a neuromuscular process used to produce sounds in a predictable pattern that is translated or interpreted into meaning by the language dominant hemisphere (generally, LH)

invlolves multiple systems

impaired comprehension and production of abstract information and impaire appreciation of visuospatial relationships; usually cased by pathology affecting the non-language copetent half of the brain.

difficulty with implied meaning, humor, sarcasm, etc.

impaired attention and memory, impaired appreciation of abstract information, and altered interpersonal behavior, usually caused by diffuse brain pathology due to MVA, fall, or assault.

** output is impaired because cognition is impaired their thinking, reasoning, judgement, organization.  When you hear their output, you hear their deficits**

Attention & Memory!

memory impairments, personality changes, and altered behavior, usually caused by progressive degenerative pathology affecting brain regions related to memory attention and affect

irreversable (Alzehemer's - progressive & degenerative)

reversable -->malnutrition

deficits in planning or programming - ONLY IN THE CNS - motor speech disorder reflecting impaired capacity to plan or program sensorimotor commands nevessary for directing movements that result in phonetically and prosodically normal speech, usually in the frontal lobe in language dominant hemisphere

co-occurs with expressive aphasia - Broca's aphasia

collective name for a group of motor-speech disorders resulting from disturbances in muscular control over speech mechanism due to damage of the CNS or PNS

motor control; execution of commands CNS or PNS (difference between apraxia)

paralysis, weakness, or incoordination of speech muscles

most frequently caused by pathology affecting nerves or speech muscles

• support and separate nerve cells and tracts
• regulate fluid levels in nerve tissue
• remove foreign substance
• participate in brain metabolism

• transfer of electrochemical impulses from 1 neuron to another
• neurotransmitters excite or inhibit with transmission

1. cortex/cerebrum - most superior
2. diencephalon (thalmus & B.G.)
3. Brainstem (midbrain, pons, medulla)
4. Cerebellum
5. Spinal Cord

What is the role of the autonomic nervous system (PNS)?

Cranial vault

Foramen magnum

• cranial vault - inside the skull 

• Foramen magnum - opening in base of skull - allows brainstem to pass to the spinal cord

notches between the vertebrae

provide space for spinal nerves and blood vessels to pass to the extremities

surrounds the CNS

1. dura mater
2. arachnoid
3. pia mater

long, but thin crescent-shaped band that protrudes downward & crosses front to back on the skull midline, dividing the cranial vault into 2 compartments

keepts from 2 hemispheres from rubbing together

protects brain against rotational surfaces

DOME-shaped protuding forward horizontally from back of the cranial vault - creates 2 compartments

**brain occupies upper; cerebellum occupies lower**

divides cranial cavity into cerebral and cerebellar regions

** main source of support & protection for spinal cord (in addition to vertebral column) **

continuation of inner meningeal layer of cranial dura

extends in "tube-form"  from foramen magnum down to S2

separates dura from underlying arachnoid membrane

narrow space filled with serous fluid

acts as lubricant - prevents adhesion of dura and arachnoid

- no blood supply (non-vascular) cobweb-like between dura & pia mater

- surrounds, but does not conform to contours of underlying cranial & spinal tissue

the space between the arachnoid and the pia; filled with CSF

- CSFprovides pathway to CNS for metabolic and nutritional compounds & medium for removal of waste products

1. dura mater - "tough mother"
2. arachnoid mater - "spider mother";
• subarachnoid space
3. Pia mater - "delicate mother" - closest to cerebral cortex

protrusions from the arachnoid into venous sinuses

provide sites for absorption and removal of excess CSF from subarachnoid space

- delicate membrane that adheres tightly to brain, brainstem, cerebellum and spinal cord surface - directly follows their contours

- tissue filaments connect w/ arachnoid

- outer layer: epipial - arteries & veins

- inner layer: intia pia - lies directly on brain, brainstem, cerebellum & spinal cord

Gyri (Deep & shallow)

• Gyri - folds
• sulci - shallow grooves
• fissures - deep grooves

Superior Longitudinal Fissure

-- falx cerebri lies w/in the fissure

• runs vertically along lateral surface - roughly divides hemishere into an anterior and posterior region

fibers from temporal to broca's

lesions deep here = expressive aphasia & apraxia of speech

• largest lobe
• Front of brain (front pole) extending to Rolandic fissure/central sulcus
• lateral fissure marks inferior border

primary motor area; controls voluntary movement for the entire body

contralateral control (left controls right & right controls left)

anterior (Front) border = precentral sulcus

1. orbital
2. triangular
3. opercular portions

triangular & opercular = Broca's area - motor speech area' adjacent to lower part of motor strip

