chapter 6 Flashcards
define cognitive-communication disorder
reduced ability in language skills due to impairments in one or more areas of cognition
Common cognitive communication deficits
-attention
-long-term memory
-dysfunctional behaviors
-poor self-regulation of emotions and behaviors
-limited insight
Attention deficits
difficulty in
-focusing
-easily distracted
-switching tasks
-responding to simultaneously presented stimuli
Long-term memory deficits
Relatively uncommon but could be deficits in learning new info and retaining info about recent events
Dysfunctions behaviors
inappropriate
-time management
-planning daily tasks
-difficulties with maintaining a schedule
Poor self-regulation of emotions and behaviors
sudden or frequent episodes of anger, aggression, possible physical harm
Limited insight
is common among people with moderate to severe TBIs
Characteristics of Cognitive-Communication Deficits
Macrolinguistic Processing
- topic selection and maintenance
- coherence and cohesion
- grammar
- gist comprehension
Topic selection and maintenance
- deficits in selecting a topic
- deficits maintaining a topic
- deficits in appropriate conversational skills
Coherence and cohesion
- deficits in use of certain cohesive markers
–personal pronouns (he, she, it)
–demonstrative pronouns (this/that, these/those)
–conjunctive markers (yet, though, but)
–comparative words (same, equal, similar)
grammar
-deficits in inclusion and formation of key ideas and characters of story
- deficits in story organization
sometimes have adequate knowledge of the characters but may not be able to apply them due to high cognitive load
gist comprehension
- deficits in summarizing a story
- may miss some key take-home messages from a reading
Characteristics of Cognitive-Communication Deficits
Microlinguistic Processing
- verbal processing
- word selection and retrieval
verbal production
- may display logorrhea (compulsive talkativeness)
- may display interruptions initiating and maintaining conversational topics
Word selection and retrieval
deficits with word selction and retrieval are very common in people with TBIs
Characteristics of Cognitive-Communication Deficits
Extralinguistic contributors
- eye gaze
- affect
- gestures
affect
- emotional lability
- pathological laughing/crying
- involuntary emotional expression disorder
gestures
deficits in appropriate use of gestures during conversations
Characteristics of Cognitive-Communication Deficits
Paralinguistic contrbutors
May include changes in the supra-segmental features of language
- vocal tone
- rhythm
- stress
- intonation
Initial assessments of acute care
- Bedside assessments
- Functional assessment
Bedside assessment
very common during the initial stages of hospital admission and may include administration of some of the cognitive screeners
Functional assessment
may use functional assessments (FIM and FAM) to determine the person’s level of functioning with ADLs
Residual deficits
- detailed case history
- self-reports (whenever possible)
- information from close family members
Patterns of Recovey for Mild TBI
- majority of individuals with mild TBIs have relatively uncomplicated recovery and resume premorbid levels of functioning
- there still may be some permanent changes related to one or more areas of cognition
Patterns of Recovery for Moderate to Severe TBI
majority fo individuals with moderate or severe TBIs have more residual impairments that affect their levels of functioning
Initial stages of recovery for mod-severe TBI
- within the first 4 weeks, majority of survivors spontaneously open their eyes and develop sleep-wake cycles
- may not still have any purposeful behaviors or apparent understanding of what is going on around them
- 2% of patients continue to remain in a minimally vegetative state for a year or more
- first signs of recovery= track visual stimuli & orientation to auditory stimuli
- individuals may now begin to respond to some commands and may experience some agitation and restlessness
Middle phase of recovery for mod-severe TBI
- orientation and recent memory may be restored at this point
- deficits in memory and learning may persist
- length of phase varies with the severity of the brain injury
- this stage involves emphasis on training and resumption/stabilization of self-care activities, ambulation, other motor activities
- many individuals with TBI have no or limited awareness of the extent or implications of their deficits or functional impairments
Later Phase of mod-severe TBI
- following discharge from the in-patient rehabilitation, a majority of people with TBI return home or transition to a nursing home or an assisted living facility
- based on the severity of the injury and degree of residual functional impairments, most individuals with mod or severe TBIs are able to redevelop at least some level of independence in self-care
- residual problems are seen in a wide range of areas including attention, memory, organization, and carrying out goal-directed behaviors
Orientation components
- spatial location= current location, city, state, zipcode, room number
- temporal time= day, date, month, year, season, time of day
- self
- time
- situation
- place
If they have PTA this is a factor to consider
Orientation assessments
- Galveston Orientation and Amnesia Test (GOAT)
- Informal questioning
- Cognitive Screeners (MMSE, MOCA)
Treatment for Orientation
- Teach clients to attend to visual and verbal cues
- use of clock, calendars, signs, newspapers, alarms can be helpful
- keeping directions short and to the point
-keeping the treatment environment (room and schedule)
Factors affecting attention
- increased arousal means better attention
Assessment for Attention
- Standardized tests: attention process training, DRS-2, RIPA
- Rating scales/questionnaires: attention questionnaire, Dysexecutive questionnaire (DEX)
- structured interviews/ observations
Treatment for Attention
Attention Process Training (APT)
- client engages in a series of repetitive drills or exercises aimed to improve their attention.
- ex. consisted of a group of hierarchically organized tasks that include different components of attention commonly affected after brain injury
Treatment strategies and environment supports
- self management=
–orienting-> helpful for sustained attention, goal is to help clients monitor their own activities more consciously and thereby avoid attentional lapses
–Pacing-> goal is to have realistic expectations for productivity and keep clients engaged for a longer time
– notes-> keep reminders of important meetings or questions
Memory Assessment considerations
Shout test :
-Encoding: present info to clients and ask them to repeat it back. Immediate correct response indicates intact working memory. Delayed response indicates possible deficits in encoding
- Retention over time: delayed recall of presented items
- Recognition: yes/no responses may be administered to assess retrieval abilities.
Specific Memroy tests
- Auditory Verbal Learning Test (AVLT): helpful for learning memory and assessing interference effects
- California Verbal Learning Test (CVLT): provides info about recognition of learned information
- Rivermead Behavioral Memory Test (RBMT): involves real life scenarios. Most appropriate for mod-severe impaired clients. Not sensitive to assess mild deficits
Memory treatments
- give short directions
- use slow controlled rate of speech
- use emphatic stress on important words
- include overlearning and extra rehearsal whenever possible
- breaking big tasks into individual components
- complete rehearsal training before other memory training
- keep items functionally related
Executive functioning components
- Initiation and Drive (starting)- volition
- Response inhibition (stopping)- purposive action
- Task persistence (maintaining)- purposive action
- Organization (actions and thoughts)- planning
- Generative Thinking (creativity, flexibility)- planning
- Awareness (monitoring and self-correcting)- effective performance
EF assessment
Standardized- Stroop, planning tasks, tower of London
- route-finding task
- work like tasks
- functional tasks (let patient succeed/ sail safely)
EF treatment
- treat other functions that impact ef
- attention, memory, eternal memory aids, organization
Errorless Learning
useful for severe cognitive deficits where the responses are never corrected and they are always provided with the correct responses to a question/prompt
