Q1) Ali has lately been experiencing low mood, low self-esteem, poor memory

and extreme anxiety. After consulting a doctor he came to know that it is due
to the low levels of a neurotransmitter in his body.
a) According to you, which neurotransmitter deficiency is Ali
experiencing? What are its major function in our body? (6 marks)
Neurotransmitter is something that allows communication between different
neurons of the brain they are of many types each neurotransmitter has different
properties like GABA gives sense of calmness dopamine gives alertness etc.
Based on the size of neurotransmitter two main group can be identified
 Small molecule neurotransmitter
 Large molecule peptides
Serotonin deficiency may cause poor memory low mood extreme anxiety and
anger outburst serotonin is a chemical that has a wide variety of functions in
human body it is also known as happy chemical due to its contribution in
wellbeing and happiness Serotonin acts as a neurotransmitter a type of chemical that
helps relay signals from one area of the brain to another it is also use to transmit
between nerve cells due to melatonin it helps to regulates the an individual’s body
sleep wake cycle serotonin released from Neurons of the brainstem It participates
in regulation of body temperature perception of pain emotions and sleep cycle An
insufficient secretion of serotonin may result in decreased immune system function
as well as a range of emotional disorders like depression anger
Functions of serotonin
Function of serotonin in human body is as follows:
Bowel movements: Serotonin is found primarily in the body’s stomach and
intestines it helps control your bowel movements and function
Mood: Serotonin in the brain is thought to regulate anxiety happiness and mood.
Low levels of the chemical have been associated with depression and increased
serotonin levels brought on by medication are thought to decrease arousal
Nausea: Serotonin is part of the reason why you become nauseated Production of
serotonin rises to push out noxious or upsetting food more quickly in diarrhea the
chemical also increases in the blood which stimulates the part of the brain that
controls nausea
Sleep: This chemical is responsible for stimulating the parts of the brain that
control sleep and waking. Whether you sleep or wake depends on what area is
stimulated and which serotonin receptor is used
Blood clotting: Blood platelets release serotonin to help heal wounds. The
serotonin causes tiny arteries to narrow helping form blood clots
Bone health: Serotonin plays a role in bone health significantly high levels of
serotonin in the bones can lead to osteoporosis which makes the bones weaker
Sexual function: Low levels of serotonin are associated with increased libido
while increased serotonin levels are associated with reduced libido
Dopamine
Dopamine is one of the many brain chemicals that regulates brain mood and
other cognitive processes Lower dopamine level signals may include movement
lack of concentration poor memory and lack of appetite Dopamine receptors play
an important role in many neurological processes including pleasure cognition
memory and learning.
As it is mentioned in above Ali’s case he is facing poor memory and extreme
anxiety all these symptoms shows that he is suffering from serotonin and
dopamine deficiency and he is facing low level of serotonin neurotransmitter
 b) Due to prolonged anxiety and work stress, Ali is unable to stay relaxed
and experiences restlessness. Which neurotransmitter deficiency
according to you is the cause of Ali’s present condition? Explain in
detail. (4 marks)
A neurotransmitter is a chemical messenger of neurologic information from one
cell to other Neurotransmitters is chemical substances made by the
neuron specifically to transmit a message throughout the body
GABA is an amino acid that serves as the primary inhibitory neurotransmitter in
the brain and a major inhibitory neurotransmitter in the spinal cord Because GABA
is the fundamental neurotransmitter for inhibiting neuronal firing its function is
determined by the neural circuit that it is inhibiting It is involved in complex
circuits throughout the central nervous system this neurotransmitter is released
from Neurons of the spinal cord cerebellum basal ganglia and many areas of the
cerebral cortex Functions of GABA are closely related to mood and emotions It is
an inhibitory neurotransmitter that acts as a brake to excitatory neurotransmitters
thus when it is abnormally low this can lead to anxiety It is widely distributed in the
brain and plays a principal role in reducing neuronal excitability throughout the
nervous system
Ali is unable to stay relaxed and experience restlessness it is because of GABA
deficiency basically when it is abnormally low this can lead to anxiety it is a
neurotransmitter that sends chemical messages through the brain and
the nervous system and is involved in regulating communication
between brain cells The role of GABA is to inhibit or reduce the activity of the
neurons or nerve cells GABA is the body’s most important inhibitory
neurotransmitter which means it lowers the activity of neural cells in the brain
and central nervous system having the effect of moving the brain and the body
into lower gear By inhibiting neural activity GABA facilitates sleep reduces
 mental and physical stress lowers anxiety and creates a calmness of mood
GABA works to inhibit neural signaling If it inhibits cells too much, it can lead
to seizures and other problems But this neurotransmitter also plays an important
role in brain development GABA’s natural function is to reduce the activity of
the neurons to which it binds GABA is an important contributor to the body’s
overall mental and physical homeostasis or balance GABA enables the body
and mind to relax and fall asleep, and sleep soundly throughout the night low
GABA levels also corresponded to more restless wakeful sleep GABA
contributes to motor control vision and many other cortical functions It also
regulates anxiety (GABA) is a mood regulator It has an inhibitory action which
stops neurons from becoming overexcited This is why low levels of GABA can
cause anxiety irritability, and restlessness As we know that Ali is unable to stay
relaxed or experience restlessness all these symptoms shows that he is facing
low level of GABA neurotransmitter
Q2) Mr. K has been experiencing muscle spasms, especially in the legs,
difficulty walking, vision problems and pain in the eye, chronic pain and
trouble with coordination and balance.
