EXEC fx Assess Flashcards
Assessment challenges:
multiple
paradox between ?
need to determine ?
need for assessment of
components of exec fx
structured vs spontaneous activity
fundamental as well as higher level cog skills
activity/participation levels
Current guidelines for cog com assessment after TBI:
use both
consider comm. needs of ? communicative ? and comm?
standardized and non standardized
indiv./ context / partner
Organizational Framework for Assessment:
1) tests of ?
includes tests that require creation of ? using environmental feedbakc to guide ?
2) tests of ?
-includes tests that require generation of ? and measure of lack of ?
3) tests of
-includes tests that requires ? and inhibition of ?
4) tests of ?
includes tests that requires formation of ? and conceptualization of?
planning, scheduling, strategy use, rule adherence
-subgoals, temporal sequencing, strategy generation/ behavior and self-monitoring
generation, fluency, initiation:
-concepts and compliance with encironmental constraints / lack of monitoring
shifting and suppression
-shifting between tasks / external or internal overlearned responses
concept formation and abstract reasoning
-concepts/ abstract relationships
Treatment:
the strongest research evidence favors compensatory tx that train individuals with TBI to use ?
selection of therapy approach depends on:
clinicians
time since
severity of
co-occurence of ?
clients level of
rehabilitation ?
support available in
strategies to circumvent exec fx impairments in daily activities
theoretical belief on nature of exec fx
-injury
-dysexecutive symptoms
-other cog. deficits
awarness
priorities of pt
environment
Treatment guiding principles:
1) structure: an organizational pla
-anchors: routines that are
-scaffolding: use of ?
-strategies: behaviors to help pt transition to
well est. in indiv. life
reminders, prompts, encouragment, reinforcement to develop systems to maintain or est. anchors
independent use of aids in natural environment
Tx guiding principles:
2) systematic insturction: a method that focuses on how instruction is ?
emphasizes
task?
-pre?
-..
-faded
-high amounts of
-immediate
designed and delivered
-error control
analysis
-pre-instruction
-modeling
-faded support
-high amounts of corrective practice
-corrective feedback
Tx guiding principles:
3) collaboration: partnership betweem
goal?
4) context: personal ?
train in ?
clinician and client
-goal setting and achievement
relevance of tx
-contextually rich, relevant environments with meaningful materials
Tx guiding principles:
5) metacog. instruction: self? self? and self? of cognition while performing activity
uses direct instruction to guide?
-identify
-predict
-identify
-self-monitor
-change behavior if
awareness/monitoring, control
-integration and internalization of self-reg. process
-goal
-performance
-possible solutions
assess performance during activity
-goal not met
Tx protocol:
PIE
planning stage:
who is ? what type of ? where will skill?: why is skill? and how will?
implementation: 3 phases
initial
… and…
…
E…
Plan Implement Evaluate
who is learner, wat type of info, where will skill be used, why skill being trained, how will outcome be eval.
initial acquisiton
mastery and generalization
maintenance
evalutae
Tx protocl:
TEACH-M
T- task
E- errorless
A- assess
C- cumulative
H- high rates of
M- Metacog.
Outcome: 5 participants learned a? in .. tx sessions
analysis
learning
performance
review
practice
strategy training
5 participants learned a 7 step email system in 7-15 tx sessiosn
Tx protocol : TATE
Training assistive technology in environment
acquisiton: modeling with ? frequent? corrective
generalization: training in a variety of
maintenance: regular
faded cues/ correct practice / feedback
variety of locations
review sessions
Other protocols:
group
problem solving
interpersonall
NICE ?
interactive structured treatment for social competence (GIST)
group protocol
recall
protocol
Problem-solving therapy:
meta-analysis of exec fx interventions indicated problem solving tx involved:
self
self
making
adjusting or modifying:
monitoring
recording of performance
strategy decisions based on goals
plan based on self assessment or external feedback
Problem solving therapy: SWAPS
STOP is there a
WHAT is the
ALTERNATIVES:
PICK and …
Satisfied with the ?
outcome: 98 indiv. made significant gains in ? handling? and dealing with ?
problem
problem
options to solve problem
plan chosen option
outcome of the plan
decision making/ interpersonal diff./ crises in everyday life after 3 hours of therapy each for 12 weeks
Goal Management training: a mindful approach to problem solving: raises awareness of ?
STOP
DEFINE
LIST
LEARN
DO IT
CHECK
Attentional lapses
ask what they are doing
main task
list all steps required
ask themselves whether they know all the steps
execute task
asking if they are doing what they planned to do
TIme Pressure mngmt:
decisions for timely completion of tasks depends on ?
three levels:
no pressure: there is enough time to ? plans can be determined ?
- some pressure but manageable: need to adjust decisions via ?
high pressure: requires immediate ? in order to prevent
amount of time pressure present
make decision/ in advance of task
anticipating and adapting behavior before time pressure builds up
decisions and actions/ failure
Time Pressure Mngmt:
teaches strategies to prevent or manage time pressure
3 stages:
1. increase awareness that mental slowness is a ?
2. educate pts that speed of processing may not ?
3. strategy application and ?
problem and can significantly impact daily life
return to normal and introduced strategy “let me give myself enough time”
generalization -train under more distracting conditions
Time pressure Mngmt:
compensatory strategies;
environmental support: auditory tone during task completion as a reminder to
outcome: performance on completion of multiple tasks improved to level of
think about what they were doing overall and aim of the task
control group
Awareness Training:
pt predict performance on tasks within and outside
monitor task performance with and without use of
outcomes: increased awareness evidence by:
more accurate
differences between ?
skill level
compensatory strategies
predictions of performance
predicted and actual time decreased
Cognitive Behavioral Therapy:
psychological approach usedfor tx of ?
specialized training to ? by relying on ?
teaches individuals to:
recognize
recognize and ?
use problem solving in a combination of
depression, ADHD, and other psych. conditions
change thinking patterns/ exec fx and may help train these functions
distortions in thinking
adjust problem behaviors
with coping skills
Cog comm interventions:
tx often conducted in a group format though sometimes done with indiv.:
-
-
-…playing
-… feedback
-self–
social
discussion
modeling
role playing
verbal or visual feedback
self-monitoring
social reinforcement
Cog-comm tx:
cognitive pragmatic treatment: designed to increase inferential abilities to ?
comprehension: matching lingquistic utterance with ?
production: modulation of comm. according to ?
outcome: higher levels of ? sensitive to ? and social ?
fill in gap/ what is said and what is intende d
pralinguistic info
particular context
social appropriateness/ context / social judgment
Environmental supports:
modification of task demands:
break task into smaller
remove or minimize
provide
allow extra time to
reduce
smaller steps
stimuli that may elicit inappropriate behavior
break
complete tasks
environmental distractions
Environmental supports:
2. organization of physical space
-designated areas for
centralized space for
create ?
- cueing and prompting:
lists of tasks to be
steps in
create
items
calendar, schedules etc
filing system for bills and other important items
completed
specific routines
schedules
Environmental supports:
manipulation of physiologic factors:
monitor ?
implement ?
montior level of ?
nutrition, sleep , acitivty level, medications
specific routines
fatigue by checking in during completion of activities
