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Neurogenics > Exam 2 Week 3 > Flashcards

Exam 2 Week 3 Flashcards

1
Q

“RHD individuals appear to _____

than they ______”

A

speak better

communicate

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2
Q

Role of SLP in Treatment of RHD

A

Educate the family and caregivers regarding the nature of right hemisphere disorders

Provide therapy to reduce or compensate for deficits while maximizing the patient’s recovery to facilitate as close to a return to normal life as possible

Encourage the patient to complete home exercise program (especially when formal therapy has been discontinued)

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3
Q

Treatment to Improve Facial Affect

A

May need to refer patient to psychiatrist to rule out presence of true emotional disorder (such as depression)

Patients can be taught to express emotion through facial affect by consciously producing facial expressions that reflect their true emotional state

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4
Q

Treatment for Prosodic Deficits

A

Provide education on the use of prosody and counsel patients to identify their emotional state verbally to their families

Provide patient with a short story to read that ends with a quote by a character in the story. The patient must produce the final quote with appropriate emotional prosody.

Teach patient to discriminate between changes in pitch

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5
Q

Treatment to Improve Discourse Deficits

A

Use pictures that require the patient to put together appropriate clues and details necessary to understand the overall meaning of a picture

Present short stories (magazines, newspapers, websites) and have the patient generate appropriate titles of the stories or pictures

Increase the patient’s awareness of:
The listener’s needs
Social conventions and expectations
Theory of mind (ability to see things from another’s point of view)

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6
Q

Treatment to Improve Discourse Deficits
Increase the patient’s awareness of:
3 things

A

Increase the patient’s awareness of:

  1. The listener’s needs
  2. Social conventions and expectations
  3. Theory of mind (ability to see things from another’s point of view)
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7
Q

Treatment for Pragmatic Deficits

A

Teach overt rules of social interactions and ask patient to view and analyze prerecorded interactions among individuals

Teach patients to apply social skills to own interactions and detect and repair social problems

Role play tasks with common targets:
Conversational turn-taking
Maintaining eye contact
Topic maintenance
Improving them can strongly affect RHD pt’s conversational appropriateness)
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8
Q

Treatment for Pragmatic Deficits-
role play tasks with common targets:
3 things

A
  1. Conversational turn-taking
  2. Maintaining eye contact
  3. Topic maintenance
    Improving them can strongly affect RHD pt’s conversational appropriateness)
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9
Q

pragmatics-eye contact

A

May require only that the clinician say look at me at appropriate times in treatment interactions

When pt responds consistently to the clinician verbal cues, the cues may be faded and replaced by pt’s self-cueing

Giving pt specific points at which to make eye contact may be helpful if pt has difficulties transitioning from clinician’s cues and self-cues

Teach pt to make eye contact when:

  • Pt begins and ends each utterance
  • Extending eye contact to the beginning and end of the conversational partner’s utterance
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10
Q

pragmatics-turn taking

A

Clinician explains how conversational participants know when to take or yield conversational turns

Explain that pt’s contributions during conversation should be brief and should allow for contributions by their communicative patterns

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11
Q

pragmatics-Specific structured practices:

A

Watch videotapes of conversational interactions (e.g., television talk shows) and explains the turn-taking pattern

Prepares a script for a conversational interaction with appropriate turns, possibly videotaping it and critiquing it

Videotaping pt participating on a free conversation, watching it and identifying appropriate and inappropriate turn-taking behavior

Group activities with other pts

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12
Q

pragmatics- maintaining conversation topic

A

Structured tasks may involve:

  1. Identifying topics in printed materials (e.g., magazines, newspapers articles)
  2. Watching videotapes of conversational interactions, identifying when the topic changes, and discussing how the topic change was brought about by the participants
  3. Engaging in structured conversation with the clinician while maintaining a specified topic for a given period of time or a given number of conversational turns
  4. Practicing topic maintenance in group conversations with other pts
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13
Q

left side neglect- general suggestions

A
  1. Be sure pt is seated all the way back in the chair, sitting tall with shoulders squared
  2. Check the location of pt’s arm and leg, especially if he/she have changed position or transferred
  3. Assist pt in aligning his/her body parts to a straight position
  4. Remind pt to turn and look to the left side
  5. Sit on pt’s left side, encouraging eye contact with you while talking
  6. Touch the left side of their body such as holding their left hand
  7. Encourage pt to check in a mirror to ensure that the left side has been properly groomed, after dressing, shaving, putting on make up
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14
Q

treatment for neglect

A

Edgeness: uses a flat container (baking pan) with raised edges and small cubes or blocks. Patient is to find all blocks

Advantage: patient can monitor their own success and complete the task with little cueing from SLP

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15
Q

edgeness

A

uses a flat container (baking pan) with raised edges and small cubes or blocks. Patient is to find all blocks

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16
Q

uses a flat container (baking pan) with raised edges and small cubes or blocks. Patient is to find all blocks

A

edgeness

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17
Q

advantage of edgeness

A

patient can monitor their own success and complete the task with little cueing from SLP

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18
Q

left neglect and reading:

scanning training

A

Colored vertical lines, colored dots, or rulers are placed on the left margin of printed material

Pts are instructed to scan leftward until they see the marker

You can instruct pt to keep one finger on marker and to scan back to it when beginning each line of the text

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19
Q

Colored vertical lines, colored dots, or rulers are placed on the left margin of printed material

Pts are instructed to scan leftward until they see the marker

You can instruct pt to keep one finger on marker and to scan back to it when beginning each line of the text

A

scanning training

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20
Q

For left neglect and reading, reliance on markers is gradually is reduced by?

A

Making the markers less noticeable

Eventually substituting the pt’s monitoring of whether the material makes sense for the external markers

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21
Q

left neglect and reading: train pt to?

A

Train pt to look to the left as pt engages in daily life activities, such as reading, writing, and eating

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22
Q

verbal cues for left neglect

A
  1. Use cues to remind pt to attend to the left side of materials
  2. Begin by instructing the pt “tell yourself out loud, look to the left” at the end of each line
  3. Progress to pt-initiated verbal cues (e.g., training pt to vocalize or subvocalize look to the left at the end of each line
  4. As pt becomes adept to attending to the left side, pt is trained to think look to the left side instead of saying it aloud
  5. Take advantage of RHD pts’ good verbal skills and having them ask themselves, Does it make sense at the end of each sentence or periodically while they read
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23
Q

left neglect and reading: bookness technique

A

each pt to look to the left without external cues, increasing the likelihood of generalization

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24
Q

each pt to look to the left without external cues, increasing the likelihood of generalization

A

bookness technique

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25
Q

describe the bookness technique

A

Used in left neglect and reading
1. First pt orally describes a closed book placed on his/her midline while traces the perimeter of the book with a finger

  1. Next pt opens and describe the book while tracing its perimeter
  2. Pt carries out activities printed in the book (e.g. matching stimuli on the left and right pages of the book), with pt tracing perimeter of book before each trial
  3. Clinician increases the task difficulty by increasing number of stimuli
  4. As pt’s attention to left side of the book improves, the requirement to trace the perimeter of the book fades
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26
Q

left neglect and reading: left-limb activation

A

tapping with left foot, moving left arm up and down

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27
Q

left neglect is a type of _____ disorder

A

attention

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28
Q

tapping with left foot, moving left arm up and down

A

left-limb activation

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29
Q

left limb activation: Pts perfrom better when?

A

Pts seem to perform better on left neglect tests when they are requested to perform left-limb movement before tests are administered

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30
Q

reason why patients perfrom better in lef-limb activation task?

