BCPR Module 2 Flashcards
(162 cards)
1
Q
Cognition
A
Information-processing functions carried out by the brain that include attention, memory, executive functioning, comprehension, formation of speech, calculation, visual perception, praxis
2
Q
Cognitive Dysfunction
A
Functioning that is below expected normative levels/loss of ability in any area of cognitive functioning capacities
3
Q
Functional Cognition
A
How people use/integrate their thinking and processing skills to accomplish everyday activities in clinical/community settings
4
Q
Mild Neurocognitive Disorder (NCD)
A
Typically 1-2 SD below age-/education-adjusted norms
Modest decline from previous level of performance in 1+ cognitive domain
Concern of the individual, knowledgeable informant, or clinician that there has been a mild decline in cog function AND
Modest impairment in cog performance, preferably documented by standardized neuropsych testing/clinical assessment
Cog deficits DO NOT interfere with capacity for independence in ADLs but greater effort/compensatory strategies/accommodations may be required
5
Q
Major NCD
A
Impairment in only one cognitive domain (except in Alzheimers - 2 required, one must be memory)
Preferrably confirmed by neuropsych testing/quantitative clinical assessment
Typically less than/equal to 1 SD below age-/education-related norms
6
Q
Mild Major NCD
A
Impairment only in IADLs (use of mild is potentially leading to confusion as mild severity within the broader classification of Major NCD is different from outright Mild NCD)
7
Q
Moderate Major NCD
A
Impairment in basic day-to-day functions such as clothing and feeding
8
Q
Severe Major NCD
A
Completely dependent on others
9
Q
Domains of Cognitive Function
A
Complex attention
Executive function
Learning/memory
Language
Perceptual-motor function
Social cognition
10
Q
Cognitive Rehabilitation
A
Services designed to improve cog functioning and participation in activities that may be affected by difficulties in 1+ cog domains
Use of interventions to increase participation and abilities as well as learn new adaptive/compensatory strategies
11
Q
L Hemisphere Deficits
A
Sequencing
Decreased logical thought progression
Difficulty distinguishing details
Memory deficits of past/recent events
Cautious
Fearful
12
Q
R Hemisphere Deficits
A
Significant safety/judgement deficits
Lack of insight/awareness of deficits
Loss of prosody of speech
Attention deficits
Impulsive
Unrealistic
13
Q
Frontal Lobe Deficits
A
Poor executive functioning
Impaired pragmatics
Personality changes
Decreased inhibition
Impulsivity/delayed initiation
Eyes (gaze preference, head deviation)
14
Q
Temporal Lobe Deficits
A
Auditory input deficits
L-side lesion: ST verbal memory loss
R-side lesion: ST memory loss
15
Q
Parietal Lobe Deficits
A
Spatial relations
Neglect/inattention
Sensory integration
Poor personal space boundaries
Emotional/labile behavior
Apraxia
16
Q
Occipital Lobe Deficits
A
Perceptual
Visual input and processing
17
Q
Cerebellar Deficits
A
Potential for general cognitive deficits
18
Q
Internal Strategies
A
A change in the way the person thinks
Implementation of formal problem-solving routines
19
Q
External Strategies
A
Use of an aid (smartphone, schedule), environmental modification, or altering activity demand
20
Q
Restitution Model
A
Focuses on recovery of lost abilities
21
Q
Remedial Model
A
Process oriented
Direct retraining/restoration of impaired core cognitive skills
Targets the underlying mechanisms of memory, attention, EF that may cause deficits
22
Q
Substitution Model
A
Relates to the development of new ways to circumvent the impaired function
23
Q
Adaptive/Functional Model
A
Targets the tasks/functions individuals need to perform
Directly teaches/trains people to accomplish these despite cognitive disability
Adapt the environment to the person’s abilities
24
Q
Neuroanatomical Intervention Model
A
Phasic alerting
Eye patching
Prism adaptation
25
Restorative/Remedial Intervention Model
Focused on specific cognitive components
Cognitive computer-based training programs
26
Cognitive Compensatory Intervention Model
Focus on providing methods that compensate for areas of dysfunction
Dynamic Interactional Model (DIM)
Cognitive Orientation to Daily Occupational Performance (CO-OP)
Dynamic cognitive intervention
