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611 Exam 2 > Cognitive & Perceptual Function > Flashcards

Cognitive & Perceptual Function Flashcards

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1
Q

General Assessments : Performance Based ADL Assessments

A

Performance of Self Care Skills (PASS)
Structured Observation Test of Function (STOP)
This assessments allow to see the pt. functioning vs just using a pen & paper assessment.

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2
Q

General Assessments: Clinical Vision Screen

A

Should be used with ALL neuro pts.

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3
Q

General Assessments : Perception Test

A

Such as the MVPT which can be linked with driving

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4
Q

Perception

A

The integration of sensory impressions into meaningful information.
Recognitions of sounds (i.e. doorbell) also visual & tactile stims.

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5
Q

Motor Planning (Praxis) : Apraxia

A

Absence of motor planning ability (frontal & parietal lobe dysfunction)
Lack of purposeful, skilled movement that cannot be attributed to weakness, tremor, spasticity, loss of position in space.

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6
Q

Motor Planing Consist of 2 Steps

A
  1. Conceptual/ideation

2. Production/planning

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7
Q

Ideational Apraxia : Clinical Manifestations

A

*Inappropriate tool use
Sequences activity incorrectly
Overall loss of concept of tasks
Uses familiar objects incorrectly (i.e. toothbrush as a hairbrush)
Can’t relate object together (can’t put toothpaste on toothbrush)
**You can see hesitation when pt. is completing a task

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8
Q

Ideational Apraxia : Clinical Manifestations Continued

A

Multi-step tasks, requiring multiple objects are especially difficult such as morning or bedtime routine
Culturally inappropriate use of objects
Eats with fingers, stirs coffee with finger
Slow task performance
Cant initiate task
Task perseveration

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9
Q

Ideomotor Apraxia

A

A disorder of the production praxis system. A loss of kinesthetic memory patterns so that purposeful movement cannot be produced or achieved due to defective planning & sequencing of movements even though the idea/purpose of task is understood.

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10
Q

Ideormotor Apraxia : Clinical Manifestations

A 
Awkward or clumsy movements 
Difficulty crossing midline 
Trouble with grasping patterns 
Trouble orienting hand to objects (i.e. fork backwards) 
Inflexible or static hand positions
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11
Q

Ideomotor Apraxia : Clinical Manifestations Continued

A

Spatial errors such as moving scissors laterally
Difficulty coordinating 2 or > joints for tasks
Difficulty with timing of movement
Impercise movements
Poor gestural ability (cant replicate waving/blowing a kiss)
Difficulty with completing a task on command but can initiate a task when needed (i.e. they can get a drink when thirsty)

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12
Q

Ideomotor Apraxia : Tx. Ideas

A

Hand over hand A to start ADL’s
Work on familiar tasks
Pt.s can struggle in a new envt. vs. their home envt.
Use a lot of gestures, mock the task (i.e. mimic what a taking a drink looks like)

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13
Q

Apraxia Prevalence

A

Of those w/ (L) brain damage 25% have apraxia
Those w/ global aphasia have more apraxia than others.
Strong association btw expressive aphasia & ideomotor apraxia.
Occurs w/ aquired brain injury, CVA, parkinson’s, alzhimers, suprnuclear palsy, & Huntingtons.

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14
Q

Apraxia & ADL Impact

A

The # of errors made during B & IADL’s is predictive of the severity of the apraxia (dressing & grooming are the best indicators) The pt. moving “slowly” is a warning sign.

Those pt. with ideomotor apraxia have > dependence in toileting, dressing, & bathing compared to age matched controls.