Explain Mr. K’s condition in detail with respect to the types and severity of
his condition. (10marks)
Multiple sclerosis is a distinct disorder that largely affects the central nervous
system of the human body This disorder ideally impacts the communication of
brain with the other parts of the body This is considered an autoimmune disorder
which basically means that in case of this medical condition the immune system of
the body starts acting against its own tissues Multiple sclerosis can affect a patient
at any age and women are comparatively much more effected to it than men.
Multiple sclerosis is a condition that can affect the brain and spinal cord causing a
wide range of potential symptoms including problems with vision arm or leg
movement sensation or balance The multiple sclerosis result in nerve damage
which disrupts communication between the brain and body Multiple sclerosis is a
potentially disabling disease of brain and spinal cord In this sclerosis the immune
system attack the protective sheath myelin that cover nerve fiber and cause
communication between brain and rest of the body This disease can lead to
permanent damage or deterioration of nerves Multiple sclerosis which is an long
lasting disease that affect brain spinal cord optic nerves in eyes which cause
problems in vision balance muscle movements and other body movements
Symptoms
The symptoms are different these may vary from person to person
Walking difficulties: Related to several factors including weakness spasticity loss
of balance sensory deficit and fatigue
Vision Problems: The first symptom of MS for many people Onset of blurred
vision poor contrast or color vision and pain on eye movement
Sexual Problems: it is Very common in the general population including
people with MS Sexual responses can be affected by damage in the central
nervous system as well by symptoms such as fatigue and disability and by
psychological factors
Emotional Changes: It can be a reaction to the stresses of living with MS as well
as the result of neurologic and immune changes
Depression: The severest form of depression is among the most common
symptoms of MS
Types and severity of MS
Relapsing Remitting Multiple Sclerosis
Most people with multiple sclerosis have this type They usually have their first
signs of the disease in their early 20s After that they have attacks of symptoms called
relapses from time to time followed by weeks months or years of recovery called
remissions
Secondary progressive MS
In secondary progressive MS people may still experience relapses these are
then followed by partial recoveries or periods of remission but the disease doesn’t
disappear between cycles Instead it steadily worsens Symptoms get worse at a
different rate for each person
Primary Progressive MS
 This type of MS is not very common occurring in less people with MS. It is
characterized by slowly worsening symptoms from the beginning with no relapses
or remissions in addition MS treatments don't work as well with this type of MS.
Progressive Relapsing MS
A rare form of MS it is characterized by a steadily worsening disease state
from the beginning with acute relapses but no remissions with or without recovery
Causes of MS
MS is an autoimmune condition This is when something goes wrong with
the immune system and it mistakenly attacks a healthy part of the body in this case
the brain or spinal cord of the nervous system In MS the immune system attacks
the layer that surrounds and protects the nerves called the myelin sheath This
damages and scars the sheath and potentially the underlying nerves meaning that
messages travelling along the nerves become slowed or disrupted Exactly what
causes the immune system to act in this way is unclear but most experts think a
combination of genetic and environmental factors is involved
Cerebral palsy
Cerebral palsy is a group of disorders that affect a person’s ability to move
and maintain balance and posture. CP is the most common motor disability in
childhood. Cerebral means having to do with the brain. Palsy means weakness or
problems with using the muscles CP is caused by abnormal brain development or
damage to the developing brain that affects a person’s ability to control his or her
muscles
All above mentioned symptoms those are describe in Mr. K’s case shows that he is
suffering from MS(multiple sclerosis ) also he is having problems in maintaining
balance and movement which shows that he is also suffering from cerebral palsy
which is a group of disorders which effect a person’s ability to move and create
difficulty in maintaining balance
Q3) 9 out of 10 people die from their injuries. Young adults and the elderly
are the age groups at highest risk for traumatic brain injury (TBI). Along
with a traumatic brain injury, persons are also susceptible to spinal cord
injuries which is another type of traumatic injury that can result out of
vehicle crashes, firearms and falls.