- lies immediately POSTERIOR to frontal love & above sylvian fissure (lateral fissure)

      - lateral surface:

           -anterior boundary formed by central sulcus

           -posterior boundary formed by 2 lines:

1. parieto-occipital sulcus
2. pre-occipital notch

Sylvian fissures (lateral) upper boundary - lateral surface

underside of each hemisphere = lower boundary

posterior boundar = imaginary lines marking anterior border of the occipital lobe

run perpendicular to each superior gyrus

right under pre-motor cortex

important for audition & mark primary auditory cortex

located in the upper posterior portion of the superior temporal gyrus in the dominant hemisphere & is the auditory association cortex

signal comes in & recognizes the linguistic information - translate the information (interprets)

island of Reil

deep in the latera/Sylvian fissure

concealed by frontal, parietal, & temporal opercula

fluid filled cavitites containing choroid plexus (produces CSF)

1) two lateral ventricles

2) third ventricle

3) fourth ventricle

lateral ventricle (by formen of Munro) --> 3rd ventricle (by cerebral acqueduct) --> 4th ventricle (cerebellum & lower medulla) --> flows out of 4th ventricle by median apeture = magandy & lusca = 2 lateral apeture

circulates subarachnoid space **extra CSF is absorbed in villi --> venous sinuses & circulates

Composed of : hypothalamus & thalamus (sometimes BG)

**hypothalamus group of nuclei that form the 3rd ventricle**

• emotional behavior, aid in body temperature, food & water intake, and sexual & sleep behavior
• neural control over pituitary gland (releases hormones in many bodily functions)

group of NUCLEI - caudate, putamen, GP - (CNS) situated subcortically

flows in circuit - receive from frontal love to thalamus

band of motor and sensory fibers that pass thru thalamus and basal ganglia

(major band of fiber tracts to and from cortex)

Putamen & Globus Pallidus

cognitive functions : timing, processing emotional info

1. Midbrain - upper portion - contain red nucleus & substantia nigra
2. Pons - middle - nuclei involved in hearing & balance
3. medulla - lower - site of decussation for many fibers in cortical spinal tract (motor control becomes contralateral)

located behind pons

aka "miniature brain"

2 hemispheres

outer layer = cerebellar cortex

SYNERGY of motion - coordintation

lies posterior to 4th ventricle

• white matter (sensory & motor) - travel in and out
• nerve fiber tracts

1. Projection Fibers
2. commissural fibers
3. association fibers

carry information from the cortex to brainstem & spinal cord

cortex --> brainstem --> spinal cord

example: corticalbulbar & corticalspinal

connects one hemisphere to another

example: corpus collosum

connects cortical areas within a hemisphere

example arcuate fasiculus (Broca's & Wernicke's)

"associate with your neighbors"

fan shaped of fibers that travel down to internal capsule

tracts - fanned out from cortex to a portion of the internal capsule

PROJECTION FIBERS

1) heart pumps blood into aorta

2) 2 subclavian arteris (one on each side)

3) common carotid branches from RIGHT subclavian & antoher common carotid branches LEFT aorta

4) carotids ascend into neck - divide into internal & external

5) ICA "gives life" to MCA & 1 anterior comm. artery

1) subclavian arteris branch into vertebral artery - one for each side

2) vertebral arteries follow anterior surface of medulla - joins at base of pons (BASILAR ARTERY)

3) basilar continues up to connect posterior portion of Circle of Willis

1) anterior cerebral artery (ACA)

2) middle cerebral artery (MCA) -- significan for speech and language (supplies these areas) - susceptible to strokes

Venous System

various sinuses drain to Jugular vein, which returns blood to heart

1. circulatory (vascular system)
2. tumor, neoplasm
3. TBI
4. degenerative disease

disturbance of brain function cause by vascular disruptions in skull (loss of blood supply or bleeding)

symptoms: weakness, vision, speech, dizziness/falls, abrupt head ache

1) Type

2) site

3) size

1) ischemic

2) hemorrhagic

artery is blocked & part of CNS loses its blood supply

if last longer than 3-5 min necrosis (death of CNS tissue) is likely

necrosis

infarct

necrosis = death of tissue

infarct = death of tissue due to loss of blood supply

narrowing of artiers - usually caused by placque build up

partial or total occulsion of arter

1. Thrombotic
2. Embolic
3. TIA

"mini stroke" temporary occulsion of artery that over time (hours or minutes) can completely resolve