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15
Q

Apraxia & ADL Impact Continued

A

Apraxia severity is moderately predictive of meal prop competency (always have the pt. make toast, coffee, or wash dishes)

The absence of apraxia is a significant predictor of the ability to return to work

Learning new skills and relearning old skills in those w/ apraxia requires more repetition

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16
Q

Oral Motor Apraxia

A

Pt.s have difficulty with recripcal conversation and initation of thought

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17
Q

Assessments for Apraxia : STOP Error Types

A

Content Error: Accuracy with what the pt. needs to do (i.e. handle utensils, materials)
Temporal Error: Time and efficiency with completing steps of the task
Spatial Errors: Over/Under shooting, decreased depth perception & mapping (i.e. next, behind)

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18
Q

Intervention for Apraxia : Compensatory

A

Compensatory strategies are dependent on the pt.s baseline.
A high baseline would require reps and structure
A low baseline limits the amount of compensation that can be used and these pt.s usually require 1:1 supervision.

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19
Q

Intervention for Apraxia : Interest Checklists

A

Used to determine what tasks are important to the client.
The intervention focus was error specific and determines by the problems observed during the standardized ADL observations.
Every 2 weeks new tasks were chosen.

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20
Q

Intervention for Initiation Errors

A

Developing necessary plan of action and selecting objects (Hand over Hand A)

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21
Q

Intervention for Execution Errors

A

Performing the pan (guiding & talking through task)

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22
Q

Intervention for Control Errors

A

Direct & correcting errors to ensure desired end result (more spaital errors/provide guiding)

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23
Q

Errorless Learning Background

A

Preventing mistakes through verbal and physical support vs trial and error.
Used for apraxia and memory impairments.
Trail and error can lead to increased frustration w/ Apraxix pts.

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24
Q

(Errorless learning) The therapist supports the difficult asspects of the task by:

A

Guiding w/ hand over hand A through difficult parts
Sitting parallel & doing the same action simultaneously.
Demonstrating required action & having client copy it afterword.

