A Guide to Treatment of Aphasia



LectureNotesJanuary27Precentral gyrus (primary motor cortex) -anterior to the central fissure. Postcentral gyrus (primary somato sensory-primary sensory cortex)-posterior to ventral fissure (fissure of rolando)Association areas (secondary areas)-angular gyrus near temporal, occipital and parietal junction.-arcuate fasciculus-major fiber tract that connects temporal and frontal lobesReview these terms and draw these fissures Longitudinal fissure: largest fissure: anterior/posterior central fissure: fissure of rolandolateral cerebral fissure: fissure of sylviuscalcarine fissure: the blue linepre central gyrus or primary motor cortex-motor before sensory, the dividing line is central fissurea. other mnemonic is M.S. degreeprimary somato-sensory or post central gyrus-sensory after motor, divided by the central fissureAssociated cortex: (2)a. angular gyrus: posterior to the Sylvain fissure, overlaps temporal, partial, occipital lobesb,arcuate fissure- start in the temporal lobe and ends in the frontal lobe-inferior -superior temporalBroca’s aphasia: video: inferior frontal area is damagedWernickes’s aphasia: superior temporal area is damaged as well as posterior temporalMore Knowledge: Frontal lobe: defining the boundary of the front lobe?-Where is the inferior boundary?-lateral fissure or Sylvain fissure-Where is the posterior boundary?-fissure of Rolando or the central fissureWhat is the PMC (primary motor cortex) responsible for?-motor movement on the contra lateral side of the body-opposite side of the body (contra lateral)Where is the prefrontal lobe?-above the eyebrow, lower than eyesWhat is the prefrontal lobe role and responsible?-make a person unique-responsible for executive function.What are the 7deadly executive functions? 3 ins, 1 imp, 1consequence, 1 judgment, 1 organization-initiation an action-impulsivity (stop being impulsive)-inhibition (-insight (-consequence of actions (-other judgments-organizationsHow do we teach the deadly 7?The prefrontal area can be damage by injury as well as by stroke.-If a person has a stroke in prefrontal area, then the person’s language is intact, but cognitive function is deficit.-e.g. professor could not remember: he had bad organization skills. Think of the professor from Berkeley.What is the Temporal lobe responsible for?-hearing and auditory comprehension-What is the difference between hearing and auditory comprehension?-Wernicke’s aphasia clients can hear something, but they are not able to comprehend X.-SLP need to know the differencesTemporal Lobe: define the boundaries?-Where is the superior boundary of the temporal lobe?-Sylvain fissure or lateral fissure-Where is the inferior boundary?-underside of the hemisphere-Where is the posterior boundary?-imagery line (not well defined)E.g. wernicke aphasia-hearing what is sound, but did not comprehend the situationWhy is the temporal lobe important?1. It is important to discriminate pitch2. it is important for discriminating language from background noise 3. It is important for discriminating background noise from language.How is the temporal lobe related to language?1. the temporal lobe is important for semantic and syntax because if the patient can not make meaning from his language, the patient will be incoherent.if the temporal lobe is damaged, then the patient can not make meaningful language: no meaning and no comprehensionWhat is the Parietal lobe responsible for?1. the parietal area is responsible for sensation (touch, pain, temperature) Parietal Lobe: define the parietal boundaries?-What is the anterior boundary of the parietal lobe?-central fissure or fissure of Rolando-Where is the inferior boundary of the parietal lobe?-lateral fissure or Sylvain fissure-Where is the posterior boundary of the parietal lobe?-invisible lineWhat is the Occipital lobe responsible for?