TBI Revision Flashcards

Question

What are dysexecutive syndrome symptoms (DES)?

Answer 1

- Motivation/Initiation - Concentration/Attention - Planning/Organisation - Self-Monitoring - Flexible Thinking - Multi-tasking - Problem-solving/Making decisions - Reasoning skills - Delayed Information Processing - Memory - Repetitions - Visual-perceptual Skills - Insight/Empathy - Behaviour/Emotions/Mood - Social Skills

Answer 2

Royal College of Physician - 1986: “The Restoration of patients to their fullest physical, mental and social capability” Headway: A period of change through which the head injured person goes in attempting to regain former abilities and to compensate for lost skills

Answer 3

Gravell & Johnson - 2002: Goes through stages of care: paramedics, A&E staff, ICU/Ward staff, inpatient rehab, community/specialist rehab, support and maintenance

Answer 4

- Months since injury - Age - GCS - Months of treatment

Answer 5

- Identifying and promoting arousal/consciousness - Likely focus on dysphagia management - Identification/establishing of communication, often through low-tech AAC - Support and advice to family - There is a focus on medical stability, consciousness and out of post-traumatic amnesia

Answer 6

SMART - Sensory Modality Assessment and Rehabilitation Technique WHIM - Wessex Head Injury Matrix FIM/FAM - Not an assessment technically but can measure the baseline before therapy. Functional independence measure/functional awareness measure Observation scales can monitor responses/behaviours over time, ascertaining consistency, purposeful actions

Answer 7

Sensory Modality Assessment and Rehabilitation Technique - Used by the MDT - Used at low-arousal stage - Assesses the clients responses at rest and to a range of stimuli - olfactory, auditory, visual, tactile and gustatory - Aims to assess/gather information about the clients functional ability, communication ability and level of wakefulness

Answer 8

Wessex Head Injury Matrix - Measures the recovery in the acute/sub-acute phase - Assesses and gathers information about communication skills, cognitive skills and social interactions.

Answer 9

- Establish whether behaviours are reflexes or purposeful - Establish if there is communicative intent - Establish AAC if appropriate - Educate and support relatives and the MDT to support and communicate with the patient - Manage dysphagia

Answer 10

- Yes/No methods - nods, pointing to y/n cards, eye movements, eye blinks - Object choices - intervention tasks, clothing, food items - Simple communication boards - 2/3 pictures of family, activity choices, treatment tasks - Single message voice output devices - y/n, request an item or activity - Writing or using an alphabet board to support speech - Consider writing first because it is a more familiar ability than pointing/eye gazing with letters - Low tech alphabet or communication boards - accessed by looking at/gazing with eyes or laser pointers for those with motor-impairment - Digitised text-to-speech programs - Most people will need cues to initiate use of the systems.

Answer 11

``` Client Carers/Advocate SLT OT Physio Dietician Consultant Nursing Staff Rehab Support Workers Social Worker Clinical Psychologist Counselling Case Manager Pastoral Care Voluntary Organisations ```

Answer 12

By MacDonald, describes common deficits in cognition following TBI ``` Attention and concentration Memory Organisation, planning, initiating Reasoning and problem-solving Executive functions ``` Symptoms range mild to severe, subtle to obvious Massive variability in presentation of clients

Answer 13

Ongoing cognition difficulties Ongoing language issues TBI associated with increased incidence of neuro disorders, e.g. seizures Links to neuro-degenerative disorders like Alzheimers or Parkinsonism Social impact - reduced participation, depression, anxiety, loss of role/identity, job, relationships, insight

Answer 14

Physical - how the body works Cognitive - how the person thinks, learns and remembers Emotional - how the person feels Behavioural - how the person acts Essential to consider the individual, their presentation and how the injury has directly affected them Impact of cognitive impairments likely to impact how communication impairment is carried out

Answer 15

Attention/concentration difficulties - can impact - difficulty resisting distractions during conversations, following line of conversations, topic maintenance Memory problems - can impact - repeating self during conversation, topic maintenance, retaining instructions or messages, Social impairment - can impact - not understanding sarcasm, missing jokes, poor conversational turn taking, interrupting others, excessive talking, missing/misreading cues or non verbals

Answer 16

WFDs Poor sentence formation Lengthy, often incorrect, descriptions or explanations - often cover lack of understanding or WFD Slower or difficulty processing and understanding information Difficulty understanding jokes, sarcasm, figurative language Reading and writing often worse than receptive or expressive language Altered turn taking Altered ability to talk around a topic Fixated on a topic Perseverating Altered ability to order information/give narratives/instructions Not using/recognising/correctly interpreting non verbal cues Often unaware of errors, often blame conversation partner, can cause frustration, upset and anger Likely reduced insight into analysing situation/correcting behaviour

Answer 17

- LaTrobe Communication Questionnaire - FAVRES functional ax of verbal reasoning and executive strategies - Multi Factorial Memory Questionnaire - QOLIBRI - Quality of Life after Brain Injury Questionnaire

Answer 18

Client centred Focus on what the client wants so they’ll be more motivated and feel listened to Work with client, or if not possible, those closest to them Motivation is highest when a need exists Ensure goals are relevant IRL - e.g. can order their own drink, can accurately communicate yes or no - NOT ‘understand 20 common phrases’

Answer 19

