Neurogenic Disorders Ii

Stroke, traumatic brain injury, brain tumor, neurodegenerative disorders.

Ferré and Joanette (2016) have identified four clinical profiles characterized by (a) primarily prosodic impairments; (b) deficits during conversational discourse; (c) emotional prosody, narrative discourse, and semantic impairments that are generally mild to moderate in severity; and (d) severe deficits across multiple areas, including semantics, prosody, narrative discourse, and conversation.

a.     Informal observations: Observe client in various settings communicating with various people and engaging in different communication-based tasks (e.g. writing an email)

b.     Analyse discourse samples: Talk to families to understand pre-stroke communication styles and identify what has changed.

c.     Utilise an approach such as Ylvisaker’s hypothesis testing when considering the impact of cognitive impairments on communication competence (see Coelho et al., 2005).

Right Hemisphere Language Battery (RHLB), Mini Inventory of Right Brain Injury (MIRBI-R), Burns Brief Inventory of Communication and Cognition (Burns Inventory), Rehabilitation Institute of Chicago Evaluation Clinical Management of Right Hemisphere Dysfunction-–Revised (RICE-3), Montreal Protocol for the Evaluation of Communication (MEC).

1.     Identifying early the presence of cognitive communication impairment in dementia and MCI

2.     Documenting impaired and spared cognitive and communicative abilities

3.     Completing a culturally valid and linguistically appropriate assessment of client functioning

4.     Establishing a baseline of cognitive-communicative function, before initiating intervention

5.     Assessing personal and environmental factors that influence a particular client or family

6.     Providing information and resources about dementia or MCI and counseling family members about expected symptom progression

7.     Using dynamic assessment approaches or structured therapy trials to determine client candidacy for particular interventions or need for stimulus presentation in alternate modality

Ability to orient and respond to specific stimuli.

Sustaining attention to a target stimulus amidst distractors.

Maintaining attention to an ongoing task.

Flexibly switching between different tasks.

Engaging in multiple tasks simultaneously.

1. a.     Loss of semantic knowledge due to anterior temporal lobe atrophy, greater in the language dominant hemisphere (Gorno-Tempini et al., 2004)

   b.     Atrophy spreads throughout semantic network, eventually affecting frontal and parietal lobes as well

   c.     Progressively empty speech

   d.     Behavioral symptoms may emerge: Compulsions, Disinhibition, Personality changes, Altered eating preferences, Worsening dysexecutive symptoms

2. a.     Impaired phonological processing due to temporoparietal atrophy, greater in the language dominant hemisphere (Gorno-Tempini et al., 2004)

   b.     Underlying pathology: Alzheimer’s disease (Spinelli et al., 2017)

   c.     Atrophy begins to extend anteriorly into anterior temporal lobes, eventually affecting frontal lobe as well

   d.     Jargon-like aphasic production

   e.     Comprehension deficits emerge

   f.      Especially for long, complex utterances

AD: Single most common cause of dementia, Episodic memory deficit, Working memory deficits, Attention and executive function impairments, Language and communication impairments adversely affecting lexical retrieval and discourse

•        VD: Considered the second most common cause of dementia, Caused by ischemic or hemorrhagic cerebrovascular disease, cardiovascular disease, or circulatory disturbances that damage brain areas vital for memory and cognitive functions, Risk factors are: Hypertension, Hypercholesterolemia, Type II diabetes mellitus, Prior history of stroke, Smoking

•        DLB:  is biologically related to Parkinson’s Disease (PD), Both conditions share pathological hallmark of the presence of Lewy bodies, Lewy bodies are abnormal clumps of the neuronal protein, alpha-synuclein, Persistent and complex visual hallucinations or other sensory hallucinations, Visuospatial impairment, Sleep disturbance,Fluctuating attention and vigilance,Gait imbalances or Parkinsonian movement features, Reduced speech rate and fluency, Executive function impairments – cognitive inflexibility

•        FTD: results from frontotemporal lobar degeneration (FTLD) neuropathology, FTLDs are a heterogeneous group of rare neurodegenerative syndromes that can result in significant impairments of communication and/or movement (National Institute on Aging, 2012), FTLDs are characterized by: Progressive, focal atrophy of the frontal and anterior temporal brain regions, Spongiform changes in the cortex, Abnormal tau protein inclusions

•        HIV related- May present as: Asymptomatic neurocognitive impairment, ability to independently complete ADLs, Mild NCD, mild impact on ADLs, or, HIV-Associated Dementia (HAD), inability to complete ADLs

Sydney Language Battery

Progressive Aphasia Severity Scale (PASS)

identified three criteria for a diagnosis of MCI: (a) self-report of memory problems, with corroboration from a family member or caregiver; (b) measurable memory impairment on standardized testing, outside the range expected for age- and education-matched healthy older adults; and (c) no impairments in reasoning, general thinking skills, or ability to perform ADLs

1.Clinician provides a written description of tone of voice; client explains it back to the clinician.

2.Client matches name of emotion to description and matches picture of facial expression to description.

3.Client reads target sentence with appropriate prosody. Description, name, and face are available.

4.Client reads sentence with appropriate prosody. Name and face available.

5.Client reads sentence with appropriate prosody. Only face is available.

6.Client reads sentence with appropriate prosody. No cues are available.

Gradual onset, language disturbance as the primary symptom for at least 2 years, and disruptions in daily life related to language problems.

Repeated and rich presentation of target information, contexts for learning by doing, ways to capitalize on cognitive capacities, cognitive stimulation, task formats reducing errors, exposure to sensory stimuli, structured cues, creative activities, community engagement.

(a) breaking down tasks into component steps, (b) using guided repetition and cuing to support task completion, (c) progressing through tasks sequentially, and (d) moving from tasks based on simple, concrete concepts to those involving more complex, abstract concepts.

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1.Repeated presentation and spaced recall of target information

Researchers have also implemented cueing hierarchies utilizing semantic, autobiographical, episodic, phonological, and orthographic cues to treat anomia in lvPPA.

         Dementia-

Primary progressive aphasia

Mesulam (2001), to be conferred a diagnosis of PPA, an individual’s language disturbance must have had a gradual onset and should be the initial and primary symptom for at least the first 2 years and must remain the most prominent impairment throughout disease progression. In the early stages of the disease, any disruptions in daily life should be related to language problems. PPA diagnosis is not appropriate if visuospatial processing impairments, episodic memory deficits, or behavioral disruptions are prominent in the initial stages of the disease or if deficits can be clearly linked to stroke, brain tumor, traumatic brain injury, or psychiatric conditions.

1.Repeated and rich presentation of target information

2.Contexts for learning by doing and multiple opportunities to practice generating target responses

3.Ways to capitalize on relatively spared cognitive capacities (such as sustained attention)

 4.Cognitive stimulation to activate experience-dependent neuroplasticity

5.Task formats that reduce the likelihood of errors during initial learning and increase the chance of early success

6.Exposure to personally meaningful, tangible sensory stimuli

7.Structured cues or cueing hierarchies that support information retrieval

 8.Opportunities for creative and symbolic activity (e.g., using art, music, gardening)

 9.Experiences that offer community engagement, intergenerational programming, and regular physical activity