27
Functional and Environmental Intervention Model
Focus on skill and task-specific training
Adapt the task/environment
Caregiver education
Neurofunctional basis for training
Cognitive disabilities model
Neurocognition and function based on cognitive levels
28
Cognitive Functional Evaluation - Extended (CFE-E)
Multifaceted approach for individuals with suspected cognitive disabilities
Systematic decision-making process, customized to each person's needs
May include assessments of various domains/stages to aid intervention planning
5 steps
29
5 Steps of CFE-E
1) Initial interview, background info, occupational history, participation level
2) Functional cog assessment, cog screening, baseline status (performance-based tests, questionnaires, baseline status tests)
3) Cog tests for specific domains
4) Environment and safety assessments
5) QOL and well-being assessments
30
Top-Down
Involves higher cognitive processes to regulate lower processes
Training in self-awareness or mental cognitive control strategies
31
Bottom-Up
Intervention that focuses on repetitive practice of processes that are consistent fundamental cognitive processes
Structured sensory stimulation
Repetitive practice in attention skills
32
General Stimulation/Hierarchical-based Approach
Attempt to enhance client function by stimulation targeting cognitive deficits
Foundational cognitive processes are addressed before higher order capacities
*Little evidence supports*
*Not-generally considered evidence-based, though still in use*
33
Process-Specific Approach
Behavioral/cognitive compensatory routines
Target self-awareness and error correction
Highly focused on specific cognitive process/skill
More highly-focused approaches noted to be more effective than less-targeted alternatives
34
Strategy-driven approaches targeting EF
Metacognitive strategies
Teach pt to:
ID Problems
Develop their own methods to overcome
Implement/evaluate solutions
35
Global Learning
Assists in developing a general thinking routine
Focus on awareness of the impaired cog process rather than basic cog deficit remediation
Top-down, uses scripts
Maximize chances for generalization
Central focus: strategy
36
Function-Embedded Cog Retraining
Conducted within a performance context and is task specific
Generalization depends on degree of overlap in processing
37
Domain-Specific Strategy Training
Mental routines designed to gain mastery
Focus on strategy rather than task itself
Maximize chances for generalization
38
Process-Specific Cog Retraining
Remediation of a specific cognitive deficit
Bottom-up
I.e. prism training, eye patch training
39
Task-Specific Training
Teaches a specific functional behavior by employing errorless learning
40
Environmental Modifications/AT
Included in most strategies
Addresses task demand simplification to bolster skill acquisition and decrease cues
Match abilities and environment for success
41
Continuum of Cog Rehab
Strategic learning (teaching strategies)
Generalize strategies
Further improve cog performance
(Focus on cog compensatory, functional, environmental approaches)
42
Advance Cognitive Training for Independent and Vital Elderly (ACTIVE)
Helping older adults develop strategies for functioning in everyday
Workbook exercises to practice new strategies
Focus:
-Memory
-Reasoning
-Attention/Processing speed
43
ACTIVE Foci - Memory
Verbal episodic memory
Use of mnemonic strategies (visual imagery, semantic knowledge)
44
ACTIVE Foci - Reasoning
Inductive reasoning/working memory
How to solve problems by organizing information and ID repetitive patterns
45
ACTIVE Foci - Attention/Processing Speed
Visual search and ID
Computer-administered test of visual search in divided attention
Focus primarily on improving driving
46
CVA and NCD
CVA is a significant risk factor for later onset mild/major NCD
NCD is a risk factor for CVA
47
Spatial Attention
Detecting and allocating attention to different parts of space
48
Selective Attention
Maintaining a consistent behavioral set
Activation/inhibition of responses linked to selecting target stimuli from background stimuli
49
Sustained Attention
Maintained a consistent response set during continuous, repetitive, prolonged activity
50
Alternating Attention
Switching response sets according to environmental cues
