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spa 775 > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Patient and Family Education: Holland and Shigaki (1998)

A
  • 3 phases
  • Phase I - focus on providing basic information about what is immediately happening
  • Phase II - Larger amount of information provided
  • Phase III - additional amounts of information, adjusted to meet specific needs of both individual with TBI and their family
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2
Q

Patient and Family Education: Knowles’s (1948)

A
  • Adults need to be involved in planning and evaluation of their instruction
  • Experience (including mistakes) provides the basic for learning activities
  • Adults are most interested in learning about subjects that have immediate reliance to their job or personal life
  • Adult learning is problem centered rather than content oriented
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3
Q

Preferred Practice Patterns: Cognitive-communication intervention according to the WHO-ICF

A
  • Capitalize on the strengths of the patient to address the weaknesses
  • Facilitate individual’s activities and participation level by assisting with acquiring new skills and strategies
  • Modify contextual factors that are barriers of and facilitators to successful communication and participation
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4
Q

True or False: Interventions targeted activity and participation level may be warranted even if the prognosis for body structure/function is limited

A

True

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5
Q

Cognitive Communication Intervention should address what?

A
  • Processing of various types of information under ideal conditions (i.e., capacity) and in various activities and settings
  • Executive or self-regulatory control over cognition, language, and social skills functioning
  • Modification of cognitive and communication demands to facilitate better performance
  • Modification of communication and support competences of relevant people in everyday environment
  • Development and use of effective compensatory strategies and techniques
  • Development of plans for problems other than cognitive communication that may co-occur with the disorder
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6
Q

Cognitive Rehab Therapy (CRT)

A
  • CRT dates back to World War I with soldiers and civilians being treated for TBI
  • CRT became more popular in 1970’s demonstrating higher survival rates for those with severe TBI
  • CRT became a part of rehab services in the 1980’s
  • Evidence demonstrates positive efficacy for effectiveness of CRT for individuals with TBI
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7
Q

Definition of Cognitive Rehabilitation

A

”Cognitive rehabilitation is a systematic, functionally orientated service of therapeutic cognitive activities, based on assessment and understanding of the person’s brain behavior deficits. Services are directed to achieve functional changes by (1) reinforcing , strengthening, and reestablishing previously learned patterns or behavior, or (2) establishing new patterns of cognitive activity or compensatory mechanisms for impaired neurological systems.” - Harley et al., 1992, p. 63; Institute of Medicine (IOM), 2011.

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8
Q

Categories of CRT Approaches

A

Restoration
Compensation
Calibration

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9
Q

Restoration

A
  • Seeks to improve, strengthen, or normalize an impaired cognitive function
  • Repetition and drill or exercise-like activities targeting cognitive processes that gradually increase in difficulty and demand
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10
Q

Compensation

A
  • Seeks to provide alternative strategies for completing everyday activities, despite residual cognitive deficits
  • External and internal approaches
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11
Q

Calibration

A
  • Seeks to refine awareness and self measurements of cognitive performance and use that information to shape behavior after TBI
  • Often used in treatment that focuses on metacognition and executive function.
  • Offline awareness (metacognitive awareness) is prior to task completion
  • Online awareness is how effective the individual conceptualizes and evaluates the task (anticipatory awareness) and the self monitoring skills of error recognition and adjustment of performance accordingly (self—regulation)
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12
Q

Incidence and Prevalence of TBI

A
  • 27 million new cases worldwide (2016)
  • Prevlanece is higher for males
  • 15% of full time workers suffering TBI will not return to wrok 4 years later
  • 40% have neuropsychological needs 1 year post injury
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13
Q

Risk Factors of TBI

A
  • Males > females (at least 2:1)
  • Low SES
  • Unemployment
  • Participation in certain sports/activity-duty military
  • Recurrent TBI
    • Those with a TBI are three times more likely to get a second TBI
  • Low education level
  • History of alcoholism/drug abuse
  • Comorbidiy and prescription drug use
    • diabetes, cardia arrhythmias
  • Ethnicity
    • ER visits highest for AA and caucasions
  • Age
    • Children 0-4
    • Adolescent ages 15-25
    • Adults over 65
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14
Q