Explain the various mechanisms of injury? (10 marks)
A brain injury is an event that causes a disruption in functioning this injury
specifically indicates harm to the brain When brain injury is caused from a medical
issue such as a stroke tumor metabolic issue or other medical diagnosis the term
acquired brain injury is used A brain injury caused by an accident or intended
harm is called a traumatic brain injury A head injury can be any bump cut any
part of the head but not extending into the brain injury affects the brain Traumatic
injury is sudden damage to the brain caused by a blow to the head Common causes
include car or motorcycle crashes falls and sports Injuries can range from mild
concussions to severe permanent brain damage In brain injury there is typically an
event in the brain which cause be from disease or trauma As brain cells are
affected molecules are released into nearby tissues This creates a series of changes
in the brain at a cellular or even molecular level that leads to cell death nerve
damage and inflammation These molecular and chemical changes lead to the
chronic symptoms and deficits of brain injury Since the spinal cord is connected
directly to the brain an injury to one will affect the other the brain can be affected
by an injury to the spinal cord or the spinal cord can be affected by an injury to the
brain In many cases a brain injury is a result of damage to the spinal cord or a
medical condition that affects the entire central nervous system both spine and
brain There are two main parts of the central nervous system the brain and the
spinal cord The brain is where information is processed and acted upon The spinal
cord is the transmitter of messages to and from the brain and body both are needed
to keep the body functioning they are interdependent Areas of the brain control
and direct specific functions The spinal cord carries those messages to and from
the body in response it is an injury that affects how the brain works Traumatic
brain injury usually results from an injury to the head or body An object that goes
through brain tissue such as a bullet or shattered piece of skull also can cause
traumatic brain injury Traumatic brain injury can have wide ranging physical and
psychological effects Some signs or symptoms may appear immediately after the
traumatic event while others may appear days or weeks
Traumatic brain injuries are classified according to the severity and mechanism of
injury
Mild: person is awake eyes open Symptoms can include confusion disorientation
memory loss headache and brief loss of consciousness
Moderate: person is lethargic eyes open to stimulation Loss of consciousness
lasting 20 minutes to 6 hours some brain swelling or bleeding causing sleepiness
but still arousal
Severe: person is unconscious eyes do not open even with stimulation Loss of
consciousness lasting more than 6 hours
Mechanism of Injury
Closed brain injury: Closed brain injuries happen when there is a no penetrating
injury to the brain with no break in the skull A closed brain injury is caused by a
rapid forward or backward movement and shaking of the brain inside the bony
skull that results in bruising and tearing of brain tissue and blood vessels Closed
brain injuries are usually caused by car accidents falls and increasingly in sports
Shaking a baby can also result in this type of injury called shaken baby syndrome
Open head injuries: happen when there is a break in the skull such as when a
bullet pierces the brain
Hypoxic brain injuries are brain injuries that form due to a restriction on the
oxygen being supplied to the brain the restricted flow of oxygen causes the gradual
death and impairment of brain cells
Tumor: A brain tumor is an abnormal growth of cells inside the brain or skull
Tumors can grow from the brain tissue itself or cancer from elsewhere in the body
can spread to the brain
Infections: Patients with traumatic brain injury are considered to be at higher risk
for nosocomial infections compared with other critically ill individuals and
other neurosurgical patients 
TBI can be caused by a number of external forces including:
 The head being struck by a falling or flying object
 The head striking an object such as the windshield of a car or the ground
 An object going through the skull and entering the brain tissue which is
called a penetrating head injury
 The forces generated by a blast or explosion often called a blast injury
Complications
Altered consciousness
 Traumatic brain injuries can affect the areas of the brain those are responsible
for maintaining consciousness and a sense of self awareness These states of altered
consciousness may include the following
Coma:A person in coma is unconscious and unable to say a single word or unable
to move his body and did not respond to any stimuli
Vegetative state: this state results in a lack of self awareness but a person have an
ability to respond to stimuli
Minimally conscious state: which results in a lack of complete consciousness but
a person have a retention of limited self awareness and response to stimuli
Brain death: when there is no activity in the brain and brainstem is known as
brain death brain death is considered irreversible
