Transcript http://www.biology-online.org/8/4_brain_damage.htm

Please Understand Me!
Tips for Health Care Professionals
Assisting Clients with Aphasia
Linda Wetterau, RN, BSN
April, 2007
The Aggravation of Aphasia
They call this
condition aphasia—it
should be called
“confuse-ya”!
(*)

Aphasia is a partial or total loss of
ability to talk; and/or understand
what people say, read or write.
Aphasia is a symptom and not a
disease, and can occur in a variety
of brain injuries. As a healthcare
provider, you have a unique
opportunity to assist those affected
with aphasia to achieve improved
communication.
Used with permission from L. Johnston, “For Better or For
Objectives
This tutorial is designed to help you:
 Exhibit recognition of brain anatomy
 Name the functions of the brain
 Describe neuron pathways and communication
mechanisms
 Describe major types of aphasia
 Relate physiology of aphasia to client signs and
symptoms
 Describe appropriate nursing interventions as
related to nursing sensitive outcomes
Learning to Help
Brain
Anatomy
Neurons
Communicate
Choose a topic of interest
from the menu or simply
click on the forward arrow
to progress through the
program. Selecting the back
arrow will take you to the
previous slide.
Aphasia:
Pathophysiology
Syndromes
To return to this menu
Prognosis
Nursing
Interventions
Microsoft clipart
click on
Brain: The World Inside Your Head
The human brain is the most complex structure in the known
universe. This three pound organ is estimated to contain about
100 billion cells, all working together to enable normal day to
day living.
The brain can be divided into 3 sections:
The forebrain (prosencephalon) is the largest.
Here is the cerebrum which is composed of 2
hemispheres (right and left) connected by the
corpus callosum. The surface of each
hemisphere is made up of gray matter, called
the cerebral cortex. There are four lobes here:
the frontal, parietal, occipital, and
temporal lobes.
http://www.getbodysmart.com
Brain: The World Inside Your Head
Underneath the cerebrum is the midbrain (mesencephalon), forming part of the
brain stem and connecting it to the forebrain.
The hindbrain (rhombencephalon) occupies the posterior portion of the
cranial cavity and contains the cerebellum, pons, and the medulla oblongata.
This is where the major nerve pathways for
sensation and movement cross over, causing
each cerebral hemisphere to control
the opposite side
of the body.
http://www.getbodysmart.com
Brain: The World Inside Your Head
Below is a map of the major regions of the brain.
Place your mouse on each region for a description of it’s function.
Wikipedia,-This image is a work of the National Institutes of Health, part of the
United States Department of Health and Human Services. As a work of the U.S.
federal government, the image is in the public domain.
Brain: The World Inside Your Head
Other key structures are smaller.
The limbic system is located in the medial aspect of the cerebrum and is
the mediator of our emotions.
The amygdala, which controls some of the more basic drives such as
aggression and sexuality as well as autonomic responses associated with fear,
is located deep within the temporal lobe.
 Adjacent to this is the hippocampus, an area dedicated to
new and long term memory.
The thalamus lies at the top of the brainstem
and is the receptor center for auditory and somatosensory
signals and relays those signals to the cerebral cotex.
Just below the thalamus is the area of temperature
control and homeostasis, known as the hypothalamus.
http://getbodysmart.com
Time for Review---Name your Brain
Click on the region which corresponds to the following description:
I am the frontal lobe—
responsible for higher
cognitive functions
such as planning,
organizing and personality.
This image is a work of the National Institutes of Health,
part of the United States Department of Health and Human Services.
As a work of the U.S. federal government, the image is in the public domain.
Name your Brain
Click on the region which corresponds to the following
description:
The cerebellum plays an
Slide 22
important role in
integration of sensory
perception and motor
output and is
responsible for
coordination of
voluntary movement.
This image is a work of the National Institutes of Health,
part of the United States Department of Health and Human Services.
.
As a work of the U.S. federal government, the image is in the public domain.
Name your Brain
Click on the region which corresponds to the following
description:
The parietal lobe is
concerned with perception of
stimuli related to touch,
pressure, temperature, and
pain
This image is a work of the National Institutes of Health,
part of the United States Department of Health and Human Services.
As a work of the U.S. federal government, the image is in the public domain.
Name your Brain
Click on the region which corresponds to the following
description:
This is the center for visual
input and perception, known
as the occipital lobe.
This image is a work of the National Institutes of Health,
part of the United States Department of Health and Human Services.
As a work of the U.S. federal government, the image is in the public domain.
Name your Brain
Click on the region which corresponds to the following
description:
Involved in auditory
processing and
information retrieval,
this region is known as
the temporal lobe.
This image is a work of the National Institutes of Health,
part of the United States Department of Health and Human Services.
As a work of the U.S. federal government, the image is in the public domain.
You are correct! The frontal lobe
is the largest area of the
cerebrum and controls
awareness, problem solving, and
judgment. Broca’s area is here—
the center for expressive
language. This region is
responsible for your ability to
follow instructions and make
decisions. Please click here to
continue.
Microsoft clipart
This is the parietal lobe—center
of visual attention. The frontal
lobe is the largest of the regions
in the cerebrum and lies to the
FRONT of the brain. Please
click here to try again!
Microsoft clipart
No----this is the temporal
lobe. The frontal lobe is
the largest of the regions
in the cerebrum and lies
to the FRONT of the
brain. Please click here to
try again
Microsoft clipart
