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Bernau, Switzerland

Delirium Syndromes are no specific cerebral diseases, but reflect an "acute brain failure" including deficits at the highest level of Cognition. Causes are multifactorially and comprise physical as well as non-physical factors. Core symptoms of delirium are above all attentional deficits which lead to various impairments in language and speech motor functions. In the hypoactive subtype patients display logopenia, hypophonia and a diminished acuity of articulation as a result of reduced attentional intensity. In the hyperactive subtype of delirium patients show incoherence, hyperphonia and raised speech rate due to disturbed attentional selection. A Screening of language functions (particularly of spontaneous speech and writing, naming and language comprehension) as well as a Screening of speech motor functions (changes in oral fluency, phonation, prosody and articulation accuracy) could reinforce the delirium diagnosis.

Micrographia is an acquired disturbance of writing, which is characterized by consistent or progressive diminution of letter size. Micrographia is mainly caused by left parietal lesions and degenerative changes or focal lesions of the basal ganglia and striato-frontal circuits. Therefore, micrographia is a common symptom in Parkinson's disease or in ACM infarction. Writing samples show that micrographia in patients with right ACM infarction is embedded in numerous cognitive and perceptual deficits. Due to severe spatial impairments handwriting is neographic in spite of normal language structures. In the diagnosis of micrographia premorbid samples of writing are essential, however a patient's copy of letters and figures is more significant than free writing. Effective treatments are interventions which focus the patient's attention on the writing process or give compensatory assistance. Severe impairments in selective attention decrease therapeutic effectiveness. © Schattauer 2010.

Progressive supranuclear palsy (PSP) is a neurodegenerative disease of the basal ganglia, which was first described precisely by Steele, Richardson and Olszewski in 1964. Main features of PSP are psychomotorical deceleration and disturbed executive functions, which lead to fronto-subcortical dementia within a few years. Relevant symptoms of PSP for speech therapy are cognitive dysphasias of dysexecutive origin, mixed hypokinetic-spastic dysarthrias, neurogenic dysphagias with difficulties in oral and pharyngeal stage and impaired deglutition based on executive dysfunctions. Due to the progression of cognitive dysphasia, dysarthrophonia and dysphagia, patients with PSP should receive obligatory speech therapy besides physical and occupational therapy. In the early stage of the disease an assessment of executive function disorder is important (e. g. by use of the brief Frontal Assessment Battery) as well as a symptomatic treatment of these deficits. In the middle stage of the disease an inverse-symptomatic treatment of executive, speech motor and phagic functions is essential to stabilise still available skills as long as possible.

Nasogastric tubes are often used in acute stroke patients for enteral nutrition, but they can lead to various complications, including delayed deglutition processes, a pathogenic oral and gastric flora, gastro-esophageal reflux disease, a deprivation of cough and swallowing reflex, chronic sinusitis or ulcerations of the post cricoid region. Tubes anaesthetize the apposed mucosa and therefore influence directly cortical swallowing areas which are responsible for volitional aspects of deglutition. If a nasogastric tube is well-placed it seems to be a satisfactory option for intermittent enteral feeding in the first 14 days after acute stroke to prevent malnutrition. If enteral nutrition is expected to take longer than 28 days an (always individual) decision concerning a PEG has to be reached. © Hippocampus Verlag 2015.

Cognitive dysphasias are brain damage-related, non-aphasic language disorders caused by attentional, mnemonic and executive disturbances. Such language processing disorders are until now relatively unspecifically termed as "non-aphasic" and include a large number of heterogeneous symptoms such as tangentiality, incoherence, pragmatic disturbances, hyperverbalizations, confabulations or a reduced speech drive. A few of these non-aphasic language disorders are well described - for example language impairments after right hemisphere damage, after traumatic brain injury or within exogenic psychosis. However, until this day there is no superordinated classification and therefore no superordinated therapeutic approach for such language disorders. The term "Cognitive dysphasias" is supposed to replace the common denotation "non-aphasic central language disorders" and should integrate central language disturbances (such as those within dementias or hypoxias), which have been neglected so far in a broad classification system. This system could be the basis of a cognitive-oriented language therapy, which includes options of treatment for those cognitive impairments that most affect the patients' communication ability in everyday life. © Hippocampus Verlag 2010.

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