EXAM 2

Stroke loss of blood supply or bleeding in the brain

A temporary or permanent disturbance of brain function due to VASCULAR disruption caused by either _________ or _________

turbulence change direction or divide

A thrombosis typically begins in an area of increased ________, which means that thromboses are likely to occur where arteries _____ or ______ (at bends and bifurcations).

scripts

using preplanned utterances for specific speech situations •Practice with SLP, family •Use note cards with script in functional situations

debris lipids atherosclerotic

(Ischemic) Thrombotic Strokes: _____ in the bloodstream tends to accumulate where the arteries bend or divide In arteries the debris consists mainly of fatty substances (_____) which accumulate on the lining of the artery These accumulations are called _____

Atherosclerosis thrombosis

(ischemic thrombotic strokes) The most common problem is narrowing of the arteries in the neck or head. This is most often caused by ________, or gradual cholesterol deposition. If the arteries become too narrow, blood cells may collect and form blood clots. These blood clots can block the artery where they are formed (_______)

comprehension, formulation, and production language dominant middle cerebral artery

3 aphasias: These aphasia syndromes are caused by damage in cortical regions considered important for ______,________,and ______ of language oThese regions are located in the central part of the (left) _______ dominant hemisphere, in the area served by the ______________ artery

brocas wernickes global

3 most common aphasia syndromes

age 34% 65

Although stroke risk increases with ____, strokes can—and do—occur at any age. In 2009, ___% of people hospitalized for stroke were younger than___ years.

auditory comprehension (of spoken language)

Answer yes/no questions Point to objects/pictures Follow spoken directions Answer open ended questions Listen to paragraphs and answer questions

auditory comprehension reading comprehension

Assessment of comprehension skills: (2)

25% brain tissue, blood supply

At any given moment, about ___% of all the blood in the body is in the brain. Loss of blood supply to the brain results in the rapid destruction of ______, and interrupted ______ is a common cause of brain injury.

expressive, motor, nonfluent right sided planning speech movement slowly

Brocas aphasia : •May be called ____or _____ aphasia or _____ aphasia •Patients usually have _____ sided hemiplegia or hemiparesis (one side weakness, so stroke on left side of body, have right side weakness) •Broca's area is responsible for ________ •Words come _____, laboriously, and haltingly

self-monitoring awareness remember content, omissions nondominant

Brocas aphasia: They usually have ___________ ability, they are aware of their speech and writing errors, and they will attempt to repair errors. •Because of this ________, Broca's aphasics are upset by failed communication attempts - get frustrated, emotional. •Usually cooperative and _______ treatment tasks and goals from day to day •Patients with Broca's aphasia write as they talk: slowly and laboriously. •Written language consists of strings of ______ words with misspelling and distortions or _______ of letters •Letters are clumsily formed (in part because patient is writing with _______ hand) They usually print - rarely write in cursive form. Printing slants down the page.

between, within monotone content function telegraphic or agrammatic comprehension

Brocas aphasia: •People with Broca's aphasia demonstrate a pattern of long pauses ____ words and sometimes _____ words (blue.... Berry) •Intonation and stress patterns are diminished (______) •Utterances are short and consist mostly of _______ words (nouns, verbs, some adjectives) Tell me about family.. might say "the boys is good... the boy Jonathan" •________ words (conjunctions, articles, prepositions) are missing, so speech is described as _______ or _________ •Broca's patients understand spoken and written language better than they speak or write Better __________ (receptive) skills

surgically leaking ruptures

Cerebral Aneurysm: If an aneurysm is detected before it ruptures, it may be ____ repaired by clamping or tying off the neck of the aneurysm, by wrapping the aneurysm, or by tying off the artery that supplies blood to it. A _____ aneurysm can be repaired (sometimes) When an aneurysm _____, repair often is impossible

speech fluency/output repetition naming auditory comprehension drawing gesture/facial expression awareness of deficit reading written output

Each component of language should be tested individually and thoroughly: (9)

1. To determine the presence of communication impairment 2. Assess the severity and type of impairment 3. Determine the individual's strengths and weaknesses

Goals of assessment for aphasia: (3)

Hemorrhage

Hemorrhagic Stroke _________ Caused by rupture of a cerebral blood vessel. The ruptures may be caused by weakness of a vessel wall, by traumatic injury to a vessel, or by extreme fluctuations in blood pressure.

aneurysms weak blood pressure berry aneurysms base

Hemorrhagic Stroke from Aneurysm: __________ are pouches formed in arterial walls •They develop at places where the arterial walls are _____ •__________ within the artery causes the weakened section of the arterial wall to stretch, much like an inflating balloon. •The resulting malformations are sometimes called "___________" •Aneurysms occur most often in the arteries at the ____ of the brain (vertebral, basilar, internal carotid arteries and the circle of Willis).

