Cases reported "Cerebrovascular Disorders"

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1/20. Written communication in undifferentiated jargon aphasia: a therapy study.

    A subject, R.M.M., with a 2-year history of jargon aphasia is described. At the beginning of this study she had minimal meaningful spoken output and showed little awareness of her speech despite having relatively well-preserved auditory comprehension. Her spoken output had proved resistant to earlier periods of therapy. In contrast, R.M.M.'s written output showed some ability to access orthographic information and monitoring of this modality was shown by an acute awareness of her errors. A 3-stage therapy programme is described. This was designed to improve R.M.M.'s writing of single words and to encourage use of writing as an alternative means of communication. The initial stage of therapy aimed to increase R.M.M.'s access to written word forms by use of picture stimuli. She showed significant improvement in writing treated items in response to pictures both immediately after therapy and at re-assessment 6 weeks later. Despite the acquisition of these skills, R.M.M. failed to use them in communicative contexts. A second stage of therapy replicated the results of the first and sought to facilitate R.M.M.'s functional use of her written vocabulary by asking her to write words to spoken questions. She again showed improved written naming of the treated items and could now produce written names appropriately in a questionnaire-type assessment. Generalization of this ability extended to items that had not been trained in this way. Functional use of writing in everyday communication remained absent, however. The final stage of therapy made explicit the potential links between items which R.M.M. could now write and functional messages which they might convey. She again showed significant changes in the acquisition of new vocabulary and, encouragingly, progress was also seen in her use of the strategy in functional communication. R.M.M.'s speech is almost entirely incomprehensible. It has remained unchanged for 2 years and has not responded to therapy. Relatively well-preserved auditory comprehension and good monitoring of written output allowed therapy to effectively target a small written vocabulary. Despite significant progress in the acquisition of new items, transfer of this skill to functional communication was initially absent. Further therapy which specifically targeted the impairment causing this failure was needed before functional use was seen. The potential for treating written output in cases of jargon aphasia which have been resistant to therapy for spoken language is discussed.
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keywords = communication
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2/20. Evaluation of stroke disability.

    The disabilities resulting from a stroke are not well understood from the epidemiologic or functional point of view. The stroke may impair mental status, perception, sensation, communication and motor ability; the total resulting disability is related to the extent of impairment in each of these areas. A complete evaluation in all these areas has to be done to determine the degree of disability before any rehabilitation program is planned. A comprehensive approach to evaluating stroke disability is presented that includes correlating the degree of impairment in each of the above-mentioned areas with the overall functional ability of the patient.
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ranking = 0.125
keywords = communication
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3/20. Neurogenic stuttering as a manifestation of stroke and a mask of dysphonia.

    R. L. was a 52-year-old man who was referred for an SLP consultation to determine the nature of his fluency disorder, whether or not treatment would be beneficial, and finally whether resumption of pre-trauma vocational status was feasible. The patient was involved in a motor vehicle accident with no resulting detectable trauma. However, shortly after the accident, R. L. developed a severe dysfluency that was later described as cortical stuttering. We reviewed the medical and rehabilitation work-up that attempted to determine whether the communication disorder was functional or organic in origin. Once the fluency disorder was determined to be caused by a suspected small, focal, hemispheric lesion, a five-month treatment program was undertaken that used a noval prosthetic approach to restore fluency. Once fluency was restored with the use of an artificial larynx, a residual anomia was detected and treated. The case of R. L. illustrates a stuttering that appeared to be caused by a combined neurogenic dyspraxic (vocal control), dysarthric (motor control), and dysnomic (word-finding) dysfluency. The literature on this issue was reviewed and the underlying mechanism of recovery was discussed.
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ranking = 0.125
keywords = communication
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4/20. communication skills in an aphasic deaf adult.

    A case study is presented of a 64-year-old, right-handed, congenitally deaf man who suffered a single, unilateral, left CVA resulting in a right hemiplegia and moderate aphasia. The relationship between his verbal (reading and writing), manual, and pantomimic performances is examined in two ways. First, a comparison of the three modes of communication shows whether or not these systems can be dissociated by pathology. Second, the extent to which one mode recovers more fully than the others indicates whether the three modes function independently. Results of testing conducted at six weeks and at 18 months postonset revealed that this individual's manual, verbal, and pantomimic communication skills were all similarly impaired as a result of his CVA. Furthermore, at 18 months no single mode had recovered more rapidly or to a greater extent than any other. These results support the notion that aphasia in the deaf and hearing population is similar, and is consistent with the view that aphasia is the result of a central symbolic/cognitive process which manifests itself in parallel dysfunctions of verbal, manual, and pantomimic communication.
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ranking = 0.375
keywords = communication
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5/20. Resumption of gainful employment in aphasics: preliminary findings.

