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CBIS > Neurobehavioral and TBI > Flashcards

Neurobehavioral and TBI Flashcards

1
Q

Common neurobehavioral changes post TBI

A

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

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2
Q

emerging from coma agitation

A

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

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3
Q

addressing agitation from Coma

A 
limit environmental triggers / changes
re-orient and redirect
avoid confrontation 
medicate as needed
1:1 personnel
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4
Q

the stability triangle

A

3 key aspects to stability post TBI - interdependent in that all rely on each other

  1. establish medical stability - pain, meds, incontinence, drug/ alcohol use
  2. promote stable behavior - cognitive/ emotional issues impacting impulsive/ aggression etc.
  3. develop stable activity pattern - develop opportunity for meaningful interaction
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5
Q

Applied Behavioral Analysis

A

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

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6
Q

The individual as part of ABA

A

individuals cognition and physical disabilities greatly impact their relationship to their environment

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7
Q

the environmental and ABA

A

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

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8
Q

target behavior and ABA

A

defined in objective and measurable terms so that it can be examined in a consistent and systematic manner

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9
Q

behavior program elements / steps

A

assess behavior -> define target behavior -> collect data -> change behavior

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10
Q

assessing behavior

A

indirect method - check lists and interviews

direct method - assess pt in the target environment aka functional assessment - this is more reliable

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11
Q

functional assessment

A

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

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12
Q

define the target behavior (ABA)

A

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
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13
Q

collecting data (ABA)

A

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

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14
Q

4 term contingency

A

functions in ABA as a construct to classify and understand relationships between the behavior and environment

  1. establishing operation
  2. discriminative stimulus
  3. response/ behavior
  4. consequence
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15
Q

establishing operation

A

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

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16
Q

discriminative stimulus

A

event or stimulus that precedes a response and sets occasion for behavior to occur
ex: mary is told at 945am she has PT session

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17
Q

response / behavior

A

anything that can be done or measured

ex: mary throws her walker

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18
Q

consequence

A

any event that changes the probability of response in the future — punishment or reinforcement

ex: staff remove Mary and she misses PT appt

19
Q

antecedents

A

events which proceed the behavior
aka establishing operation
they influence behavior

e.g. make sure pain meds are taken ahead of appt

20
Q

consequences

A

follow the behavior - alter likelihood of behavior occurring in the future

21
Q

consequence based intervention

A

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

22
Q

punishment in consequence based intervention

A

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

23
Q

reinforcement in consequence based intervention

A

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

24
Q

extinction

A

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

25
Q

intermittent reinforcement

A

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

26
Q

continuous reinforcement

A

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

27
Q

Task analysis

A

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

28
Q

shaping

A

A technique in which successively closer approximations to the target response are reinforced until the target response occurs

29
Q

fading

A

Fading involves providing gradually less support either from the environment or from another individual to display the target behavior

30
Q

discrimination

A

when an organism responds differently to similar stimuli

31
Q

de-escalation techniques

A

Active Listening

Orientation

Redirection

Setting Limits

Withdrawing Attention

Contracting

32
Q

when de-escalation fails

A

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

33
Q

phrenology

A

-debunked as a science but it did provide important precursors of modern understanding of brain-behavior relationships, namely localization of brain functions

34
Q

functional systems model

A

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

35
Q

neuropsychology

A

focuses on the interaction between brain and behaviors

36
Q

experimental neuropsychology

A

studies the intact brain throughout the lifespan

37
Q

clinical neuropsychology

A

testing is used to relate behaviors to lesion sites

38
Q

scope of neuropsychology evaluation

A

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

39
Q

neuropsych assessment instruments

A

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

40
Q

record review

A

first step of the neuropsychological assessment

Past medical record
Results of prior assessments
Imaging
Specific details regarding behavioral and functional impairments

41
Q

standardized testing in neuropsych eval

A

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

42
Q

cognitive rehab process

A
  1. cognitive education - self awareness training
  2. cognitive training - restorative goal
  3. strategy training - training compensatory
  4. functional training - daily activity training
43
Q

principles of cognitive rehab

A

neuroplasticity and adaptability
neuroplasticity - focus is restorative
adaptability - focus is compensatory

we need both

CBIS (30 decks)

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