Leading causes of TBI in the US

A
  • Falls: 40.5%
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15
Q

The levels of severity (DOD)

A
  • Mild TBI
  • Mild TBI/Concussion
  • Moderate TBI
  • Severe TBI
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16
Q

Two types of TBI

A
  • Open head injury
  • Closed head injury
    • more frequent
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17
Q

Neurophysiology and cell death following TBI

Cellular

A
  • Following concussion
    • immediately post injury
    • Disruption of ions, potassium going out of cell while sodium and calcium flood into the cell (AP)
    • Glutamate is released
    • Because of the dysfunction in the sodium-potassium pump and a higher level of glutamate results in toxicsynapses and slowed communication between neurons
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18
Q

Neurophysiology and cell death following TBI

Diffuse axonal injury (DAI)

A
  • Gradient from peripheral hemispheres to deeper parts of cerebrum
    • corpus callosum and dorsolateral midbrain
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19
Q

Neurophysiology and cell death following TBI

Gliosis

A
  • phagocytes permeate area and are in charge of disposing nonfunctioning tissue
  • glial cells then permate the area that was vacated
  • provide nutrients for regenerating axons or form scar tissue
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20
Q

Know that neuroplasticity occurs in adult brains

A
  • neuroplasticity is greated during development of immature brain
  • overwhelming evidence that neuroplasticity occurs in injured and non injured adult brains
  • What helps?
    • rehab techniques SLPs can do
    • medical interventions
      • neuroprotective
      • pharmacotherapy
      • regeneration
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21
Q

Neurobehavioral concerns

A
  • recovery follows predictable pattern
  • Personality changes
    • apathy
      • 20-72%
      • dimished goal-directed behavior
      • diminished emotions
      • more common in individuals also diagnosed with depression
      • 4 subtypes
        • cognitive
        • motor
        • sensory
        • affective
  • Impulsivity
    • increased irritability
    • verbal and physical aggression
    • Loss of temper
    • impatience
    • poor decision making or judgment abilties
  • Neurobehavioral changes after TBI are influenced by..
    • nature and location of injury
    • social support system
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22
Q

Types of Behaviors…

A

Transient - temporary
Modifiable - therapy to correct
Chronic - teach compensatory strategies

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23
Q

Psychiatric disorders

A
  • After TBI the rate of developing new psychiatric disorder is 48%
  • mood, anxiety disorders and psychotic syndromes
  • substance abuse can occur 12-22%, general population is 15%
  • Depression
    • most diagnosed psychiatric disorder after TBI
    • 49% of TBI population
      -Post traumatic stress disorder
    • frequently for military population
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24
Q

Physical Changes (somatic)

A
  • can be temporary or long term (chronic)
  • trauma to cranial nerves
    • facial nerve (CN VII) and vestibucochlear nerve (CN VII) are common after TBIs
  • headache
  • fatigue
  • seizures
  • sleep disturbances
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25
Q

Emotional changes

A
  • fatigue
  • insomnia or hypersomnia
  • daytime sleepiness
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26
Q

Cognitive changes

A
  • difficulties with..
    • orientation
    • arousal
    • attention
    • speed of processing
    • memory
    • abstract reasoning
    • visuospatial perception
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27
Q

Pretraumatic amnesia

Memory

A

(retrograde)

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28
Q

Posttraumatic amnesia

Memory

A

anterograde

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29
Q

Memory deficits

A
  • Pretraumatic amnesia (retrograde)
  • Posttraumatic amnesia (anterograde)
  • Retrospective
  • Declarative
    • Episodic
    • Semantic
  • Procedural
  • Prospective
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30
Q