Microsoft clipart
This is the occipital
lobe—center for visual
input. The frontal lobe is
the largest of the
regions in the cerebrum
and lies to the FRONT of
the brain.
Please click here to try
again!
You have
found the
cerebellum.
The frontal
lobe is the
largest of the
regions in the
cerebrum and
lies to the
FRONT of the
brain. Please
click here to
try again!
Microsoft clipart
The cerebellum, although only the
size of a fist and tucked away at
the bottom of the brain, has the
most neuronal pathways in the
brain. Thus it plays a vital role in
transmitting messages to move
our muscles and maintain balance
and equilibrium. Click here to
continue
Microsoft clipart
Sorry---this is the
frontal lobe! The
cerebellum is the
“treasure at the
bottom of the brain”.
Please click here to
try again!
Microsoft clipart
Microsoft clipart
No---this is the temporal
lobe. The cerebellum is the
“treasure at the bottom of
the brain”. Please click here
to try again!
Microsoft clipart
You have located the
parietal lobe. The
cerebellum is the “treasure
at the bottom of the brain”.
Please click here to try
again!
Microsoft clipart
This is the occipital
lobe, your vision
center. The cerebellum
is the “treasure at the
bottom of the brain”.
Please click here to try
again!
You are right! The
parietal lobe
integrates different
senses allowing
understanding of a
single concept. It
helps us to
manipulate objects,
recognize faces, and
distinguish left from
right. Please click here
to continue.
Microsoft clipart
Microsoft clipart
No—this is the
frontal lobe, the
largest region in
the cerebrum. The
parietal lobe is
positioned
posterior to the
frontal lobe. Please
click here to try
again!
You have
found the
temporal lobe,
most
associated
with hearing.
The parietal
lobe is
positioned
posterior to
the frontal
lobe. Please
click here to
try again!
Microsoft clipart
Microsoft clilpart
Sorry—this is your “motor center”—
the cerebellum. The parietal lobe is
positioned posterior to the frontal
lobe. Please click here to try again!
Microsoft clipart
You have located the
occipital lobe, associated
with visual input. The
parietal lobe is positioned
posterior to the frontal
lobe. Please click here to
try again!
Microsoft clipart
Sorry---this is the
frontal lobe, our
awareness center. The
occipital lobe is the
smallest of the regions
in the cerebrum and is
located in the
posterior portion of
the brain. Please click
here to try again!
You have located
the parietal lobe,
area for sensory
integration. The
occipital lobe is the
smallest of the
regions in the
cerebrum and is
located in the
posterior portion
of the brain.
Please click here to
try again!
Microsoft clipart
Microsoft clipart
You have found the temporal lobe, most associated with hearing.
The occipital lobe is the smallest of the regions in the cerebrum
and is located in the posterior portion of the brain.
Please click here to try again!
Microsoft clipart
Sorry—this is your “motor center”—the
cerebellum. The occipital lobe is the
smallest of the regions in the cerebrum
and is located in the posterior portion of
the brain. Please click here to try again!
Microsoft clipart
You are correct!
The occipital lobe is
the visual
processing center
of the brain. It also
is responsible for
reading perception
and eye movement.
Please click here to
continue.
Microsoft clipart
Sorry, this is
the frontal
lobe, our
awareness
center. The
temporal
lobes lie at
the lateral
aspect of the
brain. Please
click here to
try again!
You have located the
parietal lobe, area for
sensory integration.
The temporal lobes lie
at the lateral aspect of
the brain. Please click
here to try again!
Microsoft clipart
This is the occipital lobe,
your vision center. The
temporal lobes lie at the
lateral aspect of the brain.
Please click here to try
again!
Microsoft clipart
Sorry—this is your “motor center”—
the cerebellum. The temporal lobes
lie at the lateral aspect of the brain.
Please click here to try again!
Microsoft clipart
Microsoft clipart
The temporal lobe contains Wernicke’s area—
responsible for receptive language. In addition
to auditory functions, it also helps with
expressed behavior and categorization of
objects.
This completes the review of brain anatomy and
function. Please click here to continue to brain
communication pathways.
Brain Communication
Communication between the regions of the
brain and our body requires a combination
of electrical and chemical activities. This takes
place via neurons-our information and
signal processors.
Microsoft clipart
Brain Communication
Their tree-like structure has 4 major parts:
Dendrites: highly branched “input” side
Soma: the cell body containing the cell’s nucleus, organelles, and the
metabolic and protein manufacturing machinery
Axon: tap-root like structure carrying signals
outward from the soma
Terminal button: located at end of axon, it
releases the transmitters
used in neuron to neuron
communication.
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(NIDA) is part of the National Institutes of Health (NIH) ,
a component of the U.S. Department of Health and Human Services As a work of the U.S.
federal government, the image is in the public domain.
Brain Communication
The site of communication between neurons is the synapse.
Chemical transmission is via neurotransmitters using single
amino acids (glutamate), serotonin, epinephrine, norepinephrine,
dopamine and acetylcholine.
Electrical transmission depends on the ion charged molecules
of potassium, sodium,
chloride, calcium, and
protein anions.
This is known as the
gated channel.
The National Institute on Drug Abuse
(NIDA) is part of the National Institutes of Health (NIH) ,
a component of the U.S. Department of Health and Human Services As a work of the U.S. federal government, the image
is in the public domain.
Brain
Communication
For additional information on nerve firing please visit
http://faculty.alverno.edu/bowneps/nervefiring/nervefiringintro.htm
Microsoft clipart
For additional information on neurotransmission, please visit
http://faculty.alverno.edu/bowneps/neurotransmission/ntindex.htm
Communication Breakdown
The workings of these neuron pathways convey perceptions and
states of mind we can recognize and put a name to---making it
possible to exchange signals as language.

