Neurobehavioral and TBI Flashcards
Common neurobehavioral changes post TBI
Aggression
Agitation/irritability, poor frustration tolerance
Poor initiation/apathy
Denial of deficits/poor self-awareness
Disinhibition/inappropriate sexual behavior
Eating disturbances
Emotional changes including flat/restricted emotions, lability, dysphoria, depression
Impulsivity
Poor judgment and reasoning
Psychosis - delusions, euphoria, hallucinations
Nighttime disturbances
Anxiety
emerging from coma agitation
behavior may be bizarre, unpredictable, impulsive, and disinhibited
During this time consequence (or learning) based programming is not indicated as learning new information is unlikely
This phase is generally short in duration when medication and environmental based management are provided
addressing agitation from Coma
limit environmental triggers / changes re-orient and redirect avoid confrontation medicate as needed 1:1 personnel
the stability triangle
3 key aspects to stability post TBI - interdependent in that all rely on each other
- establish medical stability - pain, meds, incontinence, drug/ alcohol use
- promote stable behavior - cognitive/ emotional issues impacting impulsive/ aggression etc.
- develop stable activity pattern - develop opportunity for meaningful interaction
Applied Behavioral Analysis
discover variables that reliably influence behavior to predict behavior or promote behavior change
environment -> behavior target
individual -> target behavior
explore how both avenues impact target
The individual as part of ABA
individuals cognition and physical disabilities greatly impact their relationship to their environment
the environmental and ABA
what has occurred and/or is currently occurring around the individual, both before and after the behavior of interest is displayed
noise, smell, light, environmental distractions
target behavior and ABA
defined in objective and measurable terms so that it can be examined in a consistent and systematic manner
behavior program elements / steps
assess behavior -> define target behavior -> collect data -> change behavior
assessing behavior
indirect method - check lists and interviews
direct method - assess pt in the target environment aka functional assessment - this is more reliable
functional assessment
The goal is to understand the function the behavior serves for the individual in a situation
Identifying the function of a particular behavior within a specific situation of interest
A good assessment should include a list of behaviors that will be targeted for decrease and increase
define the target behavior (ABA)
The behavior must be:
- Observable
- Measureable
- Specific enough such that multiple observers would agree on what would count as an occurrence
KEYS
- Topography is what the behavior looks like physically
- Intensity is a description or measure of force
collecting data (ABA)
frequency - counting how many times behavior occurs
duration - how long the behavior lasts from start to end
rate - count per unit of time
latency - amount of time from stimulus to target behavior
percent correct - amount of correct response / total possible opportunities for correct response
4 term contingency
functions in ABA as a construct to classify and understand relationships between the behavior and environment
- establishing operation
- discriminative stimulus
- response/ behavior
- consequence
establishing operation
Any variable that temporarily alters the effectiveness of some stimulus or event as a reinforcer
ex: mary was/ was not given medication at 9am to control back pain
discriminative stimulus
event or stimulus that precedes a response and sets occasion for behavior to occur
ex: mary is told at 945am she has PT session
response / behavior
anything that can be done or measured
ex: mary throws her walker
consequence
any event that changes the probability of response in the future — punishment or reinforcement
ex: staff remove Mary and she misses PT appt
antecedents
events which proceed the behavior
aka establishing operation
they influence behavior
e.g. make sure pain meds are taken ahead of appt
consequences
follow the behavior - alter likelihood of behavior occurring in the future
consequence based intervention
a systematic intervention where a target behavior is followed by a specific type of consequence
The type of consequence applied depends on whether the consequence is targeted for increase or decrease
punishment in consequence based intervention
refers to any process that decreases the likelihood that a particular response will occur again in the future
negative punishment - take something away to discourage behavior from occurring again
positive punishment - add stimulus to discourage behavior from
reinforcement in consequence based intervention
any process that increases the likelihood that a particular response will occur again in the future
negative reinforcement - take stimulus away to encourage behavior
positive reinforcement - add stimulus to encourage behavior
extinction
A particular response never produces a reinforcer
The disappearance of a previously learned behavior when the behavior is no longer reinforced
Behavior almost always increases before it goes away
intermittent reinforcement
A particular response sometimes produces a reinforcer
Produces greater variability in topography of behavior
Utilized to promote generalization and maintenance of behavior
Behavior is highly resistant to extinction
Think hourly pay and slot machines
continuous reinforcement
A particular response always produces a reinforcer (1:1)
Produces less variability in topography of behavior
Utilized to promote acquisition of behavior
Behavior is highly sensitive to extinction
Think piece work and soda machines
Task analysis
A task analysis is a list of very specific steps involved in completing a task
This can be used to break down larger tasks into smaller component steps
shaping
A technique in which successively closer approximations to the target response are reinforced until the target response occurs
fading
Fading involves providing gradually less support either from the environment or from another individual to display the target behavior
discrimination
when an organism responds differently to similar stimuli
de-escalation techniques
Active Listening
Orientation
Redirection
Setting Limits
Withdrawing Attention
Contracting
when de-escalation fails
CBIS staff are sometimes required to take physical action to keep individuals with brain injuries and themselves safe
A situation is considered a crisis when immediate risk is posed to the individual or other persons
There are many legal and ethical considerations that must be accounted for when individuals and facilities decide to employ physical intervention techniques including restraint and seclusion
phrenology
-debunked as a science but it did provide important precursors of modern understanding of brain-behavior relationships, namely localization of brain functions
functional systems model
Behaviors consist of a number of simple mental operations that are localized to a specific part of the brain
Thoughts, movements, sensations, heartbeats (i.e., behavior )produced by the collaboration of the local brain sites that control the mental operations composing it
Brain areas needed for a behavior can be located close together or can dispersed throughout the brain
Success of a behavior depends on intact functioning of specific brain localized areas, and intact connections between those areas
Disruption to any component of the functional system can lead to a breakdown of the entire behavioral function
The frontal lobe and its extensive connections are a prime example
neuropsychology
focuses on the interaction between brain and behaviors
experimental neuropsychology
studies the intact brain throughout the lifespan
clinical neuropsychology
testing is used to relate behaviors to lesion sites
scope of neuropsychology evaluation
Premorbid functioning – used to compare a person’s current and expected level of performance
Attention and concentration
Sensory perception and psychomotor functioning
Information processing speed
Language and communication skills
Visuospatial and constructional skills
Learning and memory
Intelligence (intellectual achievement)
Executive functions
Additional factors that can affect cognitive functioning, including mood, anxiety, personality, behavior, medications, effort and motivation
neuropsych assessment instruments
The assessment involves the administration of specialized tests that measure behavioral performance of brain functions (e.g., attention, memory, etc.)
manualize procedures - a score is representative of the individual’s ability, and not the impact of other factors
normative - scores are referenced against normative data ; norms represent a range of typical performance in a population of healthy individuals
record review
first step of the neuropsychological assessment
Past medical record
Results of prior assessments
Imaging
Specific details regarding behavioral and functional impairments
standardized testing in neuropsych eval
The fixed battery approach involves an exhaustive battery of standardized, co-normed tests that thoroughly cover every functional domain
The flexible battery is a patient-tailored hypothesis testing approach, and involves selection of assessment instruments based on careful consideration of the referral question and impressions from the initial interview
cognitive rehab process
- cognitive education - self awareness training
- cognitive training - restorative goal
- strategy training - training compensatory
- functional training - daily activity training
principles of cognitive rehab
neuroplasticity and adaptability
neuroplasticity - focus is restorative
adaptability - focus is compensatory
we need both
