Chapter 2. Interning at the Tranquility Rehabilitation Center

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You must read each slide, and complete any questions on the slide, in sequence.

Interning at the Tranquility Rehabilitation Center

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The Situation

Dr. Julie B. Hanauer, Suffolk County Community College

Hemispheres

The brain is divided into two parts, each called a “hemisphere” and termed either “right” or “left.” The hemispheres are connected by a thick band of nerves called the corpus callosum. For most individuals, each hemisphere is in charge of specific functions.

Cerebral cortex

The wrinkled outermost layer of the cerebrum, responsible for higher mental functions, such as decision making, planning, and processing visual information.

Frontal lobes

The area of the cortex that organizes information among the other lobes of the brain and is responsible for cognitive functions, such as thinking, perception, and impulse control.

Motor cortex

A band of tissue toward the rear of the frontal lobes that works with other brain regions to plan and execute voluntary movements.

Lateralization

The idea that each cerebral hemisphere processes certain types of information and excels in certain activities.

Broca’s area

A region of the cortex that is critical for speech production.

Wernicke’s area

A region of the cortex that plays a pivotal role in language comprehension.

Working memory

The active processing of information in short-term memory; the maintenance and manipulation of information in the memory system.

Neuroplasticity

The brain’s ability to heal, grow new connections, and reorganize in order to adapt to the environment.

A male nurse drives a wheelchair with a senior person outdoors.

YvanDube/Getty Images

As an intern at the Tranquility Rehabilitation Center, you’ll be working with people who have suffered a brain injury. Each patient has spent time in a hospital to take care of their immediate medical needs and is now learning how to live with their brain injuries. Today, you will visit Eduardo, a 71-year-old Hispanic male who has suffered a stroke that has impacted his active lifestyle. We will discuss the brain injury he has suffered and discuss how the different structures in the brain underlie his thoughts and behaviors.

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What You Need to Know

Vstock/Getty Images

Eduardo recently suffered a stroke in the left hemisphere of his cerebral cortex. His stroke occurred in a large portion of his left frontal lobe, going along the entire length of the motor cortex. Because of this brain damage, Eduardo has difficulty moving the entire right side of his body. In addition, he can’t say more than a syllable at a time. At this point in his recovery, he can only say ‘Ah,’ ‘Ba,’ ‘Ga,’ or ‘Ta.’

Eduardo’s wife, Gayle, described what a vibrant outgoing man he was until his stroke 4 weeks ago. He was vivacious and the life of the party. Gayle said that his goal, wherever he was, was to make other people happy with his jokes, magic tricks, and love of life. His favorite hobby was woodworking and many considered him to be a master with his hands. Now, Eduardo just sits in his bed or the wheelchair, looking depressed and angry. He is silent for the most part, except for occasional groans and difficult-to-understand syllables. Gayle is terrified that he won’t get better.

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Science Source

The Two Hemispheres

The cerebral cortex is highly-specialized. The left hemisphere controls the right side of the body and the right hemisphere controls the left side of the body. In fact, each hemisphere tends to outshine the other in specific tasks, a concept known as lateralization. The left hemisphere plays an important role in language production and comprehension in most people (as a memory device, think of the letter “L” for both left and language). For example, Broca’s area, which is in charge of language production, is located only within the left hemisphere. The same is true of Wernicke’s area, which is responsible for language comprehension. For most people, damage to the left hemisphere will result in difficulties with language abilities.

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As an intern in a rehabilitation hospital for individuals with brain injuries, you need to understand both the anatomy and function of specific brain regions. For each of the following areas of the left hemisphere of the brain, select the name of the brain region. Next to each lobe is a drop down menu. Select the name of the particular region of the brain from the terms listed.

Question

Diagram of a side view of a human brain. Lobes and areas of the brain are highlighted.

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Correct! In this image, the frontal lobe is colored blue, the motor cortex is a strip of tissue at the back of the frontal lobe (blue), the parietal lobe is green, Wernicke’s area (within the temporal lobe) is red, the occipital lobe is pink, the temporal lobe is orange and Broca’s area (within the frontal cortex) is red.

