1.     What are four possible causes of right hemisphere disorders?

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

2.     Ferré and Joanette, 2016 proposed four clinical profiles of individuals with right hemisphere disorders. From the following options, circle the four profiles.

a.     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.

3.     What are some recommended methods of informal assessment for communication changes after right hemisphere damage?

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).

4.     What are some well-known standardized assessment instruments developed for assessing communication after right hemisphere damage?

a.     Right Hemisphere Language Battery (RHLB; Bryan, 1994)

b.     Mini Inventory of Right Brain Injury (MIRBI-R; Pimental & Kingsbury, 2000)

c.     Burns Brief Inventory of Communication and Cognition (Burns Inventory; Burns, 1997),

d.     Rehabilitation Institute of Chicago Evaluation Clinical Management of Right Hemisphere Dysfunction-–Revised (RICE-3; Halper et al., 2010)

e.     Montreal Protocol for the Evaluation of Communication (MEC; Joanette et al., 2015)

5.     Within the SLP’s scope of practice, what are some important goals of conducting a comprehensive assessment for a person with dementia or MCI?

ASHA has indicated that SLPs play a key role in the screening, assessment, diagnosis, treatment, and research of dementia-based communication disorders.

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

Part 2: Matching

Each correct answer in this section is worth +2 points. Part 2 total points: 26

Match each type of attention (focused, selective, sustained, alternating, and divided) with the definition.

6.     Focused Attention  ______

7.     Selective Attention   ______

8.     Sustained Attention   ______

9.     Alternating Attention   ______

10.  Divided Attention   ______

focused attention: fundamental, low-level ability to orient and respond to specific stimuli in any modality.

sustained attention: the ability to maintain attention to an ongoing, repetitive task for a period of time.

alternating attention:  the ability to flexibly switch back and forth between different tasks and task instructions.

divided attention:  the ability to engage in multiple tasks simultaneously, as the most demanding type of attention in their model

selective attention: the ability to sustain attention to a target stimulus in the presence of irrelevant or distractor stimuli; here, too, working memory and a response set might be involved

Match each variant of primary progressive aphasia with a brief description of key characteristics.

11. Semantic variant   ______ 

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

12. Logopenic variant  ______

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

h.     Episodic memory impairment

13. Nonfluent variant  ______

a.     Impaired grammatical processing and/or apraxia of speech due to frontoinsular atrophy, greater in the language dominant hemisphere (Gorno-Tempini et al., 2004)

b.     Underlying pathology: FTLD-tau (Spinelli et al., 2017)

c.     May develop generalized motor disorder, including dysphagia

d.     Increasingly unintelligible and agrammatic

e.     Mutism

Match each of the following dementia types with a brief description of key characteristics.

14. Alzheimer’s disease  ______

15. Vascular dementia  ______

16. Dementia with Lewy bodies  ______

17. Frontotemporal dementia  ______

18. HIV-Associated Neurocognitive Disorders  ______

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

Part 3: Multiple Choice

Each correct answer is worth +3 points. Part 3 total points: 30

19. Which of the following instruments was designed to aid diagnosis by PPA subtype, includes a series of simple naming tasks, and is also available as an iPad app?

The Sydney Language Battery (SydBat)

20. Which of the following instruments is recommended for evaluating treatment efficacy and determining the appropriateness of speech and language interventions in PPA?

                        The Progressive Aphasia Severity Scale (PASS)

21. Which of the following is true of the diagnostic criteria of MCI but NOT the diagnostic criteria of dementia?

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

22. Select the description that best matches the sequence of procedures for delivering cognitive-linguistic treatment for aprosodia.

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.

23. Select the description that best matches the sequence of procedures for delivering spaced retrieval therapy.

1.Repeated presentation and spaced recall of target information

24. Select the description that best matches the principles behind the Montessori approach for dementia.

(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.

25. Select the description that best matches the principles behind using memory books or wallets.

1.Repeated presentation and spaced recall of target information

26. Which of the following client profiles would be the best candidate for a lexical retrieval therapy utilizing a cueing hierarchy with a rich variety of cues (semantic, autobiographical, episodic, phonological, and orthographic)?

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

27. Which client profile would be the best fit for reminiscence therapy?

                  Dementia-

28. Which of the following client profiles would be the best candidate for script training?

Primary progressive aphasia

Part 4:  Essay Questions

Instructions: Write a paragraph with a good logical flow and organization in response to each of the questions below. It should not be word-for-word exactly what is written in your textbook or any other source, identical or nearly identical to any other student, or identical to an AI-generated response; please respond in your own words.