•Case history •Interviews with patient, spouse/family members •Medical chart review •Discussion with other professionals

How to gather information: (4)

ABOVE

If an artery ______ the circle is compromised, alternate circulation routes are limited and more serious brain damage may occur.

embolic events cerebral embolism

In ______ events (_________), an artery is occluded by a fragment of material that travels through the circulatory system until it reaches a blood vessel smaller than its own diameter and gets stuck, occluding (blocking) the artery

circle of willis

In case one of the feeder arteries is unable to transport blood, the ______ provides an alternative channel for blood to reach the brain, that is, the other two arteries may still provide enough blood to maintain blood supply to the cerebral arteries.

right side cerebral vascular accident right hemisphere disorder

R CVA RHD

transient ischemic attacks cerebral 24 hours, 30 minutes small emboli , break up thrombus small strokes or mini strokes one third

Many stroke patients have a history of ______________ • TIA's are temporary disruptions of _____ circulation •Generally, the temporary disruption of circulation will last less than ____ hours and usually less than ____ minutes. •Transient Ischemic Attacks (TIAs) are characterized by quickly developing episodes of sensory disturbance, limb weakness, slurred speech, visual complaints, dizziness, confusion, mild aphasia... the symptoms usually resolve completely. •Most TIA's are thought to be caused by ______ that temporarily occlude an artery, then ______ or dissolve •TIAs sometimes occur when a stationary _____ has nearly, but not completely, occluded an artery TIAs are sometimes called ______ or ______. They are a sign of cerebrovascular disease. Their occurrence often precedes a complete stroke. Greenberg and associates (1993), found that about ______ of patients who have TIAs will within 5 years, have a stroke that leaves them with permanent neurologic deficits.

reading comprehension (of written language)

Match printed words to pictures Read aloud numbers, letters, words, phrases Follow a written direction Silent reading/comprehension - answer questions about a written text

copying and drawing scanning cancellation

Neglect is evaluated via various _____ and ______ tasks Stimuli should be symmetrical, with the same kind of elements to be drawn _______ tasks allow the clinician to assess neglect by asking patients to cross out or circle a target item (e.g, the letter T or the number 7) in an array of letters or numbers printed horizontally. __________: The ability to cancel an array of lines or other stimuli may be used. Letter cancellation, symbol cancellation, or other target cancellation from an array can be tested. Draw a line between the middle of every line

family members compensatory strategies prognosis team

Other Considerations •__________ should be counseled and educated to help them cope with residual deficits •Some __________ communicative strategies should be taught (ie: a few functional gestures, carrying a notebook to write crucial words with oral communication fails) •Provide realistic ______ •_______ based treatment

skills, deficits, evaluation family, patterns social, occupational support systems targets sequencing

Principles of language treatment aphasia: •Analyzing client's communication _____and _____ (via _______) •Understanding the client's ____and communication _____ •Understanding patient and family goals, including the ____ and _____ demands the client faces •Mobilizing family and social ____________ to enhance the overall functional improvement in the client's life and communication patterns •Selecting client specific and personally relevant _____ that, once taught, provide the greatest improvement in communication effectiveness in natural settings •_________ target behaviors appropriately to ensure patient success (least difficult to most difficult)

frequent amount and type consequences intensive

Principles of language treatment aphasia: •Providing ______ feedback •Arranging appropriate ____ and ____ of stimuli used in treatment •Providing naturally occurring ________ for the patient's attempts to strengthen those communication attempts. •Offering ______ therapy if possible

mild moderate severe

Range of Severity in Wernicke's Aphasia: •______: aware of errors, content of speech is semantically appropriate, follow conversational rules (turntaking) •_______: rarely notice errors or attempt repairs. Are attentive and cooperative, but may have difficulty staying on task. Go off on tangents and talk at length about unrelated topics. •_________: attentive but profound comprehension impairments interfere with performance. Oblivious to errors and communication failure. They do acknowledge their conversational partner.

