Aphasia Test 4

Aphasia Test 4

Aphasia Test 4 YOU WILL TOTALLY KICK ASS ON THIS TEST!! Behaviors of Left Neglect Excessive use of R Margin Perseverative- strokes in writing Safety Issues- hand in spokes of wheelchair

Appear hemiplegic- looks like they are paralyzed. Cant use leg or arm Appear disinterested/unmotivated- wont smile at you or laugh at your jokes. Do not complain of disorder. Neglect Attention Disorder

Affects recovery Duration Unknown Mild to severe- spectrum mild (if you help them attend to neglected area, theyll acknowledge it) to severe (wont eat food on right side of plate). Fractionation (occurs in multiple modalities)olfactory, auditory info- we only work on comm. though- reading & writing. Assessment Informal observation- as soon as you walk in room- only looking to right. Formal testing- very preliminary, not in depth Tests of extinction (both sides of body)- testing

sensation, for ex. Which finger am I touching? etc. Line Dissection- draw a straight line, divide paper in half. Line will probably be over to the right. Cancellation- if you see A cross it out. Make xs out of target etc. Assessment Drawings - ask patient to draw semmetrical items. Draw a person, a flower, a clock etc. Reading- (read or less of text) read endings of sentences. Confabulation is good. Writing- omit letters, forget to cross t, dot

i. Perseveration, when you ask patient to write, they will write on top of their old writing. Neglect Subjective (point of view)- driven by patient. Viewer centered- depends on the position of patient (turn in wheel chair). The most important for severe neglect. Environment centered- more cognitive, there is another side to the door. Object Centered (different perspectives) looking at objects at different perspectives.

Neglect Other Modalities: Auditory- but they can understand you. For some sounds though there is neglect. Tactile- tests of extinction. Olfactory- even if there is 1 olf. Bulb neglect, you can still smell w/ other nostril. Motor- Affects contralateral movement. Client will act like hemiparesis. Directional hypokinesia (moving limbs to contralateral space) Affects dressing, applying make-up. Seems like a strangers limb, someone else stole their shoes. Etc.

Areas of Damage for L Neglect R MCA- middle cerebral artery R Frontal Parietal Lesions R Thalamus R Basal Ganglia R Hemisphere= less localization,

more holistic Theories of L Neglect Representational- disruption of internal representation of space. How I see the flower. I can tell you what the flower and clock look like but cant draw it. Attention When cued, neglect is reduced. Orienting bias- RH attends to R + L sides; LH attends to R- more specific. Dont see right neglect as often Therapy for L Neglect

Bring awareness & attention to L side. Severe deficits (tactile cue) Physical Movement (wheel chair) Moderate deficits (cue to neglected side) have them feel around the plate , TV or book. Mild deficits (teach to self cue) Im gonna have you highlight all the words on the left side of the page

Attention- Heirarchy Arousal- eye contact (keeping eyes closed in bed). Sustained Attention- attending to one thing for a prolonged period of time. Put a cold washcloth on their face. Selective Attention- knowing what is the most important task to focus on. Divided Attention (multi-task)- completing multiple tasks at the same time. More for mildly impaired. Treatment- task completion if they complete task, they can attend to it. If working on neglect, do task that addresess the area of neglect.

Goals for Left Neglect 1. client will draw symmetrical items with 100% accuracy with tactile & visual cues. 2. Client will turn to the left (look to the left) and/or describe items shown with 100% accuracy with tactile, visual and verbal cues. Mildlook to the left with 100%, highlight written text on the left side. If goal is to have a conversation, they can have a conversation for 5 minutes, attn OK. Prosody

Melodic contour rhythm of speech. Conveys meaning: Emotional content State of speaker- how is the speaker feeling? Speakers attitude toward listener- sarcastic RHD- monotone or euphoric Linguistic effects- stress & syllable duration. Ex.green house- spondee word. Nonlinguistic (emotion, humor, formality) types of prosody. Prosody cont.. Pitch is vulnerable in RHBD (its affected)

Language can be intact, but prosody impaired. Can cause divorce. Emotional prosody most impaired. Difficulty producing & comprehending emotions** Facial expressions Content of story- might not understand emotion of story. Tx- patients need to identify their own emotions and others..

Emotional Prosody Difficulty matching to emotion (pictures of sad, happy etc) Monotone (no prosodic features)- for mild populations. Prosodic contours- draw on paper where the stress should be. Ex. Yesterday was what? Reliance on semantic info instead of prosody. Must be up front and literal. Difficulty understanding sarcasm Linguistic Prosody

Difficulty with compound nouns vs. noun phrases. (ex- light house) Minimal emphatic stress (ex- she wore that dress) Cant correct prosody- can always teach them to be louder on stressed words. RH perceives linguistic & emotional prosody LH contributes to linguistic prosody. MORE PROSODY!!! Severe L Neglect= severe prosody deficits. Prosody comprehension- R Anterior & Posterior cortical lesions

Linguistic prosodic deficits- R Frontal, temporal & parietal lobes, caudate nucleus, internal capsule, thalamus. -- neglect guides how severe rest of deficits are. Prosodic exercise

List 5 sentences that provoke emotion: 1. You look beautiful. 2. Whats wrong? 3. I had an amazing day. 4. How do you feel about healthcare reform? 5. I feel like Im gonna throw up. 6. Will you marry me? 7. This food is delicious! 8. Are you serious?

