Copyright © 2008 Delmar. All rights reserved. Unit Nine Neurological Disorders in Adults.

Unit Nine

Neurological

Disorders in Adults

Chapter 35

Causes of Neurogenic

Speech, Language, Cognitive,

and Swallowing Disorders

Strokes (CVAs)

• Third leading cause of death in United States

• Average age of stroke is 67 years

• Strokes cause brain damage due to a disruption of blood flow

F.A.S.T

• A test to determine if a person is having a stroke:

• F: Face

• A: Arms

• S: Speech

• T: Time

Occlusive Strokes

• Brain is deprived of blood due to blocked artery

• 80 percent of all strokes

Cerebral Embolism

• Fragment of material travels through the circulatory system– Reaches an artery in the brain where it

occludes a blood vessel

Cerebral Hemorrhage

• Rupture of a blood vessel sending blood into brain tissue

• 20 percent of strokes

Multicultural Considerations

• Risk factors for strokes are generally the same for all ethnic and cultural groups

Recovery from Strokes

• Most recovery occurs in the first weeks and months after a stroke

Traumas

• Leading cause of death in people under 35 years

• One-half to two-thirds caused by motor vehicle accidents (MVA)

• Frontal lobe is most commonly damaged area

Tumors

• An abnormal growth of tissue that can cause communication and swallowing problems

Toxins

• Substances that poison or cause inflammation of the CNS

Chapter 36

The Aphasias

Aphasia

• A deficit in language processing that may affect all input and output modalities

Aphasia Classification

• Receptive aphasia (fluent)– Associated with lesions posterior to the

Fissure of Rolando

• Expressive aphasia (dysfluent)– Associated with lesions around Broca’s

Language Characteristics of Fluent Aphasia

• Auditory and reading comprehension impairments

• Speaking rate of 100 to 200 words per minute

• Normal articulation

• Syntactic errors

• Little content or meaning

Wernicke’s Aphasia

• Fluent aphasia caused by damage to Wernicke’s area in posterior superior left temporal lobe

• See Figure 36-1

Anomia

• Impaired ability to remember names of people, places, or things

Paraphasias

• Literal/phonemic– Substitutions of intended sounds for

sounds in words

• Verbal/semantic– Word errors, which may be related to the

intended word

Paraphasias

• Neologisms – Combining C and V to make new “words”

Anomic Aphasia

• Persistent and severe difficulty retrieving names

Conduction Aphasia

• Rare syndrome

• Patients have difficulty repeating multisyllabic words, phrases, and sentences

Transcortical Sensory Aphasia

• Fluent aphasia with damage to left posterior temporoparietal region

• Patients have impaired comprehension and naming combined with echolalia

Language Characteristics of Nonfluent Aphasia

• Relatively good auditory comprehension

• Difficulty initiating speech

• Reduced speech rate

• Effort when speaking

• Abnormal intonation and prosody

Broca’s Aphasia

• Nonfluent aphasia

• Site of lesion in lower posterior region of the left frontal lobe in the premotor cortex

• Patient may have right-sided weakness or loss of movement

Transcortical Motor Aphasia

• Relatively good auditory comprehension

• Speech is nonfluent, agrammatic, and telegraphic

• Damage is to frontal lobe– Not including Broca’s area

Global Aphasia

• Combination of fluent and nonfluent aphasia

• Usually caused by occlusion of left middle cerebral artery

Assessment of Aphasia

• Receptive language

• Expressive language

• Nonverbal communication

• Reading and writing

Standardized Tests

• A variety of standardized tests are available

• Subtests from a variety of tests may be administered due to time constraints

Principles of Therapy

• Select functional behaviors

• Begin with easier tasks

• Provide feedback

• Train patient to self-monitor and self-correct

• Provide family education

Approaches to Therapy

• Restorative approach – Focus on improving underlying processes

that are impaired

• Compensatory approach– Provide strategies for persistent deficits

Chapter 37

Cognitive Disorders

Cognitive Impairments

• Impaired ability to process and use incoming information

Cognitive Disorders

• Three most common etiologies:– Right-hemisphere damage (RHD)– Traumatic brain injury (TBI)– Dementia

Right-Hemisphere Functions

• Arousal and attention

• Orientation

• Visual perception

• Emotional experiences

• Temporal order

• Cognition

RHD: Visual Spatial Impairments

• Difficulty associating objects that can be seen with their spatial relationships

