Neuropsychological intervention

Question 1

What is CNS/brain impairment? (4)

Answer 1

■Various neurological conditions can affect the way the central nervous system functions.
Can affect the way the nerve syst fctions, the brain itself, the way the brain comms with the body and how muscles respond to nerve impulses
■Conditions may be developmental or acquired.
Some brain conditions ppl are born with or happen at birth (lack of O2, epilepsy, ADHD) or acquired (stroke, etc.)
■Some effects are obvious and profound, others may be subtle.
■The effects differ widely from person to person.

Question 2

What are some effects of CNS/Brain impairment? (10)

Answer 2

Broad Range of Impairments
There are diff domains of abilities that can be impaired
■Physical
■Sensory
■Cognitive
■Communication/Speech
■Behavioural
■Emotional
■Psychological
■Personality
Organic or non organic impairments, organic/direct = impairments that are the direct result of the brain not fctioning

Question 2

What are some effects of CNS/Brain impairment? (10)

Answer 2

Broad Range of Impairments Resulting from CNS/Brain Damage
There are diff domains of abilities that can be impaired
■Physical
■Sensory
■Cognitive
■Communication/Speech
■Behavioural
■Emotional
■Psychological
■Personality
Organic or non organic impairments, organic/direct = impairments that are the direct result of the brain not fctioning

Question 3

What are some Physical Difficulties Resulting from CNS/Brain Impairment? (6)

Answer 3

■Motor weakness or paralysis
■Incoordination of muscle movements
■A loss of fine and/or gross motor dexterity
■Poor balance
■Reduced physical endurance/fatigue
■Tremor

Question 4

What are some Sensory Difficulties Resulting from CNS/Brain Impairment? (7)

Answer 4

Loss of certain senses
■Diminished sense of smell
■Visual impairments
■Hearing loss, sensitivity to sound
■Vertigo
■Difficulty swallowing, loss of taste
■Tactile sensory deficits
■Proprioception

Question 5

What are some Thinking Difficulties Resulting from CNS/Brain Impairment ? (7)

Answer 5

Diff areas of cognition
■Cognitive fatigue
■Attention/concentration
■Information processing; working M probs (holding and manip info in mind)
■Intellectual Abilities
–Verbal
–Nonverbal
■Academic Functions
–Literacy
–Numeracy
■Learning and memory
–Verbal
–Nonverbal
■Executive Functions

Question 6

What are some Communication and Speech Difficulties Resulting from CNS/Brain Impairment (6)

Answer 6

■A reduced capacity to articulate speech sounds
■Difficulties with phonation, resonance and prosody
■Impaired motor programming of articulation
■Swallowing disorders
■Expressive language disorders
■Receptive language disorders

Question 7

What are 3 categories of Behaviour Difficulties Resulting from CNS/Brain Impairment

Answer 7

DRIVE
CONTROL
AWARENESS

Question 8

What are 5 Emotional Changes Resulting from Brain Impairment?

Answer 8

■Emotional lability; more intense emotional reactions
■Irritability, low frustration tolerance
■Poor emotion regulation; feel emotions more intensely or for longer
■Inappropriate emotional responses
■Blunted affect

Question 9

What are 3 Psychological/Personality Changes Resulting from Brain Impairment?

Answer 9

■Self-centeredness
■Psychiatric symptoms
■Changes in affect/mood
–Anxiety
–Depression
–Euphoria
–Withdrawal

Question 10

What is The functional impact of CNS/brain impairment?

Answer 10

Disability

Question 11

What determines the impact or extent of disability? ( 4 direct and 4 indirect effects)

Answer 11

DIRECT EFFECTS
Neurological
*Cause
*Location
*Extent
*Severity
Of the damage

INDIRECT EFFECTS
*Reactions and responses
*Environmental factors
*Individual characteristics
*Family characteristics

Question 12

How did the neuropsychologist’s profession progress?