Physical complications
Damage to blood vessels: Blood vessels in the brain can sustain damage during a
brain injury when that happens strokes and blood clots are a possibility
Infection: Skull fractures or injuries that invade the skull can damage the layers of
tissue that surround the brain to protect it When these tissues are damaged germs
and bacteria are able to get in and cause an infection When this happens if
treatment is not provided properly the infection can spread to other parts of the
nervous system
Headaches: Headaches that occur again and again are normal after a distressing
brain injury they could begin after about a week after the injury and could stay as
long as a few months
Vertigo: Most of individuals have dizziness or vertigo terrible brain injury any of
these symptoms may stay for a couple of weeks to a few months after a distressing
brain injury
Traumatic brain injury effect cognitive skills communication skills a person who
had experience TBI have problem to think properly and have difficulty to focus on
a task
Q4) Aslam has lately been experiencing feelings of demotivation, he is unable
to experience feelings of pleasure. Moreover, he has problem in movement as
well as his cognitive skills are also getting weak day by day. After consulting a
doctor he came to know that it is due to the low levels of a neurotransmitter in
his body.
According to you, which neurotransmitter deficiency is Aslam experiencing?
What are its major function in our body? (6 marks)
Neurotransmitters are chemicals those allows communication between different
neurons of the brain they are of many types each neurotransmitter has different
roles like GABA gives sense of calmness dopamine gives pleasure play a role to
keep a person motivated acetylcholine plays a role in motivation etc.
The specific neurotransmitter which has changed Aslam’s life is Dopamine due to
its role in pleasurable behavior and moreover acetylcholine has a contribution to
decrease his motivation level
Acetylcholine is another neurotransmitter which is also involved in Aslam’s case
because it controls motivation
Acetylcholine (ACh) is an sufficient neurotransmitter in the human body it is
found in both the central nervous system (CNS) and the peripheral nervous system
Acetylcholine was the first neurotransmitter to be identified It was discovered by
Henry Hallett Dale in 1914 and its existence was later confirmed by Otto Loewi
Acetylcholine (ACh) is one of the major neurotransmitters in the brain because of
its importance for attention memory and learning reward and pain It has a major
role in the control of motor tone and movement
Dopamine has various function in a human body one of important function from
its function is Attention and concentration this important neurotransmitter boosts
mood motivation and attention and helps regulate movement learning and
emotional responses the brain releases it during pleasurable situations Dopamine
has a very important role in motor and cognitive programs
Role of dopamine in cognition: Dopamine in the frontal lobes of the brain controls
the flow of information from other areas of the brain disorders of dopamine in this
region lead to decline in neurocognitive functions especially memory attention and
problem solving
Role of dopamine in movement:
A part of the brain called the basal ganglia regulates movement Basal ganglia in
turn depend on a certain amount of dopamine to function at peak when there is a
deficiency in dopamine in the brain movements may become delayed and
uncoordinated
Dopamine is a neurotransmitter it controls the pleasure of the brain bringing
happiness joy emotion responses Dopamine levels can fall due to poor nutrition
and lack of sleep dopamine is one of many important neurotransmitter it regulates
the pleasure response Dopamine is released during situations in which people
experience pleasure The release of dopamine helps reinforce the pleasurable
behavior increasing the likelihood the individual will repeat that behavior to get
the same feeling Activities that stimulate the release of dopamine function as
survival or coping strategies The more times they are repeated the more they
may become reinforced Irregular dopamine levels can cause a variety of
psychological problems For example Parkinson’s disease is caused partially by
the death of dopamine secreting neurons in this disease a person loses the
ability to execute smooth controlled movement It is released during pleasurable
situations and stimulates one to seek out the pleasurable activity or occupation
dopamine disorders in the frontal lobe may cause problems in cognitive and mostly
those functions those are linked to frontal lobe For example memory problem
solving etc Dopamine also play an important role to keep a person motivated in
Aslam’s case dopamine level decrease and due to problem in this neurotransmitter
he is unable to enjoy his life and less motivated in his previous life acetylcholine
neurotransmitter also play a role in a person’s life by keeping him motivated to
perform his tasks and it is possible that due to issue in this neurotransmitter he is
demotivated and unable to enjoy his life
Aslam is unable to concentrate on any stimulus in his environment.
