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Cognitive Retraining > CR: Lesson 3 > Flashcards

CR: Lesson 3 Flashcards

1
Q

Following a moderate to severe TBI, it is common for a client to experience a time of_________

A

coma

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2
Q

Severity and level of arousal are often assessed using the

A

Glascow Coma Scale

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3
Q

Glascow Coma Scale

A

15pt scale measuring eye opening, best motor response, and best verbal response. The higher the number, the better.

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4
Q

GCS, Eye opening points

A

opens eyes on own= 4
opens eyes on request= 3
opens eyes in response to pain= 2
does not open eyes= 1

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5
Q

GCS, verbal response points

A 
coverses and is oriented= 5
confused, disoriented speech= 4
uses words, but doesn't make sense= 3
sounds or words are incomprehensible= 2
makes no noise=1
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6
Q

GCS, motor response

A 
follows request to move= 6
pushes painful stimulus away= 5
withdrawal from painful stimuli= 4
abnormal (decorticate) flexion= 3
abnormal (decorticate) extension= 2
makes no motor respone= 1
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7
Q

Dual purposes of coma stimulation

A

physiological- increase neuronal activity, improve arousal

behavioral- improve recognition of environment, shape responses

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8
Q

True or False: Coma stimulation is highly controversial and not much research is there to back up its efficacy

A

TRUE

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9
Q

Coma Stimulation consists in providing stimulation to what senses?

A 
visual
auditory
gustatory
olfactory
tactile
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10
Q

Coma Stimulation Guidelines

A
  1. approach pt as if they understand everything
  2. sessions are brief, distraction free
  3. limited noise
  4. monitor physciological status carefully
  5. use stimuli familiar to pt
  6. train family & caregivers to do stim
  7. shape pt’s natural attempts at communication
  8. model appropriate stimulation behavior to caregivers
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11
Q

Try to elicit the following things when doing coma stimulation:

A
  1. response sound
  2. response voice
  3. visual focus- turn to left/right/midline
  4. visual tracking- track object left, right, up, down
  5. response to oral stim–(does it elicit a swallow?)
  6. response to cold stim
  7. response to facial massage/stim
  8. respons to oral motor movements…(puckers, smiles, frown, open/close)
  9. attempts to follow 1 -step directions
  10. response to olfactory stimuli
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12
Q

The ultimate goal with coma stim is __________

A

sensory regulation

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13
Q

When emerging from coma, pt. may have impaired ___________and exhibit:

A

orientation

confusion, disorientation, combativeness, aggression, unpredictability

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14
Q

Post-Traumatice Amnesia (PTA)

A

unable to maintain memory, new learning

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15
Q

Galveston Orientation and Amnesia Test

A

determines wheter person is oriented to person, place, time, & orientation. It is also a measure of PTA

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16
Q

The goal of therapy when dealing with PTA/ orientation deficits is…

A

to orient the person to time, place, person (x3)

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17
Q

Tools for orientation therapy

A

calendars, schedules, clocks, environmental cues, orientation cards, books, etc…..
**Challenge= training pt to remember to use the cues!

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18
Q

Severity of injury correlates highly with ________ and _____________

A

coma level

PTA length

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19
Q

MILD injury=

A

GCS= 13-15, PTA less than 1 hr….
may be able to return to premorbid levels of activity, but may have some residual deficits that affect functionality (usually attention concentration & memory are impaired)

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20
Q

MODERATE injury=

A

GCS= 9-12, PTA 1-24hrs

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21
Q

SEVERE injury=

A

GCS 0-8, PTA more than 24 hrs

22
Q

Attention must be intact in order to participatein the many types of ____________

A

cognitive rehabilitation (or reorganization)

23
Q

What does attention entail?

A

vigilance, selectivity, capacity, attention shift, mental manipulation

24
Q

vigilance

A

sustained attention over time

25
selectivity
able to focus on one thing, ignore others
26
capacity
amt of info one can attend to at once
27
attention shift
the ability to shift focus from one thing to another
28
mental manipulation
attending to stimuli while completeing a mental taks with it
29
___________is the most advanced level of attentions and relies on all of the other types.
mental manipulation
30
Attention while performing mental manipulation is often called
working memory
31
Working memory is thought to be controlled in the __________lobe, so many brain injuries will result in attentional and working memory deficits.
prefrontal
32
The clincal model of attention breaks functional attention down into 5 components to assess and rehabilitate, which are...
``` focused attention sustained attention selective attention alternating attention divided attention ```
33
A coma patient responds to an external stimuli such as pain---this is an example of...
focused attention
34
______is the most basic ability to respond to external sensory stimuli
focused attention
35
What are the 2 parts of sustained attention?
vigilance | working memory
36
Sustained attention
the ability to maintain response to a stimulus during continuous and repetive activity
37
being able to focus on studying while the TV is on is an example of
selective attention
38
a secretary being interrupted and changing tasks back and forth is an example of
alternating attention
39
driving a care while one the phone is an example of
divided attention
40
Assessments options for assessing attention
standardized attention tests (The Test of Everyday Attention) standardized test with attention subtests rating scale (The Attention Questionnaire) behavioral checklists or observation during attenition requiring tasks (ex, number/letter cancellation, clock-drawing,etc)
41
Attention Process Training
retrains attention by stimulating particular aspect of attention. assumes repeated attentional demands will increase cognitive capacity for attention. does NOT resemble real life tasks bc ecologically valid tasks require MANY cognitive skills
42
Examples of Attention Process Training Tasks for sustained attention
``` number or letter cancellation listen for certain word or number in a passage alphabetize a list of words sort words into categories math problems ```
43
Examples of Attention Process Training Task for alternating attention
listen for one word, then when you hear it, switch to another number and letter trail marking
44
Examples of Attention Process Training Task for selective attention
any tasks from sustained or alternating attention tasks with background distractors read passages or work problems on a paper with distracting marks
45
Exmaples of Attention Process Training Task for divided attention
reading a passage for comprehension while scanning for a chosen word repeating words while solving math problems
46
Strategies & Environmental Supports
1- self-managment strategies | 2- environmental supports
47
Types of self-managment strategies
orienting- client monitors activities constantly (asks himself questions, set up routines...) pacing- setting up schedules in which the client does most of the activities requiring attention during his best times of day, building in breaks key ideas log- provide the client w/ notebook or memo sheet to write down thoughts or questions to abe asked when the task at hand is completed
48
Types of Environmentall Supports
Task Management Strategies- identify what settings, surroundings, cues are helpful & harmful to attention Environmental Modification- putting things in an obvious place, setting up filing systems, placing "do not disturb" signs on doors
49
Use of External Devices
calendars, day planners, electronic organizer, voice activate message recorders, pill boxes, key finders, watch alarms....
50
Psychosocial Support
``` Alieviate psychological stressors by: supported listening brain injury education relaxation training psychotherapy grief therapy ```
51
Therapy Principles to REMEMBER:
1. activities hierarchically organized 2. sufficient repetition 3. therapy modified based on client progress 4. facilitate generalization

Cognitive Retraining (6 decks)

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