Actually, in this image, the frontal lobe is colored blue, the motor cortex is a strip of tissue at the back of the frontal lobe (blue), the parietal lobe is green, Wernicke’s area (within the temporal lobe) is red, the occipital lobe is pink, the temporal lobe is orange and Broca’s area (within the frontal cortex) is red.

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matching_test

Now that you’ve identified key areas in the brain’s anatomy, let’s focus on the primary functions of these brain regions. Match the area of the brain with its specific function. Create matches by selecting the circle next to an option in the left column. Then click on the circle next to the option in the right column where you want to make the match.

You correctly matched up each part of the brain to the appropriate spot.

Incorrect. Try again.

Question

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Completed brain/function mapping exercise

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Question

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Based on your knowledge of the hemispheres of the brain, which parts of Eduardo’s body are likely to be affected by his stroke? Check all that apply.

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Correct! The left hemisphere controls the right side, and the right hemisphere controls the left side of the body. So, Eduardo’s stroke in the left hemisphere would affect the entire right side of his body including his right arm and right leg. How much Eduardo’s body is affected depends on the severity of his stroke.

Actually, the left hemisphere controls the right side, and the right hemisphere controls the left side of the body. So, Eduardo’s stroke in the left hemisphere would affect the entire right side of his body including his right arm and right leg. How much Eduardo’s body is affected depends on the severity of his stroke.

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Skills You Can Use

FredFroese/Getty Images

Besides being responsible for motor abilities and language, the frontal lobe also plays an important role in what are called executive functions. Executive functions involve our ability to plan, hold small amounts of information in memory (working memory), inhibit thoughts and behaviors (control impulses), make judgments, and pay attention. In addition, the frontal lobes play a role in many aspects of our personality, including mood regulation. Essentially, the frontal lobes are responsible for the types of behaviors and thinking that differentiate humans from other species.

A stroke to the frontal lobes can impair many aspects of Eduardo’s life including the active lifestyle he and Gayle so fully enjoyed. He had been a happy person and loved being the center of attention. Eduardo is 4 weeks into his rehabilitation, but he has not made much progress. He is becoming more withdrawn and depressed, and yesterday he refused to participate in therapy. Gayle pleaded with him but nothing worked. Even when Gayle broke down in tears, Eduardo refused to perform his exercises or speech therapy.

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Given that Eduardo experienced damage to his left frontal lobe, how do you expect his personality to change? Check all that apply.

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Correct! The frontal lobes control many of our emotional responses, so Eduardo will be most likely angrier, sadder, and more withdrawn than before he suffered the stroke. His loss of ability in so many aspects of functioning contributes to those emotions. His executive functions will be compromised, so he will be less able to pay attention, less able to inhibit angry thoughts and behaviors, and he will also show deficits in working memory. He will also likely be less engaged with family and friends after the stroke.

Actually, the frontal lobes control many of our emotional responses, so Eduardo will be most likely angrier, sadder, and more withdrawn than before he suffered the stroke. His loss of ability in so many aspects of functioning contributes to those emotions. His executive functions will be compromised, so he will be less able to pay attention, less able to inhibit angry thoughts and behaviors, and he will also show deficits in working memory. He will also likely be less engaged with family and friends after the stroke.

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Answers will vary, but a few things are known. Since Eduardo is right-handed, he will likely have difficulty performing many of his daily activities. These might include using his right arm for brushing his teeth, writing, dialing his phone, and his favorite hobby of woodworking. Because of his speech difficulties, Eduardo would have trouble holding conversations, making requests, and discussing his feelings. He may also experience a lack of inhibition with thoughts and behaviors, lashing out in anger and frustration when unable to communicate. He may have a harder time paying attention in both speech therapy and physical rehabilitation due to frontal lobe damage. Gayle’s life will be impacted tremendously—she has lost her active, outgoing, and happy life companion, and much of the caretaking will fall to her if Eduardo does not recover.

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Think It Through!