verbal expression

Recitation Object/picture naming Phrase or sentence completion Phrase/sentence repetition Produce single sentences → longer utterances

5 40 795,000 4 35 , 21 disability preventable one of four 36.5 billion

STATS: Stroke is the No. __ cause of death in the United States, killing nearly 130,000 people a year Someone in the U.S. has a stroke about once every ___seconds About ______ people have a stroke every year Stroke kills someone in the U.S. about once every __ minutes Over the past 10 years, the death rate from stroke has fallen about __ percent and the number of stroke deaths has dropped about ___ percent Stroke is a leading cause of ____ Stroke is the leading ____ cause of disability About 185,00 strokes—nearly ___ of ___—are in people who have had a previous stroke Stroke costs the United States an estimated ______ each year This total includes the cost of health care services, medications to treat stroke, and missed days of work

single words spoken questions general knowledge directions comprehension

Sequence of Auditory Comprehension Treatment •Comprehension of ________ - pointing to body parts, objects, noun pictures, verb pictures •Comprehension of _______ - yes/no questions (Personal: do you have a daughter? ____________: Is San Francisco in New Jersey? Word Classes: Is a dog an anima?) •Following spoken ______ •Discourse ________

effectively divergent thinking (expansion) semantics

Tend to name common objects _____ word finding problems occur on ________ thinking (______) tasks (catch phrase: describe a work without saying it) Tend to generate fewer words on fluency tasks (naming animals, fruits/vegs) More problems with _____ than with phonology and syntax May score similar to pts. with aphasia on some clinical subtests but for different reasons! Why? Because RHD patients have impaired attention, perception, and organizational skills

arteriovenous malformation veins cerebral hemispheres hemorrhage birth headaches excised (removed) 1 to 2 percent

Some SUBARACHNOID hemorrhages come from _________ (______) AVMs are collections of dilated, thin walled ____ connected to a tangled mass of thin walled arteries. •They can occur in all parts of the brain, brainstem, and spinal cord. But most large AVMs develop deep in the __________ •The vessel walls in AVMs are usually weak and sometimes bleed causing a _______ •Most AVMs are present at _____ and become larger with the passage of time •When AVMs become large they may cause ______ and other CNS symptoms •If identified before massive bleeding occurs, they may be surgically ______ Adams and Victor (1981) found that the risk of bleeding from AVM's is about ____ to ____% per year. Suggesting that a patient with an AVM is unlikely to reach her or his 60s or 70s without hemorrhage.

one side of the body vision speaking or understanding

Symptoms of CVA: Weakness/numbness on ______ impairment of _____ difficulty _____ or ______ dizziness of falling severe headache combined with any above symptom

Cerbrovascular Accident (CVA) Brain attack

Technical term for stroke and another term for stroke

aorta two subclavian arteries -right subclavian artery -left subclavian artery

The ____ is the main artery of the heart. •The heart pumps oxygenated blood into the aorta. •The blood is distributed from the aorta to two _________ (one on each side): o_______ o_______

glucose and oxygen

The blood nourishes the brain with life sustaining ___ and ____

blood clot arterial lining atherosclerotic plaque thromboses in the heart, atherosclerotic plaque

The material in the embolus may be: ______ that has broken loose from its site of formation A fragment of ______ A piece of _______ The most frequent source of emboli are fragments from ________, followed by fragments of _______ from an artery.

race and ethnicity twice

The risk of having a stroke varies with ____ and ____. Risk of having a first stroke is nearly ____ as high for African Americans than for whites. Hispanics' risk for stroke falls between that of whites and African Americans. low to high whites -> hispanics -> Af americans

common carotid arteries right common carotid artery and left common carotid artery vertebral arteries right vertebral artery and left vertebral artery

There are four branches from the two subclavian arteries which directly ascend to the brain: oTwo ________ _______ and _______ oTwo ________ _______ and ________

•Auditory comprehension of spoken language •Verbal expression •Reading skills •Writing skills •Gesture/Drawing/Math