Words are encoded by formation of networks of neurons. In
aphasia, this chain of signals has been interrupted.
Aphasia can occur as a result of:
Brain injury
Stroke
Cerebral tumors
Degenerative diseases
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Pathophysiology of Aphasia
This injury causes an interruption of the brain’s blood
supply.



Diminished perfusion leads to inadequate oxygenation to the
affected area.
The tissue’s metabolic activities are impaired with resulting loss
of neuronal functions and interruption of electrical pathways.
This chain of reaction is known as the “ ischemic cascade”.
Pathophysiology of Aphasia
Key processes include an influx of calcium with
resultant glutamate release, acidosis and free
radical production.

In later stages, secondary inflammation and local
cell destruction (apoptosis) occur.
As a result, the intricate
functions of language
are interrupted.
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Aphasia Syndromes
Microsoft clipart
Patients with aphasia have usually sustained an
injury to the left cerebral hemisphere.

The left hemisphere tends to be the more
analytical part, taking information and applying
language to it.
Aphasia Syndromes
For example, the right hemisphere “sees” a
car and this information is transmitted to
the left hemisphere which says “There is
Joan’s new convertible”.
The specific language deficit will vary
according to area of brain injury.
Aphasia Syndromes
Cognitive and linguistic deficiencies are grouped
into aphasia syndromes. These classifications
are expanding as neuroscience research
develops. Click on each of the most currently
accepted categories below for description:
 Broca’s
 Wernicke’s
 Conduction
 Global
 Transcortical
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Broca’s Aphasia Syndrome
Using the information you learned in the overview
of brain anatomy, answer the following
question:
Broca’s area is the center for expressive
language and is located deep in the frontal lobe.
TRUE
FALSE
Wernicke’s Aphasia Syndrome
Using the information you learned in the
overview of brain anatomy, answer the
following question:
Wernicke’s area is the center for
receptive language and is located in the
temporal lobe.
TRUE
FALSE
Conduction Aphasia Syndrome
Also known as associative aphasia, this is a
relatively rare form of aphasia, thought to be
caused by a disruption in the fiber pathways
connecting Wernicke’s and Broca’s areas.
Affected individuals show the following
characteristics:




