neuro eval lect 5a

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neuro eval lect 5a
2012-10-18 17:17:28
neuro eval lect

neuro eval lect 5a
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  1. communication def
    • exchange of info thru common network or system of symbols
    • speech is the art of communication
  2. language def
    • formal set of rules used in communication for formation and transfrer of info by way of symbols
    • can be verbal, speech, or non-verbal communication
  3. examples of non-verbal communication
    hand gestures, sign language, eye contact, body language, written info, facial expresuions, gestures, nodding, intonation/pitch/loudness of voice
  4. most CVAs are where?
    L side - in L middle cerebral artery
  5. receptive vs expressive language function
    • receptive: hearing, comprehension, thought/word finding (when you're listening to someone and have to figure out what word she used)
    • expressive: thought/word finding, voice production, articulation
  6. sensory components of language
    • visual (ASL, watching nonverbal cues)
    • auditory
  7. motor components of lang
    • oral
    • written
    • gestures -- someone with expressive aphasia may need to use writing or gestures or
    • symbols
  8. neuroanatomy of lang - primary auditory sensory area
    Area 41 of Sub Temporal Gyrus (Heschi’s Gyrus)
  9. neuroanatomy of lang - auditory association cortices for sensory of hearing
    Area 42 of Sup Temporal Gyrus (Heschi’s Gyrus)

    Wernicke’s area – Post portion of area 22 of superior Temporal Gyrus
  10. neuroanatomy - primary area for motor function of lang
    Broca's area: located in frontal lobe near primary motor cortex
  11. Broca's area is responsible for ...
    • speech
    • puts together info in front of brain on what you want to say
    • coordinating the control of speech (speed of mouth, tongue movements, tone of voice, volume, etc)
  12. arcuate fasciculus
    connects Broca's area and Wernicke's area, carrying communication btwn them
  13. logorrhea
    verbal diarrhea
  14. Wernicke's aphasia aka fluent aphasia
    • problem with the receiving of language, both spoken and written
    • pt can't understand the written and/or spoken word despite intact hearing and vision
    • pt's speech is illogical sequence of words, though you might be able to pick out the intent - pt is unable to self-monitor this logorrhea
    • a construction, not production, problem
    • pt knows she's not making sense, so it's pretty frustrating for her
  15. tests for visual sensory language dysfunction
    ask pt to read a word on a flashcard or read a written passage
  16. test for expressive aphasia
    ask pt to asociate  word w a picture on a card ("is this a pic of a bird?")
  17. test for auditory sensory language problems
    • say "point to..." the door, window, etc
    • say "repeat what I say"
  18. auditory sensory lang problems
    inability to recognize speech sounds or comprehend the spoken word
  19. expressive/motor aphasia aka __ or __
    • Broca's aphasia
    • non-fluent aphasia
  20. expressive/motor aphasia def
    • inability to produce word or words, but no problem with motor apparatus of speech
    • pt will appear to hesitate, try to adjust for errors
    • ranges from small word problems to complete loss of speech
    • HOWEVER can comprehend just fine, so the pt will be aware of her sounds and be hesitant to hopen her mouth
    • common in pt's w CVA
  21. odd quirk of expressive/motor aphasia
    • automatic language is usually in tact (ie singing)
    • can't write, can paint
  22. testing oral problems for pts w Broca's aphasia
    • pt appears to know what to say but can't get words out
    • test: listen to speach repetoir and ask pt to repeat what you say
  23. testing written problems for pts w Broca's aphasia
    • ask pt to write a thought or phrase
    • pt may have agraphia
  24. agraphia
    • seen in pts w Broca's aphasia
    • can't write or print words despite strength and coordination in UE intact
  25. global aphasia
    both systems - Wernicke's and Broca's affected, so it's a combo of sensory and expressive aphasia
  26. global aphasia is most likely due to ...? associated with...? __ can be retained?
    • a large cortical lesion (MCA)
    • hemiparesis
    • ability to gesture
  27. test for global aphasia
    • communication w gestures: test this w observation of whether pt understands your gestures.
    • pt may not be able to intentionally formulate and respond w gestures, but may be able to make spontaneous meaningful gestures (pointing to water when thirsty)
  28. conduction aphasia due to what pathology in anatomy?
    discruption of arcuate fasciculus
  29. conduction aphasia - what's intact? what's lost?
    • (pretty rare)
    • speech is intact
    • primary deficit is seen in repetition, paraphasias (reordering words or switching first letters of words), and substitutions (umbrella where she meant elevator)
  30. test for conduction aphasia
    ask pt to repeat a series of words, gradually increasing the difficulty