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Cognitive Communication Disorders > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Major etiologies of closed head injuries (4)

A
  • falls
  • motor vehicle accidents
  • sports-related
  • struck by/against injuries
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2
Q

Primary effects-diffuse

closed head injury (2)

A
  • edema
  • diffuse axonal injury (DAI)
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2
Q
  • complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive, vestibular, or painful stimuli
A

Rancho Los Amigos

Level I

No response: Total assistance

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3
Q
  • intervention must be individualized
  • intervention will vary depending on deficits and participation/ activity restrictions that result
  • goals should reflect strengths and weaknesses
  • individual and significant others should actively participate in goal selection and evaluation of progress
A

Client-Centered Treatment

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4
Q

closed head injury

secondary effects (7)

A
  • ischemia
  • hypoperfusion
  • hyperperfusion
  • necrosis
  • increased intracranial pressure
  • excitotoxicity
  • oxidative stress
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5
Q

a lack of blood

A

ischemia

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6
Q

Blast Induced brain injury treatment (3)

A
  • removal of foreign bodies
  • control of bleeding
  • craniectomy
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7
Q

mild traumatic brain injury (mTBI)

A

concussion

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8
Q
  • demonstrates generalized reflex response to painful stimuli
  • responds to repeated auditory stimuli with increased or decreased activity
  • responds to external stimuli with physiologic changes generalized, gross body movement and/or not purposeful vocalization
  • responses noted above may be same regardless of type and location of stimulation
  • responses may be significantly delayed
A

Rancho Los Amigos

Level II

Generalized Resonse: Total Assistance

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9
Q

Risk factors for CTE (3)

A
  • age at which mTBIs begin
  • number of years playing for athletes
  • genetics (APOE e4)
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10
Q

ask client to remember for increasingly longer periods

A

spaced retrieval

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11
Q

monitoring of memory and learning while it is taking place

  • can the individual predict what will be difficult?
  • can the individual learn when, how, what, and how long to use a strategy?
A

metamemory

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12
Q

Categories of TBI (3)

A
  • penetrating injury
  • closed head injury
  • blast induced injury
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12
Q

Which is more common, penetrating or closed head injuries?

A

closed head injuries

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12
Q

Closed head injury

Primary effects- focal due to: (3)

A
  • impact of the brain on the inner skull
  • acceleration, deceleration, rotation of the brain within the skull
  • coup, counter- coup effects (acceleration-deceleration injuries)
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12
Q

reduced blood flow

A

hypoperfusion

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12
Q

excess release of glutamate, excites cells to death

A

excitotoxicity

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12
Q

capacity to attend to, recognize and interperet interpersonal cues taht enable us to:

  • understand the behavior of others
  • predict the behavior of others
  • share experiences and communicate effectively
  • also called theory of mind
A

Social cognition

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12
Q

Cognitive communication treatment principles (5)

A
  • promote restoration of function when possible
  • maximize residual functions
  • provide compensatory strategies for long term/permanent deficits
  • modify the environment in ways that help compensate for deficits
  • readjust expectations for the individual’s performance
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12
Q
  • reduce memory demands and foster successful completion of real world tasks
  • may include data storage devices, cuing devices, and environmental manipulations
  • may require intensive training
  • may be low or high tech
A

external appraoches

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14
Q

object enters brain (e.g., knife, shrapnel, bullet)

A

penetrating injury

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15
Q

Deficits that may accompany blast injury (2)

A
  • chronic pain
  • post-traumatic stress disorder
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16
Q

True or false

many tests for cognitive dysfunction have poor validity

A

true

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17
Q
  • assist with development of coping strategies, confidence, self-esteem
  • assist with behavioral and emotional control
  • assist with defining and adapting to new lifestyle post-injury
  • maximize ability to return to independent activity and participation in work, school, and social interactions
A

Treatment principles Psychosocial adjustment/adaptation

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18
Q

True or false

If metamemory is impaired, will need to use implicit training

A

true

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19
Q

tissue death

A

necrosis

20
Q

True or false

funding for TBI assessment/treatment is limited so clinical efficacy is critical

A

true

21
Q
  • 6 stages of recovery
  • used less frequently than the Rancho
A

Shoredone Scale

22
Q
  • Alert and in heightened state of activity.
  • Purposeful attempts to remove restraints or tubes or crawl out of bed.
  • May perform motor activities such as sitting, reaching and walking but without any apparent purpose or upon another’s request.
  • Very brief and usually non-purposeful moments of sustained alternatives and divided attention.
  • Absent short-term memory.
  • May cry out or scream out of proportion to stimulus even after its removal.
  • May exhibit aggressive or flight behavior.
  • Mood may swing from euphoric to hostile with no apparent relationship to environmental events.
  • Unable to cooperate with treatment efforts.
  • Verbalizations are frequently incoherent and/or inappropriate to activity or environment.
A

