Adults Final Exam
Secondary Mechanisms of Damage for TBI: Increased intracranial pressure
A raised level of pressure within the skull above the normal and healthy level When the amount of intracranial pressure (amount of pressure in skull exerted on the brain) becomes higher than blood pressure the person may suffer anoxia (no or limited oxygen pumping to brain)
The Glasgow Coma Scale, Adelaide Coma Scale, and the Ranchos Amigos Levels of Cognitive Functioning are assessments used for measuring what?
Arousal
Secondary Mechanisms of Damage: Traumatic hemorrhage
Bleeding of blood vessels as result of trauma Intracerebral hemorrhage is traumatic hemorrhage within the brain Subdural hemorrhage is hemorrhage that occurs between dura mater and surface of brain
Secondary Mechanisms of Damage: Traumatic hydrocephalus
Brain is unable to reabsorb old cerebrospinal fluid while still producing fresh cerebrospinal fluid
Dementia direct therapy strategies: Montessori approach
Breaking down complex tasks into individual parts into hierarchy of difficulty and from concrete to abstract
What is Mild Cognitive Impairment?
Changes that are significant enough to not be within normal spectrum of changes with age, but not severe enough to affect ADLs Symptoms include: Decreased ability to concentrate Decreased word-finding abilities Decreased short-term memory
Parkinson's Disease
Characterized by motor abnormalities such as rigidity, tremor, slowness of volitional movement, and cognitive deficits Neuropathology includes loss of dopamine producing cells in substantia nigra as a result of Lewy bodies Medical treatment for Parkinsonian symptoms Levodopa (L-Dopa)
What type of damage is seen in Shaken Baby Syndrome?
Damage caused is usually due to rotational and acceleration-deceleration forces imposed on the child's brain
Closed head Injury
Damage to the brain that occurs as a result of an external and forceful event Does not break the skull open or penetrate the cerebral meninges surrounding the brain Skull remains intact Does not include damage to the brain resulting from disease, stroke, or surgery Caused by falls, motor vehicle and traffic accidents, being struck by an object, sports accidents, and violent assaults
Frontotemporal Dementia
Degeneration of frontal and temporal lobe Includes: Pick's disease Progressive nonfluent aphasia Semantic dementia
Chronic traumatic encephalopathy
Degenerative disease of the brain caused by repeated head trauma -repeated concussions.-in sports or repeated IED blasts in soldiers.- that manifests as dementia, confusion, memory loss, headache, depression, and excessive aggression within months or even years of the brain damage
A sudden change in cognitive ability that fluctuates throughout the day? Usually a result of a general medical condition.
Delirium
Pick's Disease
Dementia resulting from progressive degeneration of frontal and temporal lobes Characterized by personality changes, antisocial and inappropriate behavior, and memory loss in absence of language deficits Neuropathology includes Pick bodies and ballooned neurons Results in shrinkage of frontal and temporal lobes No amyloid plaques or neurofibrillary tangles
Which disorder is best thought of as having motor difficulties like Parkinsons and cognitive changes like Alzheimers Disease?
Dementia with Lewy Bodies
Which term refers to when a person unconsciously removes themselves emotionally from painful, stressful, or upsetting situations
Diassociation
What is errorless learning?
Difficulty level of task is set within the ability of the patient to maximize patient success and minimize patient failure
Dementia direct therapy strategies: Errorless learning
Difficulty level of task is set within the ability of the patient to maximize patient success and minimize patient failure Use with spaced retrieval training
Diffuse axonal shearing/injury
Diffuse axonal injury is the shearing (tearing) of the brain's long connecting nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull. Neuron connections are pulled apart. DAI usually causes coma and injury to many different parts of the brain.-brainstem often affected
Medical Management of Dementia
Donepezil (Aricept) Memantine (Namenda)
Why is it important to review the patient's medication list?
Drug induced dementia can occur in those who take prescription meds or abuse substances Unexpected drug interactions can occur affecting cognition Older adults are more at risk for side effects of drugs
Empathizers vs. Sympathizers
Empathizers are attuned to patients and want to learn about the disorder Sympathizers feel sorry for the patients with little understanding of the patients' emotions
Dementia direct therapy strategies: Memory prostheses
External memory aids such as memory books/wallets, calendars, smart phones, or personal digital assistance to augment memory
Which of the following is an internal memory strategy?
