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BCPR > Module 2: Lesson 5: The Neurofunctional Approach > Flashcards

Module 2: Lesson 5: The Neurofunctional Approach Flashcards

1
Q

What is the neurofunctional approach (NFA)?

A

A performance based skill/habit based training approaches that involve:

  • Client centered real life relevant goal development
  • Understanding the limitations to learning imposed by the brain injury
  • Use of repetitive practice of skills
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2
Q

What are some target populations for NFA intervention?

A
  • TBI
  • Stroke
  • Other forms of neurobehavioral disability
  • Lack of insight associated with cognitive impairment from neurobehavioral disorder
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3
Q

What diagnoses was NFA intervention initially designed for?

A

Individuals with severe to profound cognitive impairments arising from traumatic brain injury and associated disorders.

  • Shown to improve ADL/IADL in those with less profound impairments like TBI, stroke, lack of insight from neurobehavioral disorder
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4
Q

What population is least appropriate for NFA intervention?

A
  • Mild impairment
  • Intact self awareness
  • The ability to benefit from trial and error learning
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5
Q

What population is most appropriate for NFA intervention?

A
  • Severe impairments of memory, attention, EF
  • Impaired trail and error learning
  • Lack of insight or impaired awareness of cognitive impairment
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6
Q

Which population described below is more appropriate for NFA interventions?

  • Severe impairments of memory, attention and EF. Impaired trial and error learning. Lack of insight or impaired awareness of cognitive impairment.
  • Mild impairment. Intact self awareness. The ability to benefit from trial and error learning.
A

The first option listed with sever impairments

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7
Q

What type of approach is the NFA?

A

Performance based

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8
Q

What tasks can be trained with NFA?

A
  • Simple IADL
  • ADL
  • Some more complex IADL can be altered so they can be made routine
  • Repetitive social routines
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9
Q

True or false:

Home management activities are challenging for persons 1 year after TBI especially for OA and those with more severe cognitive impairment.

A

True

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10
Q

Describe explicit memory system.

A
  • Declarative memory: Individual knows that they know something.
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11
Q

Describe implicit memory systems

A
  • Evolutionary older
  • About “doing”
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12
Q

What memory system is described below:

  • Memory system:
    • STM/WM
    • Episodic memory (STM, days weeks, or longer years)
    • Semantic memory (knowledge, facts, dates, etc.)
  • Neuroanatomical correlates: Primarily ventrolateral prefrontal cortex (STM), hippocampus and medial temporal structures (episodic memory), wide distribution in neocortex (semantic memory).
A

Explicit Memory System

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13
Q

Describe the Explicit Memory System

A
  • Memory system:
    • STM/WM
    • Episodic memory (STM, days weeks, or longer years)
    • Semantic memory (knowledge, facts, dates, etc.)
  • Neuroanatomical correlates: Primarily ventrolateral prefrontal cortex (STM), hippocampus and medial temporal structures (episodic memory), wide distribution in neocortex (semantic memory).
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14
Q

What memory system is described below:

  • Nondeclarative learning
  • Memory systems involved:
    • Perceptual priming: Object identification
    • Conceptual priming
    • Motor skill learning/procedural learning
    • Associative conditioning, “habit learning”
    • Habituation
    • Sensitization
  • Neuroanatomical correlates: Modality specific cortex, BG and cerebellum, limbic cortex
A

Implicit memory system

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15
Q

Describe the implicit memory system.

A
  • Nondeclarative learning
  • Memory systems involved:
    • Perceptual priming: Object identification
    • Conceptual priming
    • Motor skill learning/procedural learning
    • Associative conditioning, “habit learning”
    • Habituation
    • Sensitization
  • Neuroanatomical correlates: Modality specific cortex, BG and cerebellum, limbic cortex
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16
Q

Name some prerequisites for procedural memory transfer

A

Necessary factors
- High level of practice
- Consistent mapping (when Y happens do only X)
- Attention to task/DO the task

Helping factors
- Verbal labels (mnemonic strategy of saying along with doing)
- Goal consistency (assists attention)
- Variable practice for stimulus generalization (near transfer)

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17
Q

What approach is described below:

  • Addresses ADL and simple IADL skills and can be used during PTA
  • Occupation based for tasks in the “real world”
  • Learning by doing
  • Training in situ
  • Development of habitual routines/automatic functioning/competencies in areas the client has identified as important
  • Far transfer of skills (generalization) not expected
A

The Neurofunctional approach

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18
Q

Describe the neurofunctional approach.

A
  • Addresses ADL and simple IADL skills and can be used during PTA
  • Occupation based for tasks in the “real world”
  • Learning by doing
  • Training in situ
  • Development of habitual routines/automatic functioning/competencies in areas the client has identified as important
  • Far transfer of skills (generalization) not expected
19
Q

What approach is described below?