A

Reason:

  1. Increased activation of right hemisphere
  2. Visual cueing toward left hemispace
  3. Motor cueing toward left hemispace
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31
Q

left-limb activation: unknown:

A
  1. how long the facilitating effects of left-limb movement lasts
  2. variable degrees of generalization and treatment effects have been reported
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32
Q

Passive limb movements (does or does not) seem to have effect on neglect for those RHD pts with paralyzed limbs

A

does not

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33
Q

left neglect and reading: Researchers have been pointing out more positive findings when _____ or more of these treatments are used

A

two

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34
Q

Hemianopia (left side)

Use of compensatory strategies:

A
  1. Move the paper a little to the right
  2. Turn your head a little to the left
  3. Keep your eyes straight down on the paper
  4. Read one word at a time, using your finger as a guide
  5. When you get to the end of a line, remember that you need to look all the way to the left on the next line
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35
Q

Attention: Attention processing training (APT) programs

A

Based on the notion that attentional abilities can be improved by providing opportunities for stimulating a particular aspect of attention

There are several commercially available attention training packages and computer programs

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36
Q

Sustained Attention: Different tasks can be used to improve sustained attention:

A
  1. Paper-pencil tasks such as letter cancellation
  2. Vigilance drills:
    - Pt monitors a visual display (e.g., computer-presented stimuli)
    - Pt monitors strings of auditory stimuli and signal when stimulus occur (e.g., patient listens for designated targets in lists of letters, numbers, or word read aloud by the clinician)
  3. Paper-pencil tasks are less challenging than computerized tasks
    - They do not require a constant level of sustained attention
    - pt may minimize errors by slowing down or stopping when attention legs and resuming the tasks when attention recovers
    - Computer can also record latency time, vary precisely interval between stimuli, and the frequency of the stimuli)
  4. Simple games: Checkers, tic-tac-toe, card games
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37
Q
  • Pt monitors a visual display (e.g., computer-presented stimuli)
  • Pt monitors strings of auditory stimuli and signal when stimulus occur (e.g., patient listens for designated targets in lists of letters, numbers, or word read aloud by the clinician)
A

Vigilance drills

38
Q

vigilance drills

A
  • Pt monitors a visual display (e.g., computer-presented stimuli)
  • Pt monitors strings of auditory stimuli and signal when stimulus occur (e.g., patient listens for designated targets in lists of letters, numbers, or word read aloud by the clinician)
39
Q

Paper-pencil tasks are less challenging than computerized tasks

A
  • They do not require a constant level of sustained attention
  • pt may minimize errors by slowing down or stopping when attention legs and resuming the tasks when attention recovers
  • Computer can also record latency time, vary precisely interval between stimuli, and the frequency of the stimuli)
40
Q

Simple games for sustained attention

A

Checkers, tic-tac-toe, card games

41
Q

selective attention

A

Usually relies on pts performing sustained attention tasks in the presence of competing or distracting stimuli (e.g. a tape recording of distracting sounds playing in the background)

42
Q

Usually relies on pts performing sustained attention tasks in the presence of competing or distracting stimuli (e.g. a tape recording of distracting sounds playing in the background)

A

selective attention

43
Q

Selective Attention: Stroop task

A

-Pt must inhibit a habitual or automatic response in favor of a clinician-defined response
Examples:

reading aloud color words printed in colors that conflict with the words – read the word red printed in blue ink;

telling the size of words large and small printed in type sizes that conflict with the words

44
Q

divided attention

A

Dual-task format (pt performs two tasks concurrently)
Tasks:

Card sorting by suit while selecting those cards that have the letter “e” in their name

Pt listens to a tape recording and pt says yes whenever he/she hears a designated letter, while simultaneously performing a paper-pencil cancellation task

45
Q

attention

A
  • Conflicting results with respect to generalization to untrained attention tasks and other cognitive abilities
  • Clinicians may enhance generalization by working on attention in contexts similar to those the patient will encounter in daily life
  • Attention training tasks combined with strategy training (verbal mediation, rehearsal, self-pacing, task demands estimation, and positive self-statements) seem to improve generalization
46
Q

Decreased Attention Span and Caregiver Education:

Behavioral examples:

A
  1. Unable to follow one conversation with several people in the room
  2. Unable to follow the story of a television show or movie
  3. Unable to complete simple chores at home
47
Q

