get larger picture or sarcasm Be very literal Don't say anything that you want them to interpret Don't want them drawing own conclusions Don't say anything that's not relevant -make it simple, don't use allusions, keep a focus short concise clear direct statement to make it easier for them Conversation will be declarative - what do you want to do, how do you want to do it? -but phrasing in yes no questions it will be more affective -opposite of what you do for little kids Do you want to eat dinner? - yes/no, but not a lot of information Do you want this or that for dinner? - better -don't make them come up with story on their own - trouble expressing it?

video:

Video: He's responding and understands what the question is about, but hard time producing a real time response -He can produce intination that carries meaning "makes it hard to use the tractor" - he says "oh yeah" -right hemisphere giving emotional flavor to what they said -person can communicate meaning through the emotional tone of what they are trying to say Ex: Canadian wife "eh" - can fit in multiple places in a sentence (it's short, can be said in multiple contents, can be said with emotion) -these people can communicate pretty well with Broca's aphasia -may not know exactly the meaning they are trying to convey but you have a pretty good idea -short word utterances that you say with emotion already ("f***") - we use it because it's not the word, just that it can convey a huge amount of meaning -as a therapist you need not just work with the client, but help the family understand that they aren't swearing just to swear, it's how they communicate, listen to how they say it not what they say, this can be stressful for the family -Oral expression is described as "telegraphic" - pause and then a word, pause and then a word, but word said quickly, but not produced fluently (not a flowing conversation) --going to be in ballpark for the word they want to use, may talk around it because can't get THE word --therapist should use yes no questions because they are short and easy words to say --play 20 questions, but you have to wait for the response before you go on to the next question, let them do the interaction --a lot of frustration occurs for the client when someone else puts words in their mouth (caregivers do this to try to be helpful but it's frustrating for the client) -they will know that they aren't being clear, that you're not getting it, that they're having a hard time so they will get really frustrated - if so, take a break, have them do something else

note

Want this! If you know how to ride a bike you know the rules, you've internalized it. You might not know you know the rules. You could explain the rules of how to do it to someone how to do it, but not the rules Explicit - rules Implicit - doing Declarative memory - explicit learning go hand in hand (explicit learning = learning rules, declarative memory = explaining or stating the rules) Procedural memory - (implicit is the doing, learning by doing, procedural memory - is the doing of the behavior (can't explain how to do it but you can do it) Ex: explain rules of how to fix computer over the phone to your parents ex: declarative - naming that a toothbrush is a toothbrush. procedural - how to use the toothbrush

notes:..

We believe that memories and learning are both normal more sophisticated aspects of neural plasticity Synaptic plasticity is changing the synapse in response to an external event, we know synapses become more efficient and stronger if that event keeps happening Ex: doing algebra homework is building synapses so he would have better memory and learn how to do algebra -this is why we practice, why we do things more than once -one trial learning is not likely for most things that we do -one trial learning occurs when it's a highly stressful highly emotional experience We think of memory now as patterns of activities - a group of synapses that are coherently activated all at once because they've been practiced and activated together -we think of memory not as an event in our mind, it probably is more like a hologram Memory as a hologram: cut film in half, you end up with complete picture but lost half the resolution so it's grainer, in half again its grainer but still have whole picture. As we have an experience we create a memory and this fresh memory is clear and detailed but the further back in time we go the less clear that memory is in detail because it hasn't been accessed for a while and those synapses in it's pattern are used for other things too - so gradual degradation of the memory to the point where the memory may be nonexistent Ex: friend haven't seen in 25 years - only one person could remember the person's name cause everyone had forgotten it. This is what memory does in real like in our head - What is the emotion that is associated with that experience (what did it look like, sound like, feel like, etc. ) and that is assembled into your memory. -You think you have a really good memory, very few people have memories that are so precise that they can remember details from long ago -many of those people have cognitive problems because they're doing the memory thing not the current experience thing Ex: memory of going to grandma's house and baking cookies (big olfactory experience) - can't remember details, just parts (salient parts) Unless you keep practicing those memories you won't remember them Practicing memories can shift Ronald Regan - claiming to be somewhere he wasn't (early dementia, practiced memory) -why we need to be careful how we ask questions!! Limbic arousal: will help solidify memories. If practicing making synapses to make a memory, having a significant emotional stressful response, arousing the limbic system will make that memory more permanent - we believe this is what underlies PTS (post traumatic stress) you're in an environment where its highly emotionally charged and highly stressful, there cause you have to be, it's out of your control, relatively helpless, not determining events, that then is priming that person to experience PTS. Traumatic memory Most likely person to experience PTS: rape victims - by 3x at least (victims of abuse, physical/sexual/etc. - high stress, high emotional tone, feelings of helplessness. Feelings of if I hadn't done this and put myself in that situation then it wouldn't have happened - self-guilt as a factor - therapists address -algebra hard to remember - no limbic system arousal Limited by random neural activity: patterns, everything being active it's hard to make salient patterns. Ex: seizure disorders - random activity of the brain, if what you're trying to do is practice and enhance a pattern, amidst all this other random activity = hard. Strategy is to reduce that random activity with anti-seizure medication but that limits all neural activity = even harder to enhance the pattern you care about, this is why kids who have seizure disorders or hyperactive attention problems their brain is really active with other things, the more you can get them to focus on the pattern you care about, the quicker they will learn it, it may still take a while or a lot more effort and practice than a typical child Korsakoff's syndrome: a special case of dementia. Dementia as a term is the inability to form memories. There are different' kinds of dementia, the knee-jerk response is to label them all as Alzheimer's dementia - but it's just a subcategory and all dementia's don't have the same features, each is different. Korsakoff's is a particular type of dementia - it is associated with chronic alcoholism - used to be really common in VA system, but the two factors is typically it's abuse of alcohol, coupled with poor nutrition, less vitamin B12 (niacin) in diet - alcohol interferes with B12 uptake (so even less), and lack of niacin in the diet causes certain neurons to die, and that diffuse brain injury produces Korsakoff's syndrome. Preserved long-term memories but will not remember recent events, can't form memories. Not reversible but can stop it - get person off alcohol and replace B12 - behaviors contributing to problem after you've dealt with it Trauma

