Lecture 3 Flashcards
Attention
- Attention is the allocation of processing resources
- Attention forms the foundation for which all other cognitive skills are based
- Attention difficulties may be more pronounced in less structured environments
- Attention is the foundation for all cognitive processes are built upon.
Types of Attention
- Focused/Sustained
- Selective
- Alternating
- Divided
Focused/Sustained Attention
The state of focusing on one stimulus to the exclusion of all other competing stimuli
-“I try to watch TV but I just drift off.”
Selective Attention
- The ability to focus on the important/relevant stimuli in the presence of distracting stimuli
- “I can’t cook while there is noisy construction work happening next door; I get too distracted.”
Alternating Attention
- An individual is asked to focus on any two tasks that require thought and are completed at the same time
- “I can’t listen to a lecture and take notes at the same time.”
DIvided Attention
- An individual is asked to complete two tasks at once but one of the tasks requires little to no thought
- “I can’t brush my daughter’s hair while talking on the telephone; can’t do two things at once anymore.”
Frontal Lobe Disorders
The frontal lobes are responsible for higher-order functions; executive functions, emotional-behavioral-social control regulation, motor functioning, and the appropriate use of language, social pragmatics, and the subtleties of communication (innuendoes, humor)
- Think of EMAPS
- Houses intellect, cognitive processes, and regulates emotions
Frontal Lobe Damage
Motor impairment; halting/disorganized speech; personality changes; aphasia; apraxia; difficulty with emotional/behavioral control; Patients may exhibit passivity, apathy, or lack of internal drive/motivation
Executive Functions
- The executive functions relate to one’s ability to use cognitive skills efficiently in a complex environment
- EFs help us regulate our abilities so we can achieve goals
- EFs are often performed without thinking and may be age-related in terms of development
- EFs are an umbrella term that encompass many different skills
List of Executive Functions
- Planning and organization
- Multi-Tasking
- Learning Rules
- Motivation
- Generalization
- Flexible Thinking
- Problem Solving
- Social Behavior
- Initiating/Inhibiting Behavior
- Controlling emotions
- Monitoring Performance
- Self- Awareness
- Making decisions
- Goal setting
- Insight
- do not need to think about performing these tasks (very little thought involved)
EF’s allow you to have morals- determine right from wrong
Commonalities: Executive Function
- Patients may begin a task prior to thinking through all of the steps
- Repetition of a thought, behavior, action, or verbal utterance that continues even though it is no longer appropriate
- Patients tend to think about features in lieu of groups or categories
-Inability to focus on more than one thing at a time
Patients are easily distracted
Pre-morbid responses
- Prior to injury
- inhibition
- emotional stability
Post-Injury
- Cognitive-Communication Deficits
- Disinhibition
- Emotional instability
Orientation
- Person
- Place
- Time
- Purpose
- A patient is orientated times 4
- Could be person, place, month, and year.
- Use a calendar to reorient the patient about time
Types of Memory
- Procedural (implicit)
- Declarative (Explicit)
- Long term
- Recall
- Short term
- Episodic
- Prospective
Procedural (implicit)
Ability to perform skills in the absence of conscious awareness (motor memory). Remember the procedure for riding a bike.
Declarative (explicit)
-Factual memory, ability to do algebra, do well on tests, ability to recall so you don’t forget. Declarative memories can become procedural memories.
Long-term memory
- (LTM)- recall of previously known information (remote memory) The ability to remember information we have stored. Challenge yourself-crossword puzzles and brain teasers
Short-term memory
- (STM)- immediate recall of new visual or verbal information. Can recall 7 items, plus or minus 2
- can use chunking to remember (don’t do this or add intonation to the list that a patient needs to remember)
Recent memory
Delayed recall of information up to 30 minutes
Prospective memory
The ability to recall information needed in the future
Episodic memory
-Recall of temporarily dated events. Tied to a date in time or an episode
Problem Solving
- Identifying Problems
- Generating Solutions
- Organizing
- Sequencing
- Implementing Solutions
- Managing Time
- Self-Monitoring
- Safety
o Needs to use attention skills as well as executive functioning
o Organize- make lists
o Sequencing- steps in order of importance
Broad based test
- nonspecific tests, test all aspects of language or cognition- CASL or CELF
Specific tests
o Specific tests- EOWPVT (semantic test) and ROWPVT (receptive semantic test)
• Behavioral test of inattention- targets attention
Critical thinking
- Drawing inferences
- Deductive reasoning
- Inductive reasoning
- Abstract reasoning
- Flexibility of thought
Drawing inferences
- Making a connection between two otherwise unrelated facts
Deductive reasoning
- Arrive at a conclusion based on known facts
Inductive reasoning
- The process of determining how to achieve a goal or solve a problem (involves inference)
Abstract reasoning
- Drawing conclusions based on notions, ideas, concepts that are not tangible
Flexibility of thought
-Shifting from one idea to another with relative ease
Behavior
- Aspects of behavior associated with cognitive communication disorders
- metacognition
- communication problems
Communication Challenges
- Cognitive-Communication challenges impact the social, academic, behavioral, and vocational lives of survivors
- Typically, survivors of TBI have intact grammar and semantic knowledge; language appears fluent
- Deficits tend to lie in the areas of meta-semantics and pragmatics (both verbal and nonverbal types)
Meta-Semantic Deficits
- Word-retrieval deficits (anomia)
- —–Shed light on deficits- create deficit awareness for patients
- —–Give patients time to process information
- —-Patients can have poor deficit awareness
- —-Latency period- period of time when you ask patient to respond and their response. In assessment you can note that a patient has an increased latency period. - Lack of cohesive speech with poor knowledge of figurative language; their language can be very concrete centered
- Difficulty understanding words with multiple meanings
- Difficulty integrating and synthesizing information (parts = whole); figuring out salient from irrelevant information
- Slower processing speed
- Confabulation (lack of truthfulness)
Pragmatics
- Pragmatics is generically defined as the social use of language
- Pragmatics is specifically defined as functional use of verbal and nonverbal modes of communication to convey and interpret intended messages
Verbal pragmatic deficits
- Tangential Speech: Conversation topics shift without listener notification
- Limited communication initiation or maintenance per interaction with others
- Decreased topic maintenance
- Inappropriate topic selection
- Inadequate topic relevance
- Poor presupposition skills
- –implicit assumption about the world or background belief relating to an utterance whose truth is taken for granted in discourse.
Example:
Jane no longer writes fiction.
Presupposition: Jane once wrote fiction.
Nonverbal pragmatic deficits
- Poor eye contact; includes both too much and insufficient amounts
- Flat affect; Poor use of facial expressions to convey emotions
- Lability; emotional excess
- Inappropriate proxemics
- Inappropriate physical contact
- Decreased understanding of other’s nonverbal cues
Amnesia
- Traumatic brain injury can leave old memories intact but hinder the ability to store and/or retrieve new memories; also includes learning new information
- Impaired attention can also make learning new information difficult
2 types of Amnesia
- Anterograde amnesia
2. Retrograde amnesia
Anterograde Amnesia
-Loss of the ability to learn and recall new information after the trauma
Retrograde Amnesia
-Loss of memories stored before an injury
Seizures
- Change in behavioral state as a result of abnormal electrical activity within the brain
- The occurrence of a seizure in the presence of some acute precipitating physiological disturbance does not mean that it will ever happen after the cause has been resolved
- When seizures occur without any obvious precipitant or cause, then a person may be considered to have a form of epilepsy
o Know the different types of seizures in case you see them in a chart
o No medicine can prevent TBI seizures
o Place patient on the floor, move everything out of the way
Seizure Types
- Generalized Seizures:
Increased electrical impulses occur throughout the brain - Partial Seizures:
References relatively small electrical impulses in more focal parts of the brain - Nonepileptic Seizures:
Not caused by abnormal electrical activity in the brain - Status Epilepticus:
Prolonged seizures; continuous state of seizure
Post-traumatic seizure disorder
- Seizures are common following TBI and are broken down into two separate categories:
- Seizures that occur within a seven day post-injury window; Patient is still in ICU or in the acute stage
- Late onset seizures that occur more as focal issues
General seizure information
- Seizure incidence is higher in children than in adults
- Late seizures are more likely to occur in adults or when the head injury was of the penetrating type
- There are no anti-epileptic medications that will protect against post traumatic epilepsy
- Depressed skull fractures and hemorrhagic contusions tend to predispose patients to seizure disorders
Concomitant Issues (TBI)
- Post-traumatic headaches
- Post-traumatic fatigue
- Somnolence (sleepy)
- Balance disorders
- Sexual disorders
- Depression
- Mania
- Anxiety Disorders
- PTSD
- Personality Changes
- Aggression
- etc
Depression following TBI
- The level of brain injury severity poorly predicts a patient’s level of depression or susceptibility to a depressed state
- Pre-injury depression is common
- Increased anxiety levels + depression often coinside
- Decreased left prefrontal gray matter volume often correlates with depression
- Pre-injury aggression and hostile features may predict suicidal behavior
