Final Flashcards
The general term that reflects the mental enterprises related to absorbing information, thinking, and goal-direction action
Cognition
A systematic functionally oriented service of therapeutic cognitive activities based on an assessment and understanding of the person’s brain-behavior deficits for the overall goals of generalizing to promote improvement in daily life
Cognitive rehabilitation
Knowledge about one’s own cognitive processes, has been described as cognition about cognition and knowing about knowing, self-awareness of one’s own strengths and weaknesses
Metacognition
Being awake, not in a stuporous state, refers to readiness of the CNS to receive information
Alertness
Information entering the system by one or more primary systems
Sensory register
The mental process by which information is recognized, labeled, and understood by means of intact visual and language systems, required fir LTM and STM
Encoding
The mental process of recall or “pulling” information from memory either by recognition or independently recalling from storage or long-term memory
Retrieval
Maintenance of information presented a brief period prior to recall or recognition; usually with no intervening distractors
STM
Storage and retrieval through recall/recognition of information “some time” after initial presentation
LTM
The ability to understand self and the relationship to the past and present environment. Traditionally involves awareness in 4 spheres: person, place, time, and circumstance. May be negatively affected by disturbances in attention and/or memory
Orientation
A pervasive attentional deficit leading to disorientation
Confusion
The period following the comatype stage that is characterized by the inability to store/recall information on a day to day or minute to minute basis
Post-traumatic amnesia (PTA)
In the period of PTA, refers ro the loss of information or recall of experiences acquired after the injury
Anterograde memory loss
Inability to recall information stored prior to the injury, including orientation to person and other autobiographical information, considered a sign of diffuse and/or severe involvement
Retrograde amnesia
Incorrect verbal responses to orientation questions, may be bizarre or plausible but incorrect
Confabulation
Top 5 causes of TBI in order
Falls, other/unknown, struck by/against, motor vehicle, assaults
TBI peak ages
Very young children (0-4), adolescents and young adults (15-19), older adults (75+)
Frontal lobe functions
Executive functioning, initiation, termination, motor and visual involvement
TBI that occurs when an object, such as a bullet, backed by a strong force fractures the sill and meninges, damaging brain tissue and surrounding membranes
Meninges and skull fracture
Open TBI
TBI that occurs when brain tissue impacts the inside of the skull
Closed TBI
TBI symptoms resulting immediately from initial trauma
Primary TBI
TBI symptoms that are changes evolving over a period of time (hours to days) after the initial injury
Secondary TBI
Mild jostling of the brain, results in headaches, fatigues, and trouble with attention
Most common TBI, caused when the brain receives trauma from an impact or sudden momentum or movement change
Concussion
A region of injured brain tissue or skin in which blood capillaries have been ruptured, causing a bruise and increase in intracranial pressure
Contussion
2 types of contussion
Coup, contrecoup
Type of contussion that occurs under the site of impact with an object, associated with cerebral contusions
Coup
Type of contussion that occurs on the opposite side of the brain that was hit
Contracoup
Twisting motion of the brain, axonal pathways disturbed, occurs over a widespread area
Diffuse axonal injury
Mild TBI
GCS: 13-15, PTA greater than 1 hour
Moderate TBI
GCS: 9-12, PTA 1-24 hours
Severe TBI
GCS: 9 and below, PTA greater than 24 hours
Intervention for Rancho levels 1-3
Environment, positioning, PROM, sensory stimulation, communication, family involvement
Subtype of delirium in the coma-emerging patient that is associated with frontotemporal injury, disorientation, comorbid medical complications, and/or use of anticonvulsant medication. Causes excesses of behavior that include some combination of aggression, akathisia, disinhibition, and emotional lability
Agitation
ABCs of behavior management also called
Positive behavior supports/management and proactive behavior management
What do the ABCs stand for in behavior management?