Linguistic Deficits Perform normal on aphasia tests (w/ assistance for L Neglect) Problems: Convergent & Divergent thinking. Convergent: clues to the big picture- dont get humor. Ex. It is small, you sharpen it, it has lead, an eraser.. etc Divergent- single concept to more concepts (more clues) ie. problems with humor. Can only think of one meaning per word. Ex- give me 3 reasons that you would move to a different city.

Linguistic Deficits Words with dual meanings are difficult RH (works slower than LH) RH adds the nuances to language Important for single word processing Less frequent meanings Slower & Less selective than LH LH Strong semantic overlap (words w/ several meanings) Highly selective Rapid in selection

Linguistic Deficits Problems with collective nouns (eg. Furniture) Abstract categories (ex- liquids) really difficult More L Neglect= worse linguistic deficits. Problems with Generative naming. Ex FAS. Name words that begin with F, A, S. Think of 3 items that are more

abstract than 3 concrete Abstract Things that are soft Things that are rectangular shaped Things that smell bad Things that make you happy Things that turn you on Concrete Types of fish Fruits Vegetables

Farm animals Types of music Affect vs. emotion Affect- outward expression of emotion (flat affect- show no emotion, look bored) Emotion- subjective mood, state; internal experiences. How the person is feeling is not being shown. RH Dominance Theory: Perception Comprehension Expression of emotion

Emotional lability- used to describe affect- means constant crying or euphoria. Affect is impaired Problems With facial expressions (comprehension & production) Promotes social isolation Can comprehend gestures & posture Problems w/ verbal emotions (stories, conversation) Better identifying emotion when interested in story (written text)

Reduced prosody for emotional memories. Depression (DSMR-IV) 30-60% of RHD 2 or more of the following:

Poor appetite or over eating Insomnia or hypersomnia Low energy or fatigue Low self esteem Poor concentration or difficulty making decisions Feelings of hopelessness Depression and RHD Organic effects- change in neurotransmittersserotonin Reactive effects- response to deficits Refer to neuropsych Ask them if they are sad or unhappy. If they

are depressed refer out. Delusions & Confusions Agitated Confusion- will see w/ TBI, because they are forming new connections. Incoherent thoughts- similar to jargon Easily distractible Restlessness Violent outbursts Can occur w/ RHD but rare Anterior Frontal & temporal damage (prefrontal cortex and executive function

Misidentification syndromes (person, place, body parts) Will see them confabulate, make things up. Look at own body parts and not know whose they are. Reduplicative Paramnesia (place & person) Imposter- they think you are one Bifrontal or RH frontal and/or parietal lesions Korsakoffs syndrome- totally confused and paranoid. Lack of Thiamine Prolonges alcoholism- etiology Looks like Wrnickes aphasia, fluent, jargon, neologisms

Campgrass Syndrome Imposters- family members, friends- get neuropsych Psychiatric component Prosopagnosia (agnosia- sensory disturbance, occur w/ tactile & visual senses) Visual agnosia- inability to recognize faces Bilateral posterior lesions No recall of familiar face Tx.- if they can recognize voices work on that.

Somatoparaphasia: Misidentification of own body parts (crossing midline) Confabulation- about whose body part it is. L Neglect RHD disrupts the feeling of being connected and united. RCVA Discourse Deficits Communicative event Info conveyed by speaker to listener(s)

Requires situations content Not all RHD have discourse problems may be high functioning patient Cognitive problems= discourse deficits. Cognition affect communication. L Neglect= discourse affected Simple discourse is intact. Right hemisphere good verbal output. Abstract words difficult. Anomia Goal During anomic episode client will use semantic

description, embedding and sentence completion Verbal cues (sentence completion)- describe cup Semantic descriptors- describe the cup, tell me the color, tell me where you find it. Visual- point to the handle etc. Word Map. Aud Comp goal Client will answer yes/no question with verbal cues Cues: repeat question, provide key words- Name Jamie?