Decreased Attention Span and Caregiver Education: Suggestions

A
  1. Maintain eye contact with pt while speaking to him/her
  2. Be sure pt is quiet when speaking to him/her
  3. Reduce any unnecessary noise and movement in the room
  4. Direct their attention back to the activity
  5. Work on one activity at a time, setting a schedule for the chores
  6. Pt may be able to independently complete a task, but may need a verbal reminder to initiate it
48
Q

Treating Attention Deficits: Strategies to implement:

A
  1. Reduce distractions in environment
    - Close blinds on the window
    - Turn off television or radio
    - Reduce clutter on table or in work space
49
Q

Treating Attention Deficits: Instruct family to:

A
  1. Speak clearly to patient
  2. Speak to the patient one at a time
  3. Use short and easy to follow sentences
  4. Provide repetitions
  5. Provide frequent breaks
50
Q

Denial of Impairment

A

Denial of physical, cognitive, or communicative impairment:

-can be an obstacle to the success of intervention

51
Q

Many adults with RHD:

A
  • seem insensitive to the presence of impairments or minimize their severity
  • become less oblivious to impairment as they recover neurologically; but some remain oblivious for months and years
52
Q

Denial combined with poor judgment put these pts at ____

A

risk

53
Q

Denial of Impairment: Behaviors related to denial:

A
  • Pt may try to stand and move from bed or wheelchair without assistance
  • Believe they can still handle their own financing
  • Believe that once they leave the hospital, all physical limitations will disappear
  • Believe they can drive because “I’ve been driving for years.”
54
Q

denial of impairment: suggestions

A

Talk to nursing/rehab staff to become aware of pt’s limitations

Give appropriate supervision to assure safety

Break down tasks in small steps, adding verbal and self-cueing “have you finished this step?” to the end of each step

Have pts demonstrate an activity before allowing them to attempt it themselves, even if they can give you a detailed verbal description of what they are going to do

Educate family to not let them drive until driving skills have been re-evaluated through a retraining program

55
Q

denial of impairment: Can be addressed indirectly in the context of activities directed towards other goals by:

A

Giving pt immediate feedback after error or inappropriate response

Challenging pt when he/she denies errors

Improving pt’s self-monitoring, first in well structured activities, and then in less structured activities

Having pt (or pt & family) collaborate in making a list of the pt’s strengths and weakness

Videotaping treatment activities and reviewing them with pt

56
Q

denial of impairment: for pts with extreme denial

A

Many RHD adults who deny their own errors sometimes are quick to spot other people’s errors

Clinician and pt may watch and talk about videotapes of social interactions or staged interactions in which one participant makes errors or inappropriate responses resembling those made by the pt

When pt becomes adept at identifying errors in the behavior of others, videotapes in which pt is a participant can be introduced

57
Q

treatment of communication deficits

A

Tx of RHD adults’ communication problems may target a variety of deficits affecting receptive and expressive aspects of communication:

  • Organizing and synthesizing information
  • Separating what is important from what is not
  • Teach the use of contextual cues to ascertain meaning
  • Interpret figurative language
58
Q

Treatment of RHD: RHD adults’ communicative problems are often magnified by cognitive and behavioral problems:

A
  1. Neglect
  2. Denial of illness/Indifference to impairment
  3. Distractibility
  4. Inattention
  5. Memory difficulties
  6. Impulsivity
  7. Impaired reasoning or problem solving
59
Q

Verbosity/Tangentiality

A

Increase pt’s awareness about irrelevant comments or excessive detail in discourse

60
Q

Increase pt’s awareness about irrelevant comments or excessive detail in discourse

A

Verbosity/Tangentiality

61
Q

examples of Verbosity/Tangentiality

A

Clinician signal to the patient whenever he/she makes an irrelevant or over-personalized comment (e.g., hand taping, use a clicker, specific facial expression)

Clinician provides pt with a short story, and pt is asked to hold up a hand when they hear sentence that is irrelevant to the story

62
Q

Lability

A

Decreased ability to control emotional responses

Emotional responses may be appropriate but exaggerated to a given situation
e.g., yelling in response to a minor disagreement

63
Q

Decreased ability to control emotional responses-Suddenly cry or laugh for no apparent reason