Watch the videos of two different patients who have suffered strokes. Examine the speech of both patients and notice the differences. While watching, think about which patient most resembles Eduardo. This video is of Sarah Scott who suffered a stroke at age 18.

First watch this video of Sarah Scott who suffered a stroke at age 18 and answer some questions.

Video transcript

INTERVIEWER: So, what's your name?

SARAH SCOTT: Um, Scott. Oh, no. Sarah Scott.

INTERVIEWER: That's right. And how old are you?

SARAH SCOTT: I can't.

INTERVIEWER: Try.

SARAH SCOTT: I can't.

INTERVIEWER: You're 19. 19. And what happened to you?

SARAH SCOTT: Stroke.

INTERVIEWER: You had a stroke last year?

SARAH SCOTT: Yes.

INTERVIEWER: And, what happened? Can you remember what happened?

SARAH SCOTT: Um, uh, uh, school and English class.

INTERVIEWER: OK.

SARAH SCOTT: And I book. And I read it aloud, but I can't, [? because ?] straight. So I [INAUDIBLE]. And, also, it's the same as-- the same as-- kind of thing as-- you know.

INTERVIEWER: Pins and needles?

SARAH SCOTT: Yeah. The same. And also, this foot.

INTERVIEWER: Leg.

SARAH SCOTT: And the-- yeah. Yeah.

INTERVIEWER: And what happened after the stroke with your speech?

SARAH SCOTT: But, I can't.

INTERVIEWER: You have speech problems. So, you were going to go to university. What are you doing now?

SARAH SCOTT: What?

INTERVIEWER: What do you doing now everyday?

SARAH SCOTT: Oh, um, speech and speech--

INTERVIEWER: Therapy.

SARAH SCOTT: Yeah. And also, writing.

INTERVIEWER: What helps you to speak? When you write things down, it helps you, doesn't it?

SARAH SCOTT: Yes. I don't that it's-- I can't-- sometimes I'll write it down, because it's easier, and also speaking is easier. So, I don't know.

INTERVIEWER: A mixture.

SARAH SCOTT: Yeah. And I can't write like one word. I'm find that sometimes long sentences I can't read, I can't write.

INTERVIEWER: Can you read a book?

SARAH SCOTT: No.

INTERVIEWER: Do you want to read the book?

SARAH SCOTT: Yes. But I can't.

INTERVIEWER: You'd like to though.

SARAH SCOTT: Yeah.

INTERVIEWER: And what about your friends? Do you still see your friends?

SARAH SCOTT: A little.

INTERVIEWER: Is that hard for them?

SARAH SCOTT: Yeah, because I can't speak a little, but it's harder. And I can't-- sometimes it's harder, because-- speaking, like, my friends-- like, it's too hard and I don't like it. So, it's hard then friends [? than-- ?]

INTERVIEWER: Family?

SARAH SCOTT: Yeah.

INTERVIEWER: It's been nine months now since your stroke, not even a year. So that's good, because at first, you couldn't walk, you couldn't swallow, could you?

SARAH SCOTT: Yeah.

INTERVIEWER: Do you remember being in hospital?

SARAH SCOTT: I tiny bit, but I can't.

INTERVIEWER: And didn't know why you had a stroke?

SARAH SCOTT: Heart. A hole in the heart. And I close up, so--

INTERVIEWER: You had an operation?

SARAH SCOTT: Yeah.

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Question

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Although Sarah has recovered some aspects of speech, what problems in holding a conversation does she display? Check all that apply:

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Correct! Sarah suffers from Broca’s aphasia, which involves difficulties with speech production. She knows what to say, but she is experiencing great difficulty producing words and using proper grammatical phrases. In addition, she has to pause for a long time to search for a word and then writes the word instead of speaking it, which makes it difficult to communicate her thoughts.

Actually, Sarah suffers from Broca’s aphasia, which involves difficulties with speech production. She knows what to say, but she is experiencing great difficulty producing words and using proper grammatical phrases. In addition, she has to pause for a long time to search for a word and then writes the word instead of speaking it, which makes it difficult to communicate her thoughts.