Answer 12

Used to be for assessment and diagnosis, then were needed less for localisation of brain impairment (imagery)
Do differential diagnoses, now moved more to intervention side for improvement of daily lives of patients

Question 13

What is the neuropsychologist’s role? (6)

Answer 13

■Member of a multi-disciplinary team
■Background/history taking
■Analysis of cognitive strengths and weaknesses and behavioural and emotional difficulties
■Assessment of patient and family’s context/needs
■Understanding the functional impact of the brain impairment
■Active role in intervention/rehabilitation

Question 14

How does the neuropsychologist obtain background information? (8)

Answer 14

■Premorbid factors
■Injury details
■Impairments (CNS and non-CNS related)
■Functional disabilities
■Psychosocial losses
■Psychological/emotional responses
■Psychosocial adjustment
■Broader context (e.g. friends, family)
Go beyond cog and emotional difficulties, see other ppls perspectives

Question 15

What is Rehabilitation?

Answer 15

Rehabilitation is the process of helping a person to reach the fullest physical, psychological, social, vocational and educational potential consistent with his or her physiologic or anatomic impairment, environmental limitations, and desires and life plans. Patients, their families, and their rehabilitation teams work together to determine realistic goals and to develop and carry out plans to obtain optimal function despite residual disability, even if the impairment is caused by a pathologic process that cannot be reversed

Question 16

What are 4 general points of rehabilitation/intervention?

Answer 16

■The functional impact of the brain impairment should be the focus
■Rehabilitation should be individually tailored
■One needs to consider the personal, emotional and social impacts of brain impairment
■There is more than one way to plan an effective intervention program

Question 17

What are 2 approaches to rehabilitation?

Answer 17

■Remediation
–Restoring lost functions

■Compensation
–Teaching people to use their strengths more efficiently
–Finding an alternative way to achieve a desired outcome

Question 18

What are 6 common approaches to intervention?

Answer 18

■Psychological intervention
■Cognitive Rehabilitation/Intervention
■Behaviour Analysis and Intervention
■Cognitive Neuropsychological Intervention
■Pharmacology
■Holistic Approach
You can use one or a combination of these approaches

Question 19

What is psychological intervention?

Answer 19

■Generally carried out by a clinical psychologist or a clinical neuropsychologist
–A wide range of psychological intervention techniques (e.g., cognitive behaviour therapy, psychotherapy, motivational interviewing, grief counselling etc.)

Question 20

What is cognitive rehabilitation?

Answer 20

Cognitive rehabilitation refers to the therapeutic process of increasing or improving an individual’s capacity to process and use incoming information so as to allow increased functioning in everyday life. This includes both methods to restore cognitive functions and compensatory techniques
■Most cognitive theories assist in the identification of cognitive impairment ■“Cognitive theories are limited in the contribution they make to treatment/ intervention”
–Helps you identify WHAT to treat

Question 21

What are 8 basic principles of cognitive rehabilitation?

Answer 21

■Is informed by medical and neuropsychological assessment and diagnosis
■Is based on an ever-evolving formulation of the client’s needs, strengths and impairments
■Emphasises collaboration and active participation
■Is goal-oriented
■uses a variety of techniques and strategies to teach compensatory skills and to facilitate regulation of behaviour and emotion
■seeks to understand each client’s previous lifestyle
■Is team-based-offers the advantage of seeing a problem or opportunity from a number of related, but distinct professional perspectives
■professionals recognise and respond to the need to evaluate objectively the effectiveness of interventions

Question 22

What does restoration (the ‘mental muscle approach’) use? (5)

Answer 22

■Forced use
■Worksheets
■Computer exercises
■Practical exercises
■Physical exercises

Question 23

What does compensation (an alternate approach) use? (4)

Answer 23

■Psychoeducation
■Knowledge and skill development
■Internal strategies
■Environmental modification/external aides

Question 24

What is environmental modification?

Answer 24

■Involves changing the environment to compensate for the impairment ■Also includes external aides

Question 25

What is the spaced retrieval technique?

Answer 25

■effortful retrieval at increasingly longer intervals ■used to teach discrete bits of information ■correct response provided initially then free recall encouraged at increasing intervals (e.g., 15s, 30s, 1 min, 2 min etc)

Question 25

What is the spaced retrieval technique?