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25
Errorless Learning Training Focuses On
The specific difficult steps and critical features of the pereptual deficits of the task. Examples: Key details of ADL objects are explores (toothbrush bristles, sleeves on a shirt) Actions connected with the task details are practiced Specific motor skills are practiced in other activities & contexts (squeezing paint from a tube is similar to toothpaste)
26
Hemianopsia
Blindness in 1/2 of the visual field Sensory loss within the visual field Commonly lost on the L side Clinically you can see stiffness in the pts. neck and head due to decreased rotation to the L Can get better when swelling in the brain decreases however it usually results in residual deficits
27
Intervention for Hemianopsia
Prisms to shift image to center of retina (referral to a behavioral optomitrist) Head turning toward L coupled with sensorimotor tasks to reinforce environmental information and stim on the L side Pair movement with head turning toward L
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Visual Discrimination Deficits : Depth Perception
(Stereopsis) 3-D understanding of objects. | Functionally required when putting things away
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Visual Discrimination Deficits: Figure Ground
Foreground from background distinction. Functionally required when sorting laundry: whites towels off of white shirts, sheets. Intervention : Use contrasting colors
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Visual Discrimination Deficits: Spatial Relations
Relationship of objects to each other and self. | Functionally required when putting clothes in drawers.
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intervention for Visual Deficits
Task specific training (organize closets, drawers, labeling objects) Select functional activities with visuospatial demands (wrapping gifts, dressing) Combine movements with visuospatial demands (standing on moving surface and tossing bean bags) Combine compensatory stratagies with appropriate sensory cues (contrasting sleeves w/ tactile cues for dressing)
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Agnosia
Inability to RECOGNIZE incoming sensory information; sensory reception is intact. Relatively rare compared to apraxia, inattention an other disorders Loss of ability to recognize objects, people, sounds and shapes. Tends to be a SINGLE modality specific within pts.
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Visual Agnosia : Object Agnosia
Cant recognize objects in the environment
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Visual Agnosia: Prosopagnosia
poor face recognition
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Visual Agnosia: Simultanagnosia
Inability to recognize whole visual scenes
36
Visual Agnosia: Alexia
Inability to recognize letters or words
37
Tactile Agnosia : Astereognosis
Inability to recognize tactually presented objects despite adequate sensory, language and intellectual abilities
38
Agnosia Assessment
Bauer & Demery recommended ruling out sensory & memory loss, inattention, language deficit or dementia Present objects and allow pt.s to identify objects through a second sense if they respond "I dont know" to the first. If more than 1 sensory modailty is involved it is most likely NOT agnosia.
39
Cognition
The brains ability to process, store, retrieve, and manipulate information.
40
Sustained Attention
Vigilance to maintain attention over a period of time & to hold and manipulate information Alert & Oriented x3, follow directions, establish eye contact
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Selective Attention
Filtering critical information from irrelevant stimuli while ignoring distractors Driving: Focusing on the road vs. backseat conversation
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Alternating Attention
Flexibility to switch attention from one stimulus to another & return to original stimulus if needed. Listen to the news and cook @ same time. Increased level of executive functioning
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Divided Attention
Multitasking between 2 of > competing tasks simultaneously Cooking tasks: focusing on 1 thing in the over and 1 on the stove.
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Assessment of Attention : Test of everyday attention
Mainly completed through observation with a higher level pt.
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Assessment of Attention : Trail Making Test Part A
Pt.s need to connect scatterd #'s on a page in numerical order
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Assessment of Attention : Moss Attention Rating Scale
22 item self rating scale (caregiver or therapist can completed it and then compare their results w/ the pt.s)
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Intervention for Attention
Specific skills training coupled with implementation of strategies and environmental modifications. Interventions can take place in quiet spaces with simple highly structured tasks
48
Intervention for Attention : Time Pressure Management strategies (TPM) for slow information processing
Strategies for managing time by organizing and planing Rehearsing task requirements (problem solving) Modifying task requirements (problem solving) "Let me give myself enough time" - strategy development. TPM requires the pt. to have self awareness and an active roll in developing strategies.
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Executive Function Processes : Orientation
Knowing what needs to be done
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Executive Function Processes : Judgement
A pt.s impulsivity may be baseline rather than a post morbid condition. Make a real life scinerios and judge pt.s safety decisions.
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Executive Function Processes : Problem Solving
Make decisions for themselves or need vc's
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Executive Function Processes : Sequencing
Follow multi step tasks
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Memory Impairment : Encoding
Registering info for storage & later use, required language & visual system
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Memory Impairment : Storage
New memories are used for access & Retention
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Memory Impairment : Retrieval
Search for a strategy for how to recall & recognize information for retrieval (can be visual, auditory i.e. sticky notes, tape recorders)
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Amnesia : Anterograde
Difficulty with recall of info after acquired brain injury
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Amnesia : Retrograde
Difficulty with recall prior to disease or injury
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STM
Stores chunks of info for a limited time frame Usually info is recently processed visual or auditory information May be recently retrieved from long term storage May be from working memory
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Working Memory
Related to STM & deals with the active manipulation or rehearsal of information. Conscious mental effort -calculating change -Processing navigation directions while driving
