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Innovations in Neuropsychology > Section 5 Neuropsychological Rehabilitation: 31, 32, 33 > Flashcards

Section 5 Neuropsychological Rehabilitation: 31, 32, 33 Flashcards

1
Q

What is one of the most commonly reported, distressing and persistent of symptoms after an ABI?

A

Fatigue

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2
Q

Why is it that, despite persistent fatigue being frequently reported following an ABI, evidence to guide clinical interventions remains inadequate?

A

Fatigue has proven difficult to define, operationalise and therefore measure, which has frustrated researchers and clinicians in the development of evidence-based interventions.

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3
Q

What is PSF?

A

Post-stroke fatigue

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4
Q

Fatigue is subjectively experienced by many people in the general population. How is persistent pathological or chronic fatigue operationalized?

A

Fatigue = when the demands of an activity exceed available resources and it usually dissipates after a period of rest.

Persistent pathological or chronic fatigue is greater in its intensity and duration, is not necessarily improved by rest and can have a profound negative impact on a person’s functioning and quality of life. It can persist for many months or even years following ABI

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5
Q

What is a a ‘boom and bust’ approach to fatigue?

A

Cycle through attempts to push on regardless and then avoid activity as their fatigue rapidly increases.

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6
Q

increased fatigability following an ABI may be conceptualised as?

A

A decreased ability not only to activate but also to efficiently sustain recruited cortical tissue

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7
Q

It has been proposed that fatigue is considered an ‘…..’ describing different symptom clusters with potentially heterogeneous aetiologies and consequences.

A

Umbrella term

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8
Q

One of the most commonly cited definitions is that by Aaronson, who proposed that fatigue is:

A

The awareness of a decreased capacity for physical and/or mental activity due to an imbalance in the availability, utilisation, and/or restoration of resources needed to perform activity.

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9
Q

Some patients do not appear to be aware of their decreased capacity due to fatigue, why?

A

This may be due to a range of factors, including anosognosia (unaware of their neurological deficit), interoceptive challenges (trouble knowing when they feel something) or poor self-monitoring secondary to dysexecutive syndrome.

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10
Q

Physiological fatigue can be defined as?

A

‘functional organ failure generally caused by excessive energy consumption’

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11
Q

Peripheral fatigue can be defined as?

A

A diminished ability to contract muscles, involving the peripheral motor and sensory systems.

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12
Q

What is central fatigue characterized by?

A

Impairment to structures and networks within the central nervous system, depletion of hormones and neurotransmitters.

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13
Q

What is psychological (secondary) fatigue associated with?

A

A “sense of weariness” associated with prolonged information processing, chronic stress, anxiety or depression, pain, and sleep disturbance.

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14
Q

What brain areas may be implicated in fatigue?

A

The ascending reticular activating system and limbic system involving neural circuitry connecting basal ganglia, amygdala, thalamus, anterior cingulate cortex, and fronto-parietal cortices.

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15
Q

How does fatigue develop?

A

Neural circuits involved in regulation of attention and executive function may contribute to development of tiredness and aversion to effort leading to fatigue.

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16
Q

What are the two subtypes of fatigue associated with hypothalamic pituitary adrenal (HPA) axis dysregulation? => leads to abnormal stress respons

A