Olfactory System (pic in notebook)

We don't use it to gather info in a truly conscious way most of the time But important to understand motivating behaviors (that food smells good, going to be more likely to eat) important for developing memories Do you remember your grandmother? Large part of that memory is olfactory (used to bake in the kitchen, too much perfume, home smelt like something) critical fundamental elements to memory and memory has a strong odor based experience for us Olfactory nerves are individual fibers coming off receptors traveling through base of cranium and terminating in the olfactory bulb then that info travels down olfactory tract to the brain where it's used - important for OT cause this part of the brain, the orbitofrontal cortex, which overlays these structures, they all lay on top of cranium that has a surface that looks like a cheese grater, when bumped around from an accident it looks like cheese after been on a cheese grater, the structures that are damaged are the orbitofrontal area (part of the cortex) and the olfactory tracts, so if olfactory tracts damaged won't grow back part of CNS (won't be able to smell), olfactory nerves will grow back. What does that look like in a patient? - lost appetite, didn't enjoy food as much, assume he's going to loose weight, look like they're depressed, but not. They don't need drugs, they change the texture of the food and spicing of the food (flavor) amped up just to get to the point where they can taste and find it interesting cause a huge form of taste is smell. We would also be concerned about body hygiene cause they don't know they stink, can't smell something burning on the stove, gas leaks (significant household concerns) - we address that (increase in smoke detectors). Know what their abilities are and limits might be

etc

Wernicke's aphasia - Inability to understand, to comprehend, to interact with a conversational partner. You may be speaking but they're not responding properly They keep talking about the wrong word, not self-aware Video: Repeating a lot - but not tuning in that she's not following along or that the words he's using doesn't follow what he is wanting to say They get hooked on a particular word that may or may not be the word they're looking for but then they don't change that interpretation - they keep talking about the wrong word Not self-aware A lot of talking around Words are flowing - not content heavy or interrelated words, a lot of made up words that don't exist - although they're said like they do and that's - neologism Broca's was more guiding the conversation, even though not as verbal -we cannot follow this conversation Reading and writing not good Poor at repeating - they will get the after me part but they will say something else **not self aware of the difficulties they are having = frustration - more frustrated with you because you're not understanding what they 're saying

explanation:

