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Phys Dys > Cognition and CNS > Flashcards

Cognition and CNS Flashcards

1
Q

What is cognition?

A

The mental process of understanding, acquiring, and knowing information
Using that information in daily life
- memory
- executive functions
- self-awareness

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2
Q

Neuroplasticity

A

The brain’s ability to change throughout the lifespan

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3
Q

Types of brain plasticity

A

Structural plasticity: experiences or memories change a brain’s physical structure
Functional plasticity: brain functions move from damaged area to undamaged area

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4
Q

Hierarchy of Cognition

A
  1. attention, drive, arousal
  2. information processing
  3. integration, learning, and memory
  4. problem-solving, anticipation, goal-setting
  5. self-monitoring
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5
Q

Basic functions of cognition

A

Attention and processing
- processed through the frontal lobe, filtered through the parietal lobe
- can be bottom up or top down
Memory
- hippocampus and temporal lobes as well as the frontal lobes
- all types of memory
Executive functions
- prefrontal cortex
- monitoring, planning, inhibition and monitoring of performance
- multitasking
Self-awareness
- prefrontal cortex
- both cognitive awareness and psychosocial awareness

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6
Q

Screening for cognitive skills

A

Bottom up or top down
Oriented by 4
Screen any suspected patients
- Minimental
- MOCA: Montreal Cognitive Assessment

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7
Q

During evaluation, what factors might affect cognition?

A

Emotional state
- anxiety, depression, fatigue
Level of education
- more refined skills
Familiarity with the task
Environmental factors
- noise, lights, other people, medications

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8
Q

Screening for orientation, attention, and processing

A

Focused attentions or arousal
Selective attention
Sustained attention
Alternating attention
Divided attention

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9
Q

Types of memory

A

Episodic memory
- related to time
Procedural memory
- how to do something
Semantic or declarative memory
- work based knowledge, words
Prospective memory
- remembering upcoming events
Topographical memory
- how to get somewhere, maps

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10
Q

Retrograde memory

A

Memory prior to incident

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11
Q

Anterograde memory

A

Memory status after the incident

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12
Q

Screening executive function

A

Planning
- proposal to action
Problem solving
- process with solution
Organization
- putting things in order
Judgement
- considered decision
- not impulsive
Self-regulation
- ramp up or down
Flexibility
- compromise or change ideas
Categorization
- sorting according to attributes
Abstract reasoning
Divergent thinking
- outside the box
- new ideas or methods
- creativity
Conceptualization
- invent something or formulate an idea

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13
Q

Screening self-awareness

A

Knowing one’s own capabilities, limits, skills, and level of function
- physically, cognitively, psychologically

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14
Q

Classes of cognitive issues

A

Permanent: Alzheimer’s, Parkinson’s, CVA, TBI
Temporary: CVA, TBI, Cancer
Progressive: Ms., Alzheimer’s

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15
Q

3 common approaches to cognitive rehab

A

Skill-habit training
Cognitive strategy training
Environmental modification/adaptation

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16
Q

Skill-habit training

A

Helping clients develop new routines and habits
- Requires little to no mental energy
- Doesn’t require problem solving
The goal:
- Improve a specific task
- Does not generalize to other tasks
- Improve self confidence
- Improve independence in THAT skill
Who?
- Anyone
- Those with severe impairments of memory or self awareness
- PTA-Post Traumatic Amnesia
Models:
- Occupation Oriented
- Task Oriented
For:
- Moderate to severe
- Memory loss
- Limited self awareness
- Diminished executive function

17
Q

Implementing skill-habit training

A
  1. Identify Key Skills
    - very specific skills
  2. Analysis of the space, time and situation the “habit” will occur in
    - Dressing doesn’t happen at 2:00
  3. Practice the task
    - Family and therapist cue the client through the task
    - Errorless Learning
    - Consistency
    - Chaining
    * Backward and forward
18
Q

Compensatory cognitive strategy training

A

This strategy only works if the person recognizes they have limitations
- Self awareness
Metacognition Strategy Instruction (MSI)
- You know what you know and what you don’t
We all use these strategies!

19
Q

Three phases of compensatory cognitive strategy training

A

Acquisition
- The therapist explains the technique
- The client practices the technique
- The family supports the technique
Mastery and Generalization
- Practice opportunities to use this technique
- Generalization: if you use a paper checklist for grocery shopping, a paper checklist may be beneficial with household chores
- Therapists backs off
“did you forget something”
If they don’t know what they forgot and this occurs often, they may be a better candidate for skills-habit training.
Maintenance
- Therapist checks in to see

20
Q

Cognitive Memory Strategies

A

Internal Memory Strategies
- Rehearsal
* Practice saying over and over
- Visual Imagery
* Take a “mental” picture
- Mnemonics

External Memory Strategies
- Checklists
- Timetables and memory books
- Day planners/Organizers
- Phones
- CAT (cognitive assistive device)

21
Q

Cognitive Metacognition Strategies

A

CO-OP plan
- Goal
- Plan
- Do
- Check
Therapist as a coach, not telling the patient what to do
Mild to moderate cognitive loss, or temporary loss and you’re trying to restore their memory
The hope is that we get some generalization and carry over into other skills