Allowing 2 activities with distinct response requirements to be performed in sequence
51
Divided Attention
Dividing attention to respond to 2+ tasks at the same time
52
Test of Attention (TEA)
Targets:
Visual selective attention/speed
Attentional switching
Sustained attention
Auditory-verbal working memory
53
Attention Interventions
Very limited support
Pen/paper or computer based
54
Attention Process Training Approach (APT)
Organize therapy activities using a theoretically grounded model
Provide sufficient repetition
Use patient performance data to direct therapy
Included metacognitive strategy training
ID and practice functional goals related to attention
55
Declarative Memory
Introspection/the person knows that they know something
Immediate or sensory
56
Episodic Memory
Discrete events that retain temporal/sensory associations
Memory of autobiographical events
Relevant to events of the recent/distant past
**Important for hip precautions, transfer strategies, hemi-dressing**
Age-related deficits ~50, prospective/remote stable until ~70s
57
Semantic Memory
Facts, dates, majority of institutionally-conveyed information
Older adults typically perform as well as younger adults
58
Procedural Memory
Acquisition of skills and other aspects of knowledge that are not directly accessible to consciousness
Minimally affected by the passage of time
59
Nondeclarative Memory
Store of acquired patterns of behavior not necessarily mediated by cog learning
Info accessed through performance
60
Prospective Memory
Involves both memory and EF
Remembering when a task needs to be completed
Interrupting ongoing activity to complete and returning to previous activity
61
Crucial questions about memory
Have your relatives, friends, colleagues noticed any change?
Does the cog change affect the way you carry out daily activities?
62
Orientation return
Person --> place --> time
63
Standardized Memory Testing
Rivermead Behavioral Memory Test (RBMT)
Contextual Memory Tests
64
Visualization
Use of imagery/visualization to retrieve isolated bits of information
65
Evidence-Based Memory Strategies
Compensatory approaches
Use of external cueing devices and specific learning strategies (overlearning, spaced-retrieval, errorless learning)
66
Executive Functioning
Multiple higher order thinking processes
Coordinates multiple behaviors to support functional task performance
I.e. goal setting, problem solving, inhibition, organization, planning, multitasking
67
Remediation of EF
Top-down, metacognitive approaches
Builds on client's self-awareness and personal motivation
Negatively impacted by low client motivation/decreased self-awareness
68
Cognitive Orientation to Daily Occupational Performance (CO-OP)
Guided discovery
Goal - plan - do - check
Clients develop their own domain-specific strategy to solve specific performance problems
69
Unilateral Neglect
Characterized by slowness/failure to orient/attend/respond to novel stimuli present in the hemisphere contralateral to lesion
80% R hemisphere, 15-20% L hemisphere
70
Personal Neglect
Related to attending to the body
71
Object-centered Neglect
Centered on the external object
72
Peripersonal Spatial Neglect
Within arm's reach
73
Extrapersonal Spatial Neglect
Beyond arm's reach
Radial neglect
74
Vertical Spatial Neglect
Altitudinal
75
Attending Deficits
Failing to take note of objects/events in one half of space
76
Intending/Motor Neglect
Being unable to perform actions/maintain action in one hemisphere
77
Representational Neglect
Being unable to imagine/think about one half of space
78
Evaluation of Neglect
Test battery is preferable
Behavioral Inattention Test (BIT)
Catherine Bergego Scale (CBS)
Paper/Pen Test (line bisection, clock drawing, drawing from memory, cancellation test)
79
Supported strategies for Neglect
Visual scanning training
Visual scanning training + trunk rotation
Visual scanning + neck muscle vibration
Mental imagery (video feedback and prism adaptation)
80
Visual-Object Agnosia
Inability to recognize/verbally ID objects despite adequate visual acuity and language skills
81
Apperceptive Visual Agnosia
Deficit in the final integration of various perceptual attributes
82
Associative Agnosia
Able to see an object with sufficient clarity to match/draw it but do not know what object is