``` GAS Goals DRS - Disability Rating Scale QOLIBRI - Quality of Life after Brain Injury FIM/FAM EKOS ```

Answer 20

Functional independence measure/functional assessment measure - assess disability resulting from physical and cognitive impairments

Answer 21

Multifactorial Memory Questionnaire Assesses functional memory, applicable to everyday life, Ω Good for monitoring changes to memory overtime. As well as ability, it assesses what self-help strategies people use to facilitate any memory difficulties, as well as how people feel about their memory. This is important, as care needs to be person centred - ?what use are raw scores, surely it matters what the persons perception of their difficulties are.

Answer 22

``` Client and family/friend/carer education Modifying their environment Compensatory devices and strategies Restorative approaches Managing emotions Increasing meta-cognitive awareness ```

Answer 23

Use It or Lose It - failing to use specific functions can lead to functional degradation Use It and Improve It - training drives a specific brain function to enhance the function Specificity - the nature of the training dictates the nature of the plasticity Repetition Matters - plasticity requires sufficient repetition Intensity Matters - sufficient training intensity needed Time matters - plasticity differs at different times during training Salience Matters - The training must be salient enough to induce plasticity Age Matters - training-induced plasticity occurs more readily in young brains Transference plasticity - training in one area can enhance the acquisition of similar behaviours Interference - Plasticity in one experience can interfere with acquiring other behaviours

Answer 24

``` Making changes to reduce risks specific to that client E.g. controlled door access Reducing stimulation or distractions Temperature controlled taps Controlled sharps access ```