Apparently, his fight-flight response has deteriorated. According to you which
neurotransmitter deficiency is he experiencing? (4 marks)
The fight-or-flight response plays a critical role in how we deal with stress and
danger in our environment when we are under threat the response prepares the
body to either fight or flee
Epinephrine (Adrenalin) and norepinephrine (noradrenalin) are both secreted in
stress situations and help prepare the body for fight or flight After receiving a
stressful challenge and computing the right response the brain rapidly activates
nerves originating from control centers in the brainstem These cause the release of
noradrenaline in a variety of structures and of adrenaline from the adrenal glands
situated just above the kidney Their release underpins the fight or flight response
These changes happen because of receptors that are found on blood vessels causing
them to constrict and so our blood pressure to shoot up, and in the heart causing it
to accelerate and produce the pounding sensation in the chest known as
palpitations There are also receptors in the skin causing Goosebumps and in the
gut causing those disconcerting abdominal sensations that we all sense as stress
These changes are there to prepare us to fight or to flee and to concentrate blood
flow to vital organs the muscles and the brain Norepinephrine is assumed to be
involved in arousal and attention fear and anxiety Norepinephrine is secreted in
small amount Norepinephrine is a naturally occurring chemical in the body that
acts as both a stress hormone and neurotransmitter  Norepinephrine is a chemical
released from the sympathetic nervous system in response to stress
Norepinephrine are also known as noradrenaline this neurotransmitter plays very
important role in various situation and has multiple roles norepinephrine hormone
is released by hypothalamus it is a excitatory hormone this neurotransmitter is
used to increase the level of alertness and wakefulness this neurotransmitter
stimulates the various processes of body for example cause the blood pressure to
rise while leaving the body with high temperature and faster heart rate
Norepinephrine has been shown to play a role in a person's mood and ability to
concentrate The sympathetic nervous system triggers a response that is commonly
referred to as our fight or flight response The actions of norepinephrine are vital
to the fight or flight response whereby the body prepares to react to or retreat from
an acute threat The interaction of norepinephrine and the nervous system is
evidenced by its support of the of mental acuity, alertness and attentiveness in
times of stress or danger. Fight-or-flight instinct and its boosting of adrenaline Low
levels can cause lack of concentration attention deficit and possibly depression in
stressful situations norepinephrine increases as part of the fight or flight response
to mobilize the brain and body for action
Functions of norepinephrine
In order to make our body work as efficiently as possible norepinephrine causes
several changes in our body function these include the following:
An increase in the amount of oxygen going to our brain this helps us think
clearer and faster an increase in our heart rate this pumps more blood around
our body helping our muscles work faster and more efficiently An increase in
glucose release this additional sugar gives our muscles something to feed on
which helps them work better and faster When we breathe faster we deliver
more oxygen to brain and body thus helping entire body work better quicker
Shutting down of metabolic process shutting down functions like digestion
growth allows blood and energy that normally goes to these functions to be
shunted to brain and muscle
Epinephrine known as adrenaline epinephrine is involved in the body’s fight or
flight response It is both a hormone and a neurotransmitter when a person is
stressed or scared their body may release epinephrine this neurotransmitter
increases heart rate and breathing and gives the muscles a lot of energy it also
helps the brain make quick decisions in the face of danger that a person have to
face the situation or run away to keep herself safe While epinephrine is useful if a
person is threatened chronic stress can cause the body to release too much of this
hormone Over time chronic stress can lead to health problems such as decreased
immunity high blood pressure diabetes and heart disease
Aslam is unable to concentrate on a stimulus or his fight and flight response is not
working efficiently as we discussed above the role of epinephrine or
norepinephrine these two neurotransmitter plays and important in maintaining a
person’s fight and flight response so because of deficiency of these two
neurotransmitters Aslam is unable to concentrate on a stimulus and while he is
unable to concentrate on a stimulus he is also unable to produce a response
regarding to action
Q5) Ahmad is a school going young and intelligent boy. But he is unable to
adjust in his school as many fellow students make fun of him. He is unable to
speak properly. He takes long pauses while talking. Moreover, he has problem
in talking fluently and has a habit of repeating phrases.
