Neurocognitive Issues Flashcards
complex collection of conscious mental activities such as attention, perception, comprehension, remembering, language
cognition
process by which sensory input is transformed, reduced, elaborated, recovered, used
cognition
6 domains of cognitive functioning
ME CAMP metacognition executive function categorization attention memory processing speed
5 subtypes of attention
focused - selecting one source of input
sustained - maintained to complete task efficiently
selective - maintained in presence of distractions
alternating - shifting for tasks that demand multiple skills
divided - requires ability to respond simultaneously
how is retraining used to improve attention after a brain injury?
systematically increase level of distractors in an environment to stimulate high-level demands
train person to recognize what distracts them
attention process training program (APT)
hierarchically organized by difficulty with person progressing to higher level
begin with sustained attention tasks, progress to selective, alternating, and divided attention tasks
improves memory in persons with brain injuries
how do individuals with brain injuries tend to base decisions about category membership?
tend to categorize according to a single attribute
what are the stages of memory
encoding –> storage –> retrieval
of the 4 types of memory, where does rehearsal occur?
sensory, short-term, working, long-term
rehearsal occurs in working memory
retrieval occurs by moving memory from long-term to working
categorize these as explicit or implicit memory:
procedural
semantic
episodic
procedural is implicit
episodic and semantic are explicit
complex cognitive processes that involve reasoning, planning, judgement, initiation, abstract thinking
executive functions
age appropriate insight of strengths and weaknesses
self-awareness (executive function)
independently assessing behavior, responding to and making changes as needed
self-monitoring and self-evaluating (executive function)
impulse control, managing distractions, delaying response
self-inhibition (executive function)
moving freely from one activity to another, considering more than one solution when problem solving
change set (executive function)
what are 3 ways cognitive rehabilitation approaches teach individuals to use formal problem solving strategies?
approaching novel situations in systematic manner analyzing problems considering alternative solutions prioritizing solutions reviewing outcomes
higher-order, self-regulatory function that includes awareness of one’s own cognitive processing
metacognition
reduced awareness of deficits caused by brain injury (such as awareness of one’s own memory deficits), functional implications of these deficits, and awareness to set realistic goals are 3 levels of what kind of impairment following a brain injury?
impairment in metacognition (awareness of one’s own cognitive processing)
executive functions are to ____ directors as metacognitive functions are to _____ directors
executive functions = cognitive directors (assist in interaction between memory, attention, perception; help to solve complex problems)
metacognitive functions = awareness directors (allow for self-awareness of one’s own cognitive processes, irrespective of one’s ability to solve complex problems)
impairments in problem solving would indicate a deficit in ____, while impairments in self-awareness of one’s ability to problem solve indicate a deficit in ____
problem solving deficit = executive function deficit
self-awareness deficit = metacognition deficit
anosognosia
diminished self-awareness and failure to recognize a personal disability (metacognition deficit)
can affect compliance and rehabilitation
in what brain lobe does memory, face recognition, object categorization, and selective attention occur?
temporal
apraxia vs dysarthria
apraxia - oral motor speech disorder, individual cannot translate what they want to say into motor plans to initiate speech
dysarthria - muscle weakness affecting speech production
compensatory approach vs restorative approach to cognitive rehabilitation
compensatory approach - assumes certain cog functions cannot be recovered due to damage, focuses on strategies to accommodate limitations, functional application essential
restorative approach - uses therapeutic exercises designed to reestablish or strengthen specific cog skills or processes
what are 3 approaches to cognitive rehabilitation that use hierarchy?
environmental stimulus (quiet to distracting) task complexity (simple to complex) cognitive distance (concrete to abstract)
what are 4 factors that influence neurobehavioral changes following a brain injury?
site/severity of damage
intelligence/ learning style
pre-injury personality
current environment
brief (less than 10 days) duration of agitation following a coma, characterized by hyperactive movement without purpose and responding to internal rather than external stimuli
coma-emergent agitation
individuals may emerge from coma with bizarre, unpredictable, impulsive, disinhibited behavior
what is the most effective way to respond to coma-emergent agitation?
safest technique is to manage environment. learning based programs are not effective during this time
using the same staff repeatedly, providing frequent orientation of objects, and using redirection to avoid confrontation are effective strategies at managing ____ after a coma
coma-emergent agitation
what are the 3 components of the Stability Triangle?
establish medical stability, promote stable behavior, develop stable activity plan
functionally equivalent alternative
behavior that serves same function as target behavior but is more safe and appropriate
(rather than yelling at staff, asking for a break)
science of prediction and change of socially significant behavior
applied behavior analysis
in applied behavior analysis, the target behavior must be defined in ___ and ____ terms so it can be examined in _____ and _____ manner
target behavior must be defined in OBJECTIVE and MEASURABLE terms so it can be examined in CONSISTENT and SYSTEMATIC behavior
(behavior must be observable, measurable, specific)
what are the 4 elements of a behavior program
assess behavior (functional analysis), define target behavior (operational definition), collect data, change behavior (proactive or consequence based approaches)
in a behavior program, the goal of a ____ is to understand the function a behavior serves for an individual in a situation
functional assessment
topography and intensity of a behavior
topography - what behavior physically looks like
intensity - description or measure of force
what are 5 methods of collecting data for a behavior program?
frequency, rate, duration, latency (time between stimulus and response), percent correct responses
proactive approach interventions in behavior programs are set up to reduce likelihood of a behavior occurring by addressing the ____
establishing operations and antecedents, which contribute to or influence occurrence of behavior
(continuous/ intermittent) reinforcement produces less variability in topography of behavior, is utilized to promote acquisition of behavior, but the behavior is highly sensitive to extinction
continuous
(continuous/ intermittent) reinforcement is utilized to promote generalization and maintenance of behavior, and the behavior is highly resistant to extinction
intermittent
what type of reinforcement schedule creates behaviors very resistant to extinction
intermittent - good for promoting generalization and behavior maintenance
list of very specific steps involved in completing a task
task analysis
successively closer approximations to target response are reinforced until target response occurs
shaping
process by which one learns to produce the same response under gradually changing conditions (gradually providing less support)
fading
Alexander Luria proposed the Functional Systems Model - describe this
behaviors consist of a number of simple mental operations localized to a specific brain region
describe differences in approach in experimental vs clinical neuropsychology
experimental - intact brains (healthy brains)
clinical- brains with lesions (relate behavior changes to injury)
neuropsychological assessments are completed in standardized fashion involving 2 key principles:
manualized procedures (standard protocols for the administration of each assessment) normative data (represent range of typical performance in population of healthy people)
compare the fixed battery and flexible battery approaches to standardized testing in neuropsychological assessments
fixed battery - involves exhaustive battery of standardized tests that cover every functional domain
flexible battery - patient-tailored, selection of specific assessments
describe the purpose of each of these elements of cognitive rehabilitation:
cognitive education, cognitive training, strategy training, functional training
cognitive education - develop awareness of strengths and weaknesses
cognitive training - restore functional deficits
strategy training - develop compensatory strategies
functional training - to complete daily activities
