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Neurobehavioral Manifestations

 

      

 

The following topics are covered in this worksheet:
1. Brain Structure and Function
2. Location of Brain Damage – Characteristics of Cognitive Behavior
3. Amnesia
4. Aphasia

 

Brain Structure and Function

 

.Location of Brain Damage – Characteristics of Cognitive Behavior

Location of Damage Cognitive Behavior Example Video
Temporal lobe – includes auditory reception and visual processing areas.

Helpful mnemonic: Use tempo as your mnemonic and picture a metronome above your ear (where the temporal lobe is located)

 1. Deficits in short term memory.
2. Difficulty with sound discrimination and voice recognition. May result in auditory agnosia – the inability to recognize and process sound in spite of intact hearing mechanisms.
3. Deficits in expressive and receptive language.
4. Deficits in comprehension.
5. Problems with auditory and visual memory.
6. Wernicke’s aphasia, described in a subsequent chart.		 A patient with a temporal lobe injury may not remember events that have happened in the past few minutes, hours or days. He or she may not recognize the voices of family members and may have trouble remembering words or forming sentences when speaking. He or she may have difficulty understanding the content of a book or the plot line of a movie.
Occipital lobe – includes visual reception areas.

 

 1. Anopsia – a deficit in the visual field.
-Hemianopsia – a deficit in half of the visual field
2. Quadrantanopia – a deficit in a quarter of the visual field.
3. Deficits in object recognition. May result in visual agnosia – the inability to visually recognize objects, places, words or faces and the meanings associated with them.
4. Deficits in visual scanning.		 A patient with an occipital lobe injury may experience partial or total loss of vision. He or she may not recognize objects and may have difficulty visually scanning the room or environment. He or she may also experience visual hallucinations or difficulty perceiving color, as well as alexia (word blindness) or agraphia (inability to write).
Parietal lobe – includes the reception areas for touch, body position, and sensory integration.

 1. Problems with discrimination of sensation, including touch, pain, temperature. May result in tactile agnosia – the inability to recognize objects by touch.
2. Problems discerning body position in space and spatial relations.
3. Difficulty with self perception.
4. Difficulty with sensory integration.
5. Left parietal lobe damage – difficulty with right/left discrimination, writing (agraphia) and math (acalculia).
6. Right parietal lobe damage – neglect of one side of the body or one side of the perceptual field (contralateral neglect), difficulty making things, difficulty drawing, denial of problems.		 A patient with a parietal lobe injury may not be able to accurately report sensation and may be at risk for injury due to impaired sense of pain or temperature. He or she may have difficulty completing motor tasks and may have problems perceiving and moving around in the environment. He or she may have difficulty putting together a craft project and may need prompting to complete ADL tasks thoroughly.
Frontal lobe – includes the centers for emotion, as well as the centers that sort out and organize information, control attention and concentration, and the centers for concept formation, abstract thinking, decision making and problem solving.

 1. Difficulty with emotional control, changes in personality.
-loss or deficits in facial affect and emotional reactions
2. Deficits in ability to attend to task and concentrate on tasks.
3. Deficits in fine motor skills and sequencing complex motor activities.
4. Problems with organizational skills.
5. Difficulty solving problems and making decisions.
6. Difficulty visualizing concepts or situations.7. Difficulty responding to the environment, including perseveration, risk taking, non-compliance with rules, or difficulty gauging responses to the environment.
8. Broca’s Aphasia, described in a subsequent chart.		 A patient with a frontal lobe injury may display no or subdued emotional responses and may show a flat affect (no facial expressions). He or she may require visual and verbal cues to attend to task and may require assistance in completing tasks that have multiple steps. He or she may require assistance organizing materials for ADL or IADL activities. Cues may be required to respond to environmental situations and to solve problems during every day activities. The patient may become stuck on a problem or may attempt to solve a problem through impulsive actions that are not safe.
Thalamus – acts as a relay center for sensory information between the body and the two hemispheres of the brain.


The thalamus is the brain’s sensory switchboard. It directs messages to the sensory areas in the cortex and transmits replies to the cerebellum and medulla. Helpful mnemonic: Hal & Amos are traffic cops….

