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Adult Lang Disorders
| Question | Answer |
|---|---|
| What is the definition of 'cognition'? | stored knowledge and the processes for making and manipulating that information |
| what are the three sublevels of working memory on the memory model? | central executive, primary verbal, primary visual |
| What are the two sublevels of long term memory and what branches from each of these on the memory model? | Declarative - semantic, episodic; Nondeclarative - motor skills, cognitive skills, habits (aka procedural memory) |
| What does working memory allow us to do? | form intentions, plan what to say next, monitor expression of informtion, access and activate long-term knowledge related to incoming information |
| Describe 'semantic memory'. | refers to stored factual/conceptual knowledge; concepts, schemas, and scripts are formed from our experiences; information is stored in hierarchical, associative networks; is culturally determined |
| Describe 'episodic memory'. | memory for specific events where one was an observer or participant encoded with context (time, spatial), can be recent or remote |
| What is the difference between semantic and episodic memory? | SM underlies meaning and is more resistant, EM is time based, provides context, and is more fragile |
| What is "spreading activation" and what facilitates it? | moving from node to another in the semantic hierarchy facilitated by cuing |
| what is the weakness of the semantic memory model? | fails to consider strength associations |
| What is 'encoding'? | a procedure for transforming something a person sees, hears, thinks or feels into a memeory |
| What is 'retrieval'? | recollection of information in response to a cue |
| What is an 'engram'? | transient or enduring changes in neural networks in our brains as a result of encoding |
| which type of memory is more fragile? Semantic or episodic? | Episodic. Semantic memory is very resistant to extinction and is often a strength for our clients |
| What is 'source memory deficit'? | all semantic memories start off as episodic memory events until source fades "I can't remember when I heard about this..." |
| What kind of memory deficit is pronounced in early stage Alzheimers? | episodic memory |
| what facilitates encoding? | integrating new information with existing information |
| What is your example of expertise that you could link new information to so that encoding is facilitated? | If I could match new information with 80s songs. |
| What is the key to new learning? | Repetition |
| What is 'forgetting'? | 1. when the engram becomes degraded or weakened as time passes 2. engram exists but is inaccessible due to lack of retrieval cue |
| What are the three elements of memory? | 1. encoding 2. retrieval 3. consolidation |
| How does the hippocampus play a role in consolidation? | The hippocampus is actively involved in creation of new memories until memories are consolidated and independent of the hipppocampus. |
| What is the first stage of long term memory? | 1. synaptic changes accumulate in the cortex from many retrievals of the memory 2. Retrievals are directed by the hippocampus (perhaps for years) 3. eventually the memory becomes independent and a new, stabler engram is permanently stored in the cortex |
| What is 'anterograde amnesia'? | inability to acquire and retrieve any events or episodes from personal life that have occurred since the onset of the brain injury |
| What is 'global amnesia'? | deficit in LTM for new information |
| What is 'recollection'? | a conscious, effortful process in which prior aspects of an episode are retrieved |
| What is 'familiarity'? | a subjective feeling that arises when a stimulus is processed fluently or come to mind easily |
| The hippocampus is critical for one of the following: recollection or familiarity? | recollection - familiarity can be supported by other medial temporal lobe areas |
| What is 'retrograde amnesia'? | the loss of memory for events that occurred before onset of the brain injury |
| What happens to memories when there is limbic damage? | information that is not fully consolidated is vulnerable, whereas fully consolidated older memories can still be successfully retreived |
| What deficits result from medial temporal lesions? | acquisition of new word meanings |
| What deficits result from damage to subhippocampal cotices? | acquisition of new semantic learning |
| What deficits result from hippocampal damage? | severe day-to-day memory impairments |
| What deficits result from damage to the lateral temporal lobes? | semantic knowledge, information storage |
| What is one interpretation of category-specific deficits? | that semantic memory is represented in the brain according to taxonomic categories |
| Describe procedural memory. | memory expressed in the "doing" of an activity (ex: riding a bike) automaticity reduces effort needed to do a task - mastered through repetion - difficult to "unlearn" (ex: Tammy skiing butt out) |
| What's another term for procedural memory? | motor skills branch of the non-declarative branch of long term memory OR just non-declarative memory |
| What is cognitive skills memory? | things we can do but can't explain how ex: reading, writing |
| Which area of the brain is implicated in disturbances to verbal working memory? | left supramarginal gyrus of the inferior parietal lobe and left frontal regions |
| What does frontal lobe injury impairs which task? | source discrimination |
| Perceptual priming tasks are difficult when what part of the brain is injured? | focal occipital lobe |
| Which tasks are related to acquisition of new perceptual-motor skills? | rotary pursuit and mirror tracing |
| What is H.E.R.A.? | hemispheric encoding retrival asymmetry ie: left is encoding and right is strategic retrieval |
| Where are the convergence zones (control centers) for memory? | limbic system structures (hippocampus), prefrontal cortex, cortical association areas, basal ganglia, cerebellum, motor cortex |
| What is the limbic system H.O.M.E.? | homeostasis (hypothalamus); olfaction; memory (hippocampal formation); emotions and drives (amygdala) |
