Module 6 Flashcards
Assessment of CCD after RHD:
complicated by several factors:
few
no obvious patterns of ?
wide range of ?
cultural norms affect
reliable, valid assessment tools
deficits to guide the diagnostic process
normal pragmatic and social behaviors
pragmatics and social behaviors
Assessment of CCD after RHD:
assessment - observation
observe the client in various ?
talk to families to understand ?
assessment tools:
some batteries made specifically for ?
most have significant ?
cognitive/pragmatic assessments created for TBI:
some have
may be appropriate for ?
settings comm. with various peopl e
-pre-stroke comm./social behaviors and identify what has changed
significant limitations in terms of reliability and validity
strong relaibility and validity
RHD assessment
Informal assessment:
client/caregiver ..
should be the !!
patient and caregiver questionnaires are useful tools for RHD to provide quantitative information about:
rehabilitative measures database:
provides information about ?
quick view of the ?
interview
-first step for any assessment to obtain qualitative information about the effects of impairment on client’s life
perceived deficits , quality of life, impact of impairments, emotions
validity and reliability for multiple assessments
purpose of assessment and pop. it can be used for
Assessment Areas for RHD:
should assess multiple areas of deficits including:
attention:
-use a combo of
-… important to assess
executive function:
use a combo of
-…. etc
anosognosia:
… available
compare answer from client with those ?
pragmatics/social comm.:
usually assessed ?
observation and formal assessment
visual and auditory attention
observation and formal assess.
planning, judgment, metacognition
questionnaire/rating scales available
from family/caregiver or clinician
informally using observations and questionnaires
Assessment of attention and neglect:
unilateral neglect:
use a variety of ?
-
-..available
assess both
assess ?
tasks
-drawing/copying, cancellation, line bisection, picture description
-test batteries available
viewer centered and object centered
personal, peri-personal and extra-personal
Assessment of left neglect:
many visuospatial tasks available
-visual scanning and ?
count?
line bisection: lines should be
drawing tasks: copying and drawing from memory offers information about
cancellation tasks
-number of missed targets
divided at midline
working memory as well as left neglect
Assessment of Comm.:
prosody and affect:
some …available
talk to families to identify ?
discourse and pragmatics:
can use ?
several ..available
combine formal with observation of comm. in different ?
talk to ?
prosody/affect batteries available
changes in use/interpretation of prosody
RHD batteries
comprehension and pragmatic tests
settings with diff. partners
families to identify changes in comm.
Informal assessment: discourse
discourse analysis can be used to examine? structures of discourse to those likely to be affected
types of discourse to evaluate:
conversational ? story ? ….descriptions
stimuli should allow patient to draw ? and should have enough details that it requires?
In picture description, can tell if the client can differentiate ? as well as screening?
examine ? vs?
objective quantitative discourse measures
…
informational
main
..
..
story
may also assess narrative comprehension by using ?
micro and macro structure features of discourse
language sample, story retell, procedural descriptions
inferences /focused attention
relevant and irrelevant information/ neglect
literal concepts vs interpretive concept
informativeness, informational content analysis, main concept analysis, coherence, grammaticality, story grammar
verbal/written stories and answering comprehension questions
Assessment of Prosody and Apragmatism:
apragmatism: disorder in conveying or comprehending meaning or intent through ?
linguistic
paralinguistic
extralingustic
its highly ? yet has ?
other client/caregiver questionnaires and objectives scales are available to obtain
linguistic, paralinguistic, and or extralinguistic modes of context dependent on comm.
choice of words
vocal manipulation (prosody)
body language facial expressions
under identified, yet, has detrimental effects on life-participation
quantitative data
Informal assessment of prosody and apragmatism:
assess
common deficits in conversation includes: recognizing ? turn-, and topic
observe id patient provides ? without identifying the ?
assess ?
conversational skills
shared knowledge vs private knowledge/ turn-taking/ topic maintenance
private/personal knowledge/ referent or context of the new info
comprehension of stress.intonation/emphasis within single sentences, compund noun/verb phrases, interrogative/declarative sentences
treatment approaches and neuroplasticity:
restorative or process oriented approach:
-based on principles of
-goal is to change ?