Failure to access semantic memory
83
Color Agnosia
Inability to remember/recognize the specific colors for common objects in the environment
84
Apraxia
Disorders of skilled, purposeful movement that cannot be accounted for by weakness, akinesia, abnormal tone, sensory loss, incomprehension, noncooperation
85
Ideomotor Apraxia
Inability to perform purposeful motor task on command, even though client understands idea
If skilled movement req movement at 2+ joints: movement may not be adequately coordinated
86
Ideational Apraxia
Inability to carry out a series of actions in a sequence required to achieve goal
Improper object use, skipped/repeated movements
Severe difficulty using tools in real-life settings
87
Body Schema Perceptual Dysfunction
Distorted sense of one's own body shape, position, capacity
Unilateral neglect
88
Visual Perceptual Dysfunction
Agnosia, color agnosia, color anomia, metamorphosia, prosopagnosia, simultanagnosia
89
Visual Spatial Dysfunction
Figure-ground discrimination, form constancy, position in space, R/L discrimination, stereopsis
90
Color Anomia
Inability to name color of objext
91
Metamorphosia
Visual distortion of objects (physical properties of size and weight)
92
Prosopagnosia
Inability to recognize/ID familiar faces
93
Simultanagnosia
Inability to recognize and interpret visual arrays as a whole
94
Figure-Ground Discrimination
Allows a person to perceive the foreground from background in visual array
95
Form Constancy
Recognition of various forms, shapes, and object regardless of position, location, size
96
Position in Space/Spatial Relations
Relative orientation of a shape or object to the self
97
R/L Discrimination
Ability to accurately use concepts of L and R
98
Stereopsis
Ability to perceive depth in relation to the self/various objects in the environment
Deficit: astereopsis
99
Stereognosis
Ability to ID common objects/geometric shapes through tactile perception alone
Deficit: astereognosis
100
Graphesthesia
Ability to recognize numbers/letters/forms written on the skin
Deficit: agrapesthesia
101
Neurocognitive Disorder Treatment
Errorless learning
Prompting strategies
Cognitive stimulation to improve social participation
102
Cognitive Aging
Mild symptoms of cognitive decline that fall WNL as people age
NOT Major NCD or MCI
DOES NOT impair the ability to perform ADLs/IADLs
103
Functional Task Exercise Group
10-week program
IADL activities with focus on cog components
104
Alert
Awake
Participates in therapy with no effort to increase arousal
105
Lethargic
Drowsy
Requires loud verbal stimuli to arouse
Responds slowly
Follow occasional 1-step directions
106
Obtunded
Requires constant tactile/motor stimulation to obtain/maintain arousal
When awake, pt is confused and not able to productively participate
107
Stupor
Minimally arousable (eye opening, withdrawing, pushing) only whit noxious stimuli (sternal rub, cold washcloth, pinching)
Will not actively participate
Minimal awareness of self
108
Coma
Not arousable with any type of stimuli, including noxious
May exhibit physiological reflexive responses
109
Common Sedatives/Hypnotics
Lorazepam (ativan)
Midazolam (versed)
Dexmedetomidine HCL (precedex)
Propofol titrated (diprivan)
110
Delirium
Combination of acute cognitive changes, fluctuating arousal, altered motor activity (hyper/hypo), sleep disruption
111
Glasgow Coma Scale (GCS)
15 point, rapid assessment of consciousness/BI
Assess eye opening, verbal and motor ability
>13 mild brain injury
9-12 moderate brain injury
<8 severe injury
112
JFK Coma Recovery Scale Revised (CRS-R)
Assists in differential diagnosis of disorders of consciousness
Quantifies emergence from minimally conscious state
Provides prognostic assessment/treatment planning
Assess: auditory, visual, motor, oromotor, communication, arousal
0 - deep coma
23 - able to follow commands and use objects appropriately
113
Richmond Agitation-Sedation Scale (RASS)
+4 combative
+3 very agitated
+2 agitated
+1 restless
0 alert and calm
-1 drowsy
-2 light sedation
-3 moderate sedation
-4 deep sedation
-5 unarousable
-3 and -2: appropriate for PROM/sitting EOB
-1, 0, 1: as tolerated, progress towards ambulation/ADLs
114
Confusion Assessment Method for ICU (CAM-ICU)
AMS, inattention, altered consciousness (RASS score other than 0), disorganized thinking