speech is fluent with good comprehension
oral reading is poor
major impairment in repetition
transposing sounds within a word (i.e. using
“velitision” instead of "television“) are common.
Back to Syndromes List
Conduction Aphasia Syndrome
To understand the symptoms, recall that Broca’s area
is associated with expression and Wernicke’s area
with understanding.

With both areas intact but the neural connections
between them broken, the result is that the patient
can understand what is being said but cannot
repeat it (or repeats it incorrectly).
This patient will also end up saying something
inappropriate or wrong, realize his/her mistake, but
continue making further mistakes while trying to correct
Back to Syndromes List
it.

Global Aphasia Syndromes
Global aphasia is the most severe form. The
symptoms are those of Broca’s aphasia and
Wernicke’s aphasia combined.

There is an almost total reduction of all aspects
of spoken and written language, in expression as
well as comprehension. However, other cognitive
skills remain functioning, so the client is aware of
their deficit!
Back to Syndromes List
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Transcortical Aphasia Syndrome
Transcortical aphasia is a relatively rare
condition which occurs when the area of
injury surrounds, but does not affect Broca’s
or Wernicke’s area.

An affected individual will have both severe
speaking and comprehension impairment. The
ability to repeat is retained, making repetition the
defining quality of this syndrome.
Click here to continue to
Aphasia Prognosis
Back to Syndromes List
You are CORRECT!
When damage occurs in Broca’s area, individuals will have difficulty with
expression of language.
 Speech will be slow and labored, without intonation, but meaningful.
Affected people often speak in short, incomplete sentences—omitting functor
words such as “is”, “and”, “the”.
• For example, a person with Broca’s aphasia may say “water now” which may be
interpreted as “I would like some water now” or “I need to water the plants
now” or any of a variety of meanings. Naming of actions is typically harder than
naming of objects. Some difficulty in reading is also common.
As spontaneous speech is challenging, this syndrome is often called
“nonfluent aphasia”.
As cognitive comprehension is NOT impaired, affected individuals often suffer
from depression, anger, and frustration at their disability.
Click here to continue
Sorry—you are incorrect.
When damage occurs in Broca’s area, individuals will have difficulty with
expression of language.
 Speech will be slow and labored, without intonation, but meaningful.
 Affected people often speak in short, incomplete sentences—omitting
functor words such as “is”, “and”, “the”. For example, a person with Broca’s
aphasia may say “water now” which may be interpreted as “I would like
some water now” or “I need to water the plants now” or any of a variety of
meanings. Naming of actions is typically harder than naming of objects.
Some difficulty in reading is also common.


As spontaneous speech is challenging, this syndrome is often called
“nonfluent aphasia”.
As cognitive comprehension is NOT impaired, affected individuals often suffer from
depression, anger, and frustration at their disability.
Click here to continue
You are CORRECT!
Since Wernicke’s area is responsible for the ability to
understand language, individuals with damage to
this area exhibit impaired comprehension of
speech—both their own and that of others.
 Therefore, affected people speak easily, giving this
syndrome the description of “fluent aphasia”.

However, the long sentences are filled with the wrong
words, wrong sounds in words, or even made up words
(known as neologisms). These individuals are unaware of
their deficit, and therefore often appear “confused”.
Click here to continue
SORRY—that is incorrect.
Since Wernicke’s area is responsible for the ability to
understand language, individuals with damage to
this area exhibit impaired comprehension of
speech—both their own and that of others.
Therefore, affected people speak easily, giving this
syndrome the description of “fluent aphasia”.
However, the long sentences are filled with the
wrong words, wrong sounds in words, or even
made up words (known as neologisms). These
individuals are unaware of their deficit, and
therefore often appear “confused”.
Click here to continue
Aphasia-- What is the prognosis?
The outcome of aphasia is difficult to predict
given the wide range of variability of the
condition. Factors that influence improvement
include:
Age of individual
Cause of the brain damage
Location and extent of the injury
The person's general health
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Jacobs, 2005
Aphasia-- What is the prognosis?
In general, patients tend to recover skills in
language comprehension more completely
than those skills involving expression.