Antecedent, behavior, consequence`
Rancho levels for high cognitive impairment
4-6
Rancho levels for moderate cognitive impairment
6-7
Rancho level for low cognitive impairment
8-10
Behavioral interventions for high cognitive impairment
restraints, prevention, positive approach and antecedents, environmental considerations for safety, extinctions, calm approach, redirect, do not over-explain, avoid questioning strategies, distraction
Behavioral interventions for moderate cognitive impairment
Positive reinforcements/antecedents, reward systems, time out, redirect or substitute, explain, structure, repetition
Behavioral interventions for low cognitive impairment
Explanations of long-term consequences, oral agreements, contracts, corrective feedback, consider safe natural consequences allowed, consider group intervention and peer feedback, teach compensatory strategies, consider use of AT, teach self-management strategies
Hierarchy for process specific approach to cognitive rehab
Reasoning and concept formation, memory, visual-spatial processing, motor planning, orientation, attention/concentration, cognitive rehabilitation
Systematic intervention that is directed to achieve functional changes by reinforcing, strengthening, or re-establishing previously learned patterns of behavior or establishing new patterns of cognitive activity or mechanisms to compensate for impaired neurological systems
Multidisciplinary field and broad category of intervention methods aimed at improving cognitive functioning
Cognitive rehabilitation
Rancho scale progresses from ________ to _______
No response, purposeful & appropriate
Coma occurs at what level
1
Unarousablility with absence of sleep wake cycles and inability to interact with the environment
Coma
What level is associated with vegetative state?
Level 2
Capacity for spontaneous arousal, but still a complete inability to interact with environment, follows initial coma period and behavior is reflexive only
Vegetative state
At what stage does minimally conscious state occur?
Level 3
Have some conscious awareness, only some awareness of self or environment, follow simple commands, but inconsistent responses and require relevance and structure
Minimally conscious state
Abnormal extensor tone in UEs and LEs, wrist flexion and internal rotation
Decerebrate rigidity
Decerebrate rigidity indicates damage where?
Upper midbrain and lower pons
Abnormal flexion in UEs and extension in LEs, indicates internal capsule or other cortical disruption of the corticospinal pathways
Decorticate Rigidity
Level with no response
1
Level with generalized response
2
Nonspecific, inconsistent and non-purposeful reaction, not necessarily related to environmental stimuli
Generalized response
Level with localized response
3
Response is directly related to type of environmental stimulus but is inconsistent and/or delayed
Localized response
The ability to respond discretely to specific visual, auditory, or tactile stimuli
Focused attention
The ability to maintain a consistent behavioral response during continuous or repetitive activity
Sustained attention
Maintaining a behavioral or cognitive set in the face or competing or distracting stimuli, requires activation and inhibition of responses
Selective attention
The mental flexibility which allows an individual to shift focus of attention and move between tasks having different cognitive requirements, requires rapid switching from one response to another
Alternating attention
The ability to respond simultaneously to multiple tasks or multiple task demands, most difficult level of attention/concentration
Divided attention
The ability to recall such information as name, age, birthplace, marital status, and family members
Orientation to personal information
Identifying by name or role, familiar family members, friends, staff, or other patients in environment
Orientation to persons in immediate environment
Identifying one’s own hospital room, OT room, the building one is in, community, state, and country
Identifying immediate environmental factors
Includes the ability to state time, date, season, facts about daily scheduled events
Recall or independently locate information regarding time
Includes information about the events occurring in one’s community, state, or country, sports or political events, current president
Recall current events
Visual, auditory, and tactile stimulation facilitates a selective sensorimotor response
Generalized movement is possible in response to sensory stimulation
Specific, discrete motor responses either toward or away from a stimuli; these may be reflexive/spontaneous volitional (body turning, limb withdrawal, eye blink, vocalization)
Localized body movement occurs in response to discrete stimuli
The achievement and maintenance of a posture may be facilitated by external cues (visual, verbal, tactile)
Ability to achieve and maintain limn or body posture
The ability to reliably and volitionally produce hand or limb movements either of a familiar or unpracticed/novel nature
Ability to achieve hand and limb postures or movements
Involves re-establishing of transitional body motion, or limb and hand motions of either a familiar or unfamiliar nature
Ability to produce sequenced movements
Involves development of familiar or new complex motor planning skills needed for participation in IADLs
