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Cognitive Retraining > CR: Lesson 3 > Flashcards

CR: Lesson 3 Flashcards

1
Q

Following a moderate to severe TBI, it is common for a client to experience a time of_________

A

coma

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2
Q

Severity and level of arousal are often assessed using the

A

Glascow Coma Scale

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3
Q

Glascow Coma Scale

A

15pt scale measuring eye opening, best motor response, and best verbal response. The higher the number, the better.

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4
Q

GCS, Eye opening points

A

opens eyes on own= 4
opens eyes on request= 3
opens eyes in response to pain= 2
does not open eyes= 1

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5
Q

GCS, verbal response points

A 
coverses and is oriented= 5
confused, disoriented speech= 4
uses words, but doesn't make sense= 3
sounds or words are incomprehensible= 2
makes no noise=1
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6
Q

GCS, motor response

A 
follows request to move= 6
pushes painful stimulus away= 5
withdrawal from painful stimuli= 4
abnormal (decorticate) flexion= 3
abnormal (decorticate) extension= 2
makes no motor respone= 1
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7
Q

Dual purposes of coma stimulation

A

physiological- increase neuronal activity, improve arousal

behavioral- improve recognition of environment, shape responses

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8
Q

True or False: Coma stimulation is highly controversial and not much research is there to back up its efficacy

A

TRUE

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9
Q

Coma Stimulation consists in providing stimulation to what senses?

A 
visual
auditory
gustatory
olfactory
tactile
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10
Q

Coma Stimulation Guidelines

A
  1. approach pt as if they understand everything
  2. sessions are brief, distraction free
  3. limited noise
  4. monitor physciological status carefully
  5. use stimuli familiar to pt
  6. train family & caregivers to do stim
  7. shape pt’s natural attempts at communication
  8. model appropriate stimulation behavior to caregivers
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11
Q

Try to elicit the following things when doing coma stimulation:

A
  1. response sound
  2. response voice
  3. visual focus- turn to left/right/midline
  4. visual tracking- track object left, right, up, down
  5. response to oral stim–(does it elicit a swallow?)
  6. response to cold stim
  7. response to facial massage/stim
  8. respons to oral motor movements…(puckers, smiles, frown, open/close)
  9. attempts to follow 1 -step directions
  10. response to olfactory stimuli
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12
Q

The ultimate goal with coma stim is __________

A

sensory regulation

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13
Q

When emerging from coma, pt. may have impaired ___________and exhibit:

A

orientation

confusion, disorientation, combativeness, aggression, unpredictability

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14
Q

Post-Traumatice Amnesia (PTA)

A

unable to maintain memory, new learning

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15
Q

Galveston Orientation and Amnesia Test

A

determines wheter person is oriented to person, place, time, & orientation. It is also a measure of PTA

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16
Q

The goal of therapy when dealing with PTA/ orientation deficits is…

A

to orient the person to time, place, person (x3)

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17
Q

Tools for orientation therapy

A

calendars, schedules, clocks, environmental cues, orientation cards, books, etc…..
**Challenge= training pt to remember to use the cues!

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18
Q

Severity of injury correlates highly with ________ and _____________

A

coma level

PTA length

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19
Q

MILD injury=

A

GCS= 13-15, PTA less than 1 hr….
may be able to return to premorbid levels of activity, but may have some residual deficits that affect functionality (usually attention concentration & memory are impaired)

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20
Q

MODERATE injury=

A

GCS= 9-12, PTA 1-24hrs

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21
Q

SEVERE injury=

A

GCS 0-8, PTA more than 24 hrs

22
Q

Attention must be intact in order to participatein the many types of ____________

A

cognitive rehabilitation (or reorganization)

23
Q

What does attention entail?

A

vigilance, selectivity, capacity, attention shift, mental manipulation

24
Q

vigilance

A

sustained attention over time

25
Q

selectivity

A

able to focus on one thing, ignore others

26
Q

capacity

A

amt of info one can attend to at once

27
Q

attention shift

A

the ability to shift focus from one thing to another

28
Q

mental manipulation

A

attending to stimuli while completeing a mental taks with it

29
Q

___________is the most advanced level of attentions and relies on all of the other types.

A

mental manipulation

30
Q

Attention while performing mental manipulation is often called

A

working memory

31
Q

Working memory is thought to be controlled in the __________lobe, so many brain injuries will result in attentional and working memory deficits.

A

prefrontal

32
Q

The clincal model of attention breaks functional attention down into 5 components to assess and rehabilitate, which are…

A 
focused attention
sustained attention
selective attention
alternating attention
divided attention
33
Q

A coma patient responds to an external stimuli such as pain—this is an example of…

A

focused attention

34
Q

______is the most basic ability to respond to external sensory stimuli

A

focused attention

35
Q

What are the 2 parts of sustained attention?

A

vigilance

working memory

36
Q

Sustained attention

A

the ability to maintain response to a stimulus during continuous and repetive activity

37
Q

being able to focus on studying while the TV is on is an example of

A

selective attention

38
Q

a secretary being interrupted and changing tasks back and forth is an example of

A

alternating attention

39
Q

driving a care while one the phone is an example of

A

divided attention

40
Q

Assessments options for assessing attention

A

standardized attention tests (The Test of Everyday Attention)
standardized test with attention subtests
rating scale (The Attention Questionnaire)
behavioral checklists or observation during attenition requiring tasks (ex, number/letter cancellation, clock-drawing,etc)

41
Q

Attention Process Training

A

retrains attention by stimulating particular aspect of attention.
assumes repeated attentional demands will increase cognitive capacity for attention.
does NOT resemble real life tasks bc ecologically valid tasks require MANY cognitive skills

42
Q

Examples of Attention Process Training Tasks for sustained attention

A 
number or letter cancellation
listen for certain word or number in a passage
alphabetize a list of words
sort words into categories
math problems
43
Q

Examples of Attention Process Training Task for alternating attention

A

listen for one word, then when you hear it, switch to another number and letter trail marking

44
Q

Examples of Attention Process Training Task for selective attention

A

any tasks from sustained or alternating attention tasks with background distractors
read passages or work problems on a paper with distracting marks

45
Q

Exmaples of Attention Process Training Task for divided attention

A

reading a passage for comprehension while scanning for a chosen word
repeating words while solving math problems

46
Q

Strategies & Environmental Supports

A

1- self-managment strategies

2- environmental supports

47
Q

Types of self-managment strategies

A

orienting- client monitors activities constantly (asks himself questions, set up routines…)

pacing- setting up schedules in which the client does most of the activities requiring attention during his best times of day, building in breaks

key ideas log- provide the client w/ notebook or memo sheet to write down thoughts or questions to abe asked when the task at hand is completed

48
Q

Types of Environmentall Supports

A

Task Management Strategies- identify what settings, surroundings, cues are helpful & harmful to attention
Environmental Modification- putting things in an obvious place, setting up filing systems, placing “do not disturb” signs on doors

49
Q

Use of External Devices

A

calendars, day planners, electronic organizer, voice activate message recorders, pill boxes, key finders, watch alarms….

50
Q

Psychosocial Support

A 
Alieviate psychological stressors by:
supported listening
brain injury education
relaxation training
psychotherapy
grief therapy
51
Q

Therapy Principles to REMEMBER:

A
  1. activities hierarchically organized
  2. sufficient repetition
  3. therapy modified based on client progress
  4. facilitate generalization

Cognitive Retraining (6 decks)

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