(A) NeuroCognitive and Behavioral Impairment Flashcards
what are the 5 parts of cognitive function
alertness/orientation attention memory executive function language
what is alertness and orientation
alertness = basic arousal and response to stimuli (first goal w client bc need to be alert to do rehab)
orientation: to time, place, person (Ox3)
what are the 4 different types of attention?
- sustained attention (not getting distracted)
- selective attentnion (focus on1 when many stimuli)
- divided attention (focus on 2 task of equal importance at same time)
- alternating attention (focus on 2 things of equal importance one after the other)
describe the temporal classification of memory
- short term memory: mill sec - 1 sec
- working memory (where ot work the most ): > 1 min
- long term memory: days, month, year
what is executive functionign
high level cogntiive function responsible for the execution of complex task
give example of occupations where executive functioning is needed (adl, iadl, productivity)
adl: feeding, bathing, toileting, mobility, transfer, grooming, shower
iadl: medication, finance, groceries, housekeeping, laundry, making appointment, using phone
prod: school, work, volunterr
what are the steps(6) of executive functioning
- initiation = starting task
- planning: plan steps needed (abstract thoughts for decision making)
- organization/sequencing = execution of task in organized manner
- monitoring = check up while executing task
- adapting (problem solving and mental flexibility): devise new plan based on unexpected event
- evaluating performance (insight/awareness): understand strength, weaknesses
how do you communicate with someone with aphasia?
give time to answer, dont force answer, use concise sentence, give yes or no question, visual cues
what domain does the MOCA screen?
cognitive impairement and mild cogntive impairment
(orientation, short term memory, clock drawing test, exec function, language ability, animal drawing, abstraction, attention)
what domain does the trail making test screen
attention and executive dysfunction (mental flexibility)
what does the bells and apples test screen for?
screen attention
which assessments can be used to screen for executive functions (3)
moca (clock drawing part) and trail making
- functional assessment of them doing a task
what could influence results of cognitive test?
fatigue, mood, length of eval, language, level of education, visual/auditory impairement
name remedial treatment approaches for orientation.
- task oriented: practice walking from room to therapy room (start with more cues then reduce)
- cognitive training
- computer games involving identifying landmarks of navigation
- practice address/full name w cueing
- task related to time in session (at 3 pm ask therapist for medication
name adaptive orientation tx
- use calendar, alarm, clear signs/directions, gps
name remedial - task oriented tx ideas for attention (sustained, divided, selective using cooking soup example)
task oriented approach: practice cooking a soup
- sustained attention:
- focus on 1 task w cueing if they get distracted
- start w more cues
- grade: increase time attention must be focused (more complex meals) - divided:
- focus on>2 tasks (talking whilst cooking, sing to song)
- grade: increase distraction or make 2 nd task more complex (calling to schedule apt whilst cooking) - selective attention
- cooking with many distractions that they need to ignore (tv, music, therapist, phone)
- grade: change amount of distraction
name remedial - cognitive training tx approach for attention
- cueing to remain focuz during any activity (start w many cueing)
- ask client to complete 2 tasks in session of differing or same importance (ex: ask them to sing while practicing dressing)
- create multiple distractions w any task
name adaptive tx for attnetion (4)
- eye contact to encourage focus
- create big point of attention (clapping, speaking loud), reduce extra distraction(quiet room when eating)
- verbal, touching cueing
- automatic turn off appliances
name remedial - task oriented tx for memory
practice grocery shopping without a list but w a number of known items client is told to pick up
- grade: change amount of cueing and item (“do you need butter”)
name remedial - cognitive training tx for memory
- memory games (matching)
- hide and search games where patient is shown where items are hidden
- simon say/repeat game
- mental math (working memory)
name adaptive tx for memory
- to do list
- alarm/calendar
- visual cues (post it, pictures)
- apps (take medication)
name remedial task oriented approach tx for executive functioning.
- complete actual work w more support (visual/verbal cues) (eventually reduce suuport)
- complete tasks (complex meal prep, plan a journey using public transportation, grocery shopping)
name remedial cognitive training tx for exec funtion (4)
- problem solving games (escape room)
- board game that require decision making and adaptaion (monopoly, jenga)
- verbalization of steps of task (verbalize cooking task)
- computer games
name adaptive tx for exec function
- use of decision tree
- take time to reflex on task before starting
- cueing steps (verbal or visual)
what are task oriented and cogntivie trainign tx for insight ie self evaluate how they are doing
feedback videotaping peer group role reversal prediction of ones own performance
name adaptive tx for insight
hide unsafe appliances/tools/car keys
unplug stove
education
name the 8 neuro behavioral impairments
- disinhibition
- impulsivity
- flat affect
- emotional lability
- agitation/aggressivity
- wandering
- perseveration
8 changes in mental health
describe disinhibition
no filter, lack of judgement of what should or should not be said (ex: swearing)
what is impulsivity
doing smthing w/o thinking of consequences
what is flat affect
no emotional output
what is emotional lability
uncontrolled emotional output (cant stop laughing)
what is agitation/aggresivity
rxn of furstration
what is perseveration
continued motor loop (keep eating when no food left)
what steps should be taken when working w someone w behavioral impairments
- understand the cause
- show empathy
- educate family and friends
- disinhibition: tell client what is appropriate or not
- impulsivity: firm and structuring
- perservartion: cue them to next steps