Ability to produce complex, functional motions
Involves the basic visual system being intact and responsive to stimuli (pupillary responses, oculomotor control, acuity, peripheral fields, color vision)
Visual responsiveness and discrimination
Involves recognizing and attaching proper meaning to visual stimuli in one’s environment
Visual recognition and appreciation
The ability to integrate visual input with a motor response (ex: eye hand coordination)
Visuomotor skills
The ability to perceive input from and attend to the full range or visual space and objects within the environment. Includes scanning, depth perception, and if necessary, the ability to compensate for visual losses
Spatial perception and judgement
The ability to identify passage of time without the use of external aids
Time estimation
The ability to “remember to remember” to carry out specific activities in the future
Prospective memory
Includes accuracy and independence in using aids such as an appointment calendar, memory log, “to do” list, alarm clock
Use of external memory aids
Refers to the process of recalling verbal information (names, addresses, information), especially those learned after the brain injury itself
Retrospective verbal memory
Refers to the learning of new primarily visual information
Retrospective visual memory
Refers to memory for performing tasks and also the recall of knowledge learned AFTER brain injury, refers to the learning which occurs without an awareness level ex: person may be able to learn, perform task, but not be able to explain how it was done
Procedural memory
The ability to remember without use of external aids or via the use of memorization and self-cueing strategies
Use of internal memory aids
Requires the use of appropriate behaviors to obtain a desired result (ex: using call light, requests for food/drink)
Use of strategies to meet personal needs
Involves the identification and completion of steps to meet basic self-care needs; relating to familiar, over-learned routines, this level requires initiation and sequencing abilities
Use of strategies for self-care
Involves identifying, remembering, and executing the steps for new (or compensatory) personal cares, examples: safety in transfers, using WC or cane, using splint
Use of strategies for new self-cares
The ability to solve simple problems of everyday life needed for safety and independent functioning
Ability to solve non-routine physical or self-care problems
Requires logical reasoning, flexible thinking, deductive, and inductive reasoning, should occur in a functional period of time
Ability to solve abstract, novel problems
Examples of cognitive restoration/remediation
Attention process training, computer programs, pencil-paper tasks
Examples of adaptive/compensatory intervention
Memory notebooks, use of cues, AT, changing physical/social context, establish routines and habits
Classification of cognitive strategies that encompass both remedial and compensatory strategies, practice in multiple functional contexts, use metacognitive strategies, involve task-specific training for relevance to daily life, incorporate reality-based consequences, Toglia’s Dynamic Interactional Approach to Cognitive Rehabilitation
Contextualized
4 large areas in Dynamic Interactional Model of Cognition
Person, occupational performance, activity demands, environmnet
What does the person consist of in Dynamic Interactional Model of Cognition?
Processing/strategies, awareness/metacognititon, processing capacity, personal context
What does the environment consist of in the Dynamic Interactional Model of Cognition?
Social, physical, cultural
What are the activity demands in Dynamic Interactional Model of Cognition?
Number of items, complexity, familiarity, spatial arrangement, movement demands
4 parts of Co-op model
Goal, plan, do, check
Common long-term effects of TBI
Higher level attention deficits, STM issues, slowed processing speed, decreased reaction time
Rancho level 1, 2, 3 treatment focus
Patient protection
Rancho level 1, 2, 3 team role
Protect
Rancho level 1, 2, 3 treatment approach
Medical/physical management
Rancho level 1, 2, 3 treatment goal
Prevent complications
Rancho level 4 treatment focus
Reduce confusion and agitation
Rancho level 4 team role
Nurture
Rancho level 4 treatment approach
environmental management
Rancho level 4 treatment goal
sense of safety
Rancho level 5 and 6 treatment focus
Reduce confusion and agitation
Rancho level 5 and 6 team role
Support
Rancho level 5 and 6 treatment approach
Client and environmental management
Rancho level 5 and 6 treatment goal
awareness of self and environment
Rancho level 7 treatment focus
self management
Rancho level 7 team role
assist
Rancho level 7 treatment apporach
behavior management
Rancho level 7 treatment goal
awareness of others
Rancho level 8 treatment focus
self guidance
Rancho level 8 team role
coach
Rancho level 8 treatment approach
cognitive/behavior management
Rancho level 8 treatment goal
social competence
Rancho level 9 and 10 treatment focus
autonomy
Rancho level 9 and 10 team role
empower
Rancho level 9 and 10 treatment approach
counseling/training
Rancho level 9 and 10 treatment goal
Interdependence
Process-specific approach key concepts/features
Attention process, limb activation theory
Process-specific approach population
TBI, CVA with unilateral neglect
