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SPA 775 > TBI > Flashcards

TBI Flashcards

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1
Q

TBI?

A

external physical force to the head that is acquired brain injury, and change in levels of consciousness.

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2
Q

decontextualized approach

A

more control over a single cognitive dimension to isolate and treat cognitive processes independently.

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3
Q

contextualized approach

A

individualized enhance motivation, improve self-awareness and increase the likelihood that strategies will generalize. Used to challenge patients overtime.

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4
Q

prevalence & incidence of TBIs

A

27 million new cases of TBI in 2016
55.5 million people living with TBI in 2016
16.7% for males, 8.5% for females
75% of TBIs with mTBIs
15% of full-time workers with TBIs don’t return to work 4 yrs later
69% moderate TBIs
40% have neuropsychological needs 1 yr post injury

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5
Q

effortful behavior

A

uses many mental resourses.

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6
Q

Categories of CRT

A

Restoration: use of repetition and drill to target cog processes
Calibration: focuses on metacognitive awareness(offline), self awareness
Compensation: external & internal approaches

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7
Q

external approaches

A

journals, smart phones, checklist, calendar

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8
Q

internal approaches

A

visualization, mnemonics, repeating words back to themselves

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9
Q

CRT Cognitive Rehabilitation Therapy

A

evidence demonstrates positive efficacy and effectiveness of CRT for individuals with TBIs.

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10
Q

How should intervention be designed?

A

Tailored to the patient’s neuropsychological profile premorbid cognitive characteristics & goals for life activities & participation.
focus on engaging in meaningful activities for the patient and relevant parties.
be in their environment and applicable to their life.
strategies for generalization.
reassessment of cog performed on regular basis.

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11
Q

cognitive-communication intervention should address what?

A

process of various types of info under ideal conditions in activities/settings
Executive/self-regulatory control over cog, lang, and social skills function.
Modification of comm. and support the competencies of relevant people in everyday environments.
mod. of cog and comm. demands to facilitate better performance.
use of effective compensatory strategies/techniques.
plans for probs other than cog-comm that may occur w/disorder.

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12
Q

why is it important for patients to be included in treatment?

A

People do better when actively involved in the therapy process.
they can decide on goals and priorities together (collab partnership).
think of patients’ own knowledge regarding their deficits.

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13
Q

Types of Medical Intervention

A

Neurosurgical: repair/removal to prevent infection
Pharmacological: Sedation, a medication used for pain, seizures, and behavioral/cognitive issues.
Complementary/Alternative Medicine & Neurotherapy: homoeopathic, herbal meds, acupuncture, and naturopathy.

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14
Q

Continuum of Care

A

Emergency Medical Services: ensure the patient stabilize & prevent further neurological damage.
Acute Care: optimize patient’s medical conditions, and conduct further diagnostics and surgical/medical interventions for stabilization.
Acute Rehab: focus on relearning basic skills for everyday living.
Subacute Rehab: maximize recovery & ensure the safest, most active lifestyle possible when the individual goes home & into the community.
neurobehavioral unit: highly specialized treatment to assist individuals after an injury and adapt to less structured environments.
outpatient rehab: maximize recovery through ongoing support from a variety of agencies and medical professionals.
vocational services: reeducation, training and worksite-related services.
community-based services: continued and ongoing care and support utilized in tandem with or after formal rehabilitation care.

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15
Q

Patient-centred care?

A

Respect for patients’ values, preferences, and expressed needs.
coordination and integration of care.
info, comm, and education.
physical comfort.
emotional support and alleviation of fear and anxiety.
involvement of family and friends.
continuity and transition.
access to care.

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16
Q

Evidence for cognitive rehab

A

Directive Attention Training - sustaining & shifting attention over time
Categorization Training - target abstract thought and decision-making.
Therapy for Impaired Memory - restorative & compensatory tools to improve memory.
Intervention for social comm skills & behavior - changes in social skills related to social isolation.
Intervention for complex activities & problem-solving - goal management training and metacognitive strategy training.

