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Cognitive communication disorders (What is it? (Difficulties in…

- - - - Impact communication skills
      - Memory
      - Attention: staying on topic, X get distracted by surrounding env, able to engage in convo
      - Concentration
      - Information processing: speed, capacity
      - Executive functions: set of specific cognitive abilities, control, regulate other abilities and behaviours eg. goal setting, self monitoring, inhibition, reasoning, problem solving, initiation. Whether its appropriate for given context, you know it might be rude so inhibit that temptation. BUT pt might say rude jokes, vulgarities
    - - Knowing what, how, when, where and to whom to say it
      - Real life: change manner of how you communicate to someone very young vs. very old, your boss, power, mode of communication, r/s to interlocutor
      - Requires
        
        Linguistic skills
        
        Cognitive skills
        
        Executive fn: turn taking in convo, need to give equal speaking time. Not sensitive to non-verbal cues, eye contact, social rules of convo
- - - - Pragmatics
        
        Deficits recognising speaker's intentions
        
        Unds internal motivation of others, respond appropriately
        
        Turn-taking
        
        Topic maintainence
        
        Eye-contact
        
        Insensitive to others
        
        Oblivious to social conventions
        
        Unaware, inattentive to own physical, mental limitations
        
        Verbose, tangential, rambling
        
        X grasp overall significance, meaning of complex events
      - High lvl language
        
        Figurative, non literal language
        
        Inferencing
        
        Sequencing
        
        Abstract, ambiguous words (eg. money bank vs. river bank)
        
        Humour
      - Discourse organisation
        
        Bits and pieces, egocentric. Eg. tell famous story look for coherent narrative, setting, body, conflict, resolution
      - Affect
      - Neglect
        
        Ignore info in left visual field. SO need to present info in vision field they are attending to
        
        Tasks: draw clock, middle of line, cooying, spontaneous drawing
      - Prosody
    - - Standard aphasia tests eg. WAB, CAT
      - Formal tests: Right hemisphere Lang Battery used to rule out aphasia, get idea of how they communicate based on responses they give
      - Assess aspects eg. metaphor comprehension, inferencing, humour appreciation, prosody, affect, attention, how person was like before the stroke
      - Functional Communication
      - Pragmatic profiles
    - - Stroke: Ischemic, embolic stroke: blood clot travels from another part of body, blocks blood vessel in brain. Normally there's a focal damage point
      - haemorrhagic stroke: bleeding in brain
  - - - Leading cause of death, long term disability for adults aged <40 in USA
      - Leading causes: falls, Motor vehicl accidents, blows to head
      - Memory and other cognitive disturbances playing role
    - - Consequence of head injury: penetrating (open) or blunt (closed)
      - Diff causes of head injury (fall vs. car accident) will cause diff neuropathophysio so diff fnal conseq for cognition, communication
      - Causes diffuse damage to brain (Rapid deceleration in accident, brain shaken on multiple contact points, hitting bony protuberances, can cause cuts, lacerations to tissue)
    - - Primary sources
        
        Diffuse axonal injury: diff areas of brain have diff densities, moving at diff speeds shearing effect on axons, rotational pressure on brain
        
        Contusions, lacerations: frontal, temporal lobes actually
      - Secondary sources
        
        Cerebral oedema (collection of fluid in brain)
        
        Infection
        
        Raised intracranial pressure (brain compressed in skull)
        
        Haematoma
    - - Changes to skull shape
      - accel, decel, rotational injuries (going to bounce back after hitting frontal lobe
      - Contra-coup injury: injury at site opp to point of impact
      - Rotational injury
    - - Orientation: space, time
      - Memory
      - Attention
      - Executive function: reasoning, problem solving
    - - Damage to brain that results from bruising, laceration from forceful contact w rough inner surfaces of skull, secondary oedema (swelling), infarction (tissue death), haematoma (focal bleeding, blood pooling in brain)
    - - Classic aphasia profiles are rare: not dealing w focal point of damage, can still have pt presenting with this
      - Pragmatics
        
        Quantity
        
        Turn taking
        
        Topic maintenance
        
        Initiation conversation
        
        non-verbal commn
        
        Inappropriate content for situation: frontal lobe-control executive fn
      - Other problems
        
        Discourse organisation
        
        High level lang function
        
        Slower speed information processing
        
        Word retrieval deficits
        
        Motor speech impairments: dysarthria, dyspraxia
        
        Disinhibited, socially inapprorpriate lang
        
        Restricted output, lack of initiation
      - Assessments
        
        Standard aphasia tests (WAB, CAT)
        
        higher level lang
        
        Right hemisphere lang battery
        
        Wigg semel test of ling concepts
        
        Cognitive-ling tests
        
        measure of cognitive-ling abilities
        
        Functional communication assessments
        
        Pragmatic profiles/assessments
  - - - umbrella term for acquired pathological condition, syndrome characterised by intellectual decline, esp memory bcos of neurogenic causes
      - Deficits include poor reasoning/judgement, impaired abstract thinking, unable to attend to relevant info, impaired communication, personality changes
      - Clinical syndrome of chronic, progressive symptoms that result from acquired brain disease.
    - - Cortical
        
        Alzheimer's
        
        Changes that occur
        
        Neurofibrilary tangles-nerves become twisted, decrease neural transmissions
        
        senile plaques-laminated deposits of protein that form around degenerative neurons in brain
        
        Cerebral atrophy-shrinking brain tissue, 40-45% of cortical volume, shrinking hippocampus (memory)
        
        ventricles (brain) dilate
        
        Memory
        
        Declarative (factual knowledge): conscious learning, retrieval
        
        Semantic memory eg. tennis is a sport
        
        Episodic memory eg. rmb when you played tennis
        
        Lexical memory eg. tennis word defn
        
        Non-declarative (implicit): procedural learning)
        
        Unconscious, incidental learning, retrieval
        
        eg. rmb how to ride a bike, drive car, stopping at red light
        
        can tap into this to remember key elements--> helps w intervention
        
        Declarative memory < Non-declarative memory
        
        Language profile
        
        Early
        
        Semantic lang most affected, speech fluent, grammatical. Vague w some word-finding problems
        
        Comprehension still intact, may have difficulties in more complicated situations eg. background noise or many ppl talking
        
        Middle
        
        Speech becomes more empty, incoherent
        
        Comprehension more affected
        
        Late
        
        Grammar errors
        
        Disoriented to ppl, place, time, may become mute
        
        Can retain sensitivity to emotions, prosody, env
        
        Primary progressive aphasia-umbrella for 3 types of dementia
        
        Progressive nonfluent aphasia
        
        Logopenic dementia
        
        Semantic dementia
      - Multi-infarct/vascular dementia
      - Subcortical dementia eg. Parkinson's disease, Huntington's disease dementia
    - - Cognitive-Communication assessment eg. Arizona battery of communication disorders in dementia (ABCD) eg. recall, tell a story, word learning task
      - Functional communication assessments
      - Conversational analysis: working w caregivers as well
    - - Memory strategies eg. reminescence therapy, create diary that pts still rmb where they went to
      - Communication partner training programs (MESSAGE)
      - Env strategies: reduce distractions, promote better communication among residents