ecu cognition Flashcards
what is a grade 1 concussion
person is confused but conscious
symptoms clear within 15 minutes
what is a grade 2 concussion
person remains conscious
develops amnesia
symptoms last longer than 15 minutes
what is a grade 3 concussion
overlaps with TBI
loss of consciousness
disruption of brain function
unconscious for seconds or minutes
what is post concussive syndrome
history of head trauma that causes concussion greater than 3 occur 1. becomes fatigues easily 2. disordered sleep 3. headache 4. vertigo 5. irritability 6. anxiety 7. change in personality 8. apathy
what are the levels of assessment for TBI
- severity: Glascow Coma Scale
- level of cognitive-behavioral function: Ranchos
- cognitive-communicative function
what does the glascow coma scale measure
- best eye response
- vest verbal response
- best motor response
what is the severity scale for the glascow
3-8 severe
9-12 moderate
13-15 mild
greater than or equal to 9 are not in a coma
what are symptoms of a mild TBI
- GCS 13-15
- brief post traumatic amnesia
- alteration in mental state (dazed, confused)
- focal neurological deficit
what is post traumatic amnesia
- retrograde: loss of memory before the injury. Prognostic predictor
- anterograde: loss of memory just before and following accident
what are the levels of severity for PTA
less than 5 minutes: very mild 5-60 minutes: mild 1-24 hour: moderate 1-7 days: severe 1-4 weeks: very severe more than 4 weeks: extremely severe
how would you assess patients in RLA level 1-111
- arousal/attention 6. tactile response
- auditory response 7. object manipulation
- ausitory comprehension 8. visual tracing
- visual comprehension 9. olfactory response
- expressive communication
which standardized assessments would you use for low level patients levels 1-3
- Western Neuro Sensory Stimulation Profile
- Coma Recovery Scale
- Agitated Behavior Scale
which cognitive domains would you assess
- alertness/attention
- perception
- orientation
- memory
- organization
- reasoning
- problem solving and judgment
what are the types of alertness
- tonic: intrinsic arousal that fluctuates from minutes to hours. Important for sustaining attention and for working memory and executive control
- phasic: rapid change in attention due to a brief event
what are the types of attention
- focused: on an object or person
- sustained: attend to a task from start to finish
- selective: ignore distractions
- alternating: switch attention from one task to next
- divided attention: multitask
- directed attention: executive functioning. Highest level
how do you assess orientation
non standardized: assess person, place, time, and situation
standardized measures : orientation section of the GOAT, and the Orientation Log
what is prospective memory
remembering to do things at certain times
what is retrospective memory
memory of past events includes declarative (what we know about things) and procedural (how to do things)
what are the types of decarative memory
- episodic: memory for personally experienced events
2. semantic: our organized knowledge of the world
what is affected by impaired abstract thinking
proverb interpretation
similarities and differences
categorization and sorting tasks
what affects the prognosis of recovery for TBI
- severity of TBI
- level of post traumatic amnesia
- severity of cognitive domains
- co-existing motor speech and language deficits
- co-existing medical issues
- pre-morbid level of functioning
- pre-morbid sociodemographic characteristics
what considerations should be made for treatment of TBI
- level of alertness
- attention span
- agitation
- level of memory impairment
- premorbid level of functioning/lifestyle
- functional goals
what are the general principles of TBI treatment
- remediation: retraining specific cognitive domains with that expectation that function will improve. Based on neuroplasticity
- Compensation: strategies which may be temporary or permanent
- modify the environment to maximize abilities
what are methods of cognitive-communication treatment
- drill and practice to stimulate damaged neural networks to restore specific skills
- dual task training: improves task complexity by targeting the ability to carry out 2 competing tasks. (divided attention). Can be a cognitive paired with a motor task
- errorless learning
- metacognitive skills training
- sensory stimulation
what is errorless learning
SLP prevents the patient from making errors during the learning phase by
1. breaking task down into small steps
2. provide several models before the patient is asked to perform
3. avoid guessing
4. immediately correct errors
5. fade prompts
best for patients with intact procedural memory
what is metacognitive skills training
- focuses on improved awareness, self monitoring, and self regulaton
- helps client recognize problem situations
- helps client identify strategies that will assist in daily living
what is sensory stimulation treatment
also known as coma stimulation.
systematic exposure of a comatose, vegetative, or minimally conscious patient, to environmental stimuli
includes visual, tactile, olfactory, auditory, and kinesthetic senses
when is sensory stimulation treatment used
ranchos level 1=3.
ICU or Coma Unit
when is Cognitive Communication Rehab used
inpatient rehab
Ranchos levels 4-8
when is reintegration, modified environments used
Inpatient
outpatient
day therapy
Ranchos 7-10
when is reintegration done in a natural environment
ranchos 8-10
how do you treat focused attention
focused attention: low level patients: 1. localize to a sound 2. localize to touch 3. find an object in the environment 4. track a person or object across the midline high level patients 1. tap the table every time you hear me say the letter A 2. word generation task 3. letter/number/symbol cancellation 4. dot to dot
how do you treat sustained attention
increase the amount of time a person is able to consistently sustain their attention on a task (eating a meal, flipping through a magazine)
how do you treat selective attention
can they attend to the task with distractions or background noise
- in therapy use any sustained attention task and add distraction
- gradually increase the level of distractions by increasing noise or moving to a busy place to complete treatment
how do you treat alternating attention
- can a person continue a task with high level of accuracy when you change the rules (sorting cards by number for a minute then change to sorting by shape)
- can a person shift their attention between two things
(coding activity: assign each letter a number and decode the secret message
how do you treat divided attention
- assign a patient 2 equally important tasks to complete simultaneously (symbol cancellation where they must locate at least 2 symbols; hold a conversation while playing a game)
how do you treat memory
- have client restate in own words
- rehearse info
- complete real life tasks for practice
- compensatory strategies
Write
Repeat
Associate
Picture
what do you treat at Ranchos levels I. II. III
level of alertness
response to stimuli
what do you treat at Ranchose levels IV, V, VI
environmental management 1. stimulation management 2. freedom of movement 3. avoid unstructured time 4. fit schedule to client physical management 1. physical management of aggressive behaviors medication management
what do you treat at Ranchos level VII-X
high level cognitive rehab 1. attention concentration 2. working memory 3. executive functins behavior impairments family rehab community reintegration