Answer 25

``` e.g: AAC Calendars Alarms Watches Organisers Pagers Schedules Language related strategies ```

Answer 26

Important to make tasks tailored to the individual (or group as appropriate) Aims to restore previous ability/function Increase the complexity and demands of tasks gradually - The amount of information presented - The attention required - The memory required

Answer 27

Consider both the client and their family/carer Getting to know a person and building a rapport Empathy Couple and/or family therapy Biomusic - for those with profound/multiple disabilities, changes physiological signals such as respiration and skin temperature create music specific to that person and their current physiology.

Answer 28

Interdisciplinary approach - the team need to work together to provide consistent information an education. The information provided needs to be suitable for the stage the person is at in their ‘journey’ Don’t overwhelm Information as requested Sign post to resources - support groups, etc.

Answer 29

Meta-cognition strategies target CCD - cognitive communication difficulties Problem-solving training CBT Goal management framework: Self instruction - strategies e.g. stop and think, zoom in/out

Answer 30

1) Set main goal 2) Identify possible solutions 3) Identify and assess pros and cons for each 4) Choose the best solution for you, and plan the steps 5) Carry out the plan 6) Evaluate the process

Answer 31

Consider direct v indirect Consider group v individual Needs to be realistic, replicating IRL situations as much as possible

Answer 32

Group conversation work often beneficial Groups can provide peer support within a naturalistic, social setting Groups can role play specific social situations Groups can replay videos of communication practices to evaluate together Groups can offer more effective generalisation and maintenance of communication skills

Answer 33

Generalisation of skills/practice can be difficult | Group members may be critical

Answer 34

Building client and carer awareness of strengths and needs Identifying areas for intervention Develop skills and strategies

Answer 35

Video feedback in a naturalistic setting Role play pre planned scenarios (like shops, cafes, phonecalls) Observation of self, aided by a communication checklist This can prompt changes in behaviour and help with goal setting

Answer 36

“social communication training” for PwTBI & their CPs ``` Includes modules on: education and understanding the effects of TBI on communication Effective communication Collaboration Elaboration Putting acquired skills together ``` Typically group training

Answer 37

Individual Interpersonal Process Recall

Answer 38

Videotape 10-15 minute interaction Play video back to client, CP & SLT Identify skills and barriers/deficiencies 20 sessions of treatment Discuss adapting current, and more appropriate means of interaction Rehearse new skills with the participant

Answer 39

Noted reduced anxiety Improved social self-concept, interpersonal and communication skills Skills were generalised to communication in non-clinical settings

Answer 40

Group Interactive Structured Treatment

Answer 41

Manualised treatment Emphasis on family participation and regular practice at home and in the community 13x 0.5hr sessions in the workbook Includes self-assessment and goal setting Targets: initiating conversation, strategies for conversation maintenance and using feedback, being assertive, problem solving, positive self-talk, social boundaries Videotapes feedback and conflict resolution

Answer 42

Agitation - temporary stage rather than a permanent change Anger/irritability - seemingly excessive reaction to minor annoyances Impulsivity and disinhibition - lack of awareness of consequences, touching people inappropriately, speaking your mind regardless of circumstances. Work with neuro-psychologist to develop a behavioural management system can stop unacceptable LT behaviours developing through habit. Demanding behaviour - self-centredness - concerned only with self, not considerate of the wider family. Can damage wider relationships. Low motivation and apathy - breaking activities down can help avoid overwhelm. Sexual problems - damaged hypothalamus can increase sex drive, promiscuity or misinterpreting the behaviour of others

Answer 43

Break down activites into smaller steps Use a consistent approach across the MDT/family Routine Reducing distractions Avoiding overloading Change confusing or distressing topics of conversation Check the client is understanding throughout conversation Do/discuss things the client enjoys Reminders/rewards for what is socially acceptable MDT approach - team must have a consistent approach that involves the family. Set goals, remind of goals/revisit frequently

Answer 44

Emotional lability - very quickly move from one state to another Depression - ‘healthy depression’ can be good as it can be worked through with support, with appropriate adjustments being made. It gives a sign the client is aware of the situation and how things have changed. Anxiety - e.g. panic attacks, nightmares, feeling insecure. Talking about worries and adopting strategies to manage anxiety. Obsessional/Inflexible - e.g. unreasonable stubborness, obsessive patterns of behaviour, fear of possessions being stolen. Helpful to reassure client, and to redirect attention to more constructive ideas and behaviours. This can be hard for family and friends to deal with.

Answer 45

Adjustment and Acceptance Education Working with the family Remaining calm if the client talks about depression/anxiety/suicide etc and working appropriately with the MDT

Answer 46

Goal Attainment Scaling Not pass/fail - rates a goal from -3 to 2 to quantity the success. Overall aim is to increase engagement in activities that are meaningful to the individual. The goals set should guide the interventions chosen by the therapists

Answer 47

The hugely diverse population means that GAS goals words for patients identifying, planning and managing their own behaviour

Answer 48

Ertzgaard et al, 2011 - Completely personal to the individual - Promotes collaborative working between client & SLT (and family) - Allows SLT insight into the priorities of the client - A study in the Mayo Brain Injury Outpatient Programme showed strong correlations between GAS score and independence measures - Can be applied across the popn bc its specific to the client - Goals selected by the client their self are more likely to be motivating and therefore achieve success. - Allows for 1 or many goals to be set - Goals can facilitate future planning - e.g. in regards to appropriate rehabilitation or support in community

Answer 49

Ertzgaard et al, 2011 - Pw severe cognitive or behavioural impairments likely unable to set goals independently - A lack of insight can mean goals chosen by the client are unrealistic - clients with dysexecutive syndrome symptoms (DES) can make achieving goals harder - e.g. difficulties with attention, concentration and memory. - using a scale with '- minus' scoring can be demotivating (like in paeds) - Can be time-consuming, and requires training so could be service constraints. - Scale needs to be "clinically meaningful" - not totally subjective. How relevant is standardisation when we're looking at PCC and helping that individual?

TBI Revision Flashcards

(73 cards)