Rancho Los Amigos

Level IV Confused/Agitated: Maximal Assistance

23
Q
  • Inconsistently oriented to person, time and place.
  • Able to attend to highly familiar tasks in non-distracting environment for 30 minutes with moderate redirection.
  • Remote memory has more depth and detail than recent memory.
  • Vague recognition of some staff.
  • Able to use assistive memory aide with maximum assistance.
  • Emerging awareness of appropriate response to self, family and basic needs.
  • Moderate assist to problem solve barriers to task completion.
  • Supervised for old learning (e.g. self care).
  • Shows carry over for relearned familiar tasks (e.g. self care).
  • Maximum assistance for new learning with little or nor carry over.
  • Unaware of impairments, disabilities and safety risks.
  • Consistently follows simple directions.
  • Verbal expressions are appropriate in highly familiar and structured situations.
A

Rancho Los Amigos

Level VI- Confused, Appropriate: Moderate Assistance

24
Q

true or false

many tests for cognitive dysfunction are excellent at predicting functional abilities in real life

A

False

many tests for cognitive dysfunction are poor at predicting functional abilities in real life

25
Q

long term pathology of moderate to severe TBI (3)

A
  • continued loss of brain volume, including hippocampus (memory)
  • continued loss of axonal connections
  • accumulation of beta amyloid
26
Q

Deficits of TBI varies by what factors (2)

A
  • extent of the brain damage
  • area(s) of the brain affected
27
Q

Areas to assess when assessing social cognition (2)

A
  • emotion perception
  • cognitive empathy
28
Q

Leading causes of TBI (5)

A
  • Falls (40.5%)
  • Unknown (19%)
  • Struck by/against (15.5%)
  • Motor Vehicle, traffic (14.3%)
  • Assaults (10.7%)
29
Q
  • describes 8 stages of recovery
  • revised by one member of the team to 10 stages
  • not all individuals will pass through all stages
  • reaching level 8 does not mean full recovery
  • to be used with persons 1 year post or less
A

Rancho Los Amigos Levels

30
Q
  • educate the individual
    • ​effects of head injury
    • promote adjustment to deficits and participation in goal setting
  • educate significant others
    • to help them understand deficits

to

* help minimize reactions to the individual that may be maladaptive * educate other stakeholders e.g., teachers, employers
A

Treatment principles- education

31
Q
  • Alert, not agitated but may wander randomly or with a vague intention of going home.
  • May become agitated in response to external stimulation, and/or lack of environmental structure.
  • Not oriented to person, place or time.
  • Frequent brief periods, non-purposeful sustained attention.
  • Severely impaired recent memory, with confusion of past and present in reaction to ongoing activity.
  • Absent goal directed, problem solving, self-monitoring behavior.
  • Often demonstrates inappropriate use of objects without external direction.
  • May be able to perform previously learned tasks when structured and cues provided.
  • Unable to learn new information.
  • Able to respond appropriately to simple commands fairly consistently with external structures and cues.
  • Responses to simple commands without external structure are random and non-purposeful in relation to command.
  • Able to converse on a social, automatic level for brief periods of time when provided external structure and cues.
  • Verbalizations about present events become inappropriate and confabulatory when external structure and cues are not provided.
A

Rancho Los Amigos

Level V- Confused, Inappropriate Non-agitated: Maximal Assistance

32
Q
  • progressive neurodegenerative disease
  • build up of abnormal form of a protein in the brain (tau)
  • found in the brains of athletes and others who sustained repeated mTBI
  • first noted in 1928 in boxers
  • person may or may not have had symptomatic concussions
A

Chronic Traumatic Encepalopathy

33
Q

TBI assessment requires a team approach

A

True

34
Q

True or False

Memory drill does not work

A

true

35
Q

Primary effects-focal

Closed head injury (4)

A
  • contusion
  • laceration
  • potential skull fracture
  • hemorrhage- subdural, subarachnoid, intracerebral)
36
Q

2 types of penetrating injury damage

A
  • focal
  • diffuse
37
Q

people with cognitive communication disorders have difficulties in communication competence including: (6)

A
  • attention
  • memory
  • organization
  • information processing
  • problem solving
  • executive function
38
Q

What is the most common etiology of cognitive communication disorders?

A

TBI

39
Q
  • most commonly used scale to describe level of consciousness following TBI
  • evaluates eye opening, verbal response, motor response
A

Glasgow Coma Scale

40
Q

numerous injuries (organ damage, vision and hearing loss, spinal cord injuries, and amputations)

A

Polytrauma

41
Q
  • mainly acceleration injuries
  • movement of part of the brain relative to others causes axons to stretch and tear
  • occurs mainly in deep white matter and brain stem
A

diffuse axonal injury (DAI)

42
Q

Communication impairments resulting from underlying cognitive deficits due to neurological damage

A

cognitive communication disorders

43
Q

True or False

It may be difficult to separate TBI symptoms from PTSD symptoms

A

True

44
Q

Use errorless learning to…(2)

A
  • teach new skills (e.g., to use a planner)
  • teach new knowledge (e.g., new procedure at work)
45
Q
  • procedural memory often intact when episodic is not
  • use intact procedural to train functional skills (work, household duties, etc.)
A

Domain specific learning

47
Q

too much blood flow

A

hyperperfusion

48
Q

which has the better prognosis, penetrating or closed head injuries?

