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TBI > chapter 6 > Flashcards

chapter 6 Flashcards

1
Q

define cognitive-communication disorder

A

reduced ability in language skills due to impairments in one or more areas of cognition

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2
Q

Common cognitive communication deficits

A

-attention
-long-term memory
-dysfunctional behaviors
-poor self-regulation of emotions and behaviors
-limited insight

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3
Q

Attention deficits

A

difficulty in
-focusing
-easily distracted
-switching tasks
-responding to simultaneously presented stimuli

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4
Q

Long-term memory deficits

A

Relatively uncommon but could be deficits in learning new info and retaining info about recent events

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5
Q

Dysfunctions behaviors

A

inappropriate
-time management
-planning daily tasks
-difficulties with maintaining a schedule

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6
Q

Poor self-regulation of emotions and behaviors

A

sudden or frequent episodes of anger, aggression, possible physical harm

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7
Q

Limited insight

A

is common among people with moderate to severe TBIs

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8
Q

Characteristics of Cognitive-Communication Deficits
Macrolinguistic Processing

A
  • topic selection and maintenance
  • coherence and cohesion
  • grammar
  • gist comprehension
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9
Q

Topic selection and maintenance

A
  • deficits in selecting a topic
  • deficits maintaining a topic
  • deficits in appropriate conversational skills
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10
Q

Coherence and cohesion

A
  • 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)
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11
Q

grammar

A

-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

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12
Q

gist comprehension

A
  • deficits in summarizing a story
  • may miss some key take-home messages from a reading
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13
Q

Characteristics of Cognitive-Communication Deficits
Microlinguistic Processing

A
  • verbal processing
  • word selection and retrieval
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14
Q

verbal production

A
  • may display logorrhea (compulsive talkativeness)
  • may display interruptions initiating and maintaining conversational topics
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15
Q

Word selection and retrieval

A

deficits with word selction and retrieval are very common in people with TBIs

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16
Q

Characteristics of Cognitive-Communication Deficits
Extralinguistic contributors

A
  • eye gaze
  • affect
  • gestures
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17
Q

affect

A
  • emotional lability
  • pathological laughing/crying
  • involuntary emotional expression disorder
18
Q

gestures

A

deficits in appropriate use of gestures during conversations

19
Q

Characteristics of Cognitive-Communication Deficits
Paralinguistic contrbutors

A

May include changes in the supra-segmental features of language
- vocal tone
- rhythm
- stress
- intonation

20
Q

Initial assessments of acute care

A
  • Bedside assessments
  • Functional assessment
21
Q

Bedside assessment

A

very common during the initial stages of hospital admission and may include administration of some of the cognitive screeners

22
Q

Functional assessment

A

may use functional assessments (FIM and FAM) to determine the person’s level of functioning with ADLs

23
Q

Residual deficits

A
  • detailed case history
  • self-reports (whenever possible)
  • information from close family members
24
Q

Patterns of Recovey for Mild TBI

A
  • 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
25
Q

Patterns of Recovery for Moderate to Severe TBI

A

majority fo individuals with moderate or severe TBIs have more residual impairments that affect their levels of functioning

26
Q

Initial stages of recovery for mod-severe TBI

A
  • 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
27
Q

Middle phase of recovery for mod-severe TBI

A
  • 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
28
Q

Later Phase of mod-severe TBI

A
  • 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
29
Q

Orientation components

A
  • 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
30
Q

Orientation assessments

A
  • Galveston Orientation and Amnesia Test (GOAT)
  • Informal questioning
  • Cognitive Screeners (MMSE, MOCA)
31
Q

Treatment for Orientation

A
  • 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)
32
Q

Factors affecting attention

A
  • increased arousal means better attention
33
Q

Assessment for Attention

A
  • Standardized tests: attention process training, DRS-2, RIPA
  • Rating scales/questionnaires: attention questionnaire, Dysexecutive questionnaire (DEX)
  • structured interviews/ observations
34
Q

Treatment for Attention

A

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

35
Q

Treatment strategies and environment supports

A
  • 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
36
Q

Memory Assessment considerations

A

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.

37
Q

Specific Memroy tests

A
  • 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
38
Q

Memory treatments

A
  • 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
39
Q

Executive functioning components

A
  • 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
40
Q

EF assessment

A

Standardized- Stroop, planning tasks, tower of London
- route-finding task
- work like tasks
- functional tasks (let patient succeed/ sail safely)

41
Q

EF treatment

A
  • treat other functions that impact ef
  • attention, memory, eternal memory aids, organization
42
Q

Errorless Learning

A

useful for severe cognitive deficits where the responses are never corrected and they are always provided with the correct responses to a question/prompt

TBI (9 decks)

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