ALTERED COMMUNICATION

ALTERED COMMUNICATION

• Due to injury – Particularly Stroke

• Aphasia: loss of ability to use language and communicate thoughts verbally or in writing

FACTORS AFFECTING RECOVERY

• Age
• Area of injury and extent of injury
• In stroke or injury you will see the most improvement in the first 3-6 months.
Communication can return spontaneous.
• Changes can occur also 2-3 years after the incident
• Other health problems
• Motivation – Can make a big difference in rehabilitation

Area of the brain injured when speech problem occurs is usually on the Left Hemisphere in the
Frontal or Temporal Lobe

THREE TYPES OF APHASIA

• Receptive
o Problem with receiving information
o Problems with understanding or comprehending; can speak but may not
o Unable to comprehend the spoken word
o They may speak but it may not make cense because they could not understand
what you were asking them

• Expressive
o Problems with speaking; may be able to speak – signal works
o Patient is unable to form words that are understandable
o May be able to speak in single word responses
o Understands everything said to them but they cannot form the words. Very
FRUSTRATING for the client

• Global
o Communication of both receptive and expressive
NURSING MANAGEMENT

• Assess communication ability - #1 find out what type of aphasia

o Does client answer questions appropriately
o Read sentence and tell what means
o Write name or copy simple figure

• Nursing Diagnosis
o Impaired verbal and or written communication

• Nursing Interventions
o Remember clients feelings – They are frustrated
o Be sensitive
o Treat client as adult
o Be supportive
o Do not complete thoughts or sentences for the client
o Consistent schedule
o Provide written copy of schedule
o Get clients attention, speak slowly and keep language of instruction consistent
o Give instructions one at a time and allow to process info Consistency and
Repetition
o Talk during care activities Do not yell at client
o Communication board can be helpful – Expressive Aphasia

COMMUNICATING WITH APHASIC CLIENT

• Face client, establish eye contact
• Speak normal manner, tone
• Use short phrases, pause between phrases to allow client time to understand what is being
said
• Limit conversation to practical, concrete matters
• Use gestures – GLOBAL or Receptive
• Pictures and objects
• As client uses, handles an object, say what object is help with matching words with object
or action. Also try to label the object
• Be consistent in using same words, gestures each time give instructions or ask questions
• Keep extraneous noises, sounds to minimum. Too much background noise distract patient
or makes it difficult to sort out message being spoken
• If the patient is able to understand the written word you could use a pen and paper and
write messages
 MOTOR DYSFUNCTION
• Damage to nervous system can cause serious problems in mobility
o Hemiplegia: Paralysis of one side of the body
o Paralysis: Temporary suspension or permanent loss of function.
o Paresis: weakness; lesser degree of paralysis but can be just as disabling
o Paraplegia: Paralysis of lower portion of body and both legs
o Quadriplegia: Paralysis of all 4 extremities and usually the trunk

VOLUNTARY MOTOR SYSTEM

UPPER MOTOR NEURONS
o CNS
 Originate in the: Cerebral Cortex, Cerebellum and Brain stem
 Make up descending pathways located entirely in CNS (brain&spinal cord)
 They begin in the cortex of the opposite side of the brain
 C1 to T12

Upper Motor Neuron Lesions

• Involve motor cortex, internal capsule, spinal cord and other brain structures which cortical
spinal tract descends
• If damaged or destroyed = Paralysis
• Reflex movement : Uninhibited with UMN lesions = Hyperactive deep tendon reflex,  or
absent superficial reflexes and pathologic reflex such as Babinski response
o Severe Leg spasms because reflex lacks inhibition below level of injury
o Little or no muscle atrophy, muscle remain permanently tense, exhibiting spastic
paralysis or paresis
o Paralysis associated with UMN lesions usually affects whole extremity, both
extremities, or an entire half of the body

• Upper Motor Neurons Synapse Lower Motor Neurons in cord, pick up impulse and deliver
to muscle where it ends.

LOWER MOTOR NEURONS

• CNS / Peripheral nervous system
• Located in the Anterior horn of spinal cord gray matter or With cranial nerve nuclei in
brainstem
• Axons of neurons through peripheral nerves and terminate in skeletal muscles
• T12 to S4

Lower Motor Neuron Lesions

• Occurs when the Motor nerve severed between muscle and spinal cord
• Result muscle paralysis
• Reflexes lost, muscle becomes limp, atrophied from disuse
• Flaccid paralysis and atrophy affected muscles principle sign LMN dz
• Caused by trauma, infection (polio), toxins, vascular disorders, congenital malformations,
neoplasm’s, compression of nerve roots by herniated intervertabral disk
COMPARISON UMN / LMN
LESIONS
UMN LESIONS LMN LESIONS
Loss voluntary control
Loss voluntary control

Increased Muscle tone Decreased Muscle tone

Muscle Spasticity Flaccid Muscle paralysis

No Muscle Atrophy Muscle Atrophy

Hyperactive, abnormal reflexes Absent or diminished reflexes

 OTHER CONDITIONS RELATED TO MOTOR
DYSFUNCTION
Done when the nurse elicits a painful response to a client

• Decortication
o Flexion, internal rotation of arms, Lower extremities are at extension
• Decerebration
o (Mid Brain) Extension of upper and lower extremities
• Flaccid Posture
o (Lower brain stem) No motor function, limp, lacks motor tone; rag doll appearance

ASSESS MOTOR SYSTEM

• Muscle size
• Muscle tone (tensions) – done by palpating the muscles at rest and during PROM
• Muscle strength – Squeeze Fingers
o Tested by assessing the clients ability to flex or extend their extremities against
resistance***
• Coordination balance – Cerebellum
o Test by walking in a straight line, Hopping in place
• Reflexes

INFANT CONSIDERATIONS
• Immature system
o Movement weak / uncoordinated
o Tremors extremities and chin
o Myelin sheath not complete “short circuit”
o Reflexive behavior normal

GERONTOLOGY CONSIDERATIONS
• Flexed Posture or Slumped
• Display muscle rigidity - Tone
• Tremors
• Slow movement

NURSING INTERVENTIONS
• Position Q2o
• Good alignment
• ROM – you do not want them to get contractures
• Skin care
• Safety measures
• Teach family safety measures
• Prevent complications: Pneumonia, Skin breakdown, Contractures, DVT, Constipation

NURSING DIAGNOSIS
• Risk for Injury
• Disuse Syndrome
• Impaired Physical mobility
• Activity intolerance