Week 2 Flashcards
(75 cards)
1
Q
Testing steps: diagnostic cycle
A
Not exclusively used for neuropsychology.
1. Complaints analyses
2. Problem analysis
3. Diagnosis
4. Indication for treatment
You can start de cycle again (or a colleague) when stage 4 is not yet possible to achieve.
Check complaints problemen, dan diagnose indicatie
2
Q
Phase 1
A
- informant information: referral question + problem definition
- this need to be well-defined
- discussion in multidisciplinary team
- neuropsychologist thinks of additional questions (for example is there also a sleeping disorder?)
- patient (and close ones) information
- information that is asked: origin, nature, course, severity of complaints + impact on daily
functioning) - the neuropsychologist also asks questions to get an impression premorbid level of functioning
(education, work, social) - it will always start with open questions (if the patients can’t answer open questions this is also
information about what is going on with the patients!) - observation: physical appearance, how the patient makes contact, language, memory, attention,
awareness of illness and insight into own functioning, mood, motivation to be tested.
3
Q
Phase 2
A
- Using neuropsychological tests: both using computer and paper-and-pen tasks
- Screening tests
- Standardized test batteries (IQ-test)
- Tests on one cognitive function (e.g. Montreal Cognitive Assessment, MOCA)
- Behavioral neurological tests
- Self-assessment questionnaires
- Informant questionnaires
- Observation scales (the informant or nurses fill this in)
- Additional standardized questionnaires: Personality traits, Styles of coping and Mental
complaints (e.g. depression or anxiety)
4
Q
Phase 3
A
- Integration of data; are the test-results abnormal?
- Are the test results reliable and valid? (test situation)
- Is the test reliable and valid? (psychometric properties of test)
- Additional observational test information (how is the test performed e.g. motivation or someone
had to do the test with a non dominant arm due to injury or someone could have done better if
someone was given more time) - Reporting: Professional code (e.g. writing it down in respectful and reliable way), written,
verbally giving the information to the patient, monodisciplinair and multidisciplinair. - The patient can say he or she doesn’t want the report going the the GP or in record.
5
Q
Reliability
A
- Reliability: accuracy of the instrument
- Test-retest reliability (same results when testing the same patient at a different time)
- Inter-rater reliability (in which degree correspond the results between different researchers)
6
Q
Validity
A
does the test measure what it should measure?
7
Q
Face validity
A
The extent to which a test initially seems the measure what it is suppose to measure
8
Q
Content validity
A
The extent to which a test is representative of the topic that you want to measure
9
Q
Construct validity
A
The extent to which the result of the test actually reflect the funtion you want to measure
10
Q
Criterion validity
A
The extent to which a test can predict the performance of a patient. Tests are giving in an optimal situation, so it doesn’t reflect real life functioning BUT other people say that if someone can’t perform well on a test, you also can’t in real life, so it is predictive THRUTH is possibly in the middle
11
Q
During neuropsychological assessment look out for:
A
Confounding factors
Underperformance
12
Q
Confounding factors
A
- Sensory impairments (e.g. vision or hearing problems)
- Language barrier
- Illiteracy
- Fatigue
- Pain complaints
- Emotional state
13
Q
Underperformance
A
- Suboptimal performance: within the situation someone couldn’t give the effort to perform
optimal (e.g. when patient has burn out). - NOT same as simulation! But simulating also leads to underperforming. Simulation is when
someone purposely performs badly. - Underperforming gets in the way of correct diagnoses, but can also support a diagnosis.
- Answer: symptom validity tests (easy tasks that would be complicated for someone who has less
effort available).
14
Q
Is brain damage curable?
A
No but it is treatable
15
Q
What is recovery about?
A
Recovery is not about going back to the same person you where before, but dealing with the adjustments to be made to your new life
16
Q
How does recovery typically look like?
A
After sustaining a brain injury, some degree of spontaneous recovery is possible: it depends on the severity, location and type of the brain injury
- The majory of patients are left with permanent neurpsychological disorders with drastic consequences for their everyday life
17
Q
Most of the recovery happens in …….
A
the first 3-6 months.
After a year recovery can still happen, but more psychological than neurologically
18
Q
How does recovery work in the brain?