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LTM
Relatively permanent storage expressed in skills routines & habits
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Explicit LTM
Declarative Knowing something was learned, facts, everyday events, knowledge of general world (dates, holidays, name of president, world events)
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Implicit LTM
Procedural | Knowing HOW to perform a skill, retaining previously learned skills (driving, using AE, card game)
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Episodic Memory
``` Form of explicit LTM Autobiographical memory for personally experienced events within a context -Remembering events on the job -What was eaten at a meal -Remembering the days events ``` Struggle for TBI pt.s
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Prospective Memory
Remembering to carry out future intentions - frontal lobe (i.e. remember to get milk on the way home) Requires working memory to be functional Critical for independent living (paying bills) Struggle for TBI pt.s
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Prospective Memory : Time-based
Not linked with external cues & require self-initiated strategies (i.e. taking meds)
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Prospective Memory : Activity-based
Require an external cue but dont require an interruption in the activity progress (turning out the lights ad you leave the room)
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Prospective Memory : Event-based
Performing an action when an external cue appears (when a boss walks into the room tell them they missed a call)
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Metamemory
Awareness of one's own memory abilities | Knowledge of when compensating is needed via lists, recognizing errors
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Memory Assessments : Prospective Memory
Must be included in a functional evaluation, pre planning where your things are, what the weather is like
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Memory Assessments : Rivermead Behavioral Memory Test (RBMT)
Global memory test. Predicts everyday memory problems Takes 20-30min to administer Example activity: Place something meaningful somewhere in the room and ask them to remember to ask for it before they leave
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Contextual Memory Test
Awareness of memory, predicting memory, prior test, estimating capacity following test Immediate and delayed recall of 20 drawings Storage use
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Everyday Memory Questionnaire
35 item in original; revised from 28 items -TBI, CVA, MS, elderly Speech- keeping track of conversation Reading & Writing: Recall of spelling a word; writing a sentences Faces & Places: recall of where object was put recognition of faces and locations Actions: Routines New Learning: New skill, recall a new name, recall an appt
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More Questionnaires
The Comprehensive Assessment of Prospective Memory The Prospective Memory Questionnaire Prospecitve and Retrospective Memory Questionnaire The Cambridge Behaviour Prospective Memory Test
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Memory Interventions
Compensatory is best option Severity, presence of co-morbidities, social supports, & client needs Memory notebooks and diaries
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Errorless Learning for Memory
Provide Correct Answer immediately Backward & Forward Chaining Combined Imagery with Erroless learning Association between names & faces by having subject create a mental image based on their hair, facial features, etc.
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Backward Chaining
all steps of the task are shown/prompted by the OT; the next trial all but the last step is shown/prompted & pt. must demonstrate it; 3rd trail all but the last 2 steps are shown/prompted and pt. must demo those and so on Works well with ADL (A with whole thing & pt. completes last step, promotes success)
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Forward Chaining
OT shows/prompts first step on the first trial, the first 2 steps on the second trial, and continues until the whole sequence is remembered. Start the task so the pt. gets the idea and then see what they can do.
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Assistive Technology.Electronic Memory Aids
Neuropage-reminder system for planning and memory problems. Smartphones. Digital voice recorders with alarm system that beeps w/ auditory messages at present time. Alarm watches. Electronic pill dispenser
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Mneumonics
Broad term for strategy to help remember information - rhymes - acronyms - imagery - chunking information
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Other Memory interventions
Environmental Organization Consistent habits & routines Put most important information at the begining of the sentence (pre setting & following through) Self awareness training and feedback via reality testing, standardized testing and goal setting (increase sequencing)
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Executive Functions
Complex cognitive skills that require the coordination of several sub-skills to achieve a purposeful, goal-directed behavior Mainly frontal lobe
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Assessment of Executive Function : EFPT
Task focused vs pen & paper Executive Function Performance Test (EFPT) Uses a structured & cue/scoring system Score 0-25 >score = more deficit Light meal prep, med management, phone use & paying bills
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Executive function assessment: Behavioral Assessment of the Dysexecutive System (BADS)
Problem solving, planning and organizing behavior 6 Subtests Good for assessing those from hospital > home environments Flexibility, novel problem solving, judgement & estimation, behavioral regulation & planning
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Executive function assessment: Multiple Errands Test (MET)
Pt. is given 3 sets of tasks to perform with 8 instructions each w/ different requirements Multitasking is requires & pt. must structure, plan and execute tasks efficiently
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Executive Function Assessment : Cognitive Failures Questionnaire
Self report for pt. or others Attention lapses, memory, attention, & cognition 25 items scored based on frequency of mistakes 0=never; 4=very often
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Executive Function Assessment : Executive Function Route Finding Task (ERFT)
Pt. must find an unfamiliar office within their facility Rates aspect of route finding using a Likert Scale -understanding of task -retaining directions -detecting errors -correcting errors -remaining on task
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Interventions for Executive Skills
``` Problem solving & planning training Compensatory strategies Environmental Modifications Task Specific Training Metacognitive strategies to promote self awareness ```

611 Exam 2 (6 decks)

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