Rehabilitation and Recovery Flashcards
What are some concepts/models of brain recovery?
Biopsychosocial Model
Neuroplasticity
Robertson and Murre two main processes of recovery (Restitution and compensation) - Process of Compensation model
What is contained in the biopsychosocial model?
Pre-injury characteristics:
Genotype, age, gender, ethnicity, occupation, cognitive & physical abilities
Psychological and social resources
Psychological factors:
Personal appraisals and reactions (personality, self-awareness, coping strategies, motivation and goals)
Neuropathology:
Cause & mechanisms
Severity, location, recurrence, onset/ course
Treatment options
Direct effects on functioning (e.g., aphasia)
Social environment
Concurrent stressors
Access to resources (physical, financial, information, social support) and rehabilitation
> > Effect Outcomes (Functional, emotional and social)
Brain recovery
Initial belief that the brain was ‘hard wired
Later, recovery was thought to signify ‘spontaneous reorganisation’ of brain areas to take over the functions of damaged tissue
Today think that day-to-day experiences can have measurable effects on brain structure and function (experience-dependent plasticity).
the adult brain can show large experience-dependent change in neural circuits, including dendritic and axonal sprouting
What is prognosis for TBI recovery?
Most rapid recovery occurs in first 3-6 months but may continue for many years
What is neuroplasticity?
Neuroplasticity = brain’s ability to reorganise its structure, function and connections in response to life experiences
The lifelong capacity of the brain to change and rewire itself in response to learning and experience.
This assumes that there is a corresponding change in behaviour or function
Occurs in response to positive and adverse life experiences
adult brain has the potential for neuroplasticity through synaptogenesis (new synapses between neurons) and neurogenesis (new neurons)
Depend on:
Timing of injury and brain maturation issues
Greatest evidence of neuroplasticity exists for motor and sensory function
Some preliminary evidence for language
Little evidence yet for cognitive and behavioural functions
What to keep in mind for optimal recovery?
Recovery: greatest benefits of rehabilitation are soon after injury to capitalize on optimal window of neuroplasticity
Maintenance and further gains: Participation in rehabilitation and meaningful activities are integral for ongoing experience-dependent recovery and can prevent atrophy and functional decline
A lack of activity and stimulation or task avoidance may result in secondary functional impairments
Model of Compensation
Restitution – relearning or regaining skills to complete tasks the same as pre-injury
Compensation – learning to perform tasks in a different way
- Compensation refers to a process through which deficits or losses are moderated
- The need for compensation arises when there is a ‘mismatch’ between the skills a person possesses relative to the demands of the environment and expected performance
- The general aim of compensation is to close the gap between expected performance, environmental demands and level of skill
Experience-dependent brain plasticity forms the basis for some of these changes
Try to change/compensate for
- Environmental demands
- expected performance
- skill level - actual performance
In most cases it is important that individuals are aware of the mismatch
Poor self-awareness is linked to reduced engagement in rehabilitation, unrealistic goals, lack of strategy use, failure to benefit from rehabilitation and poorer long-term outcomes (Ownsworth & Fleming, 2014)
A first step of rehabilitation can involve facilitating individual’s self-awareness of the need for compensation. For some individuals, motivation issues may also need to be addressed
Mechanisms of Compensation (4)
Remediation – investing more time and effort through training and practice on a specific task Substitution – using previously developed skills or new skills to take over the performance of absent, lost or declining skills. Self-adjustment (Accommodate level of ability)– adjusting goals and expectations of performance to match environmental demands to one’s skill level External adjustment (Accommodate level of ability)– modifying & selecting environments & adjusting expectations of others
Aim of cognitive rehabilitation
apply to any intervention strategy or technique which intends to enable clients or patients and their families to live with, manage, bypass, reduce, or come to terms with cognitive deficits precipitated by injury to the brain
What are the main cognitive Impairments? (5)
Attention Memory & learning Language Visuo-spatial skills Executive function
Attention Rehabilitation
Some evidence for remedial, computerised training
Create an environment conducive to good attending
Set realistic goals within the person’s capabilities and still challenging
Plan activities according to arousal level
Shorten activities and the gradually increase length of activities.
Frequent breaks on long tasks; alternate between physical & mental tasks
Self Checking - Where is my attention > should i be focused on this?
Attention Rehabilitation
Alternating and Divided
Structure activities so they can be completed one step at a time
Avoid activities for which there is a high demand to process information concurrently or make multiple responses
List tasks sequentially and break these down into small parts and check items off when completed
Educate other people about the need to avoid interrupting the person while they are completing a set of tasks (put answering machine on)
Teach self-talk (verbal mediation) or visualisation to shift between tasks
Memory Problem Rehabilitation
Organise the environment
Internal strategies – e.g., PQRST
External memory aids (Diary or notebooks, Lists and checklists, Alarm clock or timer to cue actions, Calendar or whiteboards, Dictaphone or electronic organiser (iPhone etc), Pill reminder box, A memory book
- Assistive technology
– Cue intentions
– Store information
– Learn & consolidate new experiences
Develop routines/habits
Be wary of brain training app, rely more on memory support apps
Internal Strategies (Mnemonics)
- Repetitive trials of practice to learn information (e.g. numbers, words lists); i.e. memory muscle approach
- Chunking (e.g. 40 and 72) and categorising (e.g. groceries divided into logical groups)
- Acronyms (NESW, DRABC)
- Verbal associations or elaboration (e.g. the name Jessica)
Internal strategies (Substitution)
Enrichen encoding: PQRST – preview, question, read, summarise, test
Errorless learning and vanishing cues: Amnesia
Aim is to prevent and eliminate errors to prevent the development of maladaptive habit
E.g., provide step-by-step demonstration and a high level of cuing to teach someone how to set up a SPSS file or how to tap dance
Use of backward chaining to teach a basic procedure
Strategies must be applied to everyday situations to assist generalisation to the real world
Rehabilitation Language Deficits
Liaise with speech therapy
Augmentative communication devices
Allow extra time for the person to understand others and express themselves (ask them what helps, don’t assume)
Teach nonverbal means of communicating (gestures, drawing or pointing to pictured stimuli).
Multiple choice questions
Use of circumlocution for word finding
Use real life situations (e.g. making a telephone call and writing letters) and provide feedback on skills and strengths and suggestions to improve skills
Videotape conversational skills and review performance with suggested strategies for improvement
Training communication partners to provide positive and collaborative communication strategies
Rehabilitation Visuo-Spatial
Environmental modification and family education (e.g. label objects, bright colours on corners and edges)
Keep environment as consistent as possible
Systematic and paced searching to find a desired object
Avoidance of high risk situations (e.g. climbing ladders)
Substitution – use touch to find an object in the fridge
Assistive technology (visual scanning devices)
Magnifying stimuli and increasing contrast
Head/body turning for visual scanning deficits
Prism glasses for neglect