Executive functioning deficits

A
  • Goal setting
  • awareness of self
  • initation of goal-directed behavior
  • sequencing
  • planning
  • organizing
  • monitoring and controlling behavior
  • problem solving
  • self-evaluations
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31
Q

Other TBI concerns

A
  • speech conerns
  • swallowing concerns
  • visual concerns
32
Q

Stages of consciousness and self-awareness

A
  • Vector 1: consciousness counts as wakefulness
  • Vector 2: Self-awareness of “me” and “now” - egocentric
  • Vector 3: Consciousness as mental state of ToM
33
Q

Communication and behavioral consequences

A
  • language: most often WNL, however, typically every move of communication is affected in varying degrees
  • Attention: difficulty understanding complex spoken and written directions.
  • Perception: decreased acuity or increased sensitivity in vision, hearing, and or touch
  • Reasoning: deficits in executive function
34
Q

Language Production Deficits

RHD vs TBI

A
  • Language: RHD - Non-literal language, humor, multiple interpretations, TBI - Non-literal language, humor
  • Prosodic Defecits: RHD - Aprosodia (expressive and/or receptive), TBI - Interpreting emotional prosody
35
Q

TBI: Pattern of Recovery

A

Stair-step pattern of recovery and plateau

36
Q

Persisting symptoms of Mild TBI

A
  • Cognitive: attention, concentration, memory, processing speed, judgment, executive function
  • Behavioral/emotional: depression, irritabilty, anxiety, aggression, impulsivity, agitation, apathy
  • Physical: sleep disturbance, fatigue, impaired balance, dizziness, nausea
37
Q

Persisting symptoms of moderate - severe TBI

A
  • Emotional: depression, anxiety, irritability
  • Behavioral: Impulsivity, disinhibition, apathy, socially inappropriate behaviors
  • Cognitive: attention, processing speed, executive functioning, memory
    ▪ Associated with severity, with more severe TBI increasing risk for more global/pervaisve impairment
  • Physical: motor/sensory deficits, balance/coordination problems
38
Q

Recovery Period mTBI

A
  • Latest research states the trajectory for recovery as
    • Recovery for adults happens within 14 days post injury
    • Recovery for children happens within 1 month post injury (Guerriero et al., 2015)
      ▪ Across the TBI population, up to 40% or mTBI patients experience persistent symptoms several months to
      years
39
Q

Prognosis indicators

A
  • Loss of consciousness (LOC)
    • Duration
    • Glasgow coma scale measures coma and impaired consciousness
  • Post traumatic amnesia (PTA)
    • Retrograde amnesia
    • Anterograde amnesia
    • Duration
    • Galveston orientation and amnesia test (GOAT)
40
Q

Outcome measurements

A
  • Glasgow coma scale
  • Functional independence measure (FIM)
  • Functional communication measure (ASHA)
  • Rancho Los Amigos Scales of Cognitive Level
41
Q

Considerations for assessment

A
  • Injury severity
    ▪ Probably won’t work on memory with a client with a severe TBI
  • Poor performance on formal and informal assessment measure may mean there are motor or sensory-perceptual
    problems, pre-existing academic difficulties, or emotional-behavioral deficits
  • Use scales, during the acute stages of TBI, a person can dramatically change performance
  • TBI patients tend to perform better within structured tasks in a clinical setting than they do in the real world
  • We need assessments that reflect functional performance
  • TBI patients tend to perform better within structured tasks in a clinical settng than they do in the real world
    • We need assessments that reflect functional performance in the real world
  • Interprofessional collaborations may really help evaluating and documenting deficits following a TBI
  • Always better to have a team when working with a TBI
    • Interdisciplinary collaboration
  • Depression or anxiety
  • Side effects of prescription drugs
  • Repetitive brain trauma
  • Periodic, ongoing assessment
42
Q

What is included in a comprehensive exam?