| The hippocampus consists of what three structures? | hippocampus, dentate gyrus, subiculum |
| What is the hippocampus crucial for? | declarative long-term memory encoding, consolidation and retrieval. More involved with new memories versus older, consolidated memories |
| What is the dorsolateral prefrontal cortex DLPF? | part of the brain implicated in the central executive component of working memory; works with hippocampus for encoding and retrieval |
| What role do the cortical association areas play in memory? | storage site for declarative and long-term memories |
| What role does the basal ganglia play in memory? | early learning procedural memory critical feedback loop; sequence learning |
| What role does the cerebellum play in memory? | early learning procedural memory critical feedback loop |
| What role does the motor cortex play in memory? | early learning procedural memory critical feedback loop; minor role when behaviours are well-learned |
| What areas of the brain are involved with verbal working memory? | premotor, Broca's area, inferior parietal cortex |
| What areas of the brain are involved with central executive? | dorsolateral prefrontal cortex |
| What areas of the brain are involved with episodic memory, semantic memory storage? | distributed cortico-cortical association areas |
| What areas of the brain are involved with episodic and semantic memory encoding and consolidation? | hippocampus, prefrontal cortex left hemisphere |
| What areas of the brain are involved with episodic and semantic memory retrieval? | hippocampus for more recent memories, prefrontal cortex right hemisphere |
| What areas of the brain are involved with procedural memory? | prefrontal cortex, cerebellum, basal ganglia (early learning), primary motor cortex (proficiency) |
| What type of memory is involved with remembering the names of famous people? | semantic |
| What is "prospective memory"? | type of episodic memory, "remembering to remember" |
| What is the WCST and when is it appropriate? | Wisconsin Card Sorting Test 64 cards with 1-4 colored shapes; determine a sorting strategy according to criteria; test of executive function (set shifting) |
| What does dorsolateral brain damage do? | disturbs executive function; organizing, planning, working memory |
| What does orbitofrontal brain damage do? | disinhibition; social behaviour, personality |
| What does medial frontal brain damage do? | apathy; arousal, motivation |
| What is "abulia"? | a state in which an individual seems to have lost will or motivation |
| How can you assess brain damage? | neuropsychological tests ex: WCST; neuroimaging |
| How can you treat brain damage? | multidisciplinary attention; behavioural treatment approaches; |
| What is the prognosis for brain damage? | if it's a progressive neurological disease expect worsening of the problem; if not a progressive disorder it depends on the individual, his circumstances, and the extent of the damage. |
| Why is executive functioning so important? | without it, all other cognitive skills are ineffective |
| What are the levels of the attention model from lowest level to highest? | focused, sustained (vigilance), selective, alternating, divided |
| What is "attention"? | capacity limited system that allows us to select information for thought and processing and allows us to allocate processing resources to incoming sensory information |
| Which two features of a task demand 'more' attention? | novelty and complexity |
| What is focussed attention? | basic responding to stimuli ex: head turning to a sound |
| What is sustained attention? | focussing attention for an extended period of time ex: air traffic controller |
| What is selective attention? | allows you to select which stimuli to attend to ex: cocktail party conversation |
| What is alternating attention? | shifting attention and moving between tasks with different cognitive requirements |
| What is divided attention? | simultaneously performing more than one task |
| What is "concurrent cost"? | when you do two tasks requiring high levels of attention, performance in both is deteriorated due to the demand on limited mental resources |
| What neural networks are involved in attention? | prefrontal cortex, parietal cortex, anterior cingualate cortex, thalamus |
| What is "executive function"? | high level control processes that allow us to formulate, choose, organize, and regulate our goal-directed behaviours; non-routine behaviour; "supervisory system" |
| List the functions of executive function. | Awareness, Organization (DLPFC), Initiation and Drive (Medial frontal lobes), Inhibition (orbitofrontal cortices), Sustained Attention, Generative Thinking |
| What is generative thinking? | creativity, cognitive flexibility, problem solving |
| What is the strongest predictor of successful community reintegration following TBI? | integrity of executive function |
| Define "traumatic brain injury". | brain damage from trauma that results in diminished abilities that require rehabilitation |
| What are the demographics of TBI? | 2:1 male:female; most frequent occurrence btwn ages 15 - 24 due to MVA; adults 65+ due to falls; children 4-5 due to abuse |
| What are the risk factors for TBI? | alcohol, drugs, previous TBI, mental health issues, low education* (do not stereotype) |
| What are primary injuries? | those that occur immediately upon trauma; immediate injuries |
| What are secondary injuries? | complications that arise from primary injuries; delayed injuries ex: increased intracranial pressure |
| What is the hallmark feature of TBI? | diffuse axonal injury - stretching, deformation and shearing effects on axons; ranges from mild tears to complete transection of the axon from the cell body |
| What is a contusion? | dead brain tissue and blood |
| What is a coup-contrecoup injury? | contusion in areas of brain that collide with the skull and the underside of the brain gets dragged across the rough, bony surfaces at the base of the skull |
| What is intracerebral hemorrhage? | bleeding directly into the brain tissue |
