12: Cognitive Rehabilitation - Attention Flashcards
Why is attention a foundational skill?
it underlies/supports all other cognitive abilities
What are 4 methods of attention rehab?
1) Behavioral Therapy (early TBI)
2) Direct attention training
3) strategy training (metacognitive)
4) environmental modification and external aids
What is bheavioral therapy?
focus on direct modification of abnormal behaviors using stimulus control, reinforcement, and punishment
What is direct attention training
A restorative component approach that trains sustained attention
What is strategy (metacognitive) training?
a compensatory strategy
What does research say about strategy training?
more benefit for complex tasks that require attention regulation, fewer for basic aspects of attention
What does research say about acute stages of treatment?
inssufficient evidence to seperate effects of specfic training vs spontaneous recovery
What does research say about computer attention training
Can be used as supplement, but not only treatment
What are prinicples of attention rehab?
1) should work from a theoretical model/framework
2) tasks should be hierarchically organized
3) repetition is essential but supplement with strategy training
4) real world application is key
5) record performance with treatment decisions in mind (accuracy and speed)
How is attention affected in TBI/Rt CVA? (4)
1) all aspects can be impaired
2) unable to complete formal diagnostics secondary to attentional impairments
3) may have intact attention during simple/daily routines
4) demonstrate deficits in demanding tasks or distracting environments
Rancho Levels 2-3
- __________ __________
- _________ attention
- Sessions?
- GOAL = (3)
- sensory stimulation
- focused attention
- several short 10-15 min daily
- 1) increases alertness/response to environment, 2) increase consistency and specificity of response, 3) SLPs train others how to do this
What is coma stimulation?
the application of enviornmental stimuli to attempts to heighten arousal and elicity meaningful beahvorial responses
What is the theory behind coma stimulation?
environmental enrichment prevents sensory deprivation
Who is coma stimulation done with?
Coma/severe TBI
GCS < 10
Rancho 2, 3
What would be in a coma stimulation kit? (5)
1) visual (flashlight, favorite photos, familiar faces, mirror)
2) auditory (music, audiobooks, familiar voices)
3) olfactory (coffee, oranges, perfume)
4) tactile (stuff bristle brush, fur, hot/cold packs)
5) kinesthetic (passive ROM)
*use items of personal relevance when possible
What are 5 strengths of coma stimulation?
1) low risk
2) low cost
3) stimulates all senses
4) family participation
5) can be meaninful
What are 3 weaknesses of coma stimulation?
1) class III evidence (small studies, weak methods)
2) increased arousal doesn’t necessarily correlate with improved vigilance
3) questionable outcomes with individuals in persistent vegetative states
Rancho Level 4:
- What is done to reduce confusion, disordiention, and control innapropriate bhevior?
- _____________ treatment
- _____________ management
- works best with what type of consequences?
- environmental control
- behavioral
- pharmacologic
- tangible, primary (food, music, massage) consistently following occurrence of targeted behavior
What are environmental modifications that may occur for Rancho Level 4?
Acute?
Chronic?
Acute = caregiver directed Chronic = goal is patient directed
Enviornmental modifications are ____________ in nature. What are some examples?
compensatory
avoid crowds, silence phone, manage fatigue, use noise cancelling headphones, etc
The use of enviornmental control does what?
creates maximally stable and predictable surroundings
ex: therapy, meals, and family visits scheduled at consistent times
What are the 2 types of orientation training/drills?
1) passive
2) active
Passive orientation drills are used for what patients?
immediate post coma phase
Ranchos 3, 4, and 5
Passive orientation drills help orient the patient to what? (4)
1) who they are
2) where they are
3) why are they here
4) current hour, day, month, and year
What is active orientation training?
Pt given responsibility for carrying out daily life activities that involve orientation (e.g., know therapy schedule, know when to go to lunch, know when their fav tv show is on)
Rancho Levels 5 and 6
- focus on increasing patients what?
- simulating basic what? (3)
- goals (3)
- control over immediate environment
- cog skills, motor func, sensory func
- 1) reestablish basic selfcare skills, 2) improve orientation, 3) reestablish functional communication
What is component/direct training?
1) when to start it?
2) goal
3) start focusing on what?
1) when less agitation and disorientation, ranch 6 and 7 (some 5)
2) facilitate cog processes by drill
3) cog processes (att, mem, lang, comm)
What is attention process training (APT) (sohlberg and mateer)
treatment program developed tasks in heirarchy for each component of attention
What are tasks in APT?
shape/number cancellation
addition/subtraction flexibility
listening for specific number/letter orders
What pt population would APT be used with?
mild to severe TBI and stroke
What are strengths of attention process training? (4)
1) ease of admin
2) clear and concise
3) easy to monitor progress
4) different levels of difficulty
What are weaknesses of attention process training? (4)
1) limited generalization
2) not functional
3) supplementation with other methods warranted
4) predictable and can improve with practice vs. attentional improvements
What are areas of APT generalization activities?
1) sustained attention
2) alternating attention
3) selective attention
4) divided attention
What are higher and lower level APT generalization activities for sustained attention?
lower: listen for target words or sequences
higher: cooking, child care, cleaning, typing, stocking shelves, paperwork, data entry, driving, completing a list of errrands
What are higher and lower level APT generalization activities for alternating attention?
lower: listening for one word then switch to listening for another word, paper/pencil task requiring alternating addition and subtraction
higher: bookwork with phone interruptions, housecleaning with child care responsibilities, stocking shelves with interruptions from customers
What are higher and lower level APT generalization activities for selective attention?
lower: any of above tasks while introducing distractions
higher: household chores with tv on, doing puzzles with background conversations, eating at a busy/loud cafe
What are higher and lower level APT generalization activities for divided attention?
lower: reading paragraph for comprehension and simultaneously scanning for a target word
higher: getting your toddler dressed while talking on the phone, getting directions from maps while driving
Rancho Level 7
- treatment of cognitive skills including what?
- what might become apparent at this level
- start teaching what?
- att, memory, planning, organization
- cog impairments may not improve with direct treatment
- teaching compensatory strategies
Rancho Level 8+
- _______________ strategies
- facilitating what for the patient?
- compensatory
- reentry to family/community/school/work environments
What are the findings about training specific skills (e.g., making a cup of coffee)
may be more effective treatment forms
How should self-management strategies be used?
in combo with other approaches
What are some types of self-management strategies? (2)
1) self-pacing to limit fatigue
2) orientation strategy to reduce lapses in attention
What is neglect and what does it require?
unawareness often exhibited in the acute state, requires team approach
What are treatments for neglect (3)
1) visual scanning strategies
2) “anchoring” training pt to look to the left
3) “lighthouse strategy”
What are principles of visual scanning training?
1) locus of the stimulus
2) anchoring
3) pacing
4) density
5) information load
6) performance prediction and feedback
What is required for systematic and orderly scanning training?
1) establish pt understanding of the problem
2) gather and prepare materials
3) training in single stimulus visual cancellation
What is the next step of systematic and orderly scanning training once drill has been mastered?
can move to more functional tasks, reading, writing, describing pictures
What are examples or functional applications of systematic and orderly scanning training
puzzles, simple board games, describing a scene/room