RHD: Attention Impairments

• Difficulty staying focused on tasks

• Shifting attention from one task to another

RHD: Communication• Literal interpretation of language

• Difficulty with social aspects – Turn-taking, topic maintenance

• Naming problems

Assessment

• Similar procedures to those used with patients with aphasia

Principles of Therapy

• Focus on functional outcomes:– Attention– Memory– Orientation to time, place, etc.– Pragmatics

Traumatic Brain Injury (TBI)

• Closed Head Injury

• Open Head Injury

Closed Head Injury (CHI)

• Most common type of TBI

• Skull receives impact and may be fractured but it is not penetrated

• Two-thirds classified as “mild” with no loss of consciousness (LOC) or less than 30 minutes LOC

CHI Impairments

• Difficulty concentrating under distracting conditions

• Multitasking

• Attention, memory, and higher level cognitive difficulties

Open Head Injuries

• Skull and brain are penetrated by impact or projectiles

• Often have significant impairments

Cognitive Impairments of TBI

• Attention

• Memory

• Orientation

• Reasoning and problem-solving

• Executive functions

Language Impairment of TBI

• Auditory comprehension

• Anomia

• Pragmatics

• Reading and writing

Principles of Assessment for TBI

• Many patients may not be immediately testable

• Assessment results one day might differ the next day if patient changes

Principles of Therapy for TBI

• Environmental control

• Behavioral management

• Orientation therapy

• Cognitive retraining

• Compensatory training

Dementia

• A syndrome caused by acquired neurological diseases that involves intellectual, cognitive, and personality deterioration

Alzheimer’s Disease

• Most common progressive dementia

• Typically begins after age 65

• Decline in intellect, memory, communication, and personality

Stages of Alzheimer’s Disease

• Stage I – Mild – Forgetfulness

• Stage II– Moderate – Confusion stage

• Stage III– Severe – Terminal stage

Assessment of People with Dementia

• People in stages I and II of Alzheimer’s are testable

Principles of Therapy for People with Dementia

• Maximize current cognitive-linguistic abilities

• Slow the deterioration of those abilities

• Goals must be functional

Chapter 38

Speech Disorders

Motor Speech Disorders

• Neurological impairments affecting the motor planning, programming, neuromuscular control and/or execution of speech

Dysarthria

• Group of speech disorders – Characterized by weakness in the muscles

that control respiration, phonation, resonation, and articulation

Myasthenia Gravis

• Chronic fatigue and muscle weakness

• Occurs in females more than males

Parkinson’s Disease

• Gradual deterioration of nerve centers in the brain

• Speech and swallowing can be affected

Amytrophic Lateral Sclerosis

• Rapidly progressive degeneration of motor neurons that run from the brain to the muscles for control of movement

• Males affected more than females

Impaired Respiratory System

• Short inhalations decrease air for speech

• Short phrases

• Inadequate voice loudness

Impaired Phonatory System

• Breathy voice quality

• Decreased loudness

Impaired Resonatory System

• Hypernasal resonance is heard in speech

• Decrease in speech intelligibility

Impaired Articulatory System

• Imprecise articulation of consonants

Types of Dysarthria

• Spastic

• Ataxic

• Flaccid

• Hyperkinetic

• Hypokinetic

• Mixed

Assessment of Dysarthria

• Case history/medical history

• Evaluation of the speech systems– Respiratory, phonatory, resonatory,

articulatory

• Instrumental analysis

Principles of Therapy for Dysarthria

• Maximize the effectiveness, efficiency, and naturalness of communication

Apraxia of Speech

• Deficit in neural motor planning and programming of articulatory muscles for volunteer movements for speech in the absence of muscle weakness

Characteristics of Apraxia of Speech

• Variable articulation errors

• Sound substitutions more frequent

• Errors increase with length of utterance

• “Groping” behavior

• “Islands” of fluent speech

Assessment and Therapy of Apraxia of Speech• Evaluation of the speech systems

• Primary goal of therapy is to maximize effectiveness, efficiency, and naturalness of communication

Chapter 39

Emotional and

Social Effects of

Neurological Disorders

Emotional and Social Effects

• Entire family is affected by a stroke

• Family systems theory is applicable to clients and families when a neurological disorder has occurred

Emotional Effects

• Self-image/self concept changes

• Families go through the stages of grief

Social Effects

• Social lives are altered or diminished

• Jobs may be lost

• Financial expenses due to loss of work and cost of medical care

Copyright © 2008 Delmar. All rights reserved. Unit Nine Neurological Disorders in Adults.

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