13. Neuropsychological Intervention Flashcards
(32 cards)
Early Neuropsychology looked like:
Looking at someone’s symptoms and predicting where the lesion would be in their brain (localisation and lateralisation)
i.e.
Purpose: diagnostic
Dimension: abstract / academic (finding lesions does not necessarily help the patient, but more so the academic field)
Methods: Testing
What does Neuropsychology look like now?
After the innovation of cerebral imaging, we no longer needed to predict where the lesion was.
Purpose: rehabilitation
Dimension: utilitarian / ecologically valid (focussing more on practical abilities - how do we practically help this person)
Method: treatment
Difference between psychological and neuropsychological intervention?
Psych: methods used to facilitate change in an individual
Neuropsychological intervention: any method used to bring a change in an individual’s cognition, emotions, behaviour, following known or suspected brain impairment.
What are the ranges of Neuropsychological interventions?
Psychoeducation: 80% of neuropsychs deliver feedback on their diagnostic results to their client.
Adjustment/supportive counselling: helping clients adjust to new way of life (while helping them improve functional abilities)
Psychological therapy: required to know all the staple interventions (CBT, MI)
Behaviour management: where behavioural principles are applied to bring about a change in challenging behaviour
Cognitive rehabilitation
Cognitive intervention and cognitive therapy
Often get confused
intervention: content of cognition
therapy: process of cognition
Who is psychological intervention generally carried out by?
- clinical psychologist and clinical neuropsychologist
Define ‘challenging behaviour’
Repeated behaviour resulting in 1 or more of the following scenarios:
- safety risk to the person / others
- limiting access to valued activities
- withdrawal of others / social isolation (most often, they will lash out at support people and then won’t get the support they need)
Outline positive behavioural support plans:
Aim to
- understand the person and their behaviour
- reduce freq / intensity of challenging behaviour
- build prosocial replacement behaviour
- enhance independence and participation
- improve quality of life
Behavioural analysis - ethical perspective, and how its done
- the intervention serves the client themselves to increase quality of life and functioning (not the support workers)
- train the staff in delivering interventions
- clients taught functional skills (i.e. assertion, to replace their aggression)
- evidenced based practices (a Functional Behavioural Analysis)
- behaviour programs use reinforcement
Outline a functional behavioural analysis
ABCs of behaviour
Antecedent: the preceding event
Behaviour: operationally defined occurrence
Consequence: what happened afterwards (was it reinforcing, how will it affect consequent behaviour, etc)
How to provide adequate behaviour support
Develop a team approach
- educate and involve the team
- has to be undertaken by the entire team
Historical roots of cognitive rehab vs cognitive remdediation
Cognitive rehab:
- first world war (older)
- focussed more on open head injuries
- systematic, functionally oriented service of therapeutic activities based on assessment and understanding of patient’s deficits
- associated with Habilitation (reteaching of functional skills)
Vs
Cognitive remediation:
- psychiatric literature (schizophrenia)
- designed to improve cognition on people who suffered a decline in neuro functioning
What are the 4 steps of cognitive rehab?
- reinforce, strengthen or restablish previously learned patterns of behaviour
- establish new patterns of cognitive activity through compensatory cognitive mechanisms for impaired neurologic systems
- establish new patterns of activity through external compensatory mechanisms such as personal orthoses or environmental structures and support
- enable person to adapt to their cognitive disability, to improve their overall quality of life
Outline the model involving cognitive rehab, cognitive remediation, stimulation, cognitive training
Remediation (intervention strategies to mediate deterioration) = umbrella term
Next level:
- Cognitive habilitation: relying on identifying and targeting individual areas of weakness in daily functioning, implementing strategies to improve or compensate for these difficulties
- Stimulatoin: participation in activities which enhance cognitive and social functioning (non-specific techqniques such as discussions)
- Training (theoretically driven skills and strategies - guided practice)
Training is broken down into 2:
- strategy based (external or internal)
- computerized
What can we presume about the mechanisms?
Zangwill and Luria
Zangwill:
- restoration due to direct training
- circumvention of impairments via compensation
Luria:
- compensatory or functional reorganisation where intact parts of the brain take over lost function
When you have a severe lesion…
you iwll be unable to get restoration of functioning
so instead use a top down approach (compensation or environmental changes to help compensate for lost function)
when you have a mild-moderate lesion
more likely to use a restorative approach
- internal strategies and practice
What are the 2 main mechanics of dealing neuropsych interventions?
Biopsychosocial formulation and goal setting (individually tailored to person-centred goals)
Evidence based practices
Outline holistic neuropsychosocial formulation
brain pathology can cause changes in cognitive impairment, affect, physical abilities
these can effect eachother and influence insight and loss
and also have functional consequences
These are all effected by social network and identity
Outline the ICF model
Impairment level (impairment of brain structures of function) impact activity limitation (such as remembering to take one’s meds) which may impact participation restriction (participating in social life or mental stimulation).
Neuropsychs can implement strategies to increase activity probability
Does computerised cognitive training prevent dementia in older people
quality of evidence was very low
computerised training for 12+ weeks in healthy patients …
leads to slightly better overall cognitive funtioning
compared to nothing, ccts may slightly improve memory at the end of 6 months of training
Cognitive training was found to be
small effect size in healthy older adults, people with MCI, people with dementia
Meta-analysis indicates that cognitive rehab is
helpful in enabling people with mild or moderate dementia to improve their ability to manage everyday activities