Process-specific approach purpose
Increase attnetion cognitively, increase attention cognitively and perceptually
Strategy training key concepts/features
Compensatory, not retraining but teaching new ways to handle problems faced, acquisition, application, adaptation, memory-related strategies, memory-related strategies like mnemonics or checklists
Strategy training population
Acquired neuro deficits
Strategy training purpose
Optimize cognitive performance despite limitations (metacognitive strategies or rubrics, devices or AT, task-specific strategy, environmental management
Skill-task-habit training key concepts/features
procedural and errorless learning, applied behavioral analysis
Skill-task-habit training population
Acquired neuro deficits
Skill-task-habit training purpose
Promote habits, routines, and automaticity to support engagement in occupations
Task and environment modification key concepts/features
Lower cognitive demand by altering the task/env, caregiver training
Task and environment modification population
Caregivers of persons with significant or severe cognitive decline
Task and environment modification purpose
Caregivers learn to interact with their family members in new ways, including environmental strategies
Rancho level with no response/total assistance
1
Rancho level with complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive, vestibular, or painful stimuli
1
Rancho level with generalized response, total assistance
2
Rancho level with generalized reflex response to painful stimuli, responds to repeated auditory stimuli with increased or decreased activity, responds to external stimuli when physiological changes generalized, gross body movement and/or not purposeful vocalization, responses noted may be same regardless of type and location of stimulation, responses may be same regardless of type and location of stimulation, responses may be significantly delayed
2
Rancho level with localized response, total assistance
3
Rancho level with demonstration of withdrawal or vocalization to painful stimuli, turns toward or away from auditory stimuli, blinks when strong light crosses visual field
3
Rancho level with following of moving objects passed within visual field, responds to discomfort by pulling tubes or restraints
3
Rancho level with inconsistent responses to simple commands, responses directly related to type of stimulus, may respond to some persons
3
Rancho level associated with confused-agitated, maximal assistance
4
Rancho level associated with alert and heightened state of activity, purposeful attempts to remove restraints or tubes and crawl out of bed
4
Rancho level associated with performing motor activities such as sitting, reaching, and walking, but without any purpose or upon another’s request, very brief and usually non-purposeful moments of sustained alternatives and divided attention, absent STM
4
Absent goal-directed, problem-solving, and self-monitoring behavior, may cry out or scream out of proportion to stimulus even after removal, may exhibit aggressive or flight behavior
4
Rancho level associated with inability to cooperate with treatment efforts, mood swing euphoric to hostile with no apparent relationship to environmental events, verbalizations are frequently incoherent and/or inappropriate to env/activity
4
Rancho level associated with confused, inappropriate, non-agitated, maximal assistance
5
Rancho level associated with alert, not agitated but may wander randomly or with intention of going home, may become agitated in response to external stimulation and/or lack of env structure, not oriented to person/place/time
5
Rancho level associated with frequent, brief periods, non-purposeful, sustained attention, severely impaired recent memory with confusion of past and present in reaction to ongoing activity
5
Rancho level associated with 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 structure and cues are provided
5
Rancho level associated with inability to learn new information, ability to respond appropriately to simple commands fairly consistently with external structures and cues, responds to simple commands without external structure are non-purposeful and random in relation to command
5
Rancho level associated with ability to converse on a social, automatic, level for brief periods of time when provided external structure and cues, verbalizations about present events are inappropriate and confabulatory when external structure and cues are not provided
5
Rancho level associated with confused, appropriate, moderate assistance
6
Rancho level associated with when clients typically go home
6
Rancho level associated with inconsistently oriented to person and place, able to attend to highly-familiar tasks in non-distracting env for 30 mins with moderate redirection
6
Rancho level associated with remote (LTM) memory having more depth and detail than recent memory, vague recognition of some staff, able to use assistive memory aid with maximal assistance
6
Rancho level associated with emerging awareness of appropriate response to self, family, and basic needs, emerging goal-directed behavior related to meeting basic personal needs
6
Rancho level associated with moderate assist to problem solve barriers to task completion, supervised for old learning (self care), shows carry over for relearned familiar tasks
6
