Cognition and Language (DPT 542) Fall 2024 PDF

Cognition and Language DPT 542 – Functional Neuroscience Fall 2024 Think pair share 4 minutes: 3 minutes By yourself: Share with larger class 1 minutes Think about what cognition means. Pair with you ne...

Cognition and Language DPT 542 – Functional Neuroscience Fall 2024 Think pair share 4 minutes: 3 minutes By yourself: Share with larger class 1 minutes Think about what cognition means. Pair with you neighbor Discuss what does cognition mean to you? 3 minutes  Objectives Define cognition Describe the structures of cognition, unimodal, and heteromodal association cortices Identify methods to assess basic cognition in clients served by physical therapists Identify language processes and the cortical structures involved in expressive and receptive language Identify and differentiate between language processing disorders. Chapter 19 in Blumenfeld Cognition Defined “…the act or process of knowing including both awareness and judgment.”  - Webster’s 9th Collegiate Dictionary “…basic mental structures that include concentration, analysis, discrimination, organization, categorization, and memory skills. These skills allow us to process information…provide basis for appropriate interaction with our surroundings…necessary for learning, reasoning, and problem-solving and applying adequate judgment to situations.”  -Rancho Los Amigos Hospital Rehabilitation of the Head Injured Adult: A Family Guide. Schankman et al. Clinical Neuroscience for Rehab, 2013 Broad Scope Mental processes by which the brain manipulates information (internal and external) Information processing for Perception Learning Remembering Analyzing Judging Solving problems Recognition and comprehension of an external object or internal condition requires two key events in terms of brain processing. 1) a neural representation has to be generated of the object or internal condition as a whole. 2) the resulting neural representation has to be associated with stored information relevant to the object or internal condition. Review of Important Concepts A neuron is a single information processor Groups on neurons act together for common function Connectivity between neurons provide the structural relationship for cognition. Changes in sensitivity of connections strengthens cognitive processing (neuroplasticity) Gauthier, I., Skudlarski, P., Gore, J. et al. Expertise for cars and birds recruits brain areas involved in face recognition. Nat Neurosci 3, 191–197 (2000). https://doi.org/10.1038/72140  Intrinsic Circuitry of Cortex IV = INPUT layer V = OUTPUT layer Blue&gray: afferent Efferent: red Haines, fig 32-6 Interneuron: green  Cortical connects Cortical connects allow for information process Short association fibers: Local unimodal processing Multimodal processing Long association Fibers: Connecting functional units of brain Association cortices - perceptions and planning Structure and function of cognition Cortical and subcortical contributions to Cognition Primary Cortices Association Cortices Limbic (Basalmedial Association Cortices) Thalamic (Attention) Reticular Activating system (Alertness) Basal Ganglia Cerebellum Association Cortices Association Cortices Association Cortices Majority of Brain’s surface Allows for progressive high-order processing of information. Divided into: Unimodal (modality –specific) association cortex Heteromodal (higher-order) association cortex Unimodal (modality specific) Somatosensory: high processing of somatosensory. E.g. two point discrimination, determination of texture or shape through touch. Visual: Visual representation more refined for motion and figure recognition. Auditory: auditory sound recognition Premotor Formulates motor programs involving Supplementary Motor multiple joints Heteromodal (Higher order) Bidirectional connections Allows for higher order mental functions Integration of information from various modalities Are located in three locations areas of the cortex Prefrontal Parietal heteromodal association Temporal heteromodal association  Heteromodal (multimodal) Example of Processing in a Heteromodal Association area Awareness of one’s body (internal personal space or representation) and the extrapersonal space in which it moves (parietal lobe) Requires integration of vestibular, visual, and touch and proprioceptive inputs. Proprioceptive Body representation Touch Body interacting with environment Awareness of body in relationship to the Vestibular Head and neck orientation: related to gravity environment Vision Representation of the environment Multimodal Association Cortex Lateral association cortex Posterior association cortex Lateral parietal and temporal Anterior association cortex Frontal Basomedial (limbic) association cortex Lateral Association Cortex: Posterior Association Areas Spatial cognition (Parietal Association Areas) Wide variety of behaviors mediating attention to intrapersonal and extrapersonal space Parietal lobe damage involving the lateral association: Unilateral hemispatial neglect most prominent deficit Facial recognition (Temporal Association Area) Mediated by temporal association areas Damage can result in prosopagnosia Schematic of visual pathway: information is transmitted via both serial and parallel pathways: the Where and What Streams of visual processing. Where Stream: Location in space & movement Dorsal pathway to posterior parietal cortex What Stream: Shape and form Object recognition Ventral pathway to inferior temporal cortex  Lateral Association Cortex: Anterior Association Areas Neural substrates for planning, foresight, insight, empathy, altruism, abstract reasoning, self-awareness, and the governing of emotion Prefrontal cortex https://www.sicotests.com Dorsolateral prefrontal cortex (DLPFC) /newpsyarticle/Dorsolater al-prefrontal-cortex Damage results loss of initiative, diminished motivation, and apathy Impaired planning, goal attainment, problem-solving May show repetitive compulsive behaviors Orbital frontal cortex Damage results in emotional and behavior changes https://www.flintrehab.com/orbitofrontal-cortex-damage/ Executive Function Also called contingency planning Nonsocial behaviors are mediated by the anterior association cortex Social behaviors are mediated by the