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Flashcards in Lecture 3 Deck (47):
1

Attention

-Attention is the allocation of processing resources

-Attention forms the foundation for which all other cognitive skills are based

-Attention difficulties may be more pronounced in less structured environments

-Attention is the foundation for all cognitive processes are built upon.

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Types of Attention

1. Focused/Sustained
2. Selective
3. Alternating
4. Divided

3

Focused/Sustained Attention

The state of focusing on one stimulus to the exclusion of all other competing stimuli

-“I try to watch TV but I just drift off.”

4

Selective Attention

-The ability to focus on the important/relevant stimuli in the presence of distracting stimuli

-“I can’t cook while there is noisy construction work happening next door; I get too distracted.”

5

Alternating Attention

- An individual is asked to focus on any two tasks that require thought and are completed at the same time

-“I can’t listen to a lecture and take notes at the same time.”

6

DIvided Attention

-An individual is asked to complete two tasks at once but one of the tasks requires little to no thought

-“I can’t brush my daughter’s hair while talking on the telephone; can’t do two things at once anymore.”

7

Frontal Lobe Disorders

The frontal lobes are responsible for higher-order functions; executive functions, emotional-behavioral-social control regulation, motor functioning, and the appropriate use of language, social pragmatics, and the subtleties of communication (innuendoes, humor)

- Think of EMAPS

- Houses intellect, cognitive processes, and regulates emotions


8

Frontal Lobe Damage

Motor impairment; halting/disorganized speech; personality changes; aphasia; apraxia; difficulty with emotional/behavioral control; Patients may exhibit passivity, apathy, or lack of internal drive/motivation

9

Executive Functions

-The executive functions relate to one’s ability to use cognitive skills efficiently in a complex environment

-EFs help us regulate our abilities so we can achieve goals

-EFs are often performed without thinking and may be age-related in terms of development

-EFs are an umbrella term that encompass many different skills

10

List of Executive Functions

1. Planning and organization
2. Multi-Tasking
3. Learning Rules
4. Motivation
5. Generalization
6. Flexible Thinking
7. Problem Solving
8. Social Behavior
9. Initiating/Inhibiting Behavior
10. Controlling emotions
11. Monitoring Performance
12. Self- Awareness
13. Making decisions
14. Goal setting
15. Insight
- do not need to think about performing these tasks (very little thought involved)
EF's allow you to have morals- determine right from wrong

11

Commonalities: Executive Function

-Patients may begin a task prior to thinking through all of the steps

-Repetition of a thought, behavior, action, or verbal utterance that continues even though it is no longer appropriate

-Patients tend to think about features in lieu of groups or categories

-Inability to focus on more than one thing at a time
Patients are easily distracted




12

Pre-morbid responses




- Prior to injury

- inhibition

-emotional stability

13

Post-Injury

- Cognitive-Communication Deficits

- Disinhibition

- Emotional instability

14

Orientation

1. Person

2. Place

3. Time

4. Purpose

- A patient is orientated times 4

- Could be person, place, month, and year.

- Use a calendar to reorient the patient about time

15

Types of Memory

1. Procedural (implicit)
2. Declarative (Explicit)
3. Long term
4. Recall
5. Short term
6. Episodic
7. Prospective

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Procedural (implicit)

Ability to perform skills in the absence of conscious awareness (motor memory). Remember the procedure for riding a bike.




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Declarative (explicit)

-Factual memory, ability to do algebra, do well on tests, ability to recall so you don’t forget. Declarative memories can become procedural memories.

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Long-term memory

- (LTM)- recall of previously known information (remote memory) The ability to remember information we have stored. Challenge yourself-crossword puzzles and brain teasers

19

Short-term memory

- (STM)- immediate recall of new visual or verbal information. Can recall 7 items, plus or minus 2
- can use chunking to remember (don't do this or add intonation to the list that a patient needs to remember)

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Recent memory

Delayed recall of information up to 30 minutes

21

Prospective memory

The ability to recall information needed in the future

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Episodic memory

-Recall of temporarily dated events. Tied to a date in time or an episode

23

Problem Solving

1. Identifying Problems

2. Generating Solutions

3. Organizing

4. Sequencing

5. Implementing Solutions

6. Managing Time

7. Self-Monitoring

8. Safety

o Needs to use attention skills as well as executive functioning

o Organize- make lists

o Sequencing- steps in order of importance

24

Broad based test

- nonspecific tests, test all aspects of language or cognition- CASL or CELF

25

Specific tests

o Specific tests- EOWPVT (semantic test) and ROWPVT (receptive semantic test)
• Behavioral test of inattention- targets attention