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17
Q

What is generalization

A

TBI patients can learn new info and skills at a slower rate.
reduced mental resources.
reduced ability to be mentally flexible.
challenging to adapt info/skills to new environment.

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18
Q

Spaced Retrieval

A

takes advantage of persevered implicit memory process through errorless learning and large amounts of practice.

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19
Q

positive routines

A

contextualized, collaborative positive routines, identifying what could prevent negative responses or behaviors and replacing these behaviors with positive ones.

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20
Q

Principles of Cog Rehab

A

Strive for effortless behavior
capitalize on implicit processes through errorless learning
person-centered rehab
awareness deficits
challenge of generalization

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21
Q

CTE?

A

Chronic Traumatic Encephalopathy
sports-related brain injury
neurodegenerative condition

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22
Q

CTE Symptoms?

A

cognitive
behavioral
psychiatric
motor

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23
Q

Aspects of Assessment of social communication

A

Self-assessment and self-observation
Sel-report questionnaires
social problem-solving measures
measures of receptive communication skills
behavioral rating scales
behavioral rating scales for TBI interactions

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24
Q

Aspects of assessment for EF and awareness include functional tasks

A

performance of real-world tasks: specific to their home, vocational, and education contexts.
ongoing self-assessment: journal or log EF performance.

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25
Aspects of assessment for memory with functional tasks
ongoing self-assessment: journal or log about memory performance. observations: recording memory success & lapses.
26
Memory tasks examples
Prospective: remember to reply to an email episodic: remember dinner the night before semantic: remember the name of the current/past president nondeclarative: remember how to tie your shoe.
27
Aspects of Assessment for attention & processing speed with tasks
observation: specific time periods & use of logs self-assessment: knowledge, attributes, emotion, and impact Sustained attention: sort items selective attention: perform I spy alternate: prepare a meal and do laundry divide: balance a checkbook while having a conversation
28
Included in functional assessment measures
observational report discourse analysis functional, personally-relevant tasks that may/may not reflect a set of standardized objective procedures.
29
preferred practice patterns of cognitive-communication assessment?
relevant case history review of auditory, visual, motor, cog & emotional status patient/client reports of goals & preferences standardized &/non-standardized methods selected with consideration for ecological validity. follow-up services to monitor cog-comm status & ensure appropriate intervention & support for individuals.
30
Static Assessment
using procedures designed to describe current levels of functioning within relevant domains.
31
Dynamic Assessment
using the hypothesis-testing procedure to identify potentially successful intervention and support procedures. interviews questionnaires clinical observations
32
Included Comprehension Exam
Case history nonspeech examination speech production language cognitive communication swallowing
33
Considerations for Assessment
injury severity poor performance on formal/informal assessment - motor/sensory-perceptual problems, pre-existing academic difficulties/emotional-behavioral deficits. use scales to show the change in performance of patient use assessments that reflect functional performance in the real world. depression/anxiety interprofessional collaborations to help evaluations. repetitive brain trauma
34
Recovery Period
research demonstrates it's worthwhile to complete treatment for TBI starts in emergency trauma care intensive acute post-acute rehab neuropsychologist assess while SLP treat.
35
persisting symptoms of mTBI
cog: attention, concentration, memory, process speed, EF beh/emo: depression, irritability, anxiety, aggression, impulsivity, agitation, apathy. physical: sleep disturbance, fatigue, impaired balance, dizzy, nausea.
36
persisting symptoms of moderate TBI
emo: depression, irritability, anxiety beh: impulsivity, disinhibition, apathy, socially inappropriate behaviors. cog: attention, processing speed, EF, memory physical: motor/sensory deficits, balance/coordination problems.
