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Acquired comm. disorder that impaired a person’s ability to process lang, but does not affect intelligence. Impairs the ability to speak & understand others, & most people experience difficulty reading & writing.
5 phase model of outcomes research
- 1. Determine if treatment is safe
- 2. Treatment outcome
- 3. Efficacy (can the treatment work controlled setting)
- 4. Effectiveness (does treatment work-real world)
- 5. efficiency
levels of evidence
- I- randomized controlled
- II- quasi experiments
- III- non experimental study (descriptive, correlational)
- IV- expert opinion, case study
major landmarks in history
- ancient times: theory of fluids; the Greco roman period; ventricular theory
- middle ages: aphasia is a memory disorder due to phlegmy ventricles.
- Renaissance, 17th century, 18th century: overall advances in medicine; more thorough examinations of people with neurological conditions; soul matters; Newton’s vibes.
landmarks in history from 19th century
- paul broca: it’s more toward the front
- the brain of leborgne
- carl wernicke: the back also matters
landmarks in history from 20th century
luria’s functional system: lang competence & lang performance
- Brocas: (-) fluency, repetition; (+) comp
- Motor: (-) fluency; (+) comp, repetition
- Wernicke's: (-) comp, (+) fluency
- Sensory: (-) comp (+) fluency, repetition
- Conduction: (-) repetition (+) fluency, comp
- Anomia: (-) naming (+) fluency, comp, repetition
- Global: (-) all
- AC SW MB _G
world health organization & aphasia
impairment; activity limitation; participation restriction
central/peripheral nervous system (structural)
- CNS: structures are housed within bone (skull/vertebral column)- brain & spinal cord.
- PNS: contains nerve fibers that connect the CNS to the muscles & sense organs. Housed outside of bone.
autonomic/somatic nervous system (functional) & sympathetic/ parasympathetic nervous system
- SNS: voluntary control. Pyramidal- arises from motor strip; conscious initiation of movement. Extrapyramidal- arises from pre-motor strip; provides muscle tone, background support for movement.
- ANS: functions of internal organs & glands. Sympathetic system- responds to stimulation thru energy expenditure (fight or flight- raise heart rate). Parasympathetic system- responsible for quieting the body & conserving energy (undoing sympathetic stimulation)
- 2 layers of tough lining mostly attached to skull; most superficial
- falx cerebri- separates 2 hemispheres of cerebrum; mid-sagittal divion of cerebrum
- falx cerebelli- separates 2 hemispheres of cerebellum
- tentorium cerebelli- horizontal dural shelf at base of skull that deivides cerebral & cerebellar regions
- diaphragma sella- forms anterior horizontal boundary b/w cerebrum & optic chiasm
arachnoid mater, pia mater, functions
- arachnoid mater- lacey, spiderlike lining; many blood vessels thru this space; cerebrospinal fluid flows thru this layer
- pia mater- thin fascia-like covering; closely follows the contours of brain
- function: protect brain; hold structures in place during movement; provides support for brain structures.
ventricles & cerebrospinal fluid
- CSF: surrounds CNS- provides cushion for neural tissue; participates in nutrient delivery & waste removal. Flows thru 4 ventricles in brain & arachnoid mater- CSF is produced by choroid plexus within each ventricle.
- Lateral ventrical (paired)- composed of 4 spaces bounded superiorly by the corpos callosum & extending into each of the lobes of cerebrum
- 3rd ventricle- located b/w left & right thalami & hypothalami
- 4th ventricle- diamond shaped; projects upward from central canal of spinal cord & lower medulla.
cerebrum structure & organization
- grey matter (cortex)- flat sheet of cells; has many folds to reduce volume.
- White matter- connects the cerebrum to the rest of nervous system; strads of cells from bottom of sheet; connections within cerebrum as well (corpus collosum connects 2 hemispheres- white matter)
- Divided into right & left hemispheres, each divided into 5 lobes.
- 3 cell types- pyramidal cells (involved in motor function, with distant connections); nonpyramidal cells (small & star shaped, with local connections; sensory or intercommunicative in function); glial cells (provide nutrition & waste disposal; provide blood-brain barrier)
- vertical organization- from superior to deep- molecular layer- glial cells, incoming axons from other layers; eternal granular layer- small pyramidal cells; external pyramidal layer- large pyramidal cells; 2 external layers mostly for motor function.