-contains the primary visual cortex (must have association cortex)-What is the anterior/inferior/posterior boundary of the occipital? -all are imagery lines-What happens when you damage the occipital lobe? Cortical Blindness-the patient can only discriminate shades of gray (darker or lighter). Patients can not read.Cerebral cortex (Neo cortex) outer surface of cortex of both hemisphere –very thin (1.5mm-4mm thick) –large (contains 7-8 billion neurons) -2/3 of the cerebral cortex is within fissure (makes us unique for humans)- The?cerebral cortex?is the layer of the brain often referred to as gray matter. It is the outer portion of the cerebrum.Primary cortical areas-1. PMC (primary motor cortex) responsible for-initiate and control voluntary skilled movements on the contra lateral side.e.g. fine (typing) vs. gross movements-2. PSC (primary somatic-sensory cortex) responsible for-somatic sensations on the contra lateral sidee.g hemiparies-if you lose the motor, you usually lose sensation. the client will not feel their hands. Remember, 3. Primary auditory cortex-herschel gyrus -each of the auditory cortex receive info from both ears-both sides go into one hemispheres4. Primary visual cortex-look at the pathway.5. Primary olfactory cortex-Where is the olfactory cortex?-posterior-inferior frontal lobe, inferior frontal lobe.-olfactory bulbs can be damaged by picking your nose.The cortex are viewed from the top, but they are deep up to 4mmAssociative areaSecondary motor cortex-improves or refines what the primary area does (defines PMC)-anterior to the PMC-no clearly defined.Secondary somatic-sensory cortex-processing tactile information and spatial information -posterior PSC- (e.g. hot stove, take away hand is spatial)Secondary temporal area-discriminates and processes auditory information and language related informationSecondary parietal/occipital area-discriminated visual informationNo secondary olfactory area because you can directly damage the olfactory bulbs. (damaged or not)DEEP STRUCTURES OF THE BRAINDiencephalon-deep within the cerebrum on top of the brain stem.thalamus-oval-egg shaped and lateral to the 3rd ventricle and within the diencephalon.-relay station for efferent (motor) and afferent (sensory) fibers E for efferent, e for exit, -connection to other areas of cerebellum, basal ganglia, subcortical regions, brainstemWhat is the thalamus responsible for?-regulates consciousness, alertness, attentionHypothalamus--all aspects of behavior (graduate brain-emotions,feed/eating, natural rhythms)Pineal body (center of the soul)–regulates body rthyms-calcium at 30 yrs…marker for CAT scanThird ventricle-within the diencephalonBasal Ganglia: What is the Basal Ganglia role and responsible?-receive and relays information from multi-cortex sites-many connection to the frontal lobe-Responsible- adjust major group of muscles in the trunk and limbs.-Responsible-(poor)posture, muscle tone, sequence smooth movements and habit learning (stimulus and response).-damage to the Basal Ganglia=dyskinesia-involunatry movementsCaudate Nuclues, Lenticular Nucleus (putamen, globus pallidus) Substantia NigraGlobus pallidus-responsible for movement, Parkinson’s disease. -pallitomySubstantia Nigra-releases dopamine..festernation-tiny stepsAmygdala-Internal capsule-efferent and afferent fibers pass via thalamus and basal ganglia-resp. for motor movement information from the PMC to lower centers (afferent fibers)-resp. also from lower center to PMC (efferent fibers)damage results in : muscle paralysis or sensory disturbancesMOTOR PART of the Internal Capsule3 categories of movement fibers (look at picture)cortical pontine fibers-anterior limb cortex to ponscortical bulbar fibers-cortex to medulla genu portion cortical spinal fibers-cortex to spinal cord-know as the posterior limbSENSORY PART of the Internal CapsuleSensory fiber--ascended via posterior limb, travel togetherWhat is the Brainstem role?-communicative and structural link between the brain and spinal cord-cranial nerves originate in brain stem-pathways for efferent/afferent fibersWhat is the Brainstem responsible for?brainstem is resp.=controls breathing, heart rate, and consciousness (reticular formation)What is the midbrain responsible for?-resp. motor control and muscle tension connects the brain stem to cerebrumWhat is the pons responsible for?