    We report preliminary data on aphasic patients who, in spite of their language problems, have succeeded in finding a reasonably satisfactory occupational resettlement. patients who: (a) still had a moderate to sever aphasia, (b) had resumed a gainful employment requiring interpersonal communication, were recalled for a check-up and assessed with: (1) a comprehensive aphasia test: (2) a semistructured interview including detailed questioning about the type and reaction to aphasia, the type of work before the onset of aphasia, the type of current work with particular emphasis on the patients' compensatory mechanisms and emotional reactions. Results comprise 10 cases up to date. One case is described in detail. Findings indicate that the ability to resume a gainful occupation is often greater than could be expected on the sole basis of formal language examination. Findings are discussed from a neuropsychological, social and rehabilitation point of view.
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ranking = 0.125
keywords = communication
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6/20. Interdisciplinary roles in stroke care.

    Care of the stroke patient presents a complex challenge to the interdisciplinary stroke team. The physical therapist, occupational therapist, and clinical social worker are important members of that team, each of whom contributes specialized knowledge and interventions in behalf of the patient. The physical therapist focuses on prevention of joint and tissue injury and retraining of lost motor skills. The occupational therapist considers the total patient in his or her environment and assists the patient in regaining or improving function in all areas of daily living. The clinical social worker concentrates on psychosocial assessment and intervention with the patient and family, aiding them in the adjustment process and planning for discharge. The nurse, in addition to playing a unique role in the delivery of nursing care to the stroke patient, is in a position to serve as coordinator of the interdisciplinary team. The nurse can facilitate the work of the physical and occupational therapists and the social worker by providing them with timely referrals, valuable assessment information and insights, and reinforcement of therapeutic activity while the patient is on the nursing unit. The keys to making the interdisciplinary team work for the maximal benefit of the patient are threefold: mutual respect and understanding among team members; ongoing coordination of efforts; and open communication between all team members, the patient, and the family. These elements are interrelated and essential if the interdisciplinary team is to be successful at meeting its ultimate goal: expert care of the total patient to achieve maximal independence.
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ranking = 0.125
keywords = communication
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7/20. Relearning to eat late after a stroke by systematic nursing intervention: a case report.

    Using a training programme developed by Heimlich, we have attempted to train swallowing in a 78-year-old man who had been fed by a nasogastric tube for 3 years after a stroke. The training was successful and, during a follow-up of 1 year, the patient was eating normal food. The training process is analysed as a two-level communication between the patient and his trainer; the therapeutic relationship and the training programme. The development of the patient's attitudes during training is interpreted with reference to Erikson's theory of 'eight stages of man'.
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ranking = 0.125
keywords = communication
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8/20. The labeling problem in aphasia: an illustrative case.

    Twenty-five "experts" on neurogenic motor speech disorders participated in a tutorial exercise. Each was given information on M, a patient who had communication difficulties as the result of stroke, and asked to complete a questionnaire about his problem. The information included a detailed case description, an audiotape of M's speech obtained at 4, 9, 13, and 17 days post-stroke, and test results from the Western aphasia Battery, the Token Test, and a battery for apraxia of speech. The experts were in excellent agreement on M's primary problem, although it was called by seven different names. The experts were in poor agreement on his secondary problem(s), e.g., the presence and type of aphasia and dysarthria. The results suggest that labeling is difficult, even for "experts." Furthermore, the practicing clinician needs to be sensitive to the likelihood of more than one coexisting problem.
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ranking = 0.125
keywords = communication
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9/20. A communication system for the severely dysarthric speaker with an intact language system.

    Two severely dysarthric speakers who had previously spelled entire messages on an alphabet board were taught a system in which they pointed to the first letter of each word as they spoke. Rate and intelligibility of speech produced with (aided) and without (unaided) the communication system were judged by observers who viewed videotaped samples. The rate of aided and unaided speech was markedly faster than spelling the entire message. Aided speech was slower but more intelligible than unaided speech. Further analysis revealed that intelligibility was influenced by at least two factors: (1) rate and (2) information provided by the identification of the first letter of each word. For one speaker both factors contributed to increased intelligibility, while for the other speaker only initial letter information appeared to influence intelligibility.
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ranking = 0.625
keywords = communication
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10/20. Thematic role assignment in two severely aphasic patients: associations and dissociations.

    Two severely aphasic patients were compared in their abilities to comprehend and produce locative prepositional phrases and reversible S-V-O sentences using English and C-VIC, a computer-based iconographic communication system. One patient demonstrated a significant dissociation between his performance in interpreting symbol order in C-VIC prepositional phrases vs. S-V-O sentences. patients were able to comprehend order in C-VIC S-V-O sentences significantly better than they were able to assign symbol order when they produced these sentences. These data suggest that the procedures for assigning thematic roles to nouns in sentences are at least partially distinct for comprehension and production and that the ordering of nouns around prepositions involves conceptual processes distinct from those involved in ordering nouns around verbs.
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ranking = 0.125
keywords = communication
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