- longitudinal fissure- separates right & left hemispheres.
- Gyri- ridges
- Sulci- valleys (valleys still contain grey matter)
- 4 lobes plus insular lobe deeper within folds of cerebrum (bounded by circular sulcus) plus limbic system- collection of structures related to emotion & affect.
frontal lobe landmarks
- most cognitive functions (higher thinking); planning (including motor tasks); initiation & inhibition of activity
- broca’s area (frontal operculum)- important for speech motor planning
- orbital region- the region of the inferior frontal gyrus overlying the eyes (associated with memory, emotion, motor inhibition, & intellect)
- precentral gyrus (motor strip)- site of initiation of voluntary motor movement
parietal lobe landmarks
- location for somatic (body) sensory reception (not special external senses)
- postecentral gyrus (somatosensory cortex)- sensory counterpart to the motor strip; organized in the same way (contralateral & inverted)
temporal lobe landmarks
- site of aditory reception (important for auditory & receptive lang processing)
- heschl’s gyrus (area 41)- all auditory info is projected here
- area 42- higher order processing region for auditory stimulation
- wernicke’s area (area 22)- damage here results in disturbances of spoken lang decoding
occipital lobe landmarks
region responsible for receiving visual stimulation & higher-level visual processing
involved with maintaining the body (blood chemistry, hydration) & with emotion
subcortex landmarks & functions
- limbic system- integration points for info to/from cerebrum & cerebellum & brainstem
- basal ganglia- motor
- hippocampus- memory
- thalamus- sensory
- carotid supply- left & right internal carotid arteries feed into circle of willis.
- Vertebral supply- left & right vertebral arteries combine & become basilar artyery; basilar artery feeds in to circle of willis.
- Circle of willis- series of junctures b/w arteries that completely encircles optic chiasm; provides redundant pathways for blood flow to regions of cerebral cortex; interconnections are communicating arteries.
hindbrain structures & functions
- primitive part of the brain involved in basic autonomic survival functions & in low-level details of movement.
- Cerebellum- sensory/motor integration
- Brainstem- reflexes & sensory/motor transmission. Controls basic body functions like heart rate & breathing.
- Medulla- consists primarily of transmission pathways; pyramidal tract- carries signals to muscles from cortex; pyramidal decussation- motor commands from one hemisphere cross to serve the opposite side of body.
- Pons- connects motor planning centers of brain to cerebellum
- Midbrain- connecting link b/w lower & higher brain centers; connects cerebellum to cerebrum & basal ganglia; relays auditory & visual info.
- I olfactory- smell
- II optic- sight
- III occulomotor- eye movement
- IV trochlear- eye movement
- V trigeminal- sensation in face, contraction of chewing muscles
- VI abducens- eye movement
- VII facial- taste; contraction of facial muscles
- VIII vestibulcochlear- hearing & balance
- IX glossopharyngeal- taste;
- X vagus- sensation & movement of heart, lungs, larynx, pharynx
- XI accessory- neck & shoulder muscles
- XII hypoglossal- tongue movement
- Oh Once One Takes The Anatomy Final A Good Vacation So Heavenly
- structural imaging: looking at structure of brain (CT, MRI, cerebral angiography
- functional imaging: physiologic response to a stimuli (PET, fMRI, EEG
CT, MRI, PET, EEG/ERP
- CT (structural)
- MRI (structural): magnetic resonance imaging (magnetic current is applied)
- PET (functional): positron emission tomography
- EEG/ERP: brain electrical activity mapping (electroencephalograph); event-related evoked potentials
cautions about interpreting neuroimaging results
- Since We can see in the brain, we are tempted to correlate every possible thought or action with some specific area of the brain that might light up on an image
- Just b/c one area of the brain lights up, does not mean that it is the sole area responsible for a function
- Just b/c one area of the brain lights up, does not mean that it is the only area that can do a function
cranial nerve assessment & disorders
- I olfactory: smell; test id of odors; anosmia, frequently disrupted following TBI
- II optic: vision; tests visual acuity, color vision, visual fields, pupils, papillary responses to light, accommodation & condition of optic disk; vision loss, visual field cut (hemianopsia), papilledema (optic disk swelling), pallor (fading of optic disk)
- III, IV, VI: eye movement; tests by observing the eyes at rest & during volitional movements; III oculomotor- diplopia (double vision), ptosis (drooping eye lid), loss of accommodation, downward & outward rotation of affected eye. IV trochlear- diplopia, upward deflection of eye during forward gaze. VI abducens- diplopia, inward deflection of affected eye at rest, inability to rotate eye laterally
- V trigeminal-facial sensation, chewing & proprioception; tests corneal reflex, jaw-jerk reflex, open & close jaw against resistance, sensitivity to touch, pain & temp in face; weakness of jaw muscles (impaired chewing), facial numbness, trigeminal neuralgia (severe facial pain), trismus (excessive contraction of facial muscles)
- VII facial: facial expression, taste, sensation of tonsils, soft palate, external & middle ear, & salivation. Tested by moving facial muscles; upper & lower facial weakness (palsy), loss of taste, dry mouth (xerostomia), dysathria.