-addresses the underlying ?
compensatory or task-oriented approach:
its all about the ? modifications that ?
goal is to compensate for ?
focuses on the specific ? instead of ?
contextualized and individualized to ?
remember: just because we are compensating doesn;t mean that there are zero ? restorative approaches may also involve use of ?
neuroplasticity
brain/ restore what is lost
mechanism of disability
strategies/ bypass deficit
what was lost
acitivities and symptoms
client needs
benefits to brain and vice versa
strategies
Deciding which approach is best:
things to consider
goal/purpose of treatment approach
-to change
-method
what are the client’s ?
how does patient ?
will it help the client with ?
-areas that have a rapid ?
-strategies to establish ?
will it generalize to ?
areas of awareness or ?
group ?
what are some ?
… demands
issues in ?
resore the brain or to compensate for lost skill?
behind treatment approach
goals ?
achieve this goal
functional tasks/.activities
-rapid positive impact on ADL
functional interactions
other areas
stimulability
treatment
obstacles that can keep patient from achieving those goals
-situational or environmental demands
personal relationships
General Recommendations for Tx:
treatment should incorporate the daily environment or simulate the client’s?
treatment should incorporate strategies for
treatment should include
treatment should always consider patients
treatment should create awareness of and minimize:
develop an understanding of the ?
modification of ?
environment or simulate the client’s natural setting and other contextual factors as best possible
generalization
caregiver or caregiver training
goals for life particiaption
barriers
-demands of the environment or context
perceptual factors, spatial requirements for location, distance , direction and memory
Treating attention and negelct:
treatment should include functional tasks that target
may select tasks that work on both attention and neglect or executive functions and neglect
for example:
setting up
visually scanning for items in ?
use a combo of both ? particularly for left-sided scanning
using a combo of approaches increases ?
multiple domains
pillbox
refrigerator or for personal items in the room
compensatory strategies and restorative approaches
verbal cues to look left
generalization
Treatment for unilateral neglect
attention:
direct
.. strategy training
top-down treatments use :
visual scanning treatment- strong
manipulate complexity to make ?
change number of ?
systematic or random ?
.. salience of stimuli
visuospatial motor treatments- moderate
combine scanning with
bottom-up treatments: manipulate ?
examples
trainng
metacognitive strategy training
evidence of efficacy
make easier/harder
distractors
placement of targets
emotional/personal
level of efficacy
movement
stimuli and attentional systems to increase attention
prism adaptation, external sensory stimulation
Treatment for Unilateral neglect
Object-centered neglect treatment
bottom-up treatments
attentional window: use different sized stimuli to increase
compensatory treatments:
red line
training to
word reading: add ?
size of attentional focus
visual cues
move head to left
extraneous letters or characters to the left side of a word
Treatment for Unilateral Neglect:
suggestions fo rincreasing left-ward movement of attention
establishing border around
-tracing
-circling
adding ? between stimuli
using ?
left side ?
may initially draw?
may be trained as a ?
no evidence to support ?
target stimuli
outline of page
or otherwise enclosing stimuli
connectors between stimuli
asymmetrical pictures or words that cannot be sub-divided
anchors
attention automatically
compensatory strategy
how well they work
Treatment of reading and writing:
impairment-level treatment focusing on remediating or compensating for by?
treatment of reading and writing depends on the importance of ?
compensatory, organizational guides or structured sets of questions for ?
a variety of other compensations may be ? such as ?
visual processing or attention deficits
those skills in patients lives and the severity of their imapirments
self-instruction and self-analysis of reading comprehension
appropriate/ highlighting of relevant points or key information
Treating cognitive deficits:
executive function:
…strategies
task-specific treatment for
awareness:
.. strategies
experiential
visual/verbal
evidence from ? little evidence specifically for ?
metacogntiive
critical daily tasks
metacognitive strategies
experiental learning
feedback
TBI lit. / RHD
Treatment for cognitive domains:
Memory: external ? internal memory strategies such as ?
exec. functions: focus on strategies to enhance the ? may use metacognitive approaches like ?
attention: latest version of ? emphasizing use of ?
anosognosia: direct ? education and ? approaches
group tx for ?
memory aids/ mnemonics
analysis and synthesis of complex information / GMT; strategic memory and resounding training program
APT/ compensatory strategies to enhance attention
feedback/ prediction approaches
self awareness and self regulation
RHD experience linguistic impairments such as:
impaired ?
functional deficits or symptoms may include ? poor use of , and tangential ?
inferences, narrative discourse, turn taking and prosody
circumlocution/ poor comprehension for complex sentences/ poor use of complex sentences/ output
Tx for aprosodia:
motoric-imitative treatment:
goal: production of emotional prosody through ?
6-step hierarchy
-
work on using and identifying diff. types of ?
cognitive affective tx:
goal: understand qualities of emotional prosody to ?
6 step ?
matching ?
matching different types of ?
repetition and drill
unison, repetition, reading , cued production
prosody/intonations
be able to produce it
hierarchy
facial expression, descriptions, definitions - each cue removed in turn
tones to emotion
Treatment for aprosodia:
expressive aprosodia:
cognitive-lingusitic treatment: teaching emotional intonation features in?
imitative-motor tx: producing prosody that expresses the meotion with their productions moving from ? to ?
receptive aprosodia:
no published ?
determining moods from ? resolving prosodic interpretation difficulty for ?
utterances by using written language tasks
expresses the emotion/ unison with clinician to repeating after the clinician to independent productions
evidence
prosody/ nonemotional signals
Tx for pragmatics:
limited ?
pragmatics and social comm. group tx’s ?
tx based on theory:
use strong ?
-
-identification of ?
.. interpretation
use other ? to increase interpretation of intended meaning:
… scenes
ask for interpretation of
ask why ? and ?
evidence for efficacy and effectiveness
work
contextual biases to increase
appropriate meanings of ambiguities
idiom or metaphor interpretation
contextual cues
situation or social scenes
situation
questions and what next
Tx for pragmatics and social cognition:
identifying and building awareness of ? and then identifying instances of ? and negative ?
discussion of ? or a demonstration that no one’s thoughts are ?
manipulation of the nature of ? or communicative intents in ?
stimulated
social scenarios
group ?
work on topic maintenance by discussing ?
in 3 sentences tell me about
have a gesture to signal when ?
nonverbal behaviors / self-monitoring and negative nonverbal signals
social norms/ transparent
social relationships / ToM activities
-simulated conversations
social scenarios or vignettes
group tx
guidelines for activity or conversation
…
off topic, using circumlocutions etc
Tx for dicscourse:
Discourse/narratives:
work on logical ? such as describing events of ?
ask to verbally create a plan or steps for ?
ask client to self evaluate
targeting macrostructure difficulties:
targeting microstructure-level difficulties:
comprehension fo narratives can be enhances using ?
clinician may manipulate the demands of the task to require ?
sequencing of events or procedures/ process of making pb and j
an ADL task
after narrative
summarizing, sorting, explaining stimuli demonstrating appreciation of character motives or story morals
self-monitoring for typical errors
visual or context cues
multiple domains such as asking questions about what was said or identifying the context that the narrative should be used
TX for thought org.
wprk on developing ? such as identifying when its time to
… tasks
ask guided questions related to ?
how items
what main ?
what might happen next given ?
self awareness/ stop and plan
picture description and sequencing tasks
picture
relate to one another
idea or title of scene is
info in scene and why
Treatment for abstract language and concepts:
work on ?
..,..,..
may use situation such as?
may work simultaneously with prosody to include?
ask about relationships between
-ask client to
work on situations to help with ?
comprehension and use of mult. meanings
metaphors, jokes, sarcasm
why would someone use the phrase running your mouth
objects, actions and situations
interpret those relationships
problem solving and safety awareness
Tx of prosopagnosia and simultagnosia:
these two disorders are related to the patients inability to process
identify differences in teh ? of familiar and unfamilair people
may use pictures of
may use standard pictures of people
use ? while muted to ask for ?
faces and facial expressions
facial expressions, body language, and physical characteristics
-family , hospital staff
expressing emotions
us TV shows or video clipes/ inferences about their feelings