26

Critical thinking

1. Drawing inferences
2. Deductive reasoning
3. Inductive reasoning
4. Abstract reasoning
5. Flexibility of thought

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Drawing inferences

- Making a connection between two otherwise unrelated facts

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Deductive reasoning

- Arrive at a conclusion based on known facts

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Inductive reasoning

- The process of determining how to achieve a goal or solve a problem (involves inference)

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Abstract reasoning

- Drawing conclusions based on notions, ideas, concepts that are not tangible

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Flexibility of thought

-Shifting from one idea to another with relative ease

32

Behavior

-Aspects of behavior associated with cognitive communication disorders
- metacognition
- communication problems

33

Communication Challenges

-Cognitive-Communication challenges impact the social, academic, behavioral, and vocational lives of survivors

-Typically, survivors of TBI have intact grammar and semantic knowledge; language appears fluent

-Deficits tend to lie in the areas of meta-semantics and pragmatics (both verbal and nonverbal types)



34

Meta-Semantic Deficits

1. Word-retrieval deficits (anomia)
------Shed light on deficits- create deficit awareness for patients
------Give patients time to process information
-----Patients can have poor deficit awareness
-----Latency period- period of time when you ask patient to respond and their response. In assessment you can note that a patient has an increased latency period.

2. Lack of cohesive speech with poor knowledge of figurative language; their language can be very concrete centered

3. Difficulty understanding words with multiple meanings

4. Difficulty integrating and synthesizing information (parts = whole); figuring out salient from irrelevant information

5. Slower processing speed

6. Confabulation (lack of truthfulness)

35

Pragmatics

-Pragmatics is generically defined as the social use of language

-Pragmatics is specifically defined as functional use of verbal and nonverbal modes of communication to convey and interpret intended messages

36

Verbal pragmatic deficits

-Tangential Speech: Conversation topics shift without listener notification

-Limited communication initiation or maintenance per interaction with others

-Decreased topic maintenance

-Inappropriate topic selection

-Inadequate topic relevance

-Poor presupposition skills
---implicit assumption about the world or background belief relating to an utterance whose truth is taken for granted in discourse.

Example:
Jane no longer writes fiction.
Presupposition: Jane once wrote fiction.

37

Nonverbal pragmatic deficits

-Poor eye contact; includes both too much and insufficient amounts

-Flat affect; Poor use of facial expressions to convey emotions

-Lability; emotional excess

-Inappropriate proxemics

-Inappropriate physical contact

-Decreased understanding of other’s nonverbal cues

38

Amnesia

-Traumatic brain injury can leave old memories intact but hinder the ability to store and/or retrieve new memories; also includes learning new information

-Impaired attention can also make learning new information difficult

39

2 types of Amnesia

1. Anterograde amnesia

2. Retrograde amnesia

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Anterograde Amnesia

-Loss of the ability to learn and recall new information after the trauma

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Retrograde Amnesia

-Loss of memories stored before an injury

42

Seizures

-Change in behavioral state as a result of abnormal electrical activity within the brain

-The occurrence of a seizure in the presence of some acute precipitating physiological disturbance does not mean that it will ever happen after the cause has been resolved

-When seizures occur without any obvious precipitant or cause, then a person may be considered to have a form of epilepsy

o Know the different types of seizures in case you see them in a chart
o No medicine can prevent TBI seizures
o Place patient on the floor, move everything out of the way

43

Seizure Types

1. Generalized Seizures:
Increased electrical impulses occur throughout the brain

2. Partial Seizures:
References relatively small electrical impulses in more focal parts of the brain

3. Nonepileptic Seizures:
Not caused by abnormal electrical activity in the brain

4. Status Epilepticus:
Prolonged seizures; continuous state of seizure

44

Post-traumatic seizure disorder

-Seizures are common following TBI and are broken down into two separate categories:

- Seizures that occur within a seven day post-injury window; Patient is still in ICU or in the acute stage

-Late onset seizures that occur more as focal issues

45

General seizure information

-Seizure incidence is higher in children than in adults

-Late seizures are more likely to occur in adults or when the head injury was of the penetrating type

-There are no anti-epileptic medications that will protect against post traumatic epilepsy

-Depressed skull fractures and hemorrhagic contusions tend to predispose patients to seizure disorders



46

Concomitant Issues (TBI)

1. Post-traumatic headaches
2. Post-traumatic fatigue
3. Somnolence (sleepy)
4. Balance disorders
5. Sexual disorders
6. Depression
7. Mania
8. Anxiety Disorders
9. PTSD
10. Personality Changes
11. Aggression
-etc

47

Depression following TBI

-The level of brain injury severity poorly predicts a patient’s level of depression or susceptibility to a depressed state

-Pre-injury depression is common

-Increased anxiety levels + depression often coinside

-Decreased left prefrontal gray matter volume often correlates with depression

-Pre-injury aggression and hostile features may predict suicidal behavior