- VIII vestibulocochlear- tests hearing acuity; vertigo, nystagmus, disequilibrium, deafness.
- IX & X: motor- swallowing, observation of velum; sensory- gag reflex, swallowing reflex, IX- taste sensation on tongue
- IX glossopharyngeal- dysphagia, dysarthria, loss of taste, anesthesia of pharynx, xerostomia.
- X vagus: dysphagia, hoarseness, palatal weakness, cardiac dysfunction
- XI accessory- weakness of head & shoulder muscles, comprised respiration
- XII hypoglossal: weakness/atrophy of tongue (deviates to damaged side), fasciculations, dysarthria, dysphagia
- Ischemic: clot
- Hemorrhagic: bleed
other neurological causes of cognitive-comm disorders
Intracranial tumors, hydrocephalus, infections & toxins, nutritional & metabolic disorders
- Neural plasticity: micro level; cellular level; neural level; biochemical, physiologic & structural changes
- Behavioral plasticity: macro level; behavioral level; system level
recovery vs compensation
- Recovery: restoration of function within the cortex in an area that was initially lost after injury. Reperfusion hours after stroke (restoration of blood flow). Very multifaceted & based on individuals themselves, across time, & across individuals
- Compensation: different neural tissue takes over functions lost after injury
neurological factors related to recovery
Hemorrhage (better recovery) vs ischemia; lesion size (specific to structures)- larger lesion results in lesser change of recovery, but it specific to structure; initial severity; time post onset.
individual factors related to recovery
Age; education; handedness (left handers have better recovery); health status.
primary changes after stroke
- Structural changes (within neuron)- regenerative sprouting, collateral regenerative sprouting (no lesion)
- Functional changes (neural connections)- relatively ineffective synapses, denervation sensitivity (nerve connections become too sensitive & connection doesn’t take place), synapse potentials (learning & memory)
- Diaschsis: have lesion in one part of brain, but have loss of function in another part of brain that is in far distance of lesion.
- Restoration: everything is physiologically restored.
- Recruitment: enlisting other parts of brain that weren’t used to facilitate neurological recovery.
- Retraining: rehab, obtain new or additional functions.
- Functional takeover: right hem places more of a role in lang, than damaged left hem. Functionally, a diff part of brain is taking over
- Restitution-restoration-reactivation: total restoration of a behavior/system
- Reorganization-reconstitution-substitution within a functional system: rerouting system but can come up with same end result.
- Facilitation: ways to get behaviorally the result that you want
- Functional substitution- functional reorganization-functional compensation: know that person won’t have neurological recovery, so you compensation for those losses.
how does neuroplasticity inform behavioral therapy
- Behavioral manipulation can modify neuronal organization
- The goal is informed behavioral therapy based on specific neuronal plasticity mechanisms
principles of experience-dependent plasticity
- Use it or lose it: failure to drive specific brain functions can lead to functional degradation
- Use it & improve it: training that drives a specific brain function can lead to an enhancement of that function
- Specificity: the nature of the training experience dictates the nature of the plasticity
- Repetition matters: induction of plasticity requires sufficient repetition
- Intensity matters: induction of plasticity requires sufficient training intensity
- Time matters: diff forms of plasticity occur at diff times during training
- Salience matters: the training experience must be sufficiently salient/relevant to induce plasticity
- Age matters: training-induced plasticity occurs more readily in younger brains
- Transference plasticity: plasticity in response to one training experience can enhance the acquisition of similar behaviors
- Interference: plasticity in response to one experience can interfere with the acquisition of other behaviors