Treatment goal areas (4)

reading and writing

Treatment of ____ and ____ •Single words to phrases to sentences •Writing: copying to more self generated. Copy and write name, address, family names, etc •Reading: oral reading and reading comprehension: matching, multiple choice, open ended, journaling

intracerebral hemorrhage subarachnoid subdural epidural or extradural

Two general locations of hemorrhagic stroke _______ hemorrhages: located within the brain •Extracerebral hemorrhages: hemorrhages from bleeds located: __________ __________ __________ or _________

word retrieval impairment general circumlocution logorrhea cursive content

Wernickes Aphasia •Patients with Wernicke's have a severe _________impairment. Produce empty speech by substituting ______ words such as THING or STUFF or pronouns without referrents for more specific words. Filler words, "ok, yeah um uh" Some Wernicke's patients talk around missing words - ___________ oEX: cant think of chair.. bed no... thing you sit in.. talk around it, but cant actually get word out •Talk at great length unless forcibly interrupted. This is called press of speech or ________ •Handwriting resembles speech. The Wernicke's patient may write with little effort and letters are well formed/legible. •Most write in _______ form rather than printed form. Handwriting may be mechanically normal, but is deficient in _______ •Produce paraphasias, neologisms in writing. Patients with press of speech when they talk exhibit press of writing when they write.

spoken and printed mild or moderate sound or sight semantics

Wernickes Aphasia: •Poor comprehension of ______ and _____ verbal materials (range of severity) •Patients with _____ or _____ Wernicke's usually get the overall point of conversations but miss many specifics oServe Wernicke will miss the whole overall point •Have difficulty associating the ___ or ___ of words and their meanings. May have difficulty with ______ (the actual meanings of it) distinctions among words (unable to appreciate differences between words with related meanings: good vs. terrific)

verbal paraphasia literal paraphasia neologisms jargon

Wernickes Aphasia: Connected speech may be littered with: ___________- Substitution of one word for another •EX: talking about dog, said cat o_________- Transportation of sounds within words •EX: when writing, transpose or put wrong sound within word.. spelling name and add extra letters o_________ - nonsense words such as "mungamung" •EX: Not a real English word o__________- Strings of neologisms, with a sprinkling of connecting words •EX: Similar to babbling

pause

Wernickes Aphasia: Speech is smooth, effortless and copious. Patient's with Wernicke's can produce long, syntactically well formed sentences with normal intonation and stress patterns although they may ____ when experiencing word retrieval difficulty

cell death infarct

When a stroke occurs, the blood supply is disrupted, and brain cells are starved of oxygen, causing _____ in the immediate area. This area of dead cells is called an _______ These cells usually die within minutes to a few hours after being deprived of oxygen.

BELOW

When an artery becomes compromised _______ the Circle of Willis, an adequate supply of blood is maintained and damage to the brain is minimized

intact 4 revised token tact arranging passive

Word comprehension is generally ____ May have mild deficit when presented with up to __ semantically similar picture options Can follow directions (_____) May have difficulty ______ words into a grammatical sentence Problems with sentence comprehension with ______ sentences and other complex grammatical forms Subtle language deficits!

written expression

Write name and address Write to dictation -letters, numbers, words, sentences Write a sentence Write a paragraph

80-87% 13-20%

___-___% of all strokes are ischemic ___ - ___% are hemorrhagic

Wernickes Aphasia

______ aphasia: Comprehension impaired Production (expression) - fluent, but nonsensical • Usually doesn't make sense • Similar to child babbling • Expression is better than comprehension (receptive)

video assisted speech therapy (VAST) live communication mobile

______ is an innovative application of video technology to facilitate and improve communication abilities for speech-impaired individuals. Following close-up video of mouth movements allows these individuals to speak full sentences. The simultaneous combination of visual, auditory and, in some cases, written cues, allows these individuals to readily produce speech. VAST facilitates: •Support for ____ communication •Provides source for Individualized, ____ speech practice. •allows individuals to communicate ideas more fluently

Standard Aphasia Evaluations standardized aphasia test battery formal and informal assessments

______: •Formal evaluations are conducted to assess speech and language skills and the potential to benefit from a therapy program. •A typical evaluation includes a __________ plus additional ____and ______ assessments to provide more information.