Face-Name Associations
T/F: Hematoma refers to the amount of pressure in skull becoming higher than blood pressure
False - intracranial pressure
T/F: In normal aging reaction time doesn't change
False - it does change
What is a hematoma?
Gathering of blood outside of blood vessel
Secondary Mechanisms of Damage: Hematoma
Gathering of blood outside of blood vessel following hemorrhage
Helpers vs. Enablers
Helpers understand what SLPs teach and generalize those ideas outside of therapy Enablers believe they are helping the patients, even though their words and actions may go against the SLP's recommendations and suggestions Enablers often do everything for the patient and don't follow through with home assignments
Dementia is and is NOT
IS acquired, caused by a variety of diseases, global loss of brain function IS NOT a disease
State of Consciousness: Post-traumatic amnesia
If recover from coma or vegetative states often display an amnesia Anterograde - inability to take on new memories Retrograde amnesia - loss of recently acquired memory, from days, to weeks, or months before the trauma
Open head injury
Injury that penetrates the skull into the brain
Impact Based Injury
Injury to the brain that occurs as a result of stationary head being impacted by a moving object
Behavior/Safety/Environment Modifications: (Indirect Therapy)
Label everything in the environment Keep regular routines and schedules Bracelets or anklets that patient cannot remove with identifying information Sharp objects, potentially harmful items, firearms, poisonous substances, cleaning substances Install out of reach locks Car keys secured
What are the characteristics of normal aging? WRITE
Language remains intact with a slight decline in word-finding abilities Sustained attention remains mostly intact Slight decline in selective attention skills Divided attention skills intact during simple tasks but breaks down with complex tasks
Alzheimer's disease: Late stage
Loss of motor function May become nonambulatory, bedridden, incontinent, and unresponsive Memory, cognition, and expressive language deficits are profound May cause muteness and dysphagia
Vascular Dementia
Mixed dementia caused by small ischemic strokes within the cortex, subcortex, or both Neuropathology includes presence of small or unnoticed ischemic strokes Multi-infarct dementia is caused by many, usually small, infarcts to various areas of the brain Cortical multi-infarct dementia is the result of small recurrent ischemic strokes to cortex Lacunar state is result of multiple subcortical thrombotic ischemic strokes in the brainstem, basal ganglia, and other subcortical structures
Motivators vs. Demotivators
Motivators aid patients by staying positive and motivated Demotivators cause stress and negative responses such as avoidance, regression, and projection
TBI deficits
Motor function impairments Motor speech disorders can occur - apraxia and dysarthrias Dysarthrias seen are flaccid, spastic, ataxic or any combination of the 4 Swallowing disorders - very common Cognitive deficits and language deficits associated with right and left hemisphere damage. Orientation - to self, situation, place, time Attention- (all): selective, sustained, divided, alternating Memory - (all) working, short term, long term Problem solving, inferencing, Personality changes
Alzheimer's disease: Early stage
Motor function retained Short-term memory loss, word-finding difficulties, comprehension of verbal language deficits, and personality changes Early stage lasts 2 years on average
What is dementia?
Multiple diseases and conditions can cause dementia. Is a syndrome, not a disease itself Dementia is memory loss plus one additional deficit in an area that affects ADLs: Verbal/written expressive and receptive language Recognition/identification of objects Inability to execute motor activities Abstract thinking, judgment, and execution of complex tasks
Alzheimer's disease: Mid stage
Negative impact on ADLs and reliance on others More severe memory loss, attention deficits, dramatic personality changes, visuospatial and visuoconstructive deficits, and expressive language deficits May experience wanderlust, sundowner syndrome, disorientation, and confusion Mid stage lasts from 4 to 10 years
What is the neuropathology of Alzheimer's disease? WRITE
Neurofibrillary tangles Amyloid plaques Granulovacuolar degeneration General neuronal atrophy-shrinkage of cortex and widening of ventricles
Loss
One of the most consistent reactions that people with neurogenic communication disorders experience
Which term indicates an injury that penetrates the skull into the brain
Open head injury
State of Consciousness: Coma (more than 6 hrs)
Period of unconsciousness lasting more than 6 hours with individual unable to be awakened and is unresponsive to sensory stimuli
State of Consciousness: Minimally conscious state
Person displays inconsistent but definite behavioral signs of consciousness Signs of awareness of self and environment occur often enough and reliably enough to rule out reflexive behavior
State of Consciousness: Vegetative state
Person is minimally responsive to stimuli but lacking consciousness and cognition Might respond to touch, pain, or sound but doesn't reach full consciousness or awareness of surroundings
Military TBI: Tertiary-level damage
Physical displacement of the body by force of wind or shock wave
What is Spaced Retrieval Training?
