Cognition Flashcards
cognitive functions most commonly affected by ischemic stroke
language
attention
orientation
memory
cognitive functioning is a predictor of
functional impairment
goal of OT in pts with cognitive deficits
help client cope with impairments that result in reduced ability or participation
things the therapist should test before cognitive testing
sensory systems
language
visual systems
perceptual systems
important considerations when performing cognitive testing
**testing environment
input from healthcare team before determining results
observe in a number of settings
use standardized tests
optimal test battery for cognitive testing
standardized test
observation during functional tasks
areas of cognition
attention
memory
executive function
?
spatial attention
ability to attend to environment
selective attention
ability to maintain a consistent behavioral set requiring activation and inhibition of responses that are dependent on the selection of target stimuli from background stimuli
sustained attention
ability to maintain a consistent response set during continuous or repetitve activity
alternating attention
ability to switch response sets as a response to environmental cues so that two activities with distinct reponse requirements can be performed in space (finish one task and move on to another)
divided attention
ability to respond simultaneously to multiple tasks
does TBI/CVA affect automatic processing
no
standardized tests for attention
Test of everyday attention
interventions for attention deficit
- highly structured activities designed to stress specific attentional systems
- attention process training
attention process training
hierarchies of treatment tasks for each component of attention
memory system most likely to be impaired in TBI, stroke, and early dementia
episodic memory
function of short term/working memory
short term storage and processing of small amounts of information 7+/-2
function of episodic memory
may have a short term or long term encoding process; memory for events with perceptual and temporal correlates still attached to them
function of semantic memory
knowledge about the word (facts); general knowledge without acquisition context
function of perceptual priming
object identification
function of conceptual priming
activation of knowledge structures
function of associative conditioning
mapping of relationships established through repetitive painings; a tendency to respond in a certain way to a consistent cue
function of habituation
reduction in response to repetitive stimuli
function of sensitization
increased response to repetitive stimuli
location of STM/WM in brain
primary ventro-lateral prefrontal cortex
location of episodic memory in brain
hippocampus, medial temporal structures, diencephalic and ventro-lateral prefrontal cortex
location of semantic memory in brain
wide distribution in neocortex
location of motor skill learning in brain
basal ganglia, cerebellum, frontal lobes help when learning and executing
location of associative conditioning in brain
basal ganglia, cerebellum
location of habituation in brain
basal ganglia and cerebellum
location of sensitization in brain
limbic cortex, basal ganglia, cerebellum
evaluation of memory
assess orientation (person, place, time)
structured interview of client and family
standardized testing
observation of client in daily routines
order aspects of orientation return
person
place
time
progressive loss of orientation in dementia occurs in what order
time
place
person
memory retraining methods
- resistution/remedial
- substitution/adaptive
- over-learn tasks
external memory techniques
checklists
time tables
memory books
daily organizers
internal memory strategies
not very effective
visual imagery
verbal elaboration methods
components of executive function
goal formation
planning and carrying out plan
effective performance
standardized assessment of executive function
EFPT
components of problem solving
attention
memory
planning and organizing
reasoning & making judgements
2/3 of clients with acure right hemisphere stroke also have
unilateral neglect
3 attentional processes
orienting
target detection
tonic arousal
orienting
ability to orient to visual stimula in space
target detection
locating a specific object and responding to it
tonic arousal
alert state of stimuli in a certain area (located in right side of brain)
paper and pencil assessments of hemi-neglect
line bisection test
draw an object
letter or number cancellation tasks
behavioral inattention test
Part 1: paper & pencil tasks (line crossing, letter cancellation, etc)
Part 2: behavioral tests: picture scanning, telephone dialing, menu reading, etc
*Client only does part 2 if he/she falls below cutoff score on part 1
interventions for visual neglect
visual scanning training
prism adaptation
limb activation training
general arousal/vigilance training
appreciative visual agnosia
final integration of perceptual attributes (seen with widespread brain pathology)
associative agnosia
can see object with clarity to match or draw it, but do not know what object is
intervention for agnosia
limit task demands
avoid conflicting stimulus demands
apraxia
disorders of skilled purposeful movement that cannot be accounted for by weakness, abnormal tone, sensory loss, etc
apraxia is also associated with what other perceptual disorder?
agnosia (due to L hemisphere)
limb-kinetic apraxia
difficulty making fine skilled movements (most often finger movement)
ideomotor apraxia
unable to perform a purposeful motor task on command, even though he/she understands the idea or concept of the task
ideational apraxia
cannot carry out a series of actions in the sequence required to achieve the goal
oral apraxia
difficulty with oral motor movements
-feeding, initaiting swallowing
signs of apraxia during functional activity
- clumsy
- marked delay in following a command
- appear attentive to commands, but then do something else
- perform half of a task and then turn to another action
- profound difficulties in using or manipulating objects
evaluate apraxia
- ask client to gesture in response to command (ie, wave goodbye, tool use)
- ask client to perform serial acts that require a specific order of execution (write and mail a letter, brush teeth)
interventions for apraxia
- environmental modifications
- practice of functional activities
- compensatory strategies
-verbal commands are difficult for these patients, so gesturing may be more helpful
principles of motivational interviewing
- express empathy
- develop discrepancy
- avoid argumentation
- roll with resistance
- support self-efficacy
system of least prompts
therapist provides cues arranged from most general to most specific
time-delay procedures
- cue designed to elicit next step in chain is delivered to coincide with completion of the previous step in the chain
- a defined interval is inserted between the occurance of the stimulus and the response-eliciting cue (interval can be progressive or constant)
control of behavior by antecedant
indirect way to initiate a desired behavior when a direct approach has been ineffective (ie. hand client a shirt instead of saying “get dressed”)