expression comprehension (receptive) language

_______ - can speak or write _______ (____) - listen or read Aphasia is a disorder of ________ A person who has a stroke and has aphasia will typically have problems in all four areas, but usually one specific area they have the most difficulty

atherosclerotic lumen stenosis decreases increases velocity blood platelets and fibrin occlude, emboli

_______ plaque Over the course of many years, the plaque gradually thickens, until it may eventually fill the ____ (space within the artery) As the size of the lumen decreases (a condition called ______), the volume of blood flowing through the narrowed portion ______, although its velocity ________ Sometimes the plaque in the arterial wall cracks due to this increased _____ • ____ and ____ (a protein found in the blood) will adhere to the crack in the plaque, accelerating clot development. The clot may eventually block or ____ the artery, or parts of the clot may break off and become _____ traveling through the vascular system The clots eventually occlude smaller vessels downstream from the original site of the clot

arteries brain capillaries

_______- carry blood AWAY from the heart ______-carry blood TOWARDS the heart _______- connect the arteries to the vein

aphasia speaking, reading, writing, listening, (gesture, math)

_______: Loss or reduction of language skills due to brain injury. There are deficits across all language modalities: (4) (____,______)

platelets thrombus

_______: agents in the blood that contribute to the formation of clots may adhere to damaged blood vessel walls and begin the chain reaction that produces a _______

Attention

_________ impairments make it difficult for RHD patients to Determine the overall meaning of situations and events Separate what is important from what is not Identify relationships among individual elements of information Maintain appropriate patterns of interaction with conversational partners Maintain coherence in communication interaction with others

visuospatial or visual organization skills visual closure visual attention/visual spatial skills

_________ or ___________ skills Tasks include naming an incompletely drawn picture or naming a picture that shows parts of a larger picture separated and randomly arranged (i.e.: parts of the human body, parts of a bike, parts of a house) Draw half a person and have them draw the other half _________; Find the same figure with missing parts Show complete "8" and ask which drawing shows part of an 8 Or finish this drawing so it looks like this one ___________: Find the Differences

thrombolytic agents hemorrhaging

_________-used to degrade clots that have already formed there is a high incidence of serious adverse reaction, primarily ________

typical evaluation comprehensive report

__________: Following testing, specific recommendations relating to the intensity of therapy, goals for therapy and suggestions for home practice are discussed with the client and family. The evaluation may extend over several sessions. A _________ is prepared to describe the findings and recommendations.

brocas aphasia wernickes aphasia global aphasia

_____________- is caused by occlusion of the anterior branch of the middle cerebral artery ____________- is caused by occlusion of the posterior branch ______________-usually is caused by occlusion of the artery's main trunk

Melodic Intonation Therapy Brocas aphasia 3-4 notes 2 syllables convey meaning

_______________ Comprehension is better than their verbal expression and verbal expression is severely impaired (_____ Aphasia) Strategies: •Intonation pattern uses a range of ______notes •Elements include an exaggerated melody composed of at least ___ syllables. The rhythm and point of stress help to _________ •MIT is slower, similar to Chant Talking •Program Progresses to Longer syntactic units and to Clinician Question, Client Answer using progressively faster melodic patterns.

standardized assessment rehabilitation institute of chicago

________________clinical management of right hemisphere dysfunction Visual scanning and tracking Awareness of illness Attention Orientation Facial expression Intonation Storytelling Written expression Pragmatic language skills* Patient interview and observation

frontal lobe and corpus callosum lateral frontal lobe, thalamus, and basal ganglia occipital lobe temporal lobe

anterior cerebral artery - supplies blood to the upper and anterior regions of the_______ and the _________ middle cerebral artery - supplies the _____ surface of cortex including regions of the _____, ______, and ________ posterior cerebral artery - supplies blood to the ______ and the lower parts of the _________

Warfarin (Coumadin) Heparin - onsite

anticoagulants: •____________-may be used for long-term oral therapy (pill). It works by interfering with the chemicals circulating in the blood that contribute to clotting of the blood. Preventative. __________ is an intravenous (injection) anticoagulant administered at the ____ of stroke Acute stage treatment and preventative.