| What is extracerebral hemorrhage? | there are three types: epidural (potential space between dura and skull; subdural (btwn dura and arachnoid; subarachnoid (in subarachnoid space |
| What is a coma? | period of unconsciousness following brain damage; must have severe cortical damage PLUS damage to brain stem |
| What is concussion? | Grade 1-mild, does not lose consciousness; Grade 2-does not lose consciousness but has confusion and does not recall the event; Grade 3-loss of consciousness, does not recall event = mild TBI |
| What are the signs of concussion? | delayed verbal and motor responses; inability to focus attention; memory deficits; disorientation; dysarthria; gross observable incoordination |
| What is the purpose of the Glasgow Coma Scale? | To assess severity of TBI on a scale of 2 (coma) to 15 (very mild) |
| What are the three basic parameters of the Glasgow Coma Scale? | eye opening, motor responses, verbal responses |
| What duration of coma has a positive prognosis? a negative prognosis? | pos= < 24 hours; neg= > two weeks |
| What instrument is used to assess post-traumatic amnesia? | the GOAT Galveston Orientation and Amnesia Test |
| Describe the GOAT. | questions to test 1. orientation to person, place and time 2. memory recent, pre and post injury |
| Which two factors effect poorer outcome from TBI? | more diffuse injuries and presence of many secondary injuries |
| What are four positive prognostic variables for TBI recovery? | age, premorbid education/occupation, family support, absence of substance abuse |
| What is the RLAMC LOCF? | Rancho Los Amigos Medical Center Levels of Cognitive Functioning - based on observation |
| What levels of the Rancho are early stage and what are the characteristics? | 2-3; from generalized to stimulus-specific responses (ex: function of common objects); understands simple commands in context; rehab focussed on family education and "coma stim"; maximum support required for ADLs |
| What levels of the Rancho are middle stage and what are the characteristics? | 4-6; range activity - (from) is increased with heightened alertness (to) goal directed in familiar environment; confusion and disorientation - (from) some (to) reduced; agitation; residual memory impairment, impulsive socially, lack of initiation |
| What level of support is required for ADLs in the Rancho middle stage? | moderate |
| What does rehab focus on in the Rancho middle stage? | improving functional abilities, education, vocation, social abilities, structured support is provided, |
| What levels of the Rancho are late stage and what are the characteristics? | 7-8: (from) adequate orientation (to)patient's peak level of improvement; cognitive and communication impairments may still exist; rehab is on refining skills for real-world and real-life demands |
| What are the ICF model branches? | top: impairment; middle: body function and structure, activity, participation; bottom: environmental and personal factors |
| Name four sources of information for assessment purposes. | review the records, interview patient and family, standardized and nonstandardized assessment |
| What kinds of records can an SLP review for assessment? | past rehab, school, employment, medical |
| What information can an SLP get from interviewing for assessment? | verification of information derived from records review, long term goals, client expectations, find out premorbid lifestyle |
| List three standardized assessment tests for TBI? | CADL-2 (activity level); WAB (impairment based); FAVRES (mild TBI and subtle cognitive deficits) |
| List three non-standardized assessment tests for TBI? | observation (attention, memory, executive functioning); evaluation of everyday performance (stimuli, response); determine relevant contexts (individualized) |
| List some "coma stim" activities. | object use (wash cloth, toothbrush); communication; visual stim (lighting, familiar objects); auditory stim (voice, music); movement stim; tactile stim (massage, brush hair); olfactory stim (coffee, perfume) |
| What are the pros of "coma stim"? | structured intervention, involves caregivers, small changes can be observed |
| What the cons of "coma stim"? | no data to support the technique, can possibly worsen the situation |
| What is the decontextualized approach to intervention theory? | hierarchical, targets subcomponents of cognition, does not have carry-over to real-life |
| Contrast traditional and context-sensitive theories with respect to focus and goals. | Trad: focus on impairment, goal of restoration or compensatory strategies; C-S: focus is context-supported participation, goal is to achieve real-world objectives to participate in the real-world |
| Contrast traditional and context-sensitive theories with respect to assessment. | trad: standardized measures used in assessment through to outcome; C-S: systematic behavioural observations and exploration of variables that affect performance in relevant everyday activities |
| Contrast traditional and context-sensitive theories with respect to treatment modalities and methods. | trad: cognitive exercises to restore cognitive skills; C-S: flexible combination of task-specific training and environmental modifications |
| Contrast traditional and context-sensitive theories with respect to organization of treatment exercise hierarchy. | trad: reduction of impairment first; C-S: cognitive components approached nonhierarchically, generalization promoted from outset, participation limitations reduced first |
| Contrast traditional and context-sensitive theories with respect to setting, content, and providers. | trad: person specific avoided, highly trained specialists and materials used; C-S: clinic setting is made personally relevant, specialists also deal with every day people in client's life to ensure effectiveness and routines of daily life |
| What do external memory aids do? | help patient to learn behaviours to be successful in completing real-world tasks, compensates for memory impairments |
| What can an external memory aid look like? | notebook, daily planner, beeper, alarms on a wristwatch, a pager |
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