Answer 25

■effortful retrieval at increasingly longer intervals ■used to teach discrete bits of information ■correct response provided initially then free recall encouraged at increasing intervals (e.g., 15s, 30s, 1 min, 2 min etc)

Question 26

What is the effortless learning technique?

Answer 26

■Provide a model of the correct response before the client attempts to produce it ■Guessing is discouraged ■Method of vanishing cues

Question 27

What is maladaptive behaviour? (5)

Answer 27

BEHAVIOUR THAT: ■Is disruptive ■Makes others uncomfortable ■Goes against the rules of community living ■Presents a safety risk for the person or others ■Distresses the client themselves Ppl only repeate these bvrs if their needs arent being met or they're being reinforced

Question 28

What is behavioural analysis and intervention? (4)

Answer 28

■Used for reducing challenging/maladaptive behaviours and teaching new skills ■Behaviour analysis focuses on the behaviour of people and the environmental influences that precede and follow the behaviour ■The goal is to increase personal freedom ■This leads to enhanced opportunities for community, social and family interaction

Question 29

What is an Ethical Use of Behavioural Analysis and Intervention? (5)

Answer 29

■Intervention should be about benefiting the client ■Staff should be trained and competent ■Clients should be taught functional skills ■Programs should be systematically evaluated ■Behaviour programs should use reinforcement

Question 30

What are the ABCs of behavioural conditioning?

Answer 30

–Antecedent = the preceding event; either internal to the person or in the env that leads to the bvr internal is harder to determine –Behaviour = operationally defined occurrence –Consequence = reinforcing or punishing consequent event that will affect future rateof behaviour, durationof behaviour or intensity

Question 31

What are 5 other principals of behavioural conditioning?

Answer 31

■Extinction–discontinuing the reinforcement of a behaviour ■Prompting-a cue to help initiate a behaviour ■Fading-the systematic and gradual removal of prompting ■Chaining(backward and forward) –teaching a sequence of steps ■Generalization–reducing a behaviour’s dependence on the conditions under which it was learned

Question 32

Before you Implement a Behaviour Modification Program what 5 questions should you Ask?

Answer 32

§What is the purpose of the behaviour? §What are the environmental causes? §What are other likely contributors? Can we change the environment? ■Changes to the environment can be relatively easy to make ■Often have the greatest effect on an individual’s behaviour Other useful/complementary approaches? ■Psychological Intervention, Cognitive Intervention, etc., might include medication

Question 33

What are 4 behavioural approaches?

Answer 33

■Token economy; to exchange later for a reward ■Time out ■Response cost; take smtg away (can be in conjunction with tokens) ■Satiation; When someone does the bad bvr, make them do it over and over until they get tired of it (ethical consideration)

Question 34

What approach should be used for behavioural modification?

Answer 34

Develop a team approach –Educate and involve ‘the team’ (e.g. staff, families, friends, those who have frequent contact with the individual) –Behaviour modification techniques must be applied consistentlyBY THE ENTIRE TEAMif they are to be effective

Question 35

What is cognitive neuropsychology?

Answer 35

■Uses models of normal cognitive processing to interpret impairments of cognition caused by damage to the brain ■Studies people with brain impairments to test, modify and develop models of normal cognitive processing.

Question 36

What are 4 key elements of neuropsychological intervention?

Answer 36

1.A commitment to individual case studies and individually tailored treatment programs 2.The use of models of normal cognition as the rationale for assessment planning 3.The development of treatment methods that are based on assessment results and are targeted at the cognitive sub-process that represents the core underlying impairment 4.The use of formal experimental designs that enable careful analysis of treatment outcome

Question 37

How is pharmacology used in neuropsychology?

Answer 37

■Baseline measures and clinical trials should be undertaken. ■In the majority of cases, medication should be used in combination with other clinical interventions (except during clinical drug trials).

Question 38

What is a holistic approach in neuropsychology?

Answer 38

*Neuropsychological deficits do not occur in isolation *We need to consider these deficits within the context of a person’s: *Background history *Emotions and psychological functioning