verbal expression written expression

assessment for expressive skills (2)

hemorrhagic (caused by bleeding)

bleeding in the brain

intracerebral hemorrhage 90% arterial walls thalamus and basal ganglia cerebellum and brainstem

bleeding is within the brain substance (below meninges) About _____% occur in patients with high blood pressure. The hypertension causes increased pressure on ______, weakening them Most common sites are the small arteries in and around the _____ and ______, but they also occur in the _______ and _________

cell death

ischemic stroke leads to ____

anosognosia

lack of awareness or recognition of disease or disability o "Lack of insight" or "imperception of disease" o Essentially, patients are unable to become aware of the neurological dysfunction o Denial of deficits including denial of the paralyzed limb

standard aspects of assessment for RHD

o Case History o Hearing Screening o Patient and family interview o Oral-facial examination o Language sampling

pragmatic language deficits

o may have difficulty following the social rules of conversation

left neglect

oNeglect: left hemispatial characterized by •Diminished responsiveness to stimulation on the left side of the body •Diminished awareness of visual or auditory stimuli in left-sided space oA patient with left neglect may: •Exclude detail from the left side when drawing an imagined object from memory •Make more errors of omission for response choices on the left side during language or psychological testing. •Omit or misidentify letters from the left side of words, or words frin the left portion of a page, when reading •Dress or groom only the right half of the body •Bump into doorframes or furniture on the left side •Ignore sensory stimulation of the left side of the body

cerebrovascular system

the _________ refers specifically to the network of blood vessels within the brain

true

true or false: SLP might begin with an aphasia assessment tool, but this is not the best choice.... RHD pts most often do not have aphasia; they normally process most words in sentences in isolation

embolic strokes

type of ischemic stroke an artery is suddenly occluded by material that moves through the vascular system and blocks an artery

thrombotic stroke (cerebral thrombosis)

type of ischemic stroke - an artery is gradually occluded by a plug of material that accumulates at a site in the artery •Most cerebral thromboses occur in the LARGE arteries supplying blood to the brain (internal carotids, vertebrals, and the basilar artery).

ischemic (deprived of blood)

type of stroke: Blood flow is blocked "occlusive stroke"

semantic neologism phonemic

wernickes aphasia: -________ paraphasia •EX: stool for chair, spoon for fork, boy for girl -_______ Jargon •EX: chossl for chair, rugal for notebook -_______ paraphasia (too words that are close in sound) • EX: pon for pot

right

• CVA is on the ______ side of the brain • Initially, it appears that the speech/language processes have not been affected. • Patient is able to answer general types of questions about the hospital /staff • Speech is easily understood, patient uses correct grammar, does not seem to have difficulty remembering words

response elaboration training (RET) brocas spontaneous response reinforce

• Designed for nonfluent aphasia patents in order to increase the length and information content of verbal responses (_____ aphasia) •Strategies •Elicit ________ response •Model and reinforce initial response •Expand and elaborate response through scaffolding •______ client's attempts at elaboration •Always repeat and expand the client's utterance

3 pairs anterior cerebral artery middle cerebral artery posterior cerebral artery

• The ___ pairs of cerebral arteries branch upward from the circle of Willis two anterior cerebral arteries, two middle cerebral arteries, and two posterior cerebral arteries. o__________ - supplies blood to the upper and anterior regions of the frontal lobes and the corpus callosum o____________ - supplies the lateral surface of cortex including regions of the frontal lobe, plus the thalamus and the basal ganglia. o_________ - supplies blood to the occipital lobe and the lower parts of the temporal lobe.

Comprehensive evaluation instruments

•Boston Diagnostic Aphasia Examination***** •Western Aphasia Battery**** •Aphasia Diagnostic Profiles •Minnesota Test for the***** Differential Diagnosis of Aphasia (MTDDA) •Porche Index of *Communication Abilities (PICA) ( formal training needed) **** •Aphasia Language Profiles •(most popular are bolded)

tissue plasminogen activator (tPA) occluded 3-4 contraindicate brain tissue bleeding in the brain

•Current agent used is _________________ (_____). If tPA is given in large amounts, it promotes breakdown of clots in blood vessels. Used in acute ischemic stroke when arteries feeding the brain are ______. It must be used within ____-____hours of the onset of their stroke, tPA cannot be used in cerebral hemorrhage. Marked elevation of blood pressure or use of certain drugs prior to onset of symptoms may ________ use of tPA. oDesired effect is breakdown of clots in the artery allowing a return of blood flow to preserve ______ oAdverse effects - ________________

puns, sarcasm, metaphor, simile, abstract expressions communication communication