22
Q

Environmental Modification/ Adaptation

A

For use with:
- Major neurocognitive disorders
- This method is neither restorative or curative
- Heavily involves the caretaker
* Think 4 an under
The press (stress) of the task is not on the client
- Label items
- Declutter
- Minimalism
- Give two options
* Give no options
- Same every day
Evaluate each client for the needs of the caregiver,
- I need her to……

23
Q

CNS Models and FORs

A

Rood
Brunnstrom
Proprioceptive Neuromuscular Facilitation
Neurodevelopmental Treatment Techniques

24
Q

Margaret Rood

A

Key in motor learning rehab
Known for 2 things
1. Techniques of Motor Control
- Inhibition and facilitation techniques
2. Developmental Sequence
- Learn in peds

25
Q

Key concepts of Rood

A
  1. Normalized (not normal) tone is required to develop motor control and mastery of movement
    a) Facilitation techniques
    b) Inhibitory techniques
  2. Flexion and extension patterns are evident in everyday life
  3. Repetition of muscular responses is critical to learning motor patterns
  4. Motor patterns need to be learned in the context of functional activities
26
Q

Facilitation techniques

A

Increase tone
Heavy joint compression
Manual resistance
Quick stretch
Tapping
Vibration
Fast brushing
Vestibular stim (fast motion)

27
Q

Inhibitory techniques

A

Decrease tone
Neutral warmth
Slow stroking
Light joint compression (consistent)
Slow vestibular stim
Prolonged stretch

28
Q

Components of motor control

A

Reciprocal innervation
- If the agonist is contracting/the antagonist is relaxing
* Heavy flexion = relaxed extension
* Spasticity (elbow flexed up to chest) – resist against flexion – better extension
Co-Contraction
- Agonist and antagonist = stability
- Necessary for postural control
Heavy Work
- Mobility to be superimposed on stability
- Proximal stability = distal controlled mobility
- Proximal instability = distal loss of control and mobility
Skill
- Proximal stability = functional distal motion
- Painting on an upright vs. floor
- Writing board vs paper

29
Q

How is Rood used today?

A

Tone
- Only one factor and is impacted by the task, temperature, mood, etc.
* Role of function
- Facilitation and inhibition techniques are unpredictable but still used in some settings
Motor Development patterns
- Proximal to distal – yes
* Proximal control giving you distal function
- Postural control – yes
- In adults - the need to follow the developmental timeline - NO.
* No longer followed with adults, just children.

30
Q

Brunstrom

A

Common progression or stages of motor recovery after a stroke
- Like Rood’s stages of motor development
Also called Movement Theory
Theorized that normal movement is first controlled by primitive reflexes and as higher brain centers develop, they learn to control these reflexes
Following a stroke, the higher centers are no longer able to control the reflexes “development in reverse”
Viewed reflexes as “normal” after a stroke
Reflexes provide the opportunity for movement and leads to the opportunity for functional movement

31
Q

History of Brunnstrom that is no longer accepted

A

Motor return is always proximal to distal
Specific stages for motor return after a CVA
Reflexes return then functional motion
Gross motor then fine motor
Encouragement of synergy patterns

32
Q

Key intervention in Brunnstrom today

A

Motor recovery is not always proximal to distal, but we recognize that proximal stability is needed for distal precision.
Depending on the type of stroke, pts may not get reflexes at all, but if they get them, use them
Focus on functional motion
- Fugl-Meyer Assessment
Discuss moving in and out of synergy
The “move it theory”
Developmental sequence:
- Reflex (if present) to voluntary movement to functional movement
Make the motion/hold the motion
Back it up
- Reverse the motion, even if small
Facilitation can be used as needed
- Dropped as soon as volitional motion occurs
Repetition is key
Perform in the context of function

33
Q

Basic tenets of proprioceptive neuromucsular facilitation

A

All Humans have untapped potential
- Those with and without disability
Human movement occurs in combination
- Not linear
- Diagonal
The trunk is the foundation of all motion
- Trunk stability is key
Multi Sensory Approach
- Visual
- Auditory
- Tactile

34
Q

Critical concepts of PNF

A

Resistance - improves muscle contraction
Stretch - use of quick stretch
Irradiation - also called overflow
Traction or approximation - the lengthening or compressing of a limb
Body position - the therapist finds the body position that is most stable for the client

35
Q

PNF patterns

A

Combination of stretch/resistance and motion in 4 distinct FUNCTIONAL patterns
D2 – swords
D1 – pledge of allegiance

36
Q

Neurodevelopmental techniques

A

A holistic and interdisciplinary practice model
- OT/PT/SLP/Nursing/Family
Individualized to the client
Motor function can be impacted key points of physical control by the therapist to
- Facilitate or inhibit motion (not Rood’s way)
- Hands on
Active participation is a must
- Passive early on, but passive doesn’t restore function
Weight bearing to normalize tone
Avoid compensatory motions and encourage and guide effective motor patterns
PNF CANNOT WORK WITH BRUNNSTROM

Phys Dys (8 decks)

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