Emotional responses may be appropriate but exaggerated to a given situation
e.g., yelling in response to a minor disagreement

A

Lability-Suddenly cry or laugh for no apparent reason

64
Q

suggestions for lability

A

Wait until crying or laughing stops or change the focus of attention

Change the topic of conversation

Educate family members to leave the room if pt’s anger becomes uncontrollable, but assure pt you will return when they are calm

65
Q

memory

A 
Short-term memory may be affected
Pt may be unable to recall daily routine
Pt may say:
“I already had a shower today”
“I did not have any therapy today”

Pt may be able to recall a recent event, but not specific details

66
Q

suggestions for memory

A
  • Orient them to the correct information
  • When providing a large amount of information, use shorter sentences and repeat the information as needed until they retain as much as possible
  • Train/encourage pt to use strategies to help their memory
67
Q

what does S.A.L.T. go with?

A

memory

68
Q

what does SALT stand for

A 
S = Say the person’s name again when you are introduced.
A = Associated something about that person with his/her name. You may have to make up a bizarre association. If the person has an outstanding feature, you may focus on that. You may have a natural association to use for this step (e.g., Mary brown has brown hair).
L = Listen to the person as he/she speaks. You will be able to to gather more information to associate his/her name with.
T =  Terminate the conversation with the person’s name.
69
Q

other ways to help with memory

A

Mnemonics: A song, a rhyme, an image, or something else used to help encode information

Acronyms (formulate a word from the first letter of items):
Susan the Speech pathologist = SOS Susan of Speech

Rhyme and melody (formulate a rhyme to link words)

Wheelchair mobility - a heel and a toe and away we go
Ana banana

Visual imagery:

Mary Burns with hair on fire
Mr. Lee with a Sara lee pie on his face

Get organized: Always put things you use on a regular basis (keys, wallet, purse, briefcase) in the same place

Write it down

70
Q

self care and saftey

A

Promote self-care and safety in the rehabilitation process of patients with RHD

Educate family to rid the environment of hazards, such as throw rugs, protruding shelves, coat hooks

Educate family that initially pts may not be able to do an activity as well as home as they do in rehabilitation

71
Q

some things to help with self care and saftey

A
  1. Develop a written daily calendar with pt and family
  2. Include in the daily schedule all the daily activities, including self-care
  3. As a homework, pt should check off every activity completed (written checklist)
  4. Pt needs supervision/reminders until they are able to take medications without errors
  5. Use specific devices, such as pill box reminders and watch alarms
72
Q

behavioral examples for impulsivity

A
  • Act suddenly or careless
  • Pt attempts to stand without locking the brakes on the wheelchair
  • Begin to answer before a question is completed
  • Ask for help, then attempt to do the tasks before assistance has time to arrive
  • Interrupt conversations without recognizing that he/she is interrupting
73
Q

suggestions for impulsivity

A

Remind pt to slow down and think before acting
Assist them in pacing movements to ensure accuracy and safety
Rehearse safety steps before standing from wheelchair
Check with staff before removing any restraints

74
Q

Confabulation

A

is a disturbance of memory, defined as the production of fabricated, distorted, or misinterpreted memories about oneself or the world, without the conscious intention to deceive.

75
Q

suggestions for confabulation

A

-Orient pt to the correct information

  • Avoid using phrases such as “You are wrong”, or “No, you are confused”
  • —-Redirect with phrases such as : “Remember that…or simply state the correct information
  • Help pt to stay on one topic, do not permit pt to ramble
  • Immediately stop pts if they begin to make statements that are untrue
76
Q

specific tasks for: Inference Failure/ Decreased Ability to Recognize Humor/Absurdity

A

Pt is given a cartoon minus its caption, and pt chooses the humorous caption from a set containing humorous and nonhumorous captions

Pt is given a printed joke minus a punch line, and chooses the punch line from a set containing a humorous and nonhumorous punch lines

77
Q

Inference Failure/ Decreased Ability to Recognize Humor/Absurdity

A

Choosing the correct interpretation of an idiom out of several options

Identifying and explaining absurd or unlikely relationships depicted in pictures

Identifying and explaining absurd or inconsistent statements in a written narrative