A
  • Nature and onset of TBI and related hospitalizations
  • Medical status-current and prior to injury
  • Current medication
  • Review of auditory, visual, motor, and cognitive status
  • Review of emotional and mental status
  • Educational and occupational background
  • Reported areas of concern
  • Language used in contexts of concern
  • Impact of current condition on the individual and their family/caregivers
  • Goals and priorities of the individual and their family/caregivers
43
Q

Preferred practice patterns of cognitive-communication assessment include

A
  • Relevant case history
    • Medical status, education, vacation, and socioeconomic, cultural and linguistic background
  • Review of auditory, visual, motor, cognitive, and emotional status
  • Patient/client reports of goal and preferences, as well as domains and contexts of concerns
  • Standardized and/or non-standardized methods selected with consideration for ecological validity
  • Follow-up services to monitor cognitive-communication status and ensure appropriate intervention and support for
  • individuals
44
Q

What is included in functional assessment measures

A

Observational Reports
▪ Can assess general behaviors (e.g., alertness, restlessness) during standardize assessments, stimulated
situations, or real-world situations
▪ Can get a better picture of the person’s functional skills and can help detect subtle deficits that may not have
been identified in standardized assessment
Discourse Analysis
▪ Approach to identify subtle deficits
▪ Can measure various areas of deficits such as those less likely to be affected in TBI (e.g. topic
maintenance) to those likely to be affected (organization)
Functional, Personally Relevant Tasks
▪ Determines competency when standardized assessments do not exist for a particular skill
▪ Identify unique demands of a client’s personal contexts
▪ Describe performance within natural contexts
▪ Evaluate the effectiveness of potential supports to enhance competency

45
Q

Aspects of assessment for attention and processing speed including functional tasks

A
  • Observation
    • Specific time periods
    • Use of logs
  • Self-assessment
    • Knowledge
    • Attributes
    • Emotion
    • Impact
46
Q

Functional assessment tasks for attention

A

Sustained attention
▪ Engage in familiar tasks in a quiet environment
Selective attention
▪ Engaging in tasks like sorting, etc in a visually and auditory distracting environment
* Performing “I spy” or “where is waldo?”
Alternating attention
▪ Engage in either sustained or selective attention tasks but switching between them
Alternating between preparing a meal and doing laundry
Divided attention
▪ Engage in two tasks at a time
* Balancing a checkbook or pay bills while engaging in conversation

47
Q

Aspects of assessment for memory including functional tasks

A
  • Ongoing self-assessment
    • journal or log about memory performance
  • Observations
  • recording memory success and lapses
  • Direct Measures
  • california auditory verbal learning test
  • contextual memory test
  • Questionnaires/Rating Scale
  • cognitive failures questionnaire
48
Q

Aspects of assessment for memory including functional tasks

A
  • Ongoing self-assessment
    • Journal or log about memory performance
  • Observations
    • Recording memory success and lapses
  • Direct Measures
    • California auditory verbal learning test
    • Contextual memory test
  • Questionnaires/Rating Scale
    • Cognitive Failures Questionnaire
49
Q

Early Assessment Techniques

A
  • Posttraumatic amnesia (PTA)
    • The Galveston Orientation and Amnesia Test (the GOAT)
50
Q

Standardized Assessment Measures

A
  • Adequacy of measures when used in isolation is substantially lacking
  • Screening Tools
    • Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), St. Louis University Mental Status Examination (SLUMS)
    • Brief assessments – Cognitive Linguistic Quick Test-Plus (CLQT+), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
51
Q

Functional Assessment Measures

A

May include observational reports; discourse analysis; and completion of functional, personally-relevant tasks that may or may not reflect a set of standardized objective procedures

52
Q

Observational Reports

Functional Assessment Measures

A
  • Can assess general behaviors (e.g., alertness, restlessness) during standardize assessments, stimulated situations, or real-world situations
  • Can get a better picture of the person’s functional skills and can help detect subtle deficits that may not have been identified in standardized assessment
53
Q