a) Explain Ahmad’s condition in detail? (5 marks)
Stuttering
 Stuttering is the inability to speak in a straight way Stuttering is basically a
speech problem The normal flow of speech is disrupted A child who stutters
repeats or prolongs sounds syllables or words Stuttering is different from repeating
words when learning to speak Stuttering may make it difficult for a child to
communicate with others We all have times when we do not speak smoothly We
may add uh or you know to what we say Or we may say a sound or word more
than once These are called disfluencies 
People who stutter may have more disfluencies and different types of disfluencies
they may repeat parts of words which is known as repetitions stretch a sound out
for a long time known as prolongations or have a hard time getting a word out
which is known as blocks Stuttering is more than just disfluencies Stuttering also
may include tension and negative feelings about talking It may get in the way of
how you talk to others You may want to hide your stuttering So you may avoid
certain words or situations For example you may not want to talk on the phone if
that makes you stutter more Stuttering can change from day to day You may have
times when you are fluent and times when you stutter more it is observe that Stress
or excitement can lead to more stuttering
Symptoms
The following types of disfluencies happen when you stutter
 Part word repetitions For example I a-a am busy
 One syllable word repetitions For example shut-shut shut the door
 Prolonged sounds For example ssssssssshe is nice girl
 Blocks or stops For example (pause)sit down
Each child’s development is different A child may have symptoms of
stuttering that are part of his or her normal speech and language development If the
symptoms last for 3 to 6 months he or she may have developmental stuttering
Symptoms of stuttering may vary throughout the day and in different situations
You may also notice other behaviors like head nodding or eye blinking Sometimes
people who stutter use these behaviors to stop or keep from stuttering they may
also avoid using certain words or use different words to keep from stuttering.
Feelings and attitudes can affect stuttering For example frustration or tension can
cause more disfluencies being excited or feeling rushed can also increase
disfluencies A person who stutters may also stutter more if others tease them or
bring attention to their speech Stuttering may cause a person to be embarrassed and
make them feel nervous about talking
Causes
There are multiple possible causes of stuttering. Some include:
 Family history of stuttering
 Brain differences
Brain injuries from a stroke can cause neurogenic stuttering severe emotional
trauma can cause psychogenic stuttering may run in families because of an
inherited abnormality in the part of the brain that governs language if you or your
parents stuttered your children may also stutter
Risk factors
Males are much more likely to stutter than females are Factors that increase
the risk of stuttering include:
Delayed childhood development: Children who have developmental delays or
other speech problems may be more likely to stutter.
Having relatives who stutter: Stuttering tends to run in families.
Stress: Stress in the family high parental expectations or other types of pressure
can worsen existing stuttering
Ahmad is a school going and intelligent child but he is unable to speak properly
and having in difficulties in conversation all these mentioned symptoms in above
Ahmad’s case he is having an issues of stuttering because of this problem he is
repeating words and having difficulty in speaking fluently
Moreover, Ahmad has been complaining that he is unable to understand,
speak, read, or write. What is this condition? (5 marks)
Aphasia is a language disorder that affects a person's ability to communicate
Aphasia affects a person's ability to express and understand written and spoken
language Depending on which areas of the brain are affected a person might have
different levels of ability to speak and understand others. When a right handed
person suffers a serious injury on left hemisphere of brain or damage occurred on
the left hemisphere oral and speaking power will be lost or badly distorted and
impaired Right side of body will be paralyzed basically Aphasia is a
communication disorder that makes it hard to use words It can affect your speech
writing and ability to understand language Aphasia results from damage or injury to
language parts of the brain it’s more common in older adults particularly those who
have had a stroke Aphasia gets in the way of a person's ability to communicate, but it
doesn’t have an impact on the intelligence of a person’s People who have aphasia
may have a hard time speaking and finding the right words to complete their
thoughts. They may also have problems understanding conversation reading and
comprehending written words writing words and using numbers People with aphasia
may also repeat words or phrases Brain damage can also result in other problems
that affect speech. These problems include dysarthria weakness or lack of control
in the muscles of the face or mouth resulting in slowed or slurred speech apraxia
inability to move lips or tongue in the right way to say sounds
and dysphagia swallowing problems
Symptoms of Aphasia
The main symptoms of aphasia include:
 Trouble speaking
  Struggling with finding the right term or word