37
RHD vs. TBI?
Pragmatics are the same Prosodic is different - RHD: aprosodia, TBI: interprets emotional prosody. Executive Functions are the same The site of lesion is different etioloy is different Extent of damage for RHD is focal and TBI is diffuse
38
Rancho Los Amigos Scale (Neurobehavioral Recovery)
10 levels in acute phase of recovery 1: no response 4: patient is alert, disorientated & agitated 6: patient is concussed 8: patient is purposeful 10: patient is purposeful
39
Outcome Measures
Glasgow Coma Scale Functional Independence Measure (FIM) Functional Communication Measure Rancho Los Amigos Scale of Cognitive Level
40
Neurobehavioral Concerns
Personality changes: apathy, impulsivity psychiatric disorder: depression 49%, PTSD, new psych disorder 48%, anxiety, sleep disorder, psychotic syndromes
41
Behaviors
Transient: Temporary - screaming, aggression, agitation, poor arousal Modifiable: can be corrected with compensatory strategies - aggression, lack of social skills, sexual inhibition Chronic: does not resolve but can still use compensatory strategies - episodic dyscontrol and lack of initiation
42
Neuroplasticity
greatest during the development of an immature brain. it occurs in injured and noninjured brains
43
Prognosis indicators for TBI
loss of consciousness duration Glasgow coma scale to measure coma/impaired consciousness PTA retrograde amnesia anterograde amnesia Galvenston Orientation and Amnesia Test GOAT
44
Penetrating head injury
high velocity penetrating brain injury (bullets) low-velocity penetrating brain injury (knife)
45
non-acceleration head injury
moving object striking the skull causing deformation (swinging bat)
46
acceleration/deceleration head injury
moving head striking stationary/moving object or head being shaken violently
47
Closed head injury
more frequent brain moved around the skull
48
open head injury
scalp, skull, and dura mater penetrated.
49
Cell death
Diffuse Axonal Injury DAI can be delayed 12-24 hours or immediately. gliosis: phagocytes permeate the area and are in charge of disposing of nonfunctioning tissue. glial cells then permeate the area that was vacated. provide nutrients for regenerating axons/ form scar tissue.
50
Severe TBI
loss of consciousness: more than 24 hours Glasgow: 3-8 Imaging: normal/abnormal PTA: more than 7 days
51
Moderate TBI
loss of consciousness: 30 to 24 hours Glasgow: 9-12 Imaging: normal/abnormal PTA: 1-7 days
52
Persisting symptoms of moderate TBI
Cog: attention, memory, EF, processing speed Beh: impulsive, disinhibition, apathy physical: motor/sensory deficits, balance, coordination emo: depression, anxiety, irritability
53
mTBI
loss of consciousness: 0-30 mins Glasgow: 13-15 Imaging: normal PTA: 0-1 day
54
Persisting symptoms of mTBI
cog: attention, concentration, memory, EF, process speed beh/emo: depression. irritability, anxiety, aggression, impulsive physical: sleep disturbance, fatigue, impaired balance, nausea
55
Recovery period
Adults: within 14 days post-injury Children: within 1 month
56
Risk factors
Males, low SES, unemployment, low education level, drug/alcohol abuse
57
Concussion
disruption of ions, potassium going out of cells while sodium and calcium flood into cells. glutamate is released with no place to go. results in toxic synapses and slowed comm between neurons.
58
after injury
the brain goes into a hyperactive state followed by a 7-10 day decrease in cerebral blood flow and hypometabolism. DAI happens by axons begin to stretch and break due to force. impaired synaptic comm and result in increased dysfunction in the frontal lobe, cerebellum and corpus callosum. unmyelinated cells are more susceptible to damage and change thalamus, (used for sensory input, alertness, consciousness, language and working memory. edema can occur.
59
TPM (Steps, goals, strategic)
Time Pressure Management Steps: identify the problem teach the strategy generalization Strategies: must be fitted to the patient's needs, personality & abilities. must fulfil an obvious & apparent need that personally is felt by the patient & must fit the personal inclination & attitudes of the patient. must be easy enough that patient can supply it automatically & effortlessly. Goals: bring awareness to how mental slowness impacts daily activities. to assist TBI patients in creating strategies to prevent or manage time pressures created by slowed mental processing.
60
APT Attention Processing Training
Core tenants: grounding treatment in a hierarchical organization & theoretical models of attention. Providing the opportunity for practice & repetition. Using client data to drive treatment decisions. Individualizing treatment & promoting generalization to daily living tasks.