The goal of treatment is to restore as much
independence as possible.

This is done in a way that preserves an individual’s
dignity while motivating them to re-learn basic
skills
Jacobs, 2005
Aphasia--Recovery
Remember the role of neuron networks in
language? Research has shown that
stimuli repetition “retrains” the brain,
creating new wiring connections to
replace lost ones
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
“Rewiring” of communication pathways begins
within weeks of injury and can continue for years.
Wheeler, 2006
Aphasia--Recovery


As it receives repeated input, the brain
physically changes its structure. New blood
vessels begin to form and newly born
neurons migrate to the damaged area.
Therefore, provided the correct challenge
and environment, an aphasia victim can
achieve optimal communication.
Wheeler, 2006
Aphasia--Treatment


The most effective treatment begins early in the
recovery process and is maintained consistently and
intensely.
Therapy is aimed at improving a person's ability to
communicate and includes:
 Medical
and nursing supportive treatment
 Physical therapy
 Occupational therapy
 Speech therapy
Bhogal, S., and Teasell, R., and Speechley, M. 2003
Nursing Interventions

Supportive actions during the client’s acute
phase will include:
Maintaining oxygen saturation to nourish the
brain
 Ensuring adequate nutrition to “feed” neuron
pathways
 Performing regular neurological assessments to
monitor for client changes (i.e. Glasgow Coma
Scale)

Adapted from Carpentio, 1993
After survival, our most basic
human need is to
communicate with others.
Aphasic individuals report feelings of isolation and
alienation—leading to frustration and depression.
Remember, the person’s intelligence is NOT affected
by their disability.
Sundin, Jansson, and Norberg, 2000
Nursing Assessment
Therefore, after assessing the client’s vital signs and
neurological status, validation of their communication
abilities will be a priority.
Important functions to assess include:
Comprehension
Ability to name objects
Fluency
Reading ability
Repetition
Ability to write
Adapted from Carpentio, 1993
An important nursing goal will be to provide a sense of
security for our clients; ensuring that they know they
are not alone and that others DO care.
Ongoing nursing interventions are then targeted toward
maximizing the client’s ability to communicate. Specific
outcomes will be focused on interpretation and use of:



Spoken language
Written language
Nonverbal language.
Moorhead, et al (2004)
Specific Nursing Actions

First identify the methods the client can use to
communicate his/her basic needs:
 Pointing
 Eye
or other hand signals and pantomime
blinks or head nods
 Writing
or drawing
Adapted from Carpentio, 1993
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Specific Nursing Actions

Create a therapeutic environment
 Convey
respect and willingness to understand
 Minimize outside distractions
 Maintain eye contact
(the eyes are the window to the soul)
 Be aware of body language
(both yours and the client’s)
 Use touch to create a sense of connection
touch will also send nerve stimulation to boost
neuron regeneration
Adapted from Carpentio, 1993
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Tips to Promote Communication and
Comprehension
Speak slowly, in short phrases in a normal
tone of voice
 Allow person time to respond—do not
interrupt and supply words only occasionally
 Rephrase to validate what was said (or
pantomimed)
 Do not pretend to understand if you don’t
 Acknowledge the client’s frustration

Adapted from Carpentio, 1993
Tips to Promote Communication
and Comprehension
Remember repetition aids in building new
neuronal pathways:
 Repeat or rephrase requests
 Try to use the same words with the same task
(i.e. bathroom vs. toilet, pill vs. medication)
 Keep a record at the bedside of the words to
maintain continuity
 Write key words on flashcards for patient
practice
Adapted from Carpentio, 1993
Final Communication Tips
Be an active listener
Use humor and laugh together
Encourage any type of
communication, whether it is
speech, gesture, pointing, or
drawing.
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Use 'face-saving' ways of
moving on from a conversation
breakdown
Silence can be a powerful tool! Sometimes it is
best to just BE with a client—communicating via
touch and expression.
Adapted from Carpentio, 1993
Practical Application
Now that you have learned tips to communicate
with aphasic individuals it is time to
put this information into practice.
Let’s look at some case studies.
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Case Study #1
Ms. Hedy Ache

Hedy is a 34yo female who sustained a head
injury yesterday in a motor vehicle accident. A
CT scan done on admission showed a
controlled bleed in the temporal lobe.

