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Cognitive Linguistic Quick Test (CLQT)

- Enables examiner to quickly assess the relative status of five cognitive domains through ten tasks:




-Executive Function

-Visuospatial Skills

- Identify strengths and weaknesses in specific cognitive domains

- Provide a “snapshot” of cognitive skills

- Identify areas for direct treatment

- Identify areas needing further evaluation

- Criterion-Referenced


CLQT demographics

-English adults 18-89

-TBI, CVA, Dementia, PD

- can manipulate a pen, respond verbally, can be administered bedside, can be given over 2 sessions


5 Tasks CLQT 1

- Personal Facts- episodic memory, orientatiton, communication, STM and LTM

- Symbol Cancellation- visual attention, visuospatial skills, scanning, discrimination, and inhibition

- Confrontation Naming- semantica and phonology

- Clock Drawing- sustained attention, working and procedural memory, planning, comprehension, reading & writing numbers, visuospatial skills, concept of time

- Story Retelling- verbal working memory, auditory processing, expressive lang., attention


5 Tasks of CLQT 2

- Symbol Trails- attention, EF, visuospatial skills/perception

- Generative Naming- word retrieval, working memory, semantics, phonological knowledge, EF

- Design Memory- working/visual memory without language, visual attention, visuspatial skills

- Mazes-EF, attention, visuospatial skills

- Design Generation- creativity, productivitiy, self-monitoring, rule following, and effective strategies


Pediatric Test of Brain Injury (PTBI)

- Children are not little adults, they respond differently to TBIs

- prior to this test they adapted adult verions for kids

- Standardized, criterion referenced test

-English 6-16


2 Purposes of PTBI

1. Establish current ability levels

2. Track changes over time

- To estimate a child’s ability to apply neurocognitive and linguistic skills that are often vulnerable after brain injury yet applicable to functioning in school

-Item response theory- items are scaled so easier questions have less pts

-Abilitiy score


What does PTBI Measure

1. Attention

2. Memory

3. Language

4. Visuospatial Skills

5. Executive Functions

Same measures as CLQT

*** Can be with children and adolescence 6-16 with TBI or ABI (acquired brain injury)


1. Prompt

2. Probe

1.Prompt: neutral form of encouragement (“We have to move along”)

2. Probe- cue for more specific information


Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI)

- To provide a systematic method for assessment of cognitive deficits associated with TBI

-adolescents and adults

- Specifically designed to measure the following cognitive processes:

1. Perception/ discrimination

2. orientation

3. organization

4. Recall of information

5. Reasoning

-Primarily used with English speakers with a CHI


SCATBI- Subtests or scales

1. Perception and Discrimination (includes attention)- 11 testlets (sound, word, color, shape, size, picture, auditory discrimination)

2. Orientation- premorbid questions and post-morbid questions

3. Organization- 8 testlets (identifying picture categories, word categories, sequencing objects, words, events, (time of year, pictured tasks, recall task steps)

4. Recall (Memory) 9 testlets (memory for graphic elements, word retrieval, delayed recall, cued recall of words, cued recall of words in discourse, word generation, immediate recall of oral directions, recall of oral paragraphs)

5. Reasoning- 11 testlets (analogies, convergent thinking, deductive reasoning, inductive reasoning, divergent thinking, multiprocess reasoning)

- Each scale can be administered independently; the whole test does not have to be administered.

- Each scale is made up of testlets (small sets of very similar items that vary in difficulty plus a few individual items requiring more than 1 response)


Treatment for Problem Solving

- Make the therapy functional and simple

- Individuals with TBI may have difficulty recognizing when there is a problem. When solving problems they may have problems deciding what the best solution is

Functional problem solving and Simple

Simple- parts=whole

Functional- more complex, real life problems


Symptoms of deficits w/ problem solving

Behavioral- difficulty drawing conclusions

- inability to figure out and apply rules in problem-solving activities

- difficulty with production and fluency of thought

- inability to learn from trial and error

- poor decisions about behaviors and friends


Assessments that look at problem solving

- Ross information processing assessment (RIPA-2)

-PTBI- word fluency (convergent naming)

- CLQT- confrontation naming, symbol trails, generative naming, and mazes

- assessments need to show what the patient's strengths and weaknesses


Treatment at Problem Solving

Steps that allow a clear structure to the intervention process:

1. identifying problems

2. Generating solutions

3. Organizing

4. Sequencing

5. Implementing solutions

6. Managing time

7. Maintaining safety


Goals for problem solving therapy

1. Start simple and go more complex

2. Teach compensatory strategies

3. We want the individuals to be able to identify a problem and then take steps to solve this problem


Problem Solving Treatment

1. Naming categories (convergent naming and divergent naming tasks)

2. Informal assessments of executive functions (require multiple steps, ask client to plan or prepare, be an observer when the client does a task, cue only when necessary)

3. Work on medical situation problems (what would you do if you cannot remember when to take your medications)

4. Problem solving questions (ask them what the problem is and what should be done)

5. Problem solving worksheet (state the problem, potential solution, and how it worked)

6. Describing specific features (how items are similar or different)

7. Work with client to realize if there is a problem

8. Have worksheets that require them to solve problems

ASHA states that evidence supports using metacognitive strategy instruction using step by step procedures to improve organization and problem solving.