 Trouble understanding what other people say or following conversations
 Writing sentences that don’t make sense or trouble expressing yourself in
writing
 Speaking in short sentences or phrases
 Using unrecognizable words
Causes of Aphasia
Aphasia is usually caused by a stroke or brain injury with damage to one or
more parts of the brain that deal with language Most of people who survive a stroke
get aphasia may also be caused by a brain tumor brain infection or dementia such
as Alzheimer's disease in some cases aphasia is a symptom of epilepsy or another
neurological disorder Aphasia does not affect thinking skills. But the person may have
problems understanding written material and a hard time with handwriting some
people have trouble using numbers or even doing simple calculations serious aphasia
makes the person less able to communicate The person may say little and may not
take part in or understand any conversation some people with aphasia have problems
understanding what others are saying
Testing For Aphasia
Confirmation of aphasia extent of the disorder and prediction for successful
treatment may be assessed and confirmed by a set of comprehensive language tests
conducted by a speech therapist these tests include studying speech naming,
repetition comprehension reading and writing
Aphasia is a disorder of the Broca area of the brain (speech) by injury
Stroke blood clot brain swelling Expressive aphasia is when a person understands
what was said or what a person is trying to say but they are unable to express the
right words Receptive Aphasia is when the ear hears words but does not
understand their meaning those person those have a problem of aphasia their
language skills are impacted
Broca’s aphasia
Broca’s area is motor speech area to motor functions of speech will be affected for
example person knows what to speak but signals from Broca’s area are not good
so vocal muscles cant coordinate hence a broken speech is produced with slurred
words
Wernicke’s aphasia
The planning of speech is done in this area it basically analyses the words that
we’ll speak What they mean, what emotions would be displayed if spoken as we’ll
speak so in this aphasia persons voice loses emotion and meaning for example
person will speak random words in random tone
In Ahmad’s case he is unable to understand read and write all these
symptoms shows that he is suffering from aphasia

Q7) Neuropsychologists play a key role in examining the brain chemistry and
working or assessing the issues related to neurological and psychological
conditions.
Describe and explain the major neuropsychological assessment techniques
used by neurologist and psychologists to assess the brain chemistry and other
psychological conditions of individuals. (10 marks)
Neurological assessment
A neurological assessment focuses on the nervous system to assess and
identify any abnormalities that affect function and activities of daily living. It
should allow us to create individual, patient-centered goals and ultimately a
tailor-made treatment plan based on the client's needs. In order to provide the
best care and plan the best treatment a thorough assessment must be
undertaken. It is the most important step in the rehabilitation process, helps to
guide our clinical reasoning and decision when making informed decisions
about the rehabilitation process. Johnson & Thompson (1996) outlined that
treatment can only be as good as the assessment on which it was based. So in
order for us to progress and manage our treatment plan and ensure we are
identifying out patients problems the assessment should be an ongoing and
continuous process. A neurological assessment is an evaluation of a
person’s nervous system, which includes the brain, spinal cord, and the nerves that
connect these areas to other parts of the body. "Neuropsychological assessment is
an evaluation of a person's nervous system which includes the brain, spinal cord
and the nerves".
"It is a procedure used to evaluate the behavioral and functional expression of brain
dysfunction and identify the impact of brain injury or disease on the cognitive,
sensorimotor, emotional and general adaptive capacities of an individual".
Assessment may be carried out for a variety of reasons, such as:
 Clinical evaluation.
 Scientific investigation.
 Medico-legal assessment.
This assessment is often conducted if a person has experienced trauma or head
injury, or reports a range of symptoms that may include dizziness, blurry vision,
confusion, or difficulty with motor functions. This is done to detect neurological
damage or disease.
Goals of neuropsychological assessment:-
Miller outlined three broad goals of neuropsychological assessment.
 Firstly, diagnosis, to determine the nature of the underlying problem.
  Secondly, to understand the nature of any brain injury or resulting cognitive
problem and its impact on the individual, as a means of devising a
rehabilitation program or offering advice as to an individual's ability to
carry out certain tasks (for example, fitness to drive, or returning to work).
 And lastly, assessments may be undertaken to measure change in
functioning over time, such as to determine the consequences of a surgical
procedure or the impact of a rehabilitation program over time.
Techniques:-
"It is a performance-based method to assess cognitive functioning.
This method is used to examine cognitive consequences of brain damage, brain
disease and severe mental illness".