61
APT Treatment
Evaluation step: evaluation of adaptive functioning & understanding of impacts in daily activities. must plan for the generalization stage before therapy begins. Training Step: identify targets & setting task parameters during this step and initiate generalization tasks. Generalization: formal training phase to actively facilitate generalization.
62
DTT Treatment in Action
Identify real-world dual tasks that are important to the client/family that is challenging Once tasks are identified, they are put into order from most important to least by participant & family/caregiver. possibly use a motor task with challenging attention speaking task.
63
DTT Dual-Task Training Implementing treatment
first, target each component within dual-task separately, then simultaneously. home exercise program implemented to target these tasks at home as well. use self and clinician-guided reflections (can be done with questions at end of each task).
64
Memory Comprehension Internal Aids
compensation approaches comprised of mnemonic/imagery techniques. association techniques/organization & elaboration techniques.
65
Memory Comprehension External Aids
provide reminders of the need to recall info/storage and display of info that needs to be recalled. From a simple notepad to smart phone
66
Memory Compensation 4 phrases
Assessment/anticipation acquisition application adaptation
67
GMT Goal Management Training 5 stages
Stop: what am I doing Define: think about and outline the goal of the task List: learn to identify & outline steps needed to complete the goal. Learn: seeks to retain goals & subgoals outlined in prior stages. Check: am I doing what is planned?
68
SMART Strategic Memory Advanced Reasoning Training
Strategic Attention: reduce a load of incoming details by inhibiting less relevant info. integrated reasoning: having the patient combine important facts by integrating explicit content with preexisting knowledge to form a more global, gist-based representation. innovation/cognitive flexibility: teaching patient process of evaluating info from different perspectives.
69
CFAT Construction Feedback Awareness Training
Step 1: pre-task analysis - identify real-world task during the feedback stage, SLP will evaluate the task, and then have the patient do self-evaluate. Step 2: task implementation & feedback - construct feedback during/ after the task, provide methods of feedback, pause-prompt-praise. Step 3: question-answer session analysis of the task, self-evaluate again, video feedback possible.
70
SCT Social Communication Training
Step 1: establish baselines - get baselines, then see social abilities, raise awareness of social comm difficulties, and identify specific goals. Step 2: educate - learn the training, home practice expectations, and use opportunities to practice learned strategies in a natural environment with hw. Step 3: train - treatment starting social comm and emotion perception observed in interaction. Step 4: refine & plan for the transfer - review info and techniques previously taught, revise if needed, and engage in the intentional practice, patients should improve awareness of how both participants in conversation contribute to interactional exchange.
71
errorless learning
immediately correct them so they cannot make an error. using fewer mental resources.
72
ecological validity
how generalizable the results are.
73
number one cause of TBIs in all age groups?
falls
74
Physical concerns
headaches, fatigue, seizures, nausea, prone to falling
75
Cognitive concerns
orientation, arousal, awareness and theory of mind, attention, memory
76
Poor scores on Glasgow and Rancho Los Amigos have concerns of?
Swallow concerns 41-65% getting dysphagia
77
Symptoms that go along with CTE
behavior (aggression) psychiatric personality (impulsivity) motor and cognition
78
Why do TBI patients have difficulty with generalization?
difficulty with mental capacity and mental resources reduced mental flexibility hard to take in new info and use on new challenges.
79
DTT targets? Describe how?
Attention and motor start off walking and talking with SLP and then add in more familiar people and then progress to outside followed by adding in strangers.
80
Apathy prevalence in TBI
20-72%
81
50-80% of individuals with TBI suffer from?
posttraumatic fatigue PTF
82
Visual concerns in people with TBI
30-85%
83
What percentage of individuals with TBI have self-awareness impairments?
97%
84
What percentage of people with TBI report persistent memory problems
75%

SPA 775 (1 decks)

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