Question

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Besides an issue with the pronunciation of words, what other ways was Sarah impacted by the stroke? Check all that apply.

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Correct! Sarah discussed her initial inability to walk, read a book, and write more than one word at a time. She also mentioned her difficulty with her friendships because of communication problems.

Actually, Sarah discussed her initial inability to walk, to read a book, and write more than one word at a time. She also mentioned her difficulty with her friendships because of communication problems.

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Now, watch the video below of Byron Peterson, who also suffered a stroke. When someone suffers a stroke, where in the brain that stroke occurs impacts different functions. Listen carefully to how Byron speaks. Pay attention to how well he follows the questions and how well he speaks. Note any differences between Byron and Sarah.

Video transcript

WOMAN: Hi, Byron. How are you?

BYRON; I'm happy. Are you pretty? You look good.

WOMAN: What are you doing today?

BYRON: We stayed with the water over here at the moment, talked with the people of the them over there. They're diving for them at the moment. They'll save in the moment, have water very soon for him, with luck for him.

WOMAN: So we're on a cruise, and we're about to get to Juno.

BYRON: We will sort right here, and they'll save their hands right there with them.

WOMAN: And what were we just doing with the iPad?

BYRON: Right at the moment, they don't show a darn thing.

WOMAN: The iPad that we were doing. Like here?

BYRON: I'd like my change for me, and change hands for me. It was happy. I would talk with Donna sometimes. We're all with them. Other people are working with them-- them. I'm very happy with them.

WOMAN: Good.

BYRON: This girl with fairly good, and happy, and I played golf, and hit the trees. We play out with the hands. We save a lot of hands on hold for people's for us, other hands. I don't know what you get, but I talk with a lot of hand for him. Sometimes, I might talk of anymore to say.

Question

true

What aspects of speech do you see missing in Byron’s ability to hold a conversation? Check all that apply.

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Correct! Byron suffers from Wernicke’s aphasia, which involves difficulty with speech comprehension. Byron can speak fluently, but much of what he says does not make much sense. Byron has difficulty understanding what is being asked of him, participating in the conversation, interpreting questions, and producing meaningful speech when asked a question.

Actually, Byron suffers from Wernicke’s aphasia, which involves difficulty with speech comprehension. Byron can speak fluently, but much of what he says does not make much sense. Byron has difficulty understanding what is being asked of him, participating in the conversation, interpreting questions, and producing meaningful speech when asked a question.

2.12

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Question

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Answers will vary, but should discuss that neuroplasticity is the brain’s ability to heal, grow new connections, and reorganize to adapt to the environment. As we age our brains become less plastic. So, Eduardo, who is 71 years old, is less likely to recover fully from brain injury compared to someone 50 years younger. Sarah was much younger when she suffered her stroke, so her brain had a much greater capacity for recovery. However, Eduardo still has some potential to recover, depending on how much brain damage he suffered. With proper speech therapy and physical therapy, Eduardo may recover the use of the right side of his body along with partial or full speech. The length of therapy and the recovery time depend on multiple factors, but unfortunately, Eduardo’s age makes a full recovery more difficult.

2.13

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In Your Own Words

That was some first day here at Tranquility Rehabilitation Center! You did a fantastic job of examining Eduardo and recording the brain damage his stroke caused. We also hope that this experience has shown you how difficult it is to lose brain functions we take for granted.

Question

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Answers will vary, but should include the notion that the frontal lobe is involved in many functions. Along with movement (directed by the motor cortex) on the opposite side of the body, the frontal lobe is in charge of the following functions: language, executive functions (such as inhibition, attention, working memory, judgment along with planning), and personality. Answers also should address how examining Eduardo’s case developed their compassion regarding the difficulty of both sustaining a stroke and having to care for a loved one who has suffered a stroke. Finally, awareness of what dysfunctions (e.g., inability to use the right side of his body) and what those dysfunctions can lead to should be discussed.

2.14

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Show What You Know!

Question

true

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Question

true

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Question

true

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Question

true

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Question

true

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