Psychologists can start screening for these problems by using either one of the
following techniques or all of these combined:
 History taking
 Interviewing
 Test taking
 Intelligence testing
 Testing other areas
 Language processing
 Memory
 Speed of processing

History taking
This includes gathering medical history of the patient and their family,
presence or absence of developmental milestones, psychosocial history, and
character, severity, and progress of any history of complaints. The psychologist
can then gauge how to treat the patient and determine if there are any historical
determinants for his or her behavior.
Interviewing
Psychologists use structured interviews in order to determine what kind of
neurological problem the patient might be experiencing. There are a number of
specific interviews, including the Short Portable Mental Status Questionnaire,
Neuropsychological Impairment Scale, Patient's Assessment of Own Functioning,
and Structured Interview for the Diagnosis of Dementia.
Test-taking
Scores on standardized tests of adequate predictive validity predictor well
current and/or future problems. Standardized tests allow psychologists to compare
a person's results with other people because it has the same components and is
given in the same way. It is therefore representative of the person’s behavior and
cognition. The results of a standardized test are only part of the jigsaw. Further,
multidisciplinary investigations (e.g. neuroimaging, neurological) are typically
needed to officially diagnose a brain-injured patient.
Intelligence testing
Testing one's intelligence can also give a clue to whether there is a problem
in the brain-behavior connection. The Wechsler Scales are the tests most often
used to determine level of intelligence. Intelligence test scores reflect a sort of
average of a person's performance on multiple individual subtests, each assessing
competence in a general domain of cognitive functioning The variety of scales
available, the nature of the tasks, as well as a wide gap in verbal and performance
scores can give clues to whether there is a learning disability or damage to a certain
area of the brain. Intelligence testing can be helpful. Although an overall IQ may
be misleading, the results of specific subtests often are helpful in providing
evidence for one or more specific neurodevelopmental dysfunctions. Psycho
educational testing can yield highly relevant data, especially when such testing
includes error analyses that pinpoint discrete breakdowns in reading, spelling,
writing, and mathematics A psycho educational specialist, making use of input
from multiple sources, can help formulate specific recommendations for regular
and special educational teachers.
A mental health professional is valuable in identifying family-based issues
complicating or aggravating neurodevelopmental dysfunctions. That professional
also can diagnose any specific psychiatric condition contributing to the clinical
picture in a child with academic problems
Testing other areas
Other areas are also tested when a patient goes through neuropsychological
assessment. These can include sensory perception, motor functions, attention,
memory, auditory and visual processing, language, problem solving, planning,
organization, speed of processing, and many others. Neuropsychological
assessment can test many areas of cognitive and executive functioning to
determine whether a patient's difficulty in function and behavior has a
neuropsychological basis.
Bender Visual-Motor Gestalt Test 
The Bender Visual-Motor Gestalt Test (abbreviated as Bender-Gestalt test)
is a psychological test used by mental health practitioners that assesses visual-
motor functioning, developmental disorders, and neurological impairments in
children ages 3 and older and adults. The test consists of nine index cards picturing
different geometric designs. The cards are presented individually and test subjects
are asked to copy the design before the next card is shown. Test results are scored
based on the accuracy and organization of the reproductions. The Bender-Gestalt
test was originally developed in 1938 by child psychiatrist Lauretta Bender.
Additional versions were developed by other later practitioners, although
adaptations designed as projective tests have been heavily criticized in the clinical
literature due to their lack of psychometric validity all versions follow the same
general format but differ in how results are evaluated and score
Case
Superficial siderosis (SS) is a neurodegenerative condition due to the long-
term effects of hemosiderin deposition on the surface of the brain, cerebellum,
brainstem, and spinal cord. SS symptoms include sensorineural hearing loss, ataxia
and upper motor neuron signs. SS was diagnostically evasive until magnetic
resonance imaging (MRI) became available. As the detection of SS improved, case
studies have become more prevalent. To our knowledge, however, this is the first
report of SS detailing a comprehensive neuropsychological assessment.
Method
The current study presents a right-handed female in her early 60s, with a
university level of education, who was diagnosed with SS.
Results
Her neuropsychological profile showed impairment across multiple
domains, including memory and executive function, with consistent behavioral
findings. The results from a comprehensive neuropsychological assessment include
dementia and a cerebellar cognitive affective syndrome.
Conclusions
Neuropsychological evaluation of a patient with new cognitive impairment
in combination with unexplained hearing loss, gait disorder, or myelopathy should
lead to a referral for MRI that includes techniques sensitive for iron deposition, in
order to rule out SS.