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