Presentation of information for recall over increasingly greater intervals of time
Dementia direct therapy strategies: Spaced retrieval training
Presentation of new or previously known information that must be recalled over increasingly greater intervals of time
Huntington's Disease
Progressive terminal illness characterized by distinctive involuntary erratic body movements May cause changes in personality, cognition, language, and emotion Neuropathology includes Production of mutant Huntingtin protein that creates degeneration of basal ganglia, hippocampus, substantia nigra, and Purkinje cells of pons
Military TBI: Primary-level damage
Result of shock wave created by explosion from barotrauma that can affect eyes, brain, and air- and fluid-filled organs of abdomen
Secondary Mechanisms of Damage: Post-traumatic epilepsy
Seizures that occur consequently to TBI
Dementia direct therapy strategies: Reminiscence therapy
Semi-cued conversation about past events, experiences, and activities to increase orientation and recall of pleasant long-term and episodic memory
Therapy for Dementia
Should improve quality of life and ensure individual is operating at the highest level possible despite deficits Strengthen abilities that can improve Reduce demands on impaired abilities Increase use of intact cognitive abilities Provide stimuli that evoke positive emotion and memories
Repression
Similar to denial in that patients consciously suppress the negative experiences that are the result of their deficits
What is Delirium? WRITE
Sudden disturbance in consciousness or change in cognitive ability that fluctuates throughout the course of the day Onset of delirium is result of general medical condition
Supporters vs. Detractors
Supporters encourage therapy Detractors may diminish the importance and value of therapy
Secondary Mechanisms of Damage: Cerebral edema
Swelling of brain tissue that may occur following trauma to the brain
Motivation
The achievement of a balanced state among a patient's sense of purpose, perception of growth or improvement, and ownership of goals, therapy, and the therapy process
Military TBI: Quaternary-level damage
Trauma created by the blast not due to primary, secondary, and tertiary mechanisms. Examples include inhalation of toxic gases, smoke, dust or burns sustained to body
T/F: A symptom of mild cognitive impairment is difficulty following detail heavy conversations.
True
Internal Memory strategies
Use cognitive acts to increase memory Mnemonics Verbal chaining Imaging Visual association (visualization)
Sensory Stimulation Therapy AKA Coma Stimulation Therapy
Used to increase level of arousal of those in coma or vegetative state Sessions occur daily and involve stimulation of all or only some of the sensory modalities. Visual Stimulation: moving large and brightly colored objects across field of vision Auditory Stim: talking, asking questions, music. Paired with other stim techniques Oral stimulation: Cleaning oral cavity, brushing teeth, flavored swabs Olfactory stim: smells: perfumes, foods, etc. Cutaneous or Tactile stim: light brushing, various temperatures on skin, textures,
Dementia symptoms traced back to many small ischemic strokes is called?
Vascular Dementia
State of Consciousness: Persistent vegetative state
Vegetative state continues longer than four weeks
Learned helplessness
When a person behaves in a helpless manner even though they have the opportunity to improve their situation
Acceleration deceleration
When a person's body (and brain) is moving very fast (accelerating) through space and then comes to a sudden abrupt stop (decelerates) Brain slams around with damaging level of force against inside of the skull
Negative emotional reactions
Will affect progress
Military TBI: Secondary-level damage
`Result of flying debris and bomb fragments
Which is a neuropathology of Alzheimer's?
amyloid plaques
Pick the best description for minimally conscious state
displays inconsistent but definite behavioral signs of consciousness
Dementia with Lewy Bodies
hallmark symptoms of visual hallucinations and sleep disturbances; combined with motor difficulties similar to Parkinsons Disease and cognitive changes similar to Alzheimers Disease
Which is subtle cognitive changes that are similar (but worse than) normal aging, & MAY be a pre-diagostic sign of dementia?
mild cognitive impairment
Lacunar state is result of
multiple infarcts to subcortical regions of the brain
Which is the best definition of Restorative memory approaches for memory?
work to rehabilitate memory abilities.