Discourse Analysis

Functional Assessment Measures

A
  • Approach to identify subtle deficits
  • Can measure various areas of deficits such as those less likely to be affected in TBI (e.g. topic maintenance) to those likely to be affected (organization)
54
Q

Functional, Personally-Relevant Tasks

Functional Assessment Measures

A
  • Determines competency when standardized assessments do not exist for a particular skill
  • Identify unique demands of a client’s personal contexts
  • Describe performance within natural contexts
  • Evaluate the effectiveness of potential supports to enhance competency
55
Q

Direct Measure of Social Communication

A

The social communcation skills questionnaire (SCSQ)

56
Q

What is CTE? (Chronic Traumatic Encephalopathy)

A
  • Sports related brain injury
  • develop dementia
  • Behavioral and mood changes
  • Neurodegenerative Condition
  • Tau proteins
  • Symptoms include
    • Cognitive
      • Superior frontal lobe
      • imigdula
      • Mama Larry bodies
    • Behavioral
      • Compensatory strategies
    • Psychiatric
    • Motor (pyramidal and extrapyramidal)
57
Q

Principles of cognitive rehabilitation

A
  • Clients collaborating with clinicians – client centered
  • Errorless performance
  • Ongoing self evaluation
  • Striving for effortless behavior
  • Capitalizing on Implicit Processes Through Errorless Learning
  • Person-Centered Rehabilitation
  • Awareness Deficits
  • The Challenge of Generalization
  • Its really hard to generalize, it is good to target specific area at the impairment level
58
Q

Spaced Retrieval

cognitive rehabilitation

A
  • Takes advantage of preserved implicit memory process through EL (errorless learning) and large amounts of practice
  • Patient provided with maximal support beginning of treatment through EL and large amount of practice
  • Timed intervals of interference double if individual is accurate, if not accurate clinician models correct answer and reduces length of interference by 50% until patient is correct
59
Q

Direct instructions

cognitive rehabilitation

A
  • Analyzes contents for ideas, rules and generalizable strategies
  • Identifies needed skills and sequences skills hierarchically
  • Performs task analysis
  • Identifies, sequences generalizable examples
  • Simplifies instruction, including scripts
  • Identifies simple learning objectives
  • Establishes high levels of criteria
  • Focuses on prerequisite skills first and immediate feedback through modeling, prompts and cues to an EL level
  • Provides large amounts of massed, then distributed practice
  • Provides individualized instruction to target weakness and identify strengths
  • Engages in cumulative review
  • Provides ongoing assessment
    • Important to do every 30 days
60
Q

Metacognitive instruction

ognitive rehabilitation

A
  • similar to DI but addition and emphasis on self-monitoring and self control during strategy acquisition
  • Important for TBI patients with frontal lobe injury and executive dysfunction, they have difficulty with:
    • Setting goals
    • Comparing performance with goals and outcomes (self monitoring)
    • Making decisions to change behavior to reach desired goal (self control)
    • Executing the change in behavior
61
Q

Creating Positive Routines

ognitive rehabilitation

A
  • Practice routines with patients that apply to their daily lives
62
Q

What is patient centered care?

A
  • Collaborative partnership
  • Taking the clients needs/wants and needs/wants of their caregivers into consideration
  • Think of patient’s own knowledge regarding their deficits
63
Q