When you meet her this AM she is awake but
responds to your greeting with a confused look
followed by a long, complicated sentence filled with
nonsense words.
Ms. Hedy Ache
Your initial assessment reveals normal vital signs, but
a decreased pO2 of 86%.


Your first action will be to re-insert her oxygen cannula
(which she has pushed up onto her forehead) and adjust
the flow to 4l/m.
Neurological assessment findings:



PERLA with spontaneous eye opening
Motor response is maximal with good movement of all
extremities
Verbal response remains garbled although her pO2 is now 98%
Ms. Hedy Ache
As you record your findings on her chart, you
note her diagnosis:
“Acute head injury, complicated
by aphasia”
Based on your assessment and her injury, which
type of aphasia does Ms. Ache have?
Broca’s
Aphasia
Wernicke’s
Aphasia
Ms. Hedy Ache
SORRY—you are incorrect. Ms. Ache is presenting
signs of Wernicke’s aphasia.


Broca’s area in located in the frontal lobe—Ms Ache’s
injury is in the temporal lobe.
Broca’s aphasia is characterized by short, incomplete
sentences. Hedy’s speech is fluent, but
incomprehensible.
Click here to
continue
Ms. Hedy Ache
YES—you are correct


Hedy’s injury is in her temporal lobe, the
location of Wernicke’s area
Wernicke’s aphasia is characterized by fluent
but nonsensical sentences. The individual may
appear confused although intelligence
is normal.
Ms. Hedy Ache
Choose which method of communication
you feel will be most effective for
Ms. Ache:
Verbal
Written
Gestures and pantomime
Case Study #2
Sam Troke
Mr. S. Troke is a 68yo male admitted 3 days ago
following an ischemic cerebral vascular accident
(CVA) in his left frontal lobe.
His chart states his recovery has been without
complications, but slow. Nurse’s notes indicate
that Mr. Troke is “withdrawn” and “noncompliant” with his therapies.
Mr. Sam Troke
Your initial assessment findings are:
Vital signs within normal range for Mr. T.
 Eye opening spontaneously
 Verbal response delayed but appropriate
 Motor response shows right side is weaker than
his left side
Mr. Troke responds to your questions in slow and
choppy sentences, leaving out many words.

Mr. Sam Troke
Mr. Troke is exhibiting symptoms of which
type of aphasia syndrome?




Broca’s
Conduction
Transcortical
Wernicke’s
Mr. Troke’s CVA occurred in his frontal lobe--the location of Broca’s area.
 Individuals with injury in the frontal lobe will
often exhibit right-sided weakness as the
frontal lobe is also important for control of
body movement.
Mr. Sam Troke
Choose the 3 best indicators of Broca’s
aphasia syndrome:





Speech is fluent with long, flowing sentences
Speech is slow and labored, without intonation
Repetition of the same words is frequent
Individual will often use neologisms (made up
words)
Individual is aware of his language deficits
Mr. Sam Troke

Mr. Troke’s “non-compliance” may be linked
to :