•Difficulty understanding figurative language: (5) ___ •RH communication disorder we see no significant language problem in terms of the patient's ability to use words...but there is a _______ problem o____________ - transmission of a message between the giver and receiver.

excessively unrealistic monotone slow rate

•Eye contact: does not maintain eye contact during conversation •turn taking: talk ______ and without regard for the listener, have difficulty staying on topic, interject irrelevant tangential and inappropriate comments •Tend to personalize external events •Give impulsive answers to inquiries - but do not really answer the question. Responses are full of tangential, related but unnecessary detail •RHD patients do not know the extent of their problems and as a result have ______ goals of returning to work, living alone, etc. •Reduced sensitivity to emotional tone of speaker's voice oPatient will also often have impaired prosodic production in their speech: ___________ __________

parasylvian arcuate fasiculus trunk nonverbal

•Global Aphasia Massive left ________ lesion involving Broca's & Wernicke's and ________ Production, comprehension, Repetition - all impaired •Most often follows occlusion of the ____ of the middle cerebral artery which causes massive damage throughout the perisylvian region •Massive effects on the communication abilities of the patient •Severe impairments in all language functions •Most cannot perform even the simplest tests of listening comprehension •Most not reliable answering simple yes-no questions •Some may respond to conversations in a way that suggests that they at least get a rudimentary sense of what is said •Few people with global aphasia can read even simple words •Speech is severely limited, usually consisting of a few single words, stereotypical utterances (such as one-one-one, kakie-kakie-kakie) and over learned phrases such as okeedokee. Or expletives. •Over time, some become proficient at communicating in a limited way with a combination of intoned stereotypic utterances gestures and facial expression but verbal communication remains largely nonfunctional •Most are attentive, alert, on task and socially appropriate •They can usually perform _______ tasks (match objects to pictures to objects)

nonverbal cognitive systems 1. attention 2. perception 3. organizational skills

•Historically, non-dominant hemisphere strokes were not referred for speech pathology services •Mainly because the primary disorders are related to _______ (not as obvious as aphasia) 1. _____ 2. ____ 3. _____

constraint induced therapy constraint motor learning forced use massed practice

•Idea came from Occupational Therapy: Dr. Edward Taub studied the idea that much of the long term disability of stroke survivors resulted from a learned tendency to avoid using the impaired arm and hand, He called this "learned non-use" • started being applied to aphasia and apraxia in the early 2000s •______ - avoid the compensation (gesture, drawing, writing) oClients are "forced" to only use the impaired mode(s) to communicate oBased on principles of ______ theory •_____ - require use of the impaired modality (speech) •_______ - require the constraint and forced use (24 hours per day) •Caution: Do not use CIAT too early after stroke.

language visual-spatial perception and attention

•Left Hemisphere: ________ specialization for most people •Right Hemisphere: __________ and _______ BUT keep in mind, language is a complex behavior resulting from interaction of interconnected neural networks AND not everyone's brain is organized in the same way, e.g., some people have language specialization in the RH

22

•Left Posterior Lesion (Wernicke's area= broadmans area ____)

anterior posterior

•Left ______ (forward) Lesion -→ nonfluent, comprehension relatively ok •Left _______ (back) Lesion -→ fluent, comprehension impaired

nonverbal rating

•Pragmatic language skills assessed in the RIC assessment include _________ communication (intonation, eye contact, facial expression, topic maintenance, and narrative skills). •"Assessed" by ______scales - observing and noting behaviors during conversation

education assessment multi-modalities functional

•Provide ______ and support for patients and families and significant others •Based on ________, identify the patients strengths and weaknesses •Encourage communication through _______ •Promote patient independence via use of _____ treatment tasks

focusing, maintaining, and shifting communicative and behavioral

•RHD patients have difficulty______, ______, and _______ there attention •Attention deficits are a key element of ____ and ________ deficits we see in RHD (As compared to language deficits being the key element of communicative deficits we see in LHD)

Life participation approach to aphasia (LPAA) consequences re-engagement decision making

•The ________________- is a service-delivery approach that supports individuals with aphasia and others affected by it in achieving their immediate and longer term life goal •LPAA is a general philosophy and model of service delivery, rather than to a specific clinical approach. •LPAA calls for a broadening and refocusing of clinical practice and research on the ______ of aphasia •The focus is on _________ in life, beginning with initial assessment and intervention. •LPAA places the life concerns of those affected by aphasia at the center of all __________ •Empowers the consumer to select and participate in the recovery process and to collaborate on the design of interventions that aim for a more rapid return to active life.