limbic association cortex Capacity to generate behaviors that are appropriate to the circumstances for which they unfold Association cortices - perceptions and planning Basomedial (Limbic) Association Cortex Includes the anterior cingulate cortex (ACC) Involved with emotional processing and performance evaluation and optimization Roles in focused problem solving, error recognition, and anticipation Assessing cognition Adapted from Table 19.1 Blumenfeld Alertness, attention and cooperation Orientation Memory Language capability Spontaneous, comprehension, naming, repetition, reading, writing, Following instruction Calculation Apraxia Neglects (Visual or spatial) Sequencing Reasoning, Judgement, problem solving, logic and abstractions Patient interview Alert and Oriented x 4 (Person, Place, Time, Event) Oriented x 1 = awareness of person What is your name? Oriented x 2 = knowledge of place Where are you right now? Oriented x 3 = knowledge of time/date What day is it? What time of day is it? Oriented x 4 = knowledge of event Where are you? What quarter is it, who is winning the game? Attention Focused attention: ability to direct attention to specific information or tasks Sustained attention: ability to maintain attention on one specific task for a period of time. Selective Attention: ability to select from many factor or stimuli to focus on one task and filter out other distractions. Alternating Attention: ability to switch back and forth between factor, stimuli or task Divided Attention: ability to process two or more demands at the same time (multi tasking). Patient interview Ability to follow directions “Please stand up for me” “Walk to the door and back” “Walk to the stairs and climb them” (2 step commands) “Pick up the towel from the table, fold it and place it on the shelf” (3 step commands) Patient interview Problem Solving, Sequencing See example NIHSS. https://www.ninds.nih.gov/sites/default/files/NIH_Stroke_Scale.pd f language Language Centers Wernicke’s Area Area responsible for language processing that enables series of sounds to be comprehended as words. Located in posterior 2/3rds of the superior temporal gyrus Has connections to parietal lobe and temporal lobe These regions function with Wernicke’s to assist with language comprehension. Broca’s area Motor program that activates sequences of sounds to produce words and sentences formulated here.  Broca’s area Makes connections with Wernicke’s as well as regions of the frontal lobe (prefrontal cortex, premotor cortex, and supplementary motor area. Areas of frontal lobe function with Broca’s to formulate higher order motor aspects of speech. Correct syntax Listening and Replying to speech Language does not come in isolation of other components of cognition. Connections between association areas in temporal, parietal and frontal lobe are important for language and cognitive development. Think about it! How might auditory language processing be linked to object identification? How might auditory language processing be linked to reading processing? How reading processing relate to processing relate to writing? How might language production relate to motivation, memory, and other frontal lobe functions. The fox jumps over the lazy dog Language disorders Aphasia Dysarthria Dysphagia Echolalia Aphasia Acquired impairment of the ability to communicate through speech, writing, or gestures. Examples Broca’s Aphasia Wernicke’s Aphasia Global Aphasia Broca’s Aphasia Caused by lesions to Broca’s area and adjacent structures. Commonly left Middle Cerebral Artery (MCA) Symptoms: Decreased fluency of spontaneous speech Extreme difficulty naming items Phrase length fewer than 5 words # content words exceeds # function words Prosody (rhythm, stress, intonation) lacking in speech production Comprehension is intact Broca’s Aphasia Video Broca's aphasia - Sarah Scott - teenage stroke http://www.youtube.com/watch?v=1aplTvEQ6ew&feature=related Update: Sarah Scott teenage stroke, Broca's Aphasia. http://www.youtube.com/watch?v=6zNKz7YoUao&feature=fvwrel Broca’s Aphasia is not fluent https://www.youtube.com/watch?v=JWC-cVQmEmY Wernicke’s Aphasia Caused by lesions to Wernicke’s area and adjacent structures Common etiology is infarct to left MCA Symptoms Markedly impaired comprehension Patients do not respond appropriately to questions Can not follow most commands Spontaneous speech has normal fluency, prosody, and grammatical structure Speech is empty, meaningless, and full of nonsensical errors (inappropriate substitutions) Examples – saying “ink” instead of “pen” or “bus” instead of “taxi” Examples – saying “pish” instead of “fish” or “rot” instead of “rock” Wernicke’s Aphasia video Wernicke's aphasia http://www.youtube.com/watch?v=dKTdMV6cOZw https://www.youtube.com/watch?v=3oef68YabD0 Global Aphasia Symptoms Impaired Fluency Impaired Comprehension Impaired Repetition Conduction Aphasia Symptoms Normal fluency Normal comprehension Naming impaired Impaired repetition Pathology Infarct/lesion in the peri-Sylvian area that interrupts the arcuate fasciculus Transcortical Aphasia Motor, Sensory, or Mixed Symptoms Resembles Broca’s, Wernicke’s, or Global Repetition spared Pathology Watershed infarct Broca’s, Wernicke’s, Arcuate fasciculus spared Damage to frontal lobe and temporoparietal cortices responsible for language Transcortical Motor Aphasia Impaired fluency Normal Comprehension Spared Repetition Transcortical Sensory Aphasia Normal fluency Impaired comprehension Intact repetition Transcortical Mixed Aphasia Impaired fluency Impaired comprehension Intact repetition Anomic Aphasia Some naming difficulties Aphasia classification scheme Dysphagia Impaired ability to swallow Pathology Brain stem involvement Motor weakness (motor to lower cranial nerves areas) Cerebellar pathways Dysarthria Impairment in the oral production of speech due to CNS or PNS lesion causing weakness, paralysis, or incoordination of the speech musculature. Pathology Brain stem involvement Motor weakness (motor to lower cranial nerves areas) Cerebellar pathways Echolalia The automatic repetition of sounds, words, phrases, or sentences that have just been heard. May be meaningless to the person. autism early signs echolalia https://www.youtube.com/watch?v=M1PlPLZPhu8