Include at least 6 correct facts, concepts, or relevant examples to capture full points for each question. Each answer is worth 6 points. Part 4 total points: 24

29. Provide a general overview of the main cognitive and communicative changes associated with right hemisphere damage.

a.     Executive function skills enable us to control coordinate behaviours through organizational and regulatory abilities

                                                              i.     Reduced mental flexibility or set-shifting

                                                            ii.     Lack of inhibition

                                                           iii.     Poor reasoning

                                                           iv.     Reduced self-awareness

                                                            v.     Anecdotal evidence that adults with RHD have executive function deficits, but no clear evidence of direct relationship between executive function and language/pragmatics abilities – further research required

b.     Task demands likely influence performance and therefore prevalence difficulty to extrapolate

                                                              i.     Greater difficulty on passages with low predictable contexts and when spoken at faster than normal speech rates

                                                            ii.     Visual memory

                                                           iii.     Individuals with RHD score lower than neurologically typical controls on nonverbal memory tasks

c.      social perception, or the ability to interpret social cues (e.g. facial expressions)

                                                              i.     social understanding which involves the appreciation of other’s emotions, beliefs, and intensions (i.e. Theory of Mind)

                                                            ii.     social decision-making or responses to inferred meaning about others’ intentions and emotions

d.     Other impairments that may interact with or influence performance on cognitive and/or communication skills include:

                                                              i.     hemianopia - loss of sight in one half of a person’s visual field, seen in 18% with RHD (Sterzi et al. 1993

                                                            ii.     hemiplegia - paralysis or weakness on one side of the body has been reported to occur in 95% of people with RHD

                                                           iii.     somatosensory deficits (Sterzi et al. 1993)

1.     approximately 40% experience proprioception deficits (reduced ability to sense the body’s position in space)

2.     Around 57% experience hemianesthesia (unable to feel pain)

                                                           iv.     anosognosia - lack of awareness of some or all motor, sensory, perceptual, or cognitive impairments that occur following brain damage

1.     reduced awareness of deficits and its consequences is a hallmark of RHD

e.     Both comprehension and production in the linguistic domains of:

                                                              i.     semantics (lexical and/or structural)

1.     difficulty constructing meanings of words, phrases, sentences (e.g. multiple meanings of ambiguous words

2.     problems with integrating context in meaning (i.e. suppressing or inhibiting meaning)

                                                            ii.     discourse (e.g. procedural, narrative, conversation)

f.      Comprehension impairments can occur:

                                                              i.     within the phrase or sentence (e.g. metaphors, idioms, and indirect speech acts)

                                                            ii.     between and across sentences through the integration of information using different types of inferences or contextual cues

                                                           iii.     Bridging inferences: concepts/connections needed to connect 2 sentences

                                                           iv.     routinely & quickly generated by listeners/readers; rarely affected after RHD

1.     Elaborative inferences: add depth/breadth but are not needed

2.     not always generated by listeners/readers; more often affected after RHD

                                                            v.     Deficits after RHD may occur due to:

1.     generation of  correct inferences - don’t always use all relevant cues, so inferences aren’t always correct

2.     slow/inefficient revision of inference/interpretation (stick with initial interpretation too long)

3.     appreciation/use of humor which requires revision of interpretation, consideration of alternative meanings

g.     RHD most often results in:

                                                              i.     Disorganized, tangential, overly-personalized discourse production

                                                            ii.     Reduced eye contact, turn taking

                                                           iii.     Reduced use of emotionally-laden words

h.     Acropodia types: not universal, subgroups are emerging based on characteristic and severity

                                                              i.     Linguistic aprosodia:

                                                            ii.     Receptive linguistic aprosodia: impaired ability to interpret prosodic features that indicate that a question has been asked

1.     Expressive linguistic aprosodia: impaired ability to use prosodic features to indicate that a question is being asked

i.       Affective or emotional aprosodia:

                                                              i.     Receptive emotional aprosodia: impaired ability to interpret mood or emotion through prosodic features

                                                            ii.     Expressive emotional aprosodia: impaired ability to convey mood or emotion through prosodic features

30. How might one of the common deficits associated with right hemisphere disorders show up in the everyday social communication of an individual? Please illustrate with your own example.

31. Explain the diagnostic criteria for identifying primary progressive aphasia (PPA).

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.

32. On the next page, please read the descriptions of three evidence-based management strategies for dementia. These were not covered in your textbook, but you may still find them useful when working with this population. The description of each approach was taken from the ASHA Dementia Practice Portal.  For the last essay question, please select any one of these three approaches, and describe how you would maximize treatment effectiveness using one or more of the nine “Evidence-Based Features of Successful Interventions for Persons with Dementia” listed in your textbook.

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