CODI 508: Aphasia in Adults Hope to help you differentiate efficacious from poor practice.

Questions?

What is Aphasia?

Etiological Aspects of Brain Damage resulting most often in Focal Lesions Cerebrovascular Accidents Intracranial Aneurysm Arterio-Venous Malformation Neoplasms Infections Poisons Anoxia Cerebral Edema Trauma

Etiological Aspects of Brain Damage resulting most often in Focal Lesions Cerebrovascular Accidents (CVAs) Cerebral Thrombosis Cerebral Embolism Cerebral Hemorrhage Subarachnoid Hemorrhage Transient Ischemic Attack (TIA)

Cerebrovascular Accidents (CVAs) Thromboembolic Lesion Cerebral Thrombosis – obstruction at the site Cerebral Embolism – sudden blocking brought to site via blood stream

Cerebrovascular Accidents (CVAs) Hemorrhage Cerebral Hemorrhage – Rupture of one of the Cerebral vessels Subarachnoid Hemorrhage – Vessel rupture in subarachnoid space

Cerebrovascular Accidents (CVAs) Intracranial Aneurysm Dilation of the wall of the artery Variable in size Hematoma May be pulsing tumor or may burst

Hemorrhage Cranial Dura Mater

Several Hemorrhagic Effects Often due to arteriosclerotic tissue May Cause Hematoma Destroys and displaces tissue Often tracks along white matter pathways Cause severe compression and distortion of brain tissue Acute Subdural Hematoma Intracranial Hematoma Herniation is Problem Subfalcine Lateral Transtentorial Central Transtentorial Tonsillar

Arterio-Venous Malformation Venous and arterial systems are gnarled and malformed Tend to leak Usually superficial Congenital

Neoplasms Identified by tissue origin Glial Tumors (Glioblastoma, Astrocytoma, Oligodendroglioma) Meningeal Tumors (Meningioma) Nerve Sheath Tumors (Schwannoma, Neurofibroma)

Infections Abcess due to Infection Streptococcus Fungal Infection Pneumoniae Numerous causes Result in fever above 104o – typically deprives brain of oxygen (adults) May cause anoxia

Poisons Result in metabolic Problems May result in Anoxia

Anoxia Lack of oxygen…can cause generalized cortical loss Strangulation Electric Shock Hanging Drowning Cardiac Arrest Drug Overdose Alcohol Overdose

Social and Psychological Aspects of Aphasia

Social and Psychological Aspects of Aphasia Issues for IWA & Family: Anxiety Depression Emotional Lability Inadequate Judgment Under-estimation of Ability Development of Self-limiting belief system

Lezak’s “Coping Hypothesis” Perplexity Distractibility Fatigue BIG 3

Lezak’s “Coping Hypothesis” Secondary Five Irritability Tendency to Obsessive /Compulsive Traits Social Withdrawal Depression Anxiety

Impact on Families: Overall Observations Burden does not seem to improve may even grow worse over time Key is family cohesion and available perceived support High correlation between depression and family coping Severe financial hardship Poor social life More depression/anxiety in female spouses Feeling of Burden & Alienation Often results in troubled family interactions

Impact on Children: Observations Greatly impacts relationship with parents Complex adaptive problems due to sequelae such as: Communicative Difficulty Depression Social Withdrawal Irritability Children may experience behavioral change: Poor & Eroding Relationship w/ IWA Acting out behavior Emotional Problems

What do we have to do? Assist Family with: Acceptance of Changing Expectations Acquiring Information Maintaining Hope Dealing with Social Isolation

RECOVERY

Recovery Pattern A Restricted View Spontaneous Recovery Decelerating Curve Steepest During first month post-onset Flattening out 2nd & 3rd months Still rising 6 to 9 months 1 3 6 9 12 Months Post Onset (MPO)

Recovery Pattern Expanded View From social perspective change can/will continue since we are looking at social dyad Compensations from IWA Compensations from Partner

What we have Learned as Possible Solutions