what is communication partner training?
- environmental intervention
- for family and peers who interact with visuals who have acquired a language disorder
- strategies taught by anyone that can implement support communication as a two way exchange
what are the categories of CPT
- environment
- rec lang
- express lang
- reading
- writing
what is a CHI?
closed head injury is a force that causes tearing and movement inside the brain = wide spread damage
what is a PHI?
penetrating head injury - injury to the outer layer of brain called meninges is breached = concentrated damage
what is a mTBI?
mild TBI - injuries like concussions that can have a temp effect on consciousness and cognition
what is a right hemisphere disorder?
caused by lesions like strokes, TBI and brain tumor
50-78% of patients with Rbi have comm impairments - many go untreated
“location as disorder” problem
no specific/predictable pattern
what is neglect syndrome?
- most common after temporal lesions in right hemisphere
- result of lesion in other areas such as frontal lobe, thalamus and basal ganglia
- most commonly seen in visual modality
- improves within weeks or months
how to recognize visual neglect?
- H test
- line bisetction test
- drawing tasks - both copying and generative tasks
- cancellation tasks - scored # missed on L vs R side - ratio reading,writing
- writing - copy or compose
- reading - single word, sentence, paragraph
variability in spoken discourse
- improved discourse - short utterance length
- inefficient discourse - excessive # of utterances in response to each question
- confused discourse - response doesn’t answer question that was asked
what is a cognitive communication disorder
occurs after a TBI and causes difficulty with communication competence that results from underlying cognitive impairments
incidence is 75%
attention, executive function and memory are all affected
executive function & CCD
difficulty with *due to frontal lobe injury
- initiating routines
- staying organized or managing tasks
- problem solving
- maintaining balance
affects beh:
- aggression/ self harm
- vulnerability
- poor emotional/self regulation
affects social comm
- social interaction
- social cognition
- pragmatics
Memory and CCD
- diff with orientation (GOAT)
external memory aids:
- setting alarms, keeping a journal
parts of the memory:
1. working memory (info to carry out tasks)
2. short term memory
3. long term memory
process of memory:
- encoding
- storage
- retrieval
what are the types of amnesia?
retrograde - forgetting past
anterograde - forgetting upcoming things
procedural - most often preserved
ASHA’S 6 guiding principles for cognitive rehab
- recruit resilience
- cultivate therapeutic
- acknowledge multi factorial complexities
- build a team:
- focus on function
- promote realistic expectations for recovery
Ostegren’s 9 examples of cognitive rehab therapy
- modeling
- guided practice
- distributed practice
- errorless learning
- direct instruction with feedback
- paper and pencil task
- communication skills
- computer assisted restraining program s
- use of memory aids
what is a decontextualized approach?
- single cognitive dimension
might use with patients who are very driven to go an extra mile and wanting extra practice, with very specific and defined challenges
used about 10% of time
what are the principles of intervention?
- capatalize on strengths and address weaknesses related to underlying structure and functions that affect communication
- facilitate individuals activities and participation by assisting the person to acquire new skills
- modify contextual factors that serve as barriers and enhance facilitate ators of sucessful communication, including development and use of appropriate accommodations
Formal intervention approaches
- attentive reading and constrained summarization
- spaced retrieval
- external memory aids
what is the attentive reading and constrained summarization (ARCS)
- treatment steps of “read, re-read and summarize”
a. attentive reading (read 2-3 sentences knowing that you’ll have to summarize them, re read them to ensure understanding)
b. constrained summarization (summarize, but with no opinions, no using non specific pronouns and no nonspecific words)
c. repeat this process until article is finished
what is spaced retrieval?
used to increase the ability to retrieve info from memory
a. therapist and client choose a target
b. clinician develops a question and target response
c. clinician and client continue an unrelated therapy activity, 15 secs later, clinician asks target question
i. if correct, time interval doubles until question is asked again
ii. if incorrect, give correct response and return to last interval that they received a correct response
d. clinician repeats this step throughout session
e. usually done with pen or paper but now there is an app (tacitus therapy)
what is external memory aids?
physical tools to help compensate for impairments in prospective memory
- a memory aid should not be complicated that it becomes cumbersome
- EMA are an effective and cost effective way to form prospective memory support
- external memory aids are generally used for more prospective memory, they can also be used for retrospective memory
EMA hierarchy of support
stage 1 (most supportive): meet with him in the morning and make sure he has his journal and writes his schedule on a page
stage 2: send out an email reminder to the team to ensure he fills out after each session
stage 3: meet him at the end of the day and go over what he has written.
after a set amount of time, he may need less support and you are able to fade your support
what are soap notes?
S - subjective - reason for session
O objective - measurable, objective info that is achieved during session
Assessment - your opinion on the clients progress, long of the S+O
Plan - plan going forward
2 treatment approaches for language intervention
- restorative/linguistic approach
- compensatory/substitutive approach