Reasoning- Abstract and Mathematical

- patients may think more concretely and only reason literally and logically

- inability to understand relations between two or more elements

- Difficulty with understanding figurative lang, sarcasm, and slang

- trouble with calculations, understanding numerical concepts, comparisons of numbers, and arthimetical symbols

- loss of calculation can be due to deficits in memory, attention, problem solving, sequencing, organization, and language


Abstract reasoning treatment

- Add to category- complete a list with a similar word (helicopter, wasp, robin...)

- Wrong category- which item does not belong with the other four?

- multiple definitions- provide two definitions for the words

- analogies

- word deduction- describe what object the three clue words are describing

-proverb and expression- explain the meaning
(don't make a mountain out of a mole-hill)

- Comprehend figurative language- explain meaning

- interpreting emotions, personal feelings


Mathematical Reasoning Treatment

Math basics:
1. Counting- forewards, backwards, skip counting, roman numerals

2. Reading and writing numbers- order on timeline, place value

3. Comparing numbers- >, <, =

4. Adding and subtracting- tasks with money

5. Multiplication

Functional tasks:

1. Telling time- elapsed time problems

2. Money (adding/subtracting coins, bills, salary, budgeting, and shopping)- matching coins to money values

3. Cooking (measurements)


Orientation Therapy

Orientation- a person's conscious awarenes of self, time, place, and situation

1. Person- knowing basic information about oneself (name, age, birthdate)

2. Place- knowing one's present location (city, state, facility)

3. Time- current temporal information (date, month, season, year, day of the week, time of day)

4. Purpose- knowing relevant events

Alert & oriented x 4= A&Ox4


Purpose of orientation therapy

- Decrease patient's confusion

- lead patient to understand they need knowledge about themselves and their environment


Therapy for orientation:

1. Client questionaire (orient to self)

2. Work on questions that help with orientation to immediate environment and recent happenings

3. Multiple choice questions about immediate environment and recent happenings

4. yes/no immediate environment and recent happening questions

5. Yes/ no temporal orientation

6. Answer temporal orientation skills

7. Spatial orientation, ask questions based on hospital map, hotel lobby or house layout photo


Organization therapy

When treating:

- Focus on sequencing the patient's day

- sequencing automatic tasks

- categorization of items

- work/ school space and deadlines

- time management- social activities

- Money



- organization deficits are some of the most common

- Sequential- Organizing through sequencing tasks

-Categorical- Organizing through common attributes

-Expressive- Organizing your thought process so you can complete a divergent naming task


Treatment of organization
1. Sequential

1. Process of going to the grocery store

2. Organizing a picnic

3. Organize your morning routine

4. Driving safety

5. Organizing a narrative- story grammar

6. Sequencing functional tasks (setting a table, making a sandwich, making a bed)


Treatment of organization
1. Categorical

1. Alphabetical- ask them to organize books alphabetically

2. Food categorization in a grocery store

3. Laundry categorization by color

4. Naming categories- convergent naming


Treatment of organization
1. Expressive

1. Divergent naming task, fill the category in 15 seconds (has to do with word retrieval and semantic network organization)


Treatment of Organization
1. Functional tasks

- planners, folders

- create a weekly choir chart

- organize space- bedroom, desk, backpack, and kitchen

- organize medications

- use checklists/ timers

- organize money (balance a checkbook)


Treatment Approaches for Functional Activities

Grocery shopping

- work with clients on going to the grocery
- create a budget
- assess what you have in the pantry
- balance checkbook (how much do you have after paying the bills)
-practice writing checks


Treatment approaches for functional activities


- Find a recipe
- see if you have all the ingredients
- Follow the directions
- set timer so food is cooked properly
- process of cleaning up and washing dishes


Treatment approaches for functional activities


- pill sorting activity
- make sure client can follow instructions and is capable of handling their medications
- medication form


Additional functional activities

- Reading the newspaper

- Home safety

- Dressing, self care


Community reintegration after TBI

TBI can affect pyschosocial functioning

- psychological

- social

-50% - 60% of TBI survivors struggle to gain permanent employment

- many individuals will need workplace accommodations

- Assessing readiness to work- severity of injury, duration of coma, length of hospitalization, RLAS on discharge, neuropsychological tests, history of alcohol abuse, age, and amount of education


Instructional and environmental modifications

****In therapy work on strategies that will help them adjust when they go back. Teach them to be an advocate for themselves and request the modifications they need

- written materials should be clear

- presenting a model is helpful

- projects and worksheets may need to be shortened

- make sure the client is paying attention prior to speaking

- pre-teach information

- use verbal and visual cues

- see if it is possible for the patient to rest during the day

- create routines