Cognition and Interventions Flashcards
What are the hierarchy of skills of awareness?
Starting from top to bottom
Executive Functions
Memory
Attention
Alert
You have to be aware for attention, memory, and executive functions but not to be alert
What is a list of cognitive problems you might see in the neuro population?
- Confusion and disorientation
- Loses track of information
- Confabulation
- Poor initiation of actions, thoughts, or ideas
- Disinhibition
- Difficulty planning and organizing
- Unable to prioritize
- Unable to recall training procedures
- Unable to retain new learning
- Delayed processing time
- Poor regulation of speed and response
- Tangential speech or flight of ideas
- Cannot sustain mental energy
- Difficulty generating ideas and alternatives
- Poor insight
- Poor safety judgement
What are intervention principles?
1) Process training
2) Strategy training
3) Compensatory education
4) Functional activity training
Use treatment approaches that hierarchically organized and provide repetition
What is the intervention process?
1) Select area of intervention
2) Obtain baseline measure
3) Set goals with client
4) Choose and teach strategies
5) Practice strategies
6) Obtain post and practice measure
7) Practice transfer and generalization strategies for real life
8) Develop transfer and generalization strategies for real life
What should a therapist keep in mind in regard to generalization?
- Therapists should not expect generalization, they program for it
1) Be clear, explicit in training
2) General strategies should be practiced in a variety of settings
3) Change the environment to suppor the new skill or behavior
4) ID barriers and plan for high risk situations
5) Plan for recovery opportunities
What should a therapist keep in mind in regard to generalization?
- Therapists should not expect generalization, they program for it
1) Be clear, explicit in training
2) General strategies should be practiced in a variety of settings
3) Change the environment to support the new skill or behavior
4) ID barriers and plan for high risk situations
5) Plan for recovery opportunities
How can a task and the environment be changed?
Increase salient cues to attract attention to relevant information
- Full: overt demonstration
- Specific: process cue that increases self-monitoring “how will you remember…”
- Opportunity: expectant pause, raised eyebrows to indicate something is left to be done
- Spatial: using the environment
- Temporal: timed cues
- Decrease irrelevant information to reduce distraction
- Limit or reduce number of items presented (choice)
- Break up an activity (two 10 min sessions instead of one 20 min session)
- Pre-organize; pre-select items for task
- Prioritize tasks
- Grade activities
- Use keywords in instructions - select what is most important
- Space learning: brief periods, repeated at multiple, fixed intervals
- Encourage person to repeat/rehearse verbal directions
- Sentence completion rather than provision of info/guessing
- Cues/warning signals for transition to next task
How can a task and the environment be changed?
Increase salient cues to attract attention to relevant information
- Full: overt demonstration
- Specific: process cue that increases self-monitoring “how will you remember…”
- Opportunity: expectant pause, raised eyebrows to indicate something is left to be done
- Spatial: using the environment
- Temporal: timed cues
- Decrease irrelevant information to reduce distraction
- Limit or reduce number of items presented (choice)
- Break up an activity (two 10 min sessions instead of one 20 min session)
- Pre-organize; pre-select items for task
- Prioritize tasks
- Grade activities
- Use keywords in instructions: select what is most important
- Space learning: brief periods, repeated at multiple, fixed intervals
- Encourage person to repeat/rehearse verbal directions
- Sentence completion rather than provision of info/guessing
- Cues/warning signals for transition to next task
What are external compensatory interventions?
Behavioral prosthetic - change in behavior to remind to do something - rubberband on wrist, grocery bag on door knob
Cognitive prosthetic: device to take over cognitive process - digital recorder, checklist
Cognitive robot: carries out a repetitive task - automatic coffee maker, cycling timers
Cognitive corrector: figures out something overlooked/forgotten - spell check, pill box, key fob to find car
Cognitive assessor: assesses a cognitive skill (feedback) - scores on games
Cognitive trainer: opportunity to learn new skills and practice - hand held brain game
Cognitive archive: archive so information isn’t stored by individual - photo albums, online encyclopedias
Cognitive art: visual display to facilitate cognition - nutritional information charts, floor plan
Cognitive superstition: increase confidence for cognitive tasks - lucky test taking pencil
Write things down!
What are different types of feedback that can be used during interventions?
- Supportive but direct
- Indirect
- Videotape
- Peer feedback in groups
- Immediate and formal error monitoring procedures with reenactment
What are external compensatory strategies to use during interventions?
Behavioral prosthetic - change in behavior to remind to do something - rubber band on wrist, grocery bag on door knob
Cognitive prosthetic: device to take over cognitive process - digital recorder, checklist
Cognitive robot: carries out a repetitive task - automatic coffee maker, cycling timers
Cognitive corrector: figures out something overlooked/forgotten - spell check, pill box, key fob to find car
Cognitive assessor: assesses a cognitive skill (feedback) - scores on games
Cognitive trainer: opportunity to learn new skills and practice - hand held brain game
Cognitive archive: archive so information isn’t stored by individual - photo albums, online encyclopedias
Cognitive art: visual display to facilitate cognition - nutritional information charts, floor plan
Cognitive superstition: increase confidence for cognitive tasks - lucky test taking pencil
Write things down!
What are internal compensatory strategies to use during interventions?
- Visual imagery (can help with episodic memory problems)
- Mnemonics
- Associations
- Verbal mediation
- Repeating information
- Semantic elaboration (while learning names try spelling the name, exchange business cards, ask for spelling)
- Self-monitoring (score sheet, tally sheet)
- Mental organization (mental map)
- Problem solving
- Mental rehearsal of task performance
- Pace and adjust speed
- Kinesthetic cues
What are interventions to help orient someone?
- Place personal photos/items in room
- Orient without saying “you are wrong”
- Recount past events, familiar places and people
- Visitors should be consistent (people, times, numbers)
- Use memory aids or physical calendar
- Update person on activities outside of the hospital
- If person imagines things, gently orient
What are interventions to help orient someone?
- Place personal photos/items in room
- Orient without saying “you are wrong”
- Recount past events, familiar places and people
- To start, visitors should be consistent (people, times, numbers)
- Use memory aids or physical calendar
- Update person on activities outside of the hospital
- If person imagines things, gently orient
What are interventions to help someone with their attention? slide 24
- Direct training of attention processes
- Specific skills training
- Training of metacognitive strategies
- Training use of external aids
- Environmental modification/task accommodation