Continuum of care – the difference between settings

A
  • Emergency Medical Services
    • Ensure patient stabilized and prevent further neurological damage
    • Surgery, medications
  • Acute Care
    • Optimize patient’s medical condition, conduct further diagnostics, surgical, or medical interventions needed to further stabilize
  • Acute Rehabilitation
    • Focuses on relearning basic skills for everyday living
  • Subacute Rehabilitation
    • Maximize recovery and ensure safest, most active lifestyle possible when individual goes home and into community
    • Not everyone goes to subacute – depends on the client, level of care, caregivers
  • Neurobehavioral Unit
    • Highly specialized treatment to assist individuals after an injury and adapt to less structured environments
  • Outpatient Rehabilitation
    • Maximize recovery through ongoing support from a variety of agencies and medical professionals
  • Vocational Services
  • Reeducation, training, and worksite-related services
  • After receiving outpatient rehab
  • Specific to getting back to work
  • Community-based Services
    • Continued and ongoing care and supports utilized in tandem with or after formal rehabilitative care
64
Q

Types of medical intervention

A
  • Neurosurgical intervention
  • Pharmacological Intervention
  • Complementary/Alternative Medicine and Neurotherapy
65
Q

Why is it important for the patient to be included in treatment?

A
  • gold standard of care
  • an increase in response to intervention
  • improvement of overall patient satisfaction with outcomes of intervention
  • make the patient understand that they can get better
66
Q

Cognitive-communication intervention should address what?

WHO-ICF

A
  • Capitalize on the strengths of the patient to address the weaknesses
  • facilitate individual’s activites and participation level by assistig with acquiring new skills and strategies
  • Modify contextual factors that are barriers of and facilitators to successful communication and participation
67
Q

How should intervention be designed?

A
  • Capitalize on the strengths and address the weakness related to underlying structures and functions that affect communication
  • fascilitate the individual’s activities and partcipation by assisting the person to acquire new skills and strategies
  • modify contextual factors that serve as barriers and enhance facilitators of successful communication and participation, includingdevelopment and use of appropriate accommodations
  • measurements of CRT effectiveness are also predicted on demonsrating clinically meaningful changes across the categories of the WHO ICF
68
Q

Categories of CRT approaches

A
  • Restoration: seeks to improve, strengthen, or normalize an impaired cognitive function
  • Calibration: seeks to refine
  • Compensation: seeks to provide alternate strategies for completing every activties
69
Q

Goal Management Training (GMT) for executive function skills

A
  • recommended in the post-acute stagies after TBI
  • Candidacy recommendations: individuals who evidence executive function deficits, such as impaired planning, decision making, and self-regulation and individuals who have sufficient cognitive, sensory, and motor function to engage in therapy and assessment tasks
70
Q

SMART

Goal Management Training

A

Are to teach metacognitive strategies in order to improve cognitive functions such as strategic attention, integrative reasoning and innovation

71
Q

SMART treatment in action

3 phrases

A
  • strategic attention: reduce the load of incoming details by inhibiting less relevant information
  • integrated reasoning: having patient combine important facts by integrating the explicit content with preexisting form knowledge to form more global, gist based representations
  • Innovation/cogntiive flexibility: teaching patient the process of evaluating the information from different perspectives
  • Can be used in group or individual therapy
72
Q

Construction Feedback Awareness Training

A
  • Recommended in post-acute stages after TBI for individuals who demonstrate impaired self-awareness following TBI, individuals who have sufficient cognitive, sensory, and motor function to engage in therapy and assessment task
73
Q

Social Communication Training

Group based applications

A
  • Recommended in the post-acute stages after TBI for individuals who experience difficulties in social communication in real-world contexts
  • Treatment that will focus on the communication partner
  • Individuals whose memory/cognition, speech/language/ and behavior are sufficient for successful participation in a group context
  • short evidence
  • SCT employs techniques such as feedback, self-monitoring, modeling, behavior rehearsal, role-play, and social reinforcement
74
Q

Social Communication Training targets?

A
  • discourse
  • pragmatics
  • conversation
  • social communication
  • non-verbal communication
75
Q

Social communication training: 3 key components

A
  • Co-group leaders from different clinical backgrounds should be used
  • An emphasis on self awareness and self assessment
  • Use of the group process to encourage interaction, feedback, problem solving, a social support system, and awareness that they are not alone

spa 775 (3 decks)

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