Positive for the presence of delirium if both features 1 and 2 are present with at least one of features 3 or 4
115
Intensive Care Delirium Screening Checklist
LOC
Inattention
Disorientation
Hallucinations/delusions
Psychomotor agitation/retardation
Sleep-wake cycle disturbances
Symptom fluctuation
Score: >_4 within 8-24hr period is + for delirium
116
Evidence-Based Delirium Prevention
Establishing daily schedule that promotes participation
Early mobilization
Emotional regulation techniques
Schedule rest
Establishing premorbid sleep-wake cycles
Frequent reorientation
Assessing pain/agitation during sessions
Coordinating with team for treatment while sedation is lifted
117
Neurodegenerative Diseases
Conditions involving progressive damage to the function, structure (or both) of the CNS and/or the PNS
Chronic, progressive, generally incurable, variable, linked to LT changing levels of disability
118
MS Cognitive Deficits
Memory, concentration, attention, EF
119
ALS
Frontal lobe (EF and initiation)
Behavioral management
120
Altered Mental Status
An alteration in cognitive skills/functioning
Generally a symptom, not a final dx
121
Causes of AMS
Progressive degrees of Major NCD
Delirium
Metabolic encephalopathy
Depression
122
Sundowning
Decline associated with fatigue in later afternoon/early evening
Common with Major NCD
Behaviors: agitation, psychosis, confusion, mood swings
123
Metabolic Encephalopathy
Chemical, electrolyte, water, vitamin abnormalities resulting in diffuse brain dysfunction
124
Bipolar Disorders, Cog Therapy
General stimulation programs to encourage problem solving and planning
Process-specific training
125
Schizophrenia, Cog Therapy
Social abilities
Vocational interventions
Reduction of negative symptoms
126
Cancer-Related Cog Dyfunction
Memory
Attention
Concentration
Language
Multi-tasking
Organizational skills
Participation
QOL
127
Post Concussion Syndrome
Disorientation
Decreased attention/safety
Impaired memory
Impaired EF
Delayed processing
128
Post Concussion Syndrome Treatment
Initial rest - NOT BEDREST
No reading
No electronics use
Minimal stimulation
Increase stimulation as tolerated
129
Conversion Disorder
Inability to recall autobiographical info
Impaired attention
Inability to demonstrate elementary-level tasks
Ability to perform implicit complex tasks when there is an observed inability to perform simpler explicit tasks
130
Pain Impacting Cognition
Slowed responses
Impaired alertness
131
Neurofunctional Approach
Only training approach proven to accelerate recovery in the early period of TBI recovery
8-stage process
Performance-based skill/habit training approach
132
Neurofunctional Approach Target Population
Severe/profound cog impairments (memory, attention, EF)
Impaired trial-and-error learning
Lack of insight/impaired awareness of cog impairment
TBI, CVA, neurobehavioral disabilities
(Least appropriate - mild impairment, intact self-awareness)
133
Performance Integration/Chunking
Once errors are dropped out and sequence of behaviors becomes relatively stable, components of total behavior required in the situation are "integrated"
134
Integration
Previously discrete parts of a sequence come to behave functionally as a unit
135
Multicontext Approach
Use of self-monitoring skills during tasks to recognize functional cognitive performance errors
Use of guided questioning to support self-discovery
136
Dynamic Interactional Model
Performance is a result of the dynamic interaction between external and internal factors
137
Multicontext Approach Stages
Near transfer
Intermediate transfer
Far transfer
Very far transfer (generalization)
138
Multicontext Approach Target Population
Subtle/mild neuro impairment up to mod impairment
Potential to improve self-awareness and ID/apply strategies
Least appropriate: major lang impairments, mod/severe dementia, severe cog deficits, limited cue responsiveness
139
2019 AOTA Statement on Cognition, Cog Rehab, and Occ Performance
OTs are primarily concerned with occ performance
Cog in abstract sense of individual cog functional are of less interest than he way the individuals apply their cog resources to the performance of ADLs/IADLs
140
Functional Cognition
Ability to integrate thinking and performance skills to accomplish everyday activities