Rancho level associated with max assist for new learning with little or no carry over, unaware of impairments, disabilities, and safety risks, consistently follows simple directions, verbal expressions are appropriate in highly familiar and structured situations
6
Rancho level associated with automatic appropriate, minimal assistance for routine daily living skills
7
Rancho level associated with consistent orientation to person and place in highly familiar environments, mod assist for orientation to time, able to attend to highly familiar tasks in non-distracting env, able to use assistive memory devices with min assist, minimal supervision for new learning
7
Rancho level associated with demonstration of 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
7
Rancho level associated with ability to monitor accuracy and completeness of each step in routine personal and household ADLs and modify plan with min assist, min supervision for safety in routine home and community activities
7
Rancho level associated with superficial awareness of condition but unaware of specific impairments and disabilities and the limits they place on ability to safe, accurately, and completely carry out household, community, work and leisure ADLS
7
Rancho level associated with unrealistic planning for future, inability to think about consequences of a decision or action, overestimate abilities, unaware of others’ needs and abilities, oppositional/uncooperative, unable to recognize inappropriate social interaction behavior
7
Rancho level associated with purposeful and appropriate, stand-by assistance
8
Rancho level associated with consistently oriented to person, place, time, independently attends to and completes familiar tasks for 1 hour in distracting env, able to recall and integrate past and current events
8
Rancho level associated with using assistive memory devices to recall daily schedule, :to do” lists and record critical info for later use with stand-by assist, initiates and carries out steps to complete familiar personal, household, community, work and leisure routines with SBA and can modify plan when needed with min assist
8
Rancho level associated with no assistance required when new tasks/activities are learned, aware of and acknowledges impairments and disabilities when they interfere with task completion but requires SBA to take appropriate corrective action
8
Rancho level associated with thinking about consequences of decision/action with min assist, overestimates or underestimates abilities, acknowledges others’ needs and feelings and responds appropriately with minimal assistance, depressed, irritable, low frustration tolerance, easily angered, argumentative
8
Rancho level associated with self-centeredness, uncharacteristically dependent/independent, able to recognize and acknowledge inappropriate social interaction behavior while it is occurring and takes corrective action with minimal assistance
8
Rancho level associated with purposeful and appropriate, SBA or request
9
Rancho level associated with ability to independently shift back and forth between tasks and complete them accurately for at least 2 consecutive hours, uses assistive memory devices to recall daily schedule, “to do” lists and record critical information for later use with assistance when requested
9
Rancho level associated with awareness and acknowledgement of impairments and disabilities when they interfere with task completion and take appropriate corrective action but requires SBA to anticipate a problem before it occurs and take action to avoid it, able to think about consequences of decisions or actions with assistance when requested, accurately estimates abilities but requires SBA to adjust to task demands
9
Rancho level associated with acknowledgement of others’ needs and feelings and responds approximately with SBA, depression may continue, may be easily irritable, may have low frustration tolerance, able to self monitor appropriateness of social interaction with SBA
9
Rancho level associated with purposeful and appropriate, modified independent
10
Rancho level associated with ability to handle multiple tasks simultaneously in all environments but may require periodic breaks, able to independently procure, create, and maintain own AT
10
Rancho level associated with ability to independently initiate and carry out steps to familiar and unfamiliar personal, community, household, work, and leisure tasks but may require more time than and/or compensatory strategies to complete them
10
Rancho level associated with ability to anticipate impact of impairments and disabilities on ability to complete daily living tasks and takes action to avoid problems before they occur but may require more than the usual amount of time and/or compensatory strategies
10
Rancho level associated with ability to independently think about consequences of decisions, may take more time and/or compensatory strategies
10
Rancho level associated with ability to recognize needs and feelings of others and automatically respond appropriately, accurately estimates abilities and independently adjusts task demands, periodic periods of depression may occur
10
Rancho level associated with irritability and low frustration tolerance when sick, fatigues, and/ or under emotional stress, social interaction behavior is consistently appropriate
10