Visual- point to Jamie. Tactile- put jamies hand on herself when asked Are you Jamie? Goals Continued

Complex yes/no questionsDo you cut the grass with an ax? How can you make it easier? Does it snow in July? Simplify to two words Repeat the ques. Gestures for snow, July. Show pictures Aud comp- major goal- UNDERSTAND CONVERSATION!!! Cognitive communication- organization is an issue. They have problems with attention, organization. L= neglect affects discourse too. TYPES OF DISCOURSE:

Procedural- perform an activity Expository- single topic/1 speaker (for TBI everything is expository) Conversation- between 1 or more speakers Narrative- event or story. Most difficult because it requires organization and structure. Problems: Inferencing: Individual clues missed (attn) Irrelevant clues selected No intergration of clues (ie. No big picture) Dissassociation of clues to prior experience

Indirect requests (ex. Boy, its cold in here) Sarcasm (ex graceful!) Humor (problems with punchline) More deficits Misunderstanding gist if info (macrostructure)

Difficulty with implied meaning (inferencing) Providing alternative meanings Lack of referent usage (Sam- who is Sam?) Lack of sensitivity to communication content (ie. Comm. knowledge with listener Higher level language Figurative Language (Raining cats and dogs) Literal info is easier (ie. Reduce sarcasm)

Cognitive Deficits: WM- short term Attention (because of L neglect) Organization Problem solving Executive Function- lack insight etc. Speed of processing- a lot slower..

Pragmatic Deficits (Social Language) Initiation Roles & Purpose (ex- code switching) Turntaking (verbose, tangential) Poor eye contact- related to L neglect Poor organization

Theory of Mind Understanding internal mental state of others (requires inferencing) Assists in interpretation of external behavior Informs about motivation(s), emotional state & knowledge base. Evaluation of RHB

Medical chart Interview Informal assessment Formal testing: Burns Brief Inventory (neuropathologies & RH) MIRBI-2 (mini inventory of right brain inventory) Rehab institute of Chicago Assessment Review Findings Areas of Assessment

Cognitive (exec function, attn) Orientation- to person, place, time, event L neglect- tests of extinction, writing etc. Discourse- Convo. Prosody- listen for lack of prosody Affective disorder- outward signs of emotion (wont get it)

Higher language function- abstract language Pragmatic abilities- give them some jokes Screening 20 minutes Tell me where you are today What kinds of problems have you noticed?

What are your future plans? What does your family/friends think about your plans? What are you going to do today? What kinds of people have you seen here? Screening cont

Picture: humor or inferencing Emotion Affect Prosody Higher lang function L neglect L neglect Screening

Cancellation task- make xs out of paper. Symmetrical drawing- clock, flower, person Line Bisection- draw a line, divide it in half Tests of extinction- touch hands or both hands Reading/Writing- everything presented at midline

Recently Viewed Presentations

  • Gender Roles and Relationships - Job Corps

    Gender Roles and Relationships - Job Corps

    Gender Roles and Relationships. ... What are some female gender stereotypes? Emotional. Nurturing. Clean. Good mother. Takes care of the house. Can't drive. Nag. What are some male gender stereotypes? Tough. Unemotional. ... Provide a good income? Be good at...
  • Putting Our New Traditions Workbook to Work: 7-12

    Putting Our New Traditions Workbook to Work: 7-12

    Each of us has something to offer. The simple, priceless gift we give each other is the recognition of our humanity. The very best we can give is ourselves-we give freely, and what we give is hope. No one certify...
  • "Dyspnea" A Cardiologist Perspective

    "Dyspnea" A Cardiologist Perspective

    "Dyspnea" A Cardiologist's Perspective Case Stress Test: She exercised for 4 minutes and 35 seconds of a standard Bruce Protocol. She reached a heart rate of 157 beats per minute (99% max predicted), Blood pressure 188/95.
  • Loving the Universe - St. Lawrence University

    Loving the Universe - St. Lawrence University

    A sea of light and particles. quarks that make up protons & neutrons. electrons, muons and other leptons (tiny!!) Uniformly bright. light coming from everywhere! like a very bright fog. the Universe was opaque. After a few hundred thousand years...
  • A 64-year-old female with an incidental aneurysms

    A 64-year-old female with an incidental aneurysms

    Giordan et al. 47 year-old male with history of smoking and hypertension. Sudden onset of headache. Admission Head CT showed subarachnoid hemorrhage with epicenter in the interpeduncular cistern
  • Part III - University of Northern Iowa

    Part III - University of Northern Iowa

    Empirical Research Continued Research from California: 1$ spent saves 7 across states. Hester and Miller found that these treatment modalities were proven to be most effective: brief intervention, motivational interviewing (MI), use of the medication naltrexone, social skills training, aversion...
  • Chapter 25, Section 3 "Americans Face Hard Times"

    Chapter 25, Section 3 "Americans Face Hard Times"

    Most headed west looking for work, particularly in California ... Radio and movies often were upbeat to take people away from their problems. The opposite was often true of art, music, and literature. Common themes were ones where the difficulties...
  • Remote-sensing profiling instruments in Helsinki Testbed Jani Poutiainen

    Remote-sensing profiling instruments in Helsinki Testbed Jani Poutiainen

    Frequency 2-3 kHz Minimum height 75-150m Maximum height 1-1.5km Range resolution 60, 100, 200, 400m In Testbed conf: lowest range 149 m, up to 400 ..1500 m, step 62 m Temperature accuracy 1 °C Averaging time 3-60 minutes Sound pressure...