Where trunk or main branch peripheral

•The amount of brain tissue affected by occlusion of a cerebral artery will depend on exactly ______ the artery is blocked •A blockage in the __________ of a cerebral artery will affect a large region of the brain •An occlusion in a ________ branch will affect a smaller region.

internal carotid arteries neck, jaw circle of willis

•The common carotid arteries continue to branch out into the __________ as they enter the brain through the base of the skull •The internal carotids proceed upward toward the brain on each side of the ____, near the surface, just behind the angle of the ____ you can feel your pulse here the carotid arteries eventually connect to opposite sides of the ______

watershed ischemia and infarction

•The distributions of the cerebral arteries overlap slightly at their boundaries, so occlusions at the periphery of an artery's distribution may not cause much brain damage because of collateral blood supply from an adjacent artery. These areas of overlapping blood supply are called ______ areas •Because they are at the extreme ends of arterial distribution they are particularly vulnerable to _____ and ______ in those who have circulation problems

basilar artery pons circle of willis

•The left and right vertebral arteries also arise from the two subclavian arteries that extend from the heart •The two vertebral arteries unite to form the ______ at the lower level of the _____ •At the upper portion of the pons, the basilar artery connects into the posterior part of the ________

promoting aphasics communicative effectiveness (PACE) exchange brocas or wernickes

•Therapist and client take turns conveying information to each other participating equally as senders and receivers of messages. •There is an _______ of new information •Therapist can model communication options. •Any Communication channel is acceptable: visual, gestural, graphic, verbal •Barrier Activities useful in PACE therapy •_____ or _______ aphasia

Verbal expression

•Treatment of _______ Naming •Expanding to phrase and sentence length responses •Model sentences initially and encourage imitation •Ask questions to evoke specific functional sentences •Connected speech and conversational skills (story telling, sequenced picture stories, task descriptions)

information

•What __________ is needed in order to assess the language skills of a person with aphasia? •How do SLPs get the information?

anticoagulants and antiaggregants anticoagulants antiplatelet/antiaggregants

•_____ and _____ are different drug classes •Preventative treatments for stroke •Both work to prevent blood clots from forming and growing ______ reduce fibrin formation ______ prevent platelets from clumping

Anticoagulants stroke

•_______: medications that stop blood from clotting; prescribed for patients who are at risk for ______ from clotting. Preventative.

antiaggregants aspirin ticlopidine (ticlid)

•________: agents which decrease platelet aggregation and inhibit thrombus formation. Antiplatelet drugs are most effective for arterial clots that are composed largely of platelets. Preventative _______ - has been shown to decrease incidence of stroke in patients who are at a high risk because of PREVIOUS stroke, TIA, atherosclerosis, heart attack. Prevention of heart attack and ischemic stroke must be weighed against the possibility of hemorrhagic stroke •________ (_____)- used to prevent recurrence of stroke in patients who are at increased risk for stroke and who have failed to respond to or are allergic to aspirin.

prosopagnosia temporal

•____________ o RHD patients may be unable to recognize otherwise familiar persons by their facial features (may recognize familiar people only by voice) oDifficulty with ____ concepts •"Why am I exercising so late at night?" •"My wife only stayed a few minutes." •"They put my tray down, then came right back in and took it away!"

the circle of willis 2 carotid arteries and basilar artery six cerebral arteries circle of willis feeder arteries

•____________ connects the three major feeder arteries (_____ and ______) to the six cerebral arteries. •The _________ then fan out to supply the entire brain with blood (glucose and oxygen) The six cerebral arteries all have access, via the ________, to the blood supply of any of the _________

44 + 45

•left anterior lesion (Broca's area = Brodman's areas ____ + _____)