**warning sign of impending major stroke**

symptoms: rapid sensory disturbance, limb weakness, slurred speech, dizziness, confusion, mild aphasia

• blood supply compromised by insufficient blood volume - not getting blood needed because blood is reduced 
• causespatch damage in watershed regions - MCA - spreads out

1. neurons deprived of blood supply will die
2. brain tissue swells -->intracranial pressure raises
3. tissue displacement (midline shifts)
4. fimished flow to hemishperes - blood supply changes
5. neurotransmitters & neurotoxins released
6. upset neuronal metabolism
7. transneural degeneration - degenerate because they loose their connections

1) extracerebral hemorrhages

2) subarachnoid hemorrhages

3) intracerebral hemorrhage

occur in meninges or brain surface

1) epidural - btwn dura & skull (TBI)

2) subdural - beneath dura (TBI)

3) subarachnoid - beneath arachnoid - resulting from aneurysm ** MOST COMMON**

Pouch formed in weakened blood vessel wall

Balloon: more you blow, the thinner the elastic becomes - same thing with blood vessel (in wall of artery)

1) aneurysms

2) ruptured aneurysms

3) arteriovenous malformations

within the brain or brainstem

occurs with 90% of patients with hypertension - leads to degenerative changes in small arteries deep in the brain, weaking them, and creating microaneuryms

ischemic destroys ____

hemorrhagic does not destroy ______

ischemic destroys white matter/pathways - highly predictive recovery

hemorrhagic - does not destroy white matter/pathways; better recovery - more swelling, so onset of recovery begins later

• intracranial tumors
• hydrocephalus
• infections & toxins
• nutritional & metabolic disorders
• presence: slowly over period of time
• cause comm. impairment - usually accompanied by dementia or personality disruptions
• medical treatment usually resolves

Itracranial Tumors

primary vs seconday

primary - new growth - originated in specific site

secondary - abnormal growth - migrated from primary site

benign

malignant

benign - do not re-occur, usually mild pressure to adjacent area

malignant - apply pressure, invade, and destroy surrounding tissue

• plugs of bacteria or tissue bits in CSF
• swelling of tissue (edema)
• most common site = CERBRAL AQUEDUCT (between 3rd & 4th ventrcile)
• creates compression
• intraventricular shunt - regulates flow down to abdomen at citerns
• symptoms: decrease in responseive, dulling, lethargy

more basic - attention & perception - underly everything we do - affects everythign else (judgement, reasoning, organization, etc.)

must assess & address first

affects basic & higher level processes

more wide spread & parallel areas in both hemispheres

reasoning, abstract thinking, & language

-interpersonal communication

Processes & damage: Sites

• cortical
• frontal
• posterior language-dominant hemishphere
• posterior non-language dominant hemisphere

• coritcal - higher level processes
• frontal - trouble functioning in the world; difficulties with motivation, initiation, no temporal sense
• posterior language-dominant hemisphere: language comprehension & expression
• posterior-non-language-dominant hemisphere: pereceptual type - visuaospatial processing - discerning reality in terms of environment

• common area - underlies all purposeful behavior
• chain of cognitive processes
• separated into components reflecting progressively increasing levels of cognitive load (function)

What is a type of attention?

Alertness - physiologiv & behavioral readiness to respond to stimulation - basic leve

provides foudnationg for all hgiher level processes

1. tonic alertness
2. phasic alterness

over long period of time (minutes to hours)

assessed during interviews & tests

momentarily rapid changes occur

(reaction time)

**more daily problems** (address area in rehabilitation - can hinder progress - increased alertness to novel stimuli

1. focused
2. sustatined
3. selective
4. alternating
5. divided

1. focused 
2. sustained attention (vigilance)

1. focal - localization; turn head when someone walks in - basic responsiveness to stimulation
2. sustained attention - maintaining over time (minutes to hours)
• vigilance - target sustatined attention over time - waiting for specific stimulus to appear

1. selective attention
2. alternating attention
3. divided attention

1. selective attention - select something w/ competing attetion 
• Example Boston Test
2. alternation attention - shift 1 stimulus to other according to requirements
3. divided attention - multitasking

How to assess:

• tonic alertness
• phasic alertness
• sustained attention
• selective attention
• alternating atttention
• divided attetion

• tonic alterness - not tested, observed
• phasic alertness - reaction time for visual or auditory
• sustatined attention - computer presented - look for maintaining vigilence
• selective attention - paper & pencil cancellation taks (scan array for designated target)
• alertnating attn - paper & pencil cancellation, but changing the targets 
• divided attn - respond to 2 concurrent tasks - producing sequences (A1, B2, C3, etc.)