78
Q

Inference Failure/ Decreased Ability to Recognize Humor/Absurdity

A 
Work on alternative meanings: pt is asked to categorize items according to similarities and differences or class membership
-e.g., tell me why scissors and a saw are alike; listing things  that one might find at a picnic; naming wild animals

Pt listens to or reads a sentence that has two or more interpretations, and is asked to provide possible meaning to the sentence
-e.g., A broken leg kept Roger from sitting in the chair

79
Q

Reasoning and Problem solving: Pts

A

tend to get lost in the details of the activities and lose track of general goals and objectives
are usually poor at anticipating when a task is likely to give them trouble
When get into trouble, their responses are likely to be impulsive

80
Q

Reasoning and Problem Solving: May require different structured practices in a variety of tasks requiring reasoning foresight, and problem solving:

A

Role-playing activities in which problem-solving skills are needed (e.g., getting a refund for a defective merchandise)

Proposing solutions to problems posed by the clinician (e.g., You are at the shopping mall and you come upon a 4-year-old boy standing alone and crying. What do you do?)

Planning activities such as vacations, field trips, picnics

81
Q

Reasoning and Problem Solving: In the beginning, use a structured problem-solving strategy:

A
  • Identify the problem
  • Think of several possible solutions
  • Evaluate the feasibility and potential consequences of each solution
  • Choose the best solution
  • Apply it
  • Evaluate the results
82
Q

Affective Communication and Prosody Problems

A

Some pts with RHD do not comprehend or communicate emotion conveyed by facial expression, speech and body language

Flat affect: inability to express feelings by facial expressions, voice, eye contact, and body posture

Communication of their feelings through the use of gestures or facial expression may be difficult, making them appear unconcerned

83
Q

flat affect

A

inability to express feelings by facial expressions, voice, eye contact, and body posture

84
Q

inability to express feelings by facial expressions, voice, eye contact, and body posture

A

flat affect

85
Q

Affective Communication and Prosody Problems: Communication of their feelings through the use of gestures or facial expression may be difficult, making them appear ___________

A

unconcerned

86
Q

Affective Communication and Prosody Problems: Comprehension of emotions

A

Show pt pictures of faces or play tape-recorded voices expressing different emotions and ask pt to identify the emotions portrayed

Ask pt to watch episodes of television series, turning down the audio part of the program, and ask pt to describe the emotional state of the characters

87
Q

Affective communication and prosody problems: Expression of emotions:

A
  • Imitate SLPs tone of voice, facial expression, and body language
  • SLP model should gradually be faded and replaced by photographs of faces portraying various emotions or cards on which the names of emotions are printed

Have pt verbally describe inner feelings and educate family to disregard flat affect

88
Q

Non-Empathetic, Demanding, Self-centered Behaviors

A

Difficulty understanding that their behavior may affect others or that other may have more urgent needs

Behavioral examples:

Demanding assistance from someone who cannot help
Place unreasonable demands on their families

89
Q

suggestions for: Non-Empathetic, Demanding, Self-centered Behaviors

A

Assist pt in examining how his/her behavior affects others
Use stories depicting self-centered behaviors, and ask pt to critique them
Suggest family/caregiver to make a list with p of what you will be able to do and when

90
Q

One of the most challenging components of treatment for clinicians working with RHD pts

A

generalization

91
Q

Enhancing Generalization Across Settings

A

One of the most challenging components of treatment for clinicians working with RHD pts

Needs to be specifically targeted and systematically trained to assure that what pt learns in treatment does not stay in the clinic

92
Q

Procedures to enhance and ensure generalization:

A

Incorporate a variety of tasks, context, and stimuli during therapy

Treatment should include functional and personally relevant stimuli and strategies, targeting goals and functions that correspond to pts’ daily needs and activities

Provide enough training trials to consolidate and stabilize responses

Assure sufficient opportunities for practice by developing detailed homework, and training/educating family/caregivers in participating in treatment

Neurogenics (4 decks)

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