A
Mostly because of neuroplasticity
- the ability of the brain to modify itself functionally or structurally in response to injury or under the influence of stimulation and treatmetn
19
Q
structural plasticity
A
When experiences or memories can change the brains physical structure
20
Q
Functional plasticity
A
When brain functions move from the damaged area to an undamaged area
21
Q
There are different types of recovery
A
- spontaneous recovery
- Experience - dependent learning
22
Q
Spontaneous recovery
A
Changes in the brain in response to the injury occur on neuronal level due to
- diffuse and redundant connectivity: following injury, recovery takes place by activating other areas within a network
- cortical reoganization: new structural and functional connections between corticol areas take over
Non-invasive brain stimulation (TMS) stimulates or inhibits specific areas
- small short term effects, limited efect on long term or daily life
- may be a future add-on-therapy
- was first believed to not be useful for rehabilitation (research shows otherwise)
23
Q
Experience - dependent learning
A
- the brain of london taxi drivers, compared to bus drivers, have large neurological differences in areas associated with spatial memory. (neurons that fire together, wire together)
24
Q
Use it or lose it
A
Refers to the fact that if an affected limb is not used regularly, the ability of that limb will be lost entirely.
How is this idea applied in practice:
- blind able arm behind back
- setting homework goals
- rewards as reinforcements
25
How can recovery be stimulated?
- use it or lose it
- salience matters
- repetition, intensity and time matters
- age matters
26
Salience matters
refers to the fact that relevant and important experiences are better processed
How is this idea applied in practice?
- make a game a fun competition
- telling patients why a movement is relevant for example
27
Repetition, intensity and time matters
especially in the first few weeks and months following the injury
how do you keep patients exercising?
- give them homework
- involve the family
- group classes to save time
28
age matters
plasticity occurs more readily in younger brain
- cognitive deficits only become visible when more complex cognitive skills are needed: so sometimes deficits are missed in young children. When they grow older, they may grow into these deficits and need help with those
Outdated Kennard principle: there is better recovery at a young age (false)
29
Are the physical deficits experienced are less bad or the lifestyle/psychological deficits?
The physical deficits are experienced as less bad
30
What does the ICF model do?
international classification of function
- describes all the factors in a person's life and how they may be affected after an injury or how they could affect the recovery
31
How can function training be related to the ICF model
recovery of cognitive functions occurs through repeated exercise. Drill and practice
- relates to the body structure and function part of the model
- this works to a certain amount, but does not extend far: large effectiveness has never been demonstrated, and it almost never generalises to daily life
- you can with this training improve in specific areas but not all
32
How can generalisation related to the ICF model
applying what is learned to daily life
- related to the body and function part of the model
- near transfer: task is strongly related to trained/task content
- far transfer: task/context/domain is different to trained task/context
- this can be difficult for people with brain injury, as learning depends on intact cognitive functions and these are impaired
33
How can compensatory approach relate to the ICF model
Learning strategies to compensate for cognitive impairments
- related to the activity/participation part of the model
34
Skill training
training skills at task level through repeated exercise
* Not aimed at improving underlying cognitive function; you learn to compensate for a task.
35
Strategy training:
training skills that apply in multiple tasks where cognitive function is called upon (e.g. learning step by step how to plan)
- when cognitive ability is not too impaired
36
environmental adaptation
adapting the environment to disabilities or cognitive impairment
- easiest step (simple signs of where the toilet is)
37
Stimulus response conditioning
A limited routine is triggered by a stimulus
- second step (putting clothes in the right order on the bed might help a person getting dressed)
38
What are all the factors in the ICF-model
health condition
body structure and function
activity
participation
environmental factors
personal factors
39
ecological validity
The degree to which a test predicts a patients functioning in his usual environment.
Important to note: a test measures what it is supposed to measure (face validity) does not automatically predict the patient functioning in daily life
40
anosognosia
not even being aware of the disease
41
neuropsychiatric model
examining the relationship between brain, cognition, emotion and behavior. Also look at a personality assessment of specific research into the nature of psychiatric disorders
42
The neuropsychological examination
1. aim of assessment (referral question)
2. patient file investigation (with medical and psychiatric history + previous psychological examinations)
3. formulation hypotheses
4. compiling a specific set of neuropsychological tests and questionnaire
5. clinical interview about the course, extends, and limitations of the complaints, andhow they affect daily activities, mood, sleeping etcetera
6. take an interview with an informant (often family member)
7. if needed adjust previously compiled set of tests and questionnaires
8. psychometric test
9. observation of tests
10. finally -> the information from all these sources is combined and weighted, resulting in a conclusion that answers the referrer's question and gives recommendations
43
sometimes they use standardized tests to measure cognitive functions, however it is better to..
tailor tests to the individual
44
patients can help by telling complaints, but what is the downside of this
compaints can be caused by something different than what they are mentioning
45
test-retest reliability
indicates to what extent the test results for the same patient but at different times are the same.