Wernicke's aphasia - will have some problem with reading too Boca's aphasia - production problem Wernicke's - reception problem Global aphasia - often what you will see - middle cerebral artery most likely place to have a stroke and it feeds both Broca's and Wernicke's area, and if they have a big enough stroke, it will get both sides. This person will have global problems with communication, They will have difficulty understanding what is being said, coming up with words they want to say, and because motor cortex is between those two areas they will probably have issues producing language because of motor impairment (3 strikes you're out). Will also have contralateral hemiparesis in both the arm and the leg if the stroke is that big. Might be able to read.. Text., not writing, cause easier to interpret due to "blockiess" of how it looks, might not As the therapist, want to find out if they can read, write, look at pictures instead - speaking more loudly doesn't help Ex: talk to speech language pathologist, develop picture or writing strategy - something they can use, but also have a motor impairment then pointing becomes difficult and finding the right page in the book becomes difficult - just don't speak more loudly cause it doesn't help Ex: Japanese stroke populations - ABC way of spelling and one from more of a picture way of language - the two sides of the brain interpret these character structures differently - if person has a left side stroke they will have difficulty with written language but can look at ideographic language where the word dog is represented by a picture of a dog kind of language. If have a right side stroke it is the opposite A bunch of aphasias and they all sound the same -we need to know what it is generally and the speech language pathologist will tell us more about it so we can see what their strengths and limitations might need -don't just talk louder - it's not going to help -Broca's, Global, and Wernicke's aphasia = most common Broca's - expressive aphasia - non-fluent aphasia - can produce words, not necessarily full sentences or filler linking transitional words, but can usually get point across, and if not can gesture, point, or draw picture, have strategies to communicate, they just might not be able to produce language (trouble doing signing if ASL speakers) (language is not just spoken language. Wernicke's aphasia - more of a fluent aphasia, these people may talk but maybe not actually answer the question. Have difficulty interpreting the verbal directions from elsewhere. May ask them to answer a question or tell a story and they might be in the ballpark but never actually answer the question, a lot of filler/misdirecting words, words flow but content problematic Run into most = global aphasia - middle cerebral artery feeds both Broca's and Wernicke's area and all the area in-between- a lesion in that general area will cause problems with fluent end of scale and non fluent end of scale and because the sensory motor area is in-between, it will probably produce hemiparesis on the opposite side of the body. If the person has dominant for language left side global aphasia, they will probably have right side hemiparesis of the arm, which for most people is also the dominant hand for writing, so their dominant hand will also be impaired for things like writing. So then the therapist says do we train that hand or do you help them use their non-dominant hand (constraint induced movement therapy). The problem with global aphasia is they won't understand what you're saying, won't be able to produce language, will have sensory and motor problems, they will be very frustrated

cont....

You can explain it to someone else and it stays put - you can come back and do it again later Might not have the absolute details together - might have to brush up on it - but it's still there Therapists need to understand the difference between practice and learning - you can do something over and over without learning it, you haven't learned it until you can come back and teach it to someone else without practicing it first. Even with learning there are practice effects - can ride a bike successfully after 10 years, might just be a tad wobbly at first

cont...

You can't see someone learn something How do you know? - they can teach it to someone else. If you know the material you should be able to explain it to someone else in a way that is comprehensible to them Usually the problem is that it is an obvious answer - the question is not what is the right answer, it is what is the logic of the answer - if you can explain it, you understand it Ex: hard to explain how to drive a car (activity analysis - there are a lot of steps, and you don't think about them when you do it yourself)

continued

dominant: -intellectual functions - learning how to spell, ABCs, -most people it's left -call them logical, rational thoughts, ordered activity Non-dominant: -conceptual functions -spatial, emotions, prosody -cannot easily train someone to draw with right side of their brain.. (sides of brain not easily separated- need both sides) Those who are more analytical don't have bigger or stronger left side of their brain, people who are more creative don't have more synapses on right side of brain -matter of how you use what you've got -no physical evidence to clearly differentiate between left and right sides of the brain in regards to artistic vs. analytical differences in individuals -dominance for handedness - not recessive - almost always environmental No evidence based on gender for being dominant on one side -usually due to social influence -do it as a kid and get better with practice -preference for right hand motor dominance is environment and maybe a little genetic dominance -left neutral to genetic - so both left and right are influenced by the environment

Phases of "memory"

immediate: 1-2 seconds short-term: moments long-term: 'permanent' (consolidation) remote: from childhood, etc.

Arousal, Motivation, Learning and Memory: Olfactory System & Limbic System

lecture 1

Cortex and Language

lecture 2

The Aging Brain

lecture 3

"Read this out loud..."

pic in notebook

"Repeat after me..."

pic in notebook

outdated:

receptive vs. expressive aphasia

Not implicit learning..

θ = arctan ( ) where θ = angle of lean v = forward speed r = radius of the turn g = acceleration of gravity **Explicit part The rule of how to ride a bike This will not help you ride a bike Will help you understand physics of it but not learn how to do it

THIS is implicit learning

• "unconscious" awareness of a rule • can not define or specify the rule • may not even know a rule has been learned (ex: grandma gives you recipe, tastes different cause she forgot to tell you something else she does - that's implicit memory. you don't know the rules)