 1. Disorientation, altered state of arousal.
2. Deficits in memory, speech functions.
3. Deficits in sensory perception with the exception of sense of smell.
4. Apathy		 The patient with damage to the thalamus may not be oriented to person, place or time. He or she may drift in and out of an aroused state and may not be aware of his or her surroundings. He or she may display abnormal reactions to sensory input and may appear to not care about anything.
Hypothalamus – regulates bodily functions, including hunger, thirst, circadian rhythm, body temperature, and emotion. Regulates the pituitary gland and related hormonal functions.


Helpful mnemonic: Picture a HYPOdermic needle spraying two thirsty llamas with water to quench their thirst and cool them down.

 1. Changes in eating patterns with resulting weight gain or loss.
2. Changes in sleep patterns.
3. Feeling too cold or too hot most of the time.
4. Problems with hormonal functions controlled by the adrenal gland, ovaries, testes, or thyroid gland.		 A patient with a hypothalamus injury may not perceive hunger properly and may want to eat all the time or may not remember to eat. He or she may also have disruptions in sleep patterns and problems with hormone related body functions, including difficulty regulating body temperature, problem with sodium balance or water intake, and erratic emotions.
Cerebellum – regulates motor control, balance and posture.

 1. Difficulty maintaining sitting and standing balance.
2. Ataxic gait when walking.
3. Falling
4. Muscle weakness and low muscle tone.
5. Poor motor coordination.
6. Difficulty judging distances.
7. Difficulty performing rapid, alternating movements.
8. Intention tremor.		 A patient with damage to the cerebellum may have difficulty maintaining balance during motor activities, may stagger when walking, and may fall repeatedly. He or she will display problems with both gross and fine motor coordination. He or she may have difficulty judging the location of an object when reaching for it.

 

 

 

 
Reticular Formation – the core of the brain stem. Controls autonomic functions.

 1. Fluctuations in levels of consciousness.
2. Altered sleep patterns.
3. Disrupted bowel and bladder functions.
4. Problems regulating heart rate.
5. Widespread damage can result in coma or death.		 A patient with damage to the reticular formation may sleep for long periods of time. He or she may have episodes of incontinence.

The reticular activating system (RAS) is a component of the reticular formation

Limbic System – controls basic emotions and drives

LOCATION: Deep within brain, next to thalamus, at top of brain stem. FUNCTION? The 4 F’s : fight, flight, food, fornication! memory!!

 1. Erratic emotions, inappropriate emotional responses.
2. Changes in appetite.
3. Changes in sex drive.
4. Deficits in memory.
5. Addictive behavior.		 A patient with damage to the limbic system may display inappropriate emotional responses based on events or interactions, for example becoming violently angry over a change in the breakfast menu. He or she may display a change in the amount eaten or in the desire for sexual contact.

 

Amnesia

Amnesia refers to a partial or total loss of memory. It is classified using a post-traumatic amnesia classification tool.

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Type of Amnesia Description Example Video
Retrograde Unable to recall events that occurred before the onset of injury or illness. The patient may not remember who he or she is, including name, address, life roles, family members, etc.
Anterograde Able to recall events that occurred before the onset of injury or illness, but unable to recall events during and after onset. The patient has severely impaired short term memory and may not remember the onset of injury or illness and events since onset. He or she may not remember events that have happened only a few minutes prior. The patient remembers his or her identity, family members, life roles, and events that occurred before the injury.

 

Aphasia

Aphasia is the loss of the ability to produce and/or understand speech. These types of aphasia are associated with brain injury.

Type of Aphasia Description Example Video
Broca’s Aphasia (expressive aphasia) A person is able to understand speech but displays difficulty producing speech to communicate.
-may be limited to short utterances
-may have difficulty writing		 A patient with Broca’s Aphasia may have difficulty telling hospital staff what he or she needs, but may be able to gesture or point to a picture to communicate.

 

 
Wernicke’s Aphasia (receptive aphasia) A person is able to produce speech but displays difficulty understanding both spoken and written speech.
-they may use words that don’t fit in a sentence or may say things that don’t make sense
-they may display difficulty reading and writing		 A patient with Wernicke’s Aphasia may be able to speak without difficulty, but what he or she says does not make sense. He or she may have difficulty understanding and following instructions and may not be able to participate in a conversation in an understandable manner. He or she may not be able to verbally communicate needs in a manner that makes sense.

 

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