46
Inter-rater reliability
the extent to which different assessors of a test record the same results
47
multivariate normative comparisions
compare the entire profile of a patient's test scores with a group of healthy controls
48
what are we using now as a label for norming
Gaussian/normal distribution, ranging from 'exceptionally high' to 'above average, high average', 'average, low average' below average to exceptionally low
49
ethics
responsibility, integrity, respect and expertise
50
Three patient rights:
The right to view the report before it is issued; the right to corrections (in the event of factual inaccuracies) and the right to block the report from being issued
51
What are 2 examplez of disorder that is neurological as wel as non-neurological in which brain damage is not clearly demonstrated or only very subtle?
-Type 2 diabetes.
- cognitive decline during the lifetime and increased risk of dementia and mild cognitive impairment in later life.
(subtle vascular damage that is not always visible in brain scans.
Multifactorial complaints
- pain, fatigue, poor sleep etc.. can all negatively influence cognitive functioning and lead to subjective cognitive complaints in various diseases
52
psycho-education
can help patients and their loved ones understand what is going on and prevent misunderstandings
53
Injury-induced recovery
spontaneous recovery in which changes occur in the brain in response to the injury
54
Spontaneous recovery (injury induced changes) involves...
synaptogenesis (creation of new synaptic connections)
- penumbra (recovery of neurons at the site of the stroke)
- reperfusion (improvement in the blood flow in the penumbra)
55
Thrombolysis
Using blood thinning medication to dissolve a clot.
- often applied after cerebral infarction to limit the damage to the peri-infarct cortex
56
Why is it often difficult to distinguish functional recovery based on plastic changes in the brain from improved functioning
due to behavioral compensation (functional recovery)
improvements can also result from practicing skills in daily life
57
There are two mechanisms that enable recovery on a neuronal level
- diffuse connectivity
- redudant connectivity in our brains
58
diffuse connectivity means
neurons involved in complex cognitive functions are distributed throughout the cortex, so brain signals can be sent through multiple pathways.
eg., a motor pathway is injured, other redundant areas and connections can still control the motor function by using hemispheres.
The activation of intact hempispheres can sometimes get in the way of recovery of the damaged hemisphere (it takes over the functions, so it is used less)
59
cortical reoganization/remapping
sensory and motor signals run through different cortical areas than before, which creates new structural and functional connections between related cortical areas. So, areas with a similar function take ocer the function of the damaged area. Sometimes increased activation in the undamaged hemisphere has a negative effect on functioning
60
Non-invasive brain stimulation
used to investigate whether changes in activation of areas distant from the lesion are beneficial or detrimental to funtion
- transcranial magnetic stimulation
- transcranial direct current stimulation
- transcranial alternating current stimulation
61
transcranial magnetic stimulation
electromagnetic induction causes depolarization and hyperpolarization of neurons in specific cortical areas.
A special coil is placed on your head (over the skull).
It sends out magnetic pulses.
These magnetic pulses create tiny electrical currents inside your brain.
These currents activate or calm down neurons in a specific brain area.
62
transcranial direct current stimulation
A weak direct current is conducted between a positive (makes neurons more active) and a negative (makes neurons less active) electrode on the skull
63
Transcranial alternating current stimulation
Similar to TDCS, but here the direct current is offered at a specific frequency that corresponds to the frequency of electricla activity in the brain itself
64
brain reserve
the individual neuroanatomical differences that can lead to specific structural and functional properties of the brain that preserve cognitive functions despite damage
65
cognitive reserve
refers to the cognitive capacity and skills acquired before a person suffers brain injury
66
In the ICF model functioning is looked at from three levels:
1. the perspective of the human organism (functions and anatomical properties of body systems, involving cognitive functions --> problems in it are 'impairments'
2. the perspective of human actions or daily life --> problems in it are 'limitations'
3. The perspective of persons as participants in social life and society --> problems in it are participation problems
67
why are computer-assisted cognitive brain training benificial?
because they can be adapted to the individual's level of functioning and can be practiced at home too.
68
what is the most effective and widely applicable treatment for cognitive impairments?
learning strategies
69
three learning strategies
- internal: patients learn techniques to support cognitive functions
- external: patients learn to use a tool to support cognitive functions
- metacognitive: patients learns to reflect on their own thinking or cognitive functioning.
70
5 stages of Goal management training:
1. mentally stopping an activity to prepare for a new activity
2. defining the goal related to this new activity
3. dividing the task into steps
4. learning the steps
5. monitoring performance
Stop → Goal → Steps → Learn → Check
You can think of it like:
"Pause. Plan. Piece it out. Practice. Proofread." (making spaghetti example)
71
Function training focuses on.. unlinke function training skills training focusses on...
Function training aims to restore the underlying cognitive function and at generalization
Training skills focuses on teaching the patient the different task-specificic skills.
72
One technique of skills training is errorless learning, what is this
mistakes are prevented during practice (because people with cognitive impairment often don't have the capacity to learn by trial-and-error)
73
In terms of the ICF model, focus is on..
participation
74
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