A

closed head injuries

49
Q
  • “signature” injury of the wars in Iraq and Afghanistan
  • due to explosion of IEDs
  • helmets do not protect brain, neck, face from injury
  • blast waves can propel fragments, bodies, vehicles, with great force, which can also cause brain injury
  • often numerous other injuries
A

Blast-induced brain injury

50
Q
  • Demonstrates withdrawal or vocalization to painful stimuli.
  • Turns toward or away from auditory stimuli.
  • Blinks when strong light crosses visual field.
  • Follows moving object passed within visual field.
  • Responds to discomfort by pulling tubes or restraints.
  • Responds inconsistently to simple commands.
  • Responses directly related to type of stimulus.
  • May respond to some persons (especially family and friends) but not to others.
A

Rancho Los Amigos

Level III

Localized Response: Total Assistance

51
Q
  • person w/ TBI may have problems knowing incorrect from correct response
  • incorrect responses may become “primed” and what are remembered the next trial
  • goal is to prevent errors with cues, prompts, or correct answer
A

Errorless Learning

52
Q
  • hierarchically arranged series of training modules
  • modules organized by attentional domain e.g., sustained, selective etc.
A

Attention Processing Training (APT, Sohlberg, and Mateer)

53
Q

Coma/TBI Severity (2)

A
  • Glasgow coma scale
  • trauma score
54
Q

Effects of blasts (4)

A
  • sudden increase in air pressure followed immediately by decreased pressure that creates wind
  • rapid pressure shifts can injure the brain (contusion or concussion)
  • air emboli can form in blood vessels, causing infarct
  • axons throughout brain affected
55
Q
  • time pressure management
  • other self-instruction strategies; tell yourself:
    • not to get distracted by irrelevant sounds, visual stimuli, etc.
    • to imagine what is being said
    • subvocalize these strategies
  • the evidence suggests
    • select these techniques based on the client’s needs
    • identify tasks where attention problem interferes and address those
    • this approach works best for clients who are aware of their deficits
A

Metacognitive Training- Self-instructional strategies

56
Q
  • Consistently oriented to person and place, within highly familiar environments.
  • Moderate assistance for orientation to time.
  • Able to attend to highly familiar tasks in a non-distraction environment for at least 30 minutes with minimal assist to complete tasks.
  • Minimal supervision for new learning.
  • Demonstrates carry over of new learning.
  • Initiates and carries out steps to complete familiar personal and household routine but has shallow recall of what he/she has been doing.
  • Able to monitor accuracy and completeness of each step in routine personal and household ADLs and modify plan with minimal assistance.
  • Superficial awareness of his/her condition but unaware of specific impairments and disabilities and the limits they place on his/her ability to safely, accurately and completely carry out his/her household, community, work and leisure ADLs.
  • Minimal supervision for safety in routine home and community activities.
  • Unrealistic planning for the future.
  • Unable to think about consequences of a decision or action.
  • Overestimates abilities.
  • Unaware of others’ needs and feelings.
  • Oppositional/uncooperative.
  • Unable to recognize inappropriate social interaction behavior.
A

Rancho Los Amigos

Level VII- Automatic, Appropriate: Minimal Assistance for Daily Living Skills

57
Q

the clinician supports “everyday people” to be coaches for the client

A

collaboration

58
Q
  • Consistently oriented to person, place and time.
  • Independently attends to and completes familiar tasks for 1 hour in distracting environments.
  • Able to recall and integrate past and recent events.
  • Uses assistive memory devices to recall daily schedule, “to do” lists and record critical information for later use with stand-by assistance.
  • Initiates and carries out steps to complete familiar personal, household, community, work and leisure routines with stand-by assistance and can modify the plan when needed with minimal assistance.
  • Requires no assistance once new tasks/activities are learned.
  • Aware of and acknowledges impairments and disabilities when they interfere with task completion but requires stand-by assistance to take appropriate corrective action.
  • Thinks about consequences of a decision or action with minimal assistance.
  • Overestimates or underestimates abilities.
  • Acknowledges others’ needs and feelings and responds appropriately with minimal assistance.
  • Depressed.
  • Irritable.
  • Low frustration tolerance/easily angered.
  • Argumentative.
  • Self-centered.
  • Uncharacteristically dependent/independent.
  • Able to recognize and acknowledge inappropriate social interaction behavior while it is occurring and takes corrective action with minimal assistance.
A

Rancho Los Amigos

Level VIII- Purposeful, Appropriate: Stand-By Assistance

Cognitive Communication Disorders (4 decks)

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