  • A structured, multidimensional, eight stage rehabilitation process
  • A unique combination of elements in the context of the application of learning principles
A

The Neurofunctional Approach

20
Q

Name the 8 steps of the Neurofunctional approach

A
  1. Development of a positive therapeutic relationship. Focused on the client’s perspective and goals, and what he or she wants to do.
  2. Gathering information
  3. Observation - of performance in everyday situations w/ reference to the nature of the task, the client characteristics, environmental resources and constraints.
  4. Case formulation - formulation of the client’s goals and a reconciliation of these with resources available and current constraints.
  5. Operational performance goals - goals that can be translated into retraining programs (i.e. I want to be able to….).
  6. Skill retraining program - developed from analysis of the person, activity and environment. A task analysis for each individualized retraining program.
  7. Development of automaticity, generalization and the maintenance of skills in the clients everyday life.
  8. Feedback - to encourage progress
21
Q

When does automaticity occur?

A

Consistent response to a specific stimuli

22
Q

What are the types of behaviors that can become automatic?

A
  • Consistent mapping
  • Variable mapping
23
Q

True or false:

Practice does not produce automaticity with inconsistent responses to stimuli.

A

True

24
Q

What is central to learning?

A

Practice

25
Q

There is increase evidence that practicing tasks leads to what?

A

Cortical restructuring

26
Q

Stimulus & response similarity and Task transfer

A
  • Task stimuli is same, response required is same = transfer to automaticity is high
  • Task stimuli is different, response required is different = transfer is none
  • Task stimuli is different, response required is the same = transfer is positive
  • Task stimuli is the same, response required is different (but similar) = negative transfer
27
Q

What type of transfer is seen with the task stimuli and response required written below:

  • TS: Same
  • RR: Same
A

High (positive)

28
Q

What type of transfer is seen with the task stimuli and response required written below:

  • TS: Different
  • RR: Different
A

None

29
Q

What type of transfer is seen with the task stimuli and response required written below:

  • TS: Different
  • RR: Same
A

Positive

30
Q

What type of transfer is seen with the task stimuli and response required written below:

  • TS: Same
  • RR: Different (but similar)
A

Negative

31
Q

Describe the development of automaticity

A
  • Conscious engagement in behavior/self directed learning and (i.e. wanting to learn how archery, going out to do by themselves). OR stimulus driven (unintentional learning, what we need to do for our patients) we put patient in situation and cue them through situation on what they need to do , leads to:
  • Consistent engagement in activity, which leads to:
  • Decrease in conscious decision making
  • Automaticity of behavior
  • Decrease in situation cues
32
Q

What term is described below:

  • First, the organism makes a series of discrete response, often interrupted by incorrect ones.
  • Once errors are dropped out and the sequence of behavior becomes relatively stable…the various components of the total behavior required in the situation are “integrated”
A

Chunking

33
Q

What is another term for performance integration?

A

Chunking

34
Q

Describe an example of a situation of “chunking”.

A

Brushing teeth broken into various steps

  • Pick up toothbrush
  • Pick up toothpaste
  • Put toothpaste on toothbrush
  • Brush teeth
  • Top right
  • Top left
    etc…..

**Australian study: Average # of treatments that resulted in improvements: 14

35
Q

Name some key steps to documenting the neurofunctional approach.

A
  • Use of a retraining program
  • Aras of ADL/IADL being addressed
  • Clients level of support in terms of PA and cues
  • Program steps carried out independently
  • Progress made from last documentation in terms of reduced cueing and increased independence
36
Q

What type of approach is the NFA?

A

Performance based

37
Q

What types of tasks can be trained in the NFA?

A
  • Simple IADL
  • ADL
  • Repetitive social routines
38
Q

Read info

A
  • Global strategy: Plan, do , check
  • Doman specific strategy: memory strategy
  • Specific task
39
Q

The following are apart of the explicit or implicit memory system?

  • STM/working memory
  • Episodic memory
  • Semantic memory

A person knows that they know

A

Explicit

40
Q

The following are apart of the explicit or implicit memory system?

  • Perceptual priming
  • Conceptual priming
  • Motor skill learning
  • Associative conditioning
  • Habituation
  • Sensitization

Does not require the person to know that they know.

Based on practice

A

Implicit

41
Q

What is another term for implicit learning?

A
  • Non declarative
  • Procedural learning
42
Q

What are some necessary factors as prerequisites for procedural transfer?

A
  • Consistent mapping (i.e. when y happens do only x)
  • Attention to task/do the task
  • High level of practice

Helpful factors:
- Verbal lables
- Goal consistency
- Variable practice for stimulus generalization (i.e. bath in variable environments/contexts)

43
Q

What concept is central to learning?

A

Practice

44
Q

True or false

The is poor evidence that practicing tasks leads to cortical restructuring.

A

False - increasing evidence

BCPR (19 decks)

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