Confusion
Stubbornness
Depression
You are CORRECT!
Because individuals with Broca’s aphasia are aware
of their deficits, they are often frustrated and
depressed.
 Mr. Troke would benefit from interactions with
nurses who take time to patiently establish a
caring connection.
Remember: active listening and therapeutic touch
are as important a healthcare tool as your
stethoscope!
Summary
Aphasia is a symptom of a disturbance to the
brain’s neuronal communication pathways.
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These pathways CAN be reconstructed with
repeated appropriate cognitive stimulation.
Nurses have a key role in assisting aphasic
individuals to regain communication skills.
Microsoft clipart
When Communication Breaks Down:
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Try saying it in a different way.
Try writing it down or drawing it.
Take time to really listen.
Avoid interrupting or correcting the
individual's speech.
Encourage any type of communication,
whether it is speech, gesture, pointing, or
drawing.
Celebrate any successes!
Remember:
Communication is one of the most powerful
gifts given to us as human beings.
Microsoft clipart
Resources
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Ackerman, S. (1992). Discovering the brain. Washington DC: National Academy of
Sciences.
Aphasia. (2007, March 2). In Wikipedia, The Free Encyclopedia. Retrieved March
5, 2007, from http://en.wikipedia.org/wiki/Aphasia
Bhogal, S.; Teasell, R.; Speechley, M. (2003). Intensity of aphasia therapy, impact
on recovery. Stroke. 34:987. Retrieved March 15, 2007 from
http://stroke.ahajournals.org/cgi/content/full/
Bowne, P.S., (2004-2005). PATHO Physiology Tutorials. Retrieved April 21, 2007
from http://faculty.alverno.edu/bowneps/index.html
Carpentio, L. (1993). Nursing diagnosis. Application to clinical practice (5th
edition). Philadelphia, PA: J.B. Lippincott Company.
Hallett, M. (2005). Guest editorial. Neuroplasticity and rehabilitation. Journal of
Rehabilitation Research & Development, 42(4), xvii-xxi. Retrieved April 17,
2007 from the CINAHL Plus with Full Text database at
http://0-web.ebscohost.com.topcat.switchinc.org/--cinahl.
Jacobs, D. (2005, December,5). Aphasia. Retrieved February 21, 2007 from
http://www.emedicine.com/NEURO/topic437.htm
Johnson, G. (1998). Understanding how the brain works. Traumatic brain injury
survival guide. Retrieved February 21, 2007 from
http://www.tbiguide.com/howbrainworks.html.
Resources
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Johnson, L. (2007). For better or for worse. Retrieved February 12, 2007 from web
site: http://www.fborfw.com/strip_fix/
Markus, Hugh (2001, October). The pathophysiology of stroke. The British journal of
cardiology. 8 (10): 586-9. Retrieved March 12, 2007 from www.basp.ac.uk.
Microsoft (2003). Animation and clipart.
Moorhead, S., Johnson, M., and Maas, M. (Eds.). (2004). Nursing outcomes
classification (NOC) (3rd ed.). St. Louis, MO: Mosby Elsevier.
National Institute on Drug Abuse. Image retrieved March 12, 2007 from
http://www.nida.nih.gov/JSP/MOD3/page3.html
National Institutes of Health 92007). Brain image retrieved February 12, 2007 from
http://www.answers.com/topic/national-institutes-of-health
Nordehn, G., Meredith, A., & Bye, L. (2006). Grand rounds. A preliminary
investigation of barriers to achieving patient-centered communication with
patients who have stroke-related communication disorders. Topics in stroke
rehabilitation, 13 (1), 68-77. Retrieved April 17, 2007 from the CINAHL Plus
with Full Text database at http://0-web.ebscohost.com.topcat.switchinc.org/-cinahl
Porth, C. (2004). Essentials of pathophysiology: Concepts of altered health states.
Philadelphia, PA: Lipincott Williams & Wilkins.
Purdy, Michael (2007, March 14). Stroke damage keeps brain regions from “talking”
to each other. Retrieved March 21, 2007 from
http://www.eurekalert.org/pub_releases/2007.
Resources
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Restak, Richard. (1995). Brainscapes., New York, NY: Hyperion.
Sundin, K., Jansson, L., & Norberg, A. (July, 2000). Communicating with people
with stroke and aphasia: understanding through sensation without words.
Journal of Clinical Nursing, 9 (4), 481-488. Retrieved March 16, 2007 from
the CINAHL Plus with Full Text database at
http://0-web.ebscohost.com.topcat.switchinc.org/--cinahl
Sundin, K., Jansson, L., & Norberg, A. (2002) Understanding between care
providers and patients with stroke and aphasia: a phenomenological
hermeneutic inquiry. Nursing Inquiry, 9 (2), 93-103. Retrieved March 16,
2007 from the CINAHL Plus with Full Text database at
http://0-web.ebscohost.com.topcat.switchinc.org/--cinahl
Ward, Jamie (2006). Introducing Cognitive Neuroscience. Retrieved February 21,
2007 from http://www.cognitiveneuroscoencearena.com
Wheeler, Mark (2006). Cellular clues identified for stroke recovery. Retrieved
March 15, 2007 from http://www.eurekalert.org/pub_releases.
Acknowledgements
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Professor Pat Bowne, Alverno College for your guidance in
this tutorial development and use of your pathophysiology
tutorials
Mary Jo Noble MSN/Ed, RN,CNOR for your guidance as
clinical preceptor.