-resp. bulge in the brainstem-hearing and balance-contains the 4th ventricledamage results in lock-in syndrome-cognitive, but diving bell and the butterflyWhat is the medulla responsible for?-resp.located between pons and spinal cordNerve fiber tracts decussate (cross) from one side CNS to the otherDamage results in vertigo and paralysis of throat and larynx and sensory loss of limbs and face good candidate for AAC.Cerebellum (Ataxia)-responsible for regulating rates, range, direction and force to movementDamage to the cerebellum results in Ataxia (clumsiness)-over-shooting and undershooting1. it is important for motor movement.BLOOD SUPPLY to the BRAINLateral Ventricle (2)-organize chucks of brain15% of CSF in CNS-contains choroid plexus-soft sponge materials that produces CSF2 lateral V-one in each hemisphere connected to 3rd ventricle with interventricle foramen below and between the lateral ventricle then connects to the 4th by the cerebral aqueduct. 4th ventricle opens in subarachnoid space (loopy)Overpressure of ventricle results in brain damageLimbic lobe: (cingulated cortex, septum, mamillary body)-Hippocampus-used for working memory-actively keeping a moment in storage before you recall-digit span-amygdala-episodic memory-perirhinal area-auditory and visual memory-sensitive to lack of oxygenNeurons-small-axon, dendrites, cell body-multi-dendrites-one-axon (1mm-1ft)-myelin increase the speed of electrical impulse-cell body-tells the neuron what to doAxons are white-fiber tracts-projection fiber-long distance CNS carrier from brain to spinal cord or peripheral sensory nerves-efferent fibers carry info from brain to muscle and glands-dense fibers-afferent fibers receive info from periphera through the spinal cordLARGER VIEW of NEURONSRegional carrier-commissural fibers-corpus collusum-3 parts-anterior, central (genu), posteriorAnterior and Posterior Commissural Fiber-anterior crosses midline via thalamus-posterior crosses midline at the posterior end of the corpus collosumAssociation Fiber-local carriers and intra-hemispheric (short carrier)fascicles fibers (uncinate, arcuate, cingulum)arcuate via temporal to the frontalParimental Pyramidal system-nerve cells that look like pyrmanidsresp. initiate in skilled voluntary movementcontains motor neurons of PMC and axons synapse in the spinal cord-direct system (no breaking of synpnases)Upper motor neurons (UMNS in the CNS)starts in PMC and syn in LMN which are in the brain stem and spinal cordLMS related to peripheral Vestibular reticular system-neurons within the brain stem and cereResp-balance attention and alertnessExtra pyramidal system-arises from many CNS locations especially basal ganglia and projection to the cranial and spinal nerves and it is an indirect pathway. Mult-synp. from origin to resp for muscle tone and posture for volitional movementsdamage results in affects muscle tone, posture and volitional movementsMotor speech-Peripheral nervous system-not encased in bone-somatic-sensory perception and volitional motor movement. contain cranial nerve and spinal nerves-automatic nervous systemCranial Nerve # (Sensory/Motor), Function use brookshire (highlight SLP)leave the spinal cords (31 pairs of spinal cords)-name locationposterior dorsal (back)=sensory inforanterior venteral root front=motor infoAvg. 18ins. Central core is gray(neurons) white is axon-motor pathways -cortical spinal pathwaystart-PNC syn cranial nerves at anterior horns of spinal cord (it is crossed-contralateral)-spinal celleballer pathway-start with PNS connects with cerebellum (isplateral-same side)-sensory pathways (pain and temperature)-ascend in the laterl aspinal cord to the thalamus then to PNC (contralateral) pathway-proprio-ception-id location head and limbs without vision-sterogenosis-id by touch (objects)sensory from dorsal posterior spinal cord to the cerebellum and secondary somaticsenorry cortex (contra lateral pathway)-light touch-ascends in the ventral anterior spinal cord to brain stem to PSC, touch is cross and uncrossed.Should have an idea before we see the patient? ................
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