Neuro Flashcards
Neuropsychology
Study of relationship between brain function and behavior
Clinical Neuropsychology
Application of neuropsychological knowledge to evaluate & treat conditions that affect brain functioning
Neuropsychological Assessment
Evaluation of brain functioning & behavior in a specific individual
Neuropsychological Rehabilitation
Interventions meant to RESTORE/improve core ability OR to COMPENSATE for loss of ability
What are two core questions in neuropsych assessment?
Has there been a change (decline) in thinking skills and/or behaviour
If so, does the type and pattern of changes suggest a specific diagnosis or condition?
Components of a neuropsych assessment
Preparation
Interview
Formal Testing (EFs, social, personality, emotional, IQ, sensory motor, affect)
Case formulation & integration of information
Feedback & recommendations to family, client, referral source
Intra-individual patterns
Changes (decline) from estimated premorbid functioning
Beyond diagnosis and Case formulation
Answer referral question (if not diagnostic)
Describe effect on functioning – e.g., specify neurobehavioural syndrome(s)
Make recommendations
E.g., compensatory strategies, follow-up evaluation/further tests, med eval/other referrals, self- care ability, return to work, etc.
TREATMENT
TBI
Traumatic Brain Injury; Injury to the brain from an outside force
TBI neurological sequelae
Focal, diffused, or mix
cognitive TBI effects
attention, processing speed, memory/new learning,
reasoning, awareness of deficits, reduced initiation
Emotions/personality/social TBI effects
frustration tolerance, disinhibition, depression, anxiety, irritability, interpersonal sensitivity and awareness
Physical TBI effects
Fatigue, headaches, seizures, hemiparesis, ataxia, dysarthria, balance, sense of smell, gaze palsy, sexual dysfunction
Amnestic syndromes
changes in memory functioning following
TBI
Frontal lobe/dysexecutive syndromes
changes in reasoning, problem solving, mental flexibility, social awareness, etc.
The prefrontal cortex
High level of connectivity with other regions of the
brain – control and direction
Most recently developed part of the brain, thought to be largely responsible for much of what makes us human
The prefrontal cortex Three subdivisions:
Orbitofrontal PFC
Dorsolateral PFC
Mediofrontal PFC
Prefrontal Syndromes: The Apathetic Type
The medial frontal PFC region o Apathy/abulia o Poor initiation of activity (motor, speech, etc.) o Loss of spontaneity o Frontal lobe incontinence o Response slowing
Prefrontal Syndromes: The Dysexecutive Type
The dorsolateral PFC region (blue region)
o Poor planning & monitoring of outcomes
o Perseveration/inflexibility n Remember the WCST
o Distractibility/impersistence o Poor self-care
Prefrontal Syndromes: The Disinhibited Type
The orbitofrontal region (green region)
o Changes in comportment:
n Impaired inhibition of impulses
& distractibility
n Inappropriate social & sexual behavior with no insight
n Impaired judgment
n emotional lability, irritability, silly, odd sense of humor, explosive anger, no remorse
TBI Spontaneous recovery:
Most occurs in the first 12 months after injury some further recovery can occur after that time. Most with mild TBI recover to pre-injury levels within several months
Primary factors affecting TBI outcome
Injury severity, location, medical complications
Secondary factors potentially affecting outcome
Premorbid personality, coping style/resources
n Premorbid psychopathology, substance abuse
n Education/Premorbid functional level, cognition n Age
n Current family & social support
n Support from employer/school
n Financial circumstances
Neuropsychological Rehabilitation
Therapeutic changes achieved by:
n Reestablishing or strengthening premorbid skills
n Use of internal compensatory strategies
n Use of external compensatory devices or interventions
n Assist adaptation to cognitive disabilities
Rehabilitation of Executive Dysfunction
-Training for attention deficits
n during post-acute phase of rehabilitation
-Formal problem-solving training
n For executive deficits during post-acute phase of rehabilitation
-Other Metacognitive strategy training
n for deficits in executive function, including emotional self-regulation
Formal problem-solving training
Goal Management Training
- Orientation “STOP”
- Goal Selection – “Define the main task”
- Break into subtasks – “List the steps”
- Encode and retain task and subtasks – “do I know the task/steps?”
- Monitor – “am I doing what I planned to do?
TBI: Emotional and behavioural self-regulation treatment
CBT-based interventions
Group treatments to foster social communication, emotional regulation
Behavioural management, behavioural contracting, token economies
TBI: Fostering self-awareness
Metacognitive strategy training
Interactive, use of feedback, e.g. “pause, prompt, praise”
Or e.g., patients predict their task performance, given feedback regarding discrepancy between prediction and actual performance
