KATIE Flashcards
What is the clinical model of attention?
- Focused
The ability to respond discreetly to specific visual, auditory or tactile stimuli - Sustained
Ability to sustain attention continuously over time - Selective
The ability to focus on the task at hand
Individuals have difficulty with background noise confrontation naming probe task could be manipulated by adding or minimizing visual clutter or noise - Alternating
The ability to switch between two tasks that have different cognitive demans (reading recipe, cooking then coming back to read again) - Divided
Being able to multitask
Clinical model of memory?
1. Short term Limited information (3-5 items) for short duration (minutes to hours)
- Working
Intersection between attention and memory
“Set of processes that permits us to hold on to information until it is utilized or encoded, or to keep stored information readily available” - Long-term
Permanent. Unlimited capacity - Implicit
referred to as non-declarative memory, does not require the conscious or explicit recollection of past events/information, and the individual is unaware that remembering has occurred - Explicit
free recall; devoted to processing of names, dates, places, facts, events, and so forth.
Restorative and Compensatory Intervention
Attention
Memory
Executive Function
Errorless learning
Spaced retrieval
Restorative & Compensatory Intervention: Memory
Restorative/generalized memory intervention approaches: Memory practice drills Mnemonic strategy training Prospective memory training Metamemory training
External memory aids:
E.g. calendars, smart phones, etc.
Restorative & Compensatory Intervention: Attention
Restorative Strategies
Attention Process Training (APT)
Purpose: to improve the ability to focus on relevant material while ignoring irrelevant distractions
Compensatory Strategies
Strategies and environmental supports
Self-management strategies
External cognitive aids
Psychosocial support
Restorative & Compensatory Intervention: Executive function
Including external cognitive aids and metacognitive strategies such as WSCT, goal attainment
Scaling
Challenging Behaviors: what behaviors may be present?
Disinhibition Impulsivity Socially inappropriate behavior Lack of initiation Confabulation Pseudobulbar affect
Challenging Behaviors: what management strategies exist?
Models Common behavioral problems Multiple origins Approaches Family and staff education
Restorative & Compensatory Intervention: Errorless learning**
a method of instruction that reduces errors in the acquisition phase (provide sufficient practice
Restorative & Compensatory Intervention: Spaced retrieval**
can be particularly effective for learning and adaptation. The individual practices successfully recalling information over progressively longer intervals of time.
TBI severity rating: Glasgow Coma Scale
Mild: 13-15
Moderate: 9-12
Severe: 3-8
Looks at:
Verbal Response
Eye Gaze
Motor Response
TBI severity rating: time of unconsciousness
Mild: < 30 minutes
Moderate: 30 min - 24 hours
Severe: > 24 hours
TBI Severity rating: PTA (Post traumatic Amnesia)
Mild: < 24 hours
Moderate: 1-7 days
Severe: >7 days
Military: What is a blast injury?
An injury based on impact ex:bomb
Military: What are special considerations?
-Primary injury
Direct impact from over-pressure wave, compress air filled organs, catapults body backward
-Secondary injury
Energized debris/explosive fragments impact head/body
-Tertiary injury
Body impacts with wall/ground/object
-Quarternary injury
Inhalation of toxic gasses/substance
Children: Facts and figures related to prevalence/incidence and recovery
Of children who acquired brain injury 80% → MILD 10% → MODERATE 10% → SEVERE 98% are NOT referred to special ed → 2% are
Children: Special considerations when working with children?
-GenEd supports
Student study team
RTI
-Special Ed
504 accommodations plan
Individual Family Service Plan (IFSP) : for ch up to 3
Individual Education Plan (IEP): parents can request IN WRITING
Children: Children with BI & the SLP
-Memory
Cannot remember 2-3 step directions
Has difficulty remembering the daily schedule, homework assignments, needed class materials.
-Attention & Concentration
Distracted by normal classroom activity.
Delayed in responding to questions.
-Executive & Problem Solving Skills
Lacks ability to sequence steps necessary to plan an activity.
Unable to come up with solutions to problem situations.
-Language
Has difficulty turn taking
Unable to summarize and articulate thoughts
-Visuo-Spatial Skills
Has difficulty completing simple math problems when presented with a worksheet.
Becomes disoriented in the hallway, has difficulty finding their path to classes.
-Behavior and Emotion
Inappropriate social behavior
lacks self-confidence
Working with families:
Fundamental requirements?
-Practitioners need to exercise EXCELLENT listening and interview skills
Individual families’ concerns/ priorities on issues they hope
to address.
The daily routines for members in the home or community.
Clinical collaborations are most useful when practitioners have up-to-date knowledge about brain injury.
They gain trust by you SHARING your knowledge and experience.
Practitioners need to hone their observational skills
Families respond well to observations from practitioners about trends the practitioners observe
Practitioners need to be FLEXIBLE; txt focuses change→priorities shift, that is okay.
Practitioners need to structure tx that meets needs of fam. and help them implement strategies
SMART GOALS
Specific Measurable Attainable Relevant Time-Based
Goals are based on pt/family priorities
Insurance: medicare needs to do a reassessment every 30 days
Modifying goals is part of therapy, session to session, and medicare dictated
Short term: 30 days, for acute might be 1 week
Long term: 90 days, for acute might be 8 weeks
HIPPA- What is it?
Limits the non-consensual use and release of PHI (protected health information)
Gives individuals new rights to access their medical records and to know who else has accessed them.
Restricts most disclosure of health information to the minimum needed for the intended purpose of providing health care.
Established new criminal and civil standards for improper use of disclosure.
Established new requirements for access to records by researchers and others.
Why does it matter?
Outcome measures:
what are some of the validated tools used early after injury
Glasgow Coma Scale (GCS)
Loss of consciousness (LOC), measured in duration
Measures of post traumatic amnesia (PTA)
Outcome measures: what are some of the validated tools used in acute rehabilitation
FIM - Functional independence measures and FAM (functional assessment measures) - require formal training - 12 physical and 6 cognitive ratings, with 12 additional questions that add onto original FIM score to provide more detail into function.
Disability rating scale - research instrument, antiquated
Rancho los amigos level of cognitive functioning scale (LCFS) 1-8 point score based on level of cognitive function.
Outcome measures: what are some of the validated tools used in outpatient rehab and community
Craig Handicap Assessment and Reporting Technique and short form (CHART/CHART-SF) - 32 questions across physical, cognitive, mobility, occupation, social interaction, and economic self-sufficiency.
Mayo-portland adaptability index (MPAI-4).
Participation Assessment with Recombined Tools-Objective (PART-O) - designed for mod-severe BI. Scores on out and about, productivity, and social relations.
All of these are public domain, meaning accessible and free to use.