Observable performance of everyday activities resulting from a dynamic interaction b/t motor abilities, activity demands, and task environment, guided by cog abilities
*Global/Top-down approach that is not task limited*
141
Improving Medicare Post-Acute Care Transformation (IMPACT Act)
Evaluate and realign incentives and payment for post-acute care services
Emphasis: medical, function, cognition, social support for continuity of care, reduce/prevent readmissions, better outcomes
142
Problem with BIMS
Categorizes individuals with functionally relevant cog impairments as cognitively unimpaired
143
Confusion Assessment Method (CAM)
ID delirium quickly and accurately
Assess presence, severity, and fluctuation of 9 delirium features (acute onset, inattention, disorganized thinking, altered consciousness, disorientation, memory impairment, perceptual disturbances, psychomotor agitation/retardation, altered sleep-wake cycles)
144
Brief Interview of Mental Status (BIMS)
Tests memory, orientation
Scores: >7 severe impairment, 8-12 mild impairment, 13-15 "intact" cognition
*Cog deficits too mild to be identified by BIMS may compromise IADLs that are considered essential to community independence
145
Performance Based Tests (PBTs)
Designed to assess performance in one domain or assess functional cognition/IADL more generally by evaluating complex task performance in real-world/dynamic environments
*More predictive of real-world functioning*
146
Functional Cognition Screenings/Assessments
EFPT - less demanding
Weekly Calendar Planning Activity
Performance Assessment of Self-care Skills
Assessment of Motor and Process Skills
Multiple Errands TEst
147
CO-OP Approach
Client-centered, performance-based, problem-solving that enables skill acquisition through a process of strategy use and guided discovery
148
CO-OP Approach Objectives
Skill acquisition
Cognitive strategy use
Generalization
Transfer of learning
149
Dynamic Performance Analysis
Structured observation of the client-chosen goals in context
Objective: ID performance problems and ID/test potential strategies
Fit between person, environment, occupation
Environmental supports/hindrances
150
Guided Discovery Levels
Low: trial and error
Mid: try to figure it out but I will help if needed
High: just listen, I will tell you what to do
151
Age-Related Macular Degeneration, Dry/Atrophic
Breakdown of retinal pigment epithelium
Accumulation of drusen
Dysfunction of photoreceptor cells
**Central blind spot
152
Age-Related Macular Degeneration, Wet/Exudative
Neurovascularization of the choroid
Leakage in new blood vessel growth
Results in sudden/significant visual acuity
**Central blind spot
153
Diabetic Retinopathy
Neurovascularization of retina d/t not being nourished
New vessels are weak and often burst
**Blind spots, sporadic (think dalmation)
154
Glaucoma
Increased intraocular pressure leading to decreased peripheral vision
Field changes are not consistent/predictable
155
Glare/Photophobia
Due to corneal disease, cataracts, albinism, normative aging
Limits ability to participate in desired activities (outdoors, TV)
156
Decreased Visual Acuity
Due to corneal/iris/pupil conditions, cataracts, vitreous, retinal conditions
Affects reading, writing, computer use, knitting, DRIVING
157
Peripheral Field Deficits
Due to retinal, visual pathway, and brain conditions
Glaucoma, degenerative myopia, retinitis pigmentosa, retinal detachment, trauma, aneurysm, diabetic retinopathy
Implications: night blindness, orientation, mobility
158
Contrast Sentivity
AMD, glaucoma, diabetic retinopathy
Ability to differentiate foreground from background
Affects: reading, navigating environment
159
Lighting Intervention
Should meet the needs associated with the activities performed there and different tasks may req different solutions
Include natural, ambient, and task lighting
160
Contrast Interventions
Use of yellow sheets/filters to increase contrast
Typoscope: isolate print, allowing less visual clutter
CCTV: reverse polarity (black background)
Adjustable light sources, bold-lined paper, bold pens
161
Glare Control Interventions
Use of sheer curtains/shades
Glare screens for computers
Wide brimmed hats/visors/sunglasses
162
Visual Skill Interventions
Scanning
Alternate viewing areas