What are 4 stages of memory?

**know and love**

1. sensory register (perception)
2. short-term memory (primary memory)
3. long-term memory (secondary memory)
4. working memory

Sensory Register (perception)

**to know and love **

• **must register ** traces incomign stimuli are briefly stored in modality specific form - REGISTRATION
• information cannot be maintained by rehearsal
• limited capacity - can decay in 1-2 seconds
• will be sent to STM (if it is not lost)
• "registration is the means by which perceptions are introduced to memory via attn & encoding processes" - automatic process

• limited capacity: decay in several seconds to minutes
• information CAN be maintained by rehersal
• STM cpaactiy may be qualified (digit span & sentence reptition taks)
• passive storage space --> info sent to LTM

**ultimate goal of therapy:self-correcting**

Long-Term Memory (secondary memory)

**to know and love**

• slow decay rate
• a static repository for memories of our experiences and knowledge
• semantic memory in ters of information is integrated into permanent memory at this stage - able to translate
• **Semantic information is RETAINED not syntactic strucutre**

Working Memory

** too know and to love **

• can decay, unless retrieved/used
• recycling and repeating
• information stored for LTM, but search LTM - what do I knkow that is associated with this?
• WM = assimiliation - active mental processing carried out

• Long-term memory
• recent & remote memory
• Retrospective memory - What I already know
• declarative
• eposodic
• semantic
• procedural
• Prospective memory - remember to remember

Retrospective Memory: Declarative

& the two types of declaractive

• What we know about things

eposodic & semantic

Reprospective: Declarative: Eposodic Memory

Retrospective: Declarative: Semantic Memory

• Reprospective: Declarative: Eposodic Memory: - memory for personality experiened even that are specific to TIME & PLACE
  
• shape who we are; where you came from & where you are going
• Retrospective: Declarative: Semantic Memory - organized world knowledge - facts, dates, names, & places
  

• Procedural memory - know how to do things - motor componet
• know sequence/organization for completing a task
• collection of habits that can be applied without thinking
• *less affected by brain damage than declarative*

• remembering to remember
• take what we have done in the past, governs initiation
• frontal lobe patients will have difficulty with this
• failure to recognize contextual cues that ordinarily trigger recal of specific info
• contributes to daily handicaps in life

• designed to assess
• retention spanc
• retention & recall of new information
• retrieval or information from remote memory (biographical information)
• visual memory

• goal directed behavior
• plan, organize, regulate purposeful behavior
• incorporates:
• attn & memory - elementary process - higher level functions
• response flexibility - no perseverative - learn behaviors that are appropriate
• planning, reasoning, and problem solving
• abstract thinking - infer meaning w/o specifically stated

1. initiatin intention behavior - esp. spontaneous
2. planning behavioral routines to accomplish intentions
3. maintaining & regulating goal-directed behavior
4. monitoring & modifying behavior in respones to situational variables (contextual information)

• usually frontal lobes - common w/ brain injury
• impaired response flexibility
• diff. inhibiting, modifying, or stopping behavior once it started
• fail to appreciate subtle or abstract aspect of evens or situations
• diff adapting to changing tasks or repsonse requirements
• **brain damaged do not recognize another way to do something **

Perseveration

& Verbal Perseveration

• excessive repetition of pattern elements
• inability to shift from element to element in pattern
• all populations will do this: severe brain injury, RHD, Diffue TBI, Dementia

• Verbal Perseveration - repeat words over and over; may hae been appropriate at the first time
• **stop perseverating, no talking, then start again with new task**

Resource Allocation Models:

How you modify what you are doing

concept (3 types)

** TEST **

• the human brain has limited amount of cognitive resources available for carrying out mental operations (perceiving & comprehending)

1. cognitive processes - mental operations
2. processing resources - mental energy (ability to direct mental energy)
3. central pool - contains mental energy