Lecture 4: Clinical Practice II: Chapter 5 Flashcards
When is spontaneous recovery possible?
12-14 weeks after brain injury
What 3 things does spontaneous recovery depend on in brain injuries?
- Severity
- Location
- Type
When does the most recovery happen?
In the first 3-6 months after recovery
What is neuroplasticity?
The ability of the brain to modify itself functionally or structurally in response to injury (spontaneous) or under influence of stimulation and treatment (experience-dependent)
Does neuroplasticity occur in healthy people as well?
Yes, all kinds of learning experiences result in these neuronal changes throughout life
What are 2 reasons for spontaneous recovery?
- Diffuse and redundant connectivity
- Cortical reorganization
What is diffuse and redundant connectivity?
Following injury, recovery takes place by activating other areas within a network
What is cortical reorganization?
New structural and functional connections between cortical areas take over certain functions
What is the timetrack of behavioral recovery?
First you have neurological recovery in the first few months. Behavioral recovery comes next
What is recovery?
Improvement in function compared to the time of the injury
What is premorbid functioning?
The way someone functioned before the injury
When does neurological recovery in the form of regeneration of brain tissue cease?
After a year
What is the Kennard principle of neuroplasticity?
Recovery is better after an injury at a young age, because the brain is more plastic during childhood
What is some evidence on the Kennard principle of neuroplasticity?
Evidence indicates poorer recovery ofter brain injury at young age. Young individuals with TBI have the worst prognostic
What is meant with the double hazard in TBI in children?
The worst prognosis must be anticipated for the combination of severe brain injury and young age
What is the difference between direct and indirect symptoms?
Direct: loss or change in behavior or cognitive process as a direct consequence of damage (e.g. slowness of info processing)
Indirect: attempt by patient to deal with this impairment
What determines the patient’s ability to cope with impairments? (3)
- Premorbid functioning
- Coping skills
- Social support
What is the difference between adaptive and maladaptive coping?
Adaptive: avoid situations that involve overstimulation
Maladaptive: avoid all situations and sink into passivity
What are the 2 recovery levels?
- Neurological: recovery of direct symptoms
- Psychological: recovery of indirect symptoms
What is the restorative approach to rehabilitation?
Achieve recovery at the brain level
What is the compensatory approach to rehabilitation?
Achieve recovery at psychological level (current focus)
What are the 2 approaches to rehabilitation?
- Restorative
- Compensatory
What is growing into deficit?
Young children often don’t show lack of functions, but at a later age, when these functions should normally appear, serious deficiencies are noticed
With what types of injuries does treatment focused on neuroplasticity work?
For mild or moderate brain injuries
Severe injury that affects large networks of neurons will not result in neural reconnection
What is bottom-up stimulation?
Focused stimulation for neuroplasticity. External stimuli are administered in an attempt to stimulate the formation of new neural connections
What was Hebb’s principle underlying bottom-up stimulation?
Cells that fire together, wire together
What is the difference between consistent mapping and varied mapping in learning?
Consistent: learning if stimulus and response repeatedly occur in the same combination
Varied: different responses are triggered by the same stimulus –> not learning
What is state-dependent learning?
Learned behavior is easier to demonstrate if the application context has strong similarities with the learning context
So the behavior learning has to be strongly anchored, but in such a way it’s not dependent on the specific characteristics of learning context
What is the variability of practice in rehabilitation?
Therapist introduces variations in the learning process and the learning context at an early stage, so tranfer to a different application context later on is easier
What are 2 principles that stimulate transfer of learned behavior to other situations?
- Variability of practice
- Linkage to the site of application
What is linkage to the site of application in rehabilitation?
A link is made between the learning behavior and the target situation as early as possible
What is experience-dependent learning?
Promoting plasticity through learning
What is function training and what type of rehabilitation approach fits best with it? What can you say about the effectiveness?
Recovery of cognitive functions occurs through repeated exercise
–> Restorative approach
Effectiveness: not demonstrated, almost never generalization to daily life
What is generalization in learning? Why is it a challenge for people with brain injury?
Apply what is learned to everyday life
Challenge because learning depends on intact cognitive functions
On which aspect of the ICF model does the restorative approach focus? And the compensatory approach?
Restorative: functions/structures
Compensatory: activities/ participation
What is stimulus-response conditioning (S-R conditioning)? Which rehabilitation approach fits best?
A limited routine that is triggered by a stimulus. It’s not aimed at generalization
Compensatory approach
What is skill training and which rehabilitation approach fits best? Give an example
Training skills at task level through repeated exercise, not aimed to improve underlying cognitive function. It’s very task specific and aimed at generalization
–> Compensatory approach
E.g. making tea/coffee
What is strategy training and which rehabilitation approach fits best with it? Give an example
Training skills that apply in multiple tasks/situations where cognitive function is called upon. Aims for generalization and self-monitoring
–> Compensatory approach
E.g. seeing a traffic light
What is the cognitive cycle and what approach to rehabilitation fits best with it? For which people does this work best?
Breaking up each task into different steps (analyze, develop strategy, implement strategy, evaluate successfulness)
–> Compensatory approach
Works best for people with problems with planning and organization and want to have more structure
What is the difference between strategy training and cognitive cycle in rehabilitation?
Strategy: focus on teaching specific strategies that can be carried out in multiple contexts
Cognitive: focus on bringing structure in one’s own problem solving and it requires capacity to set one’s own goals
What is environmental control and what approach to rehabilitation fits best with it?
Modifying aspects of a person’s enviornment so they can better compensate for cognitive dysfunction. It improves independence and quality of life
–> Compensatory approach
What are the 5 methods in the compensatory approach in rehabilitation and what does each method aim to change?
- Environmental control: behavior
- S-R conditioning: behavior routine
- Skill training: skill
- Strategic training: strategic ability
- Cognitive cycle: attitude
What is the Gross and Schutz model of neuropsychological intervention methods?
It proposes a hierarchy with 5 levels of learning potential. Based on this potential there are different optimal interventions
1 Environmental control
2 S-R conditioning
3 Skill training
4 Strategy training
5 Cognitive cycle
What is neuropsychological rehabilitation?
It focuses on cognitive disorders and also on emotional and behavioral disorders resulting from brain injury
What is the international classification of impairments, disabilities and handicaps (ICIDH)? What are it’s levels?
It creates a hierarchy in the consequences of brain injury in 3 levels
- Impairments
- Disabilities
- Handicaps
What are impairments?
Manifestations, disorders or illnesses at the organ level
What are disabilities?
Consequences of impairments at a personal level, typically seen as a restriction or lack of an ability considered part of normal functioning
What is a handicap?
The adverse effects of impairments and disabilities on social functioning or the environmental/social barriers that limit a person’s functioning
Give an example of a handicap
Discrimination and lack of equipment can limit a person’s functioning in society
What is the ICF (International Classification of Functioning, Disability and Health)? What is the main difference with the ICIDH?
It classifies health components. It was the successor of the ICIDH
Main difference:
- ICIDH: classifies the consequences of illnesses
- ICF: focus on classification of health components. It makes it possible to chart environmental and personal/premorbid factors that can clarify classification
What are the 2 parts of the ICF model?
- Functioning and disability
- Contextual factors
What are the 3 components of functioning in the ICF model?
- Bodily functions/mental functions (properties of the person)
- Activities (person’s actions)
- Participation of a person in society (role fulfilment)
Why has the term handicap been removed from the ICF model?
It’s too stigmatizing. Functioning and disability captures it all
What are activity restrictions and participation restrictions in the ICF model?
Activity: reduction or loss of ability to carry out an activity
Participation: restriction that hampers or prevents normal societal role fulfilment
What are the 2 types of contextual factors in the ICF model?
- Environmental factors: attitudes in a person’s environment and social support
- Personal factors: a person’s characteristics (age, SES, coping style)
Study the ICF model!!! Summary p. 83/slide 22
KEEP GOING YOU’RE DOING AMAZING <3
What are disabilities in the ICF model?
Functional disorders and restrictions in activities/participation.
What are 3 types of classification in neuropsychology?
- ICIDH model
- ICF model
- Direct/indirect symptom distinguishment
What is the difference between instrumental and operant conditioning?
Instrumental: linking stimulus to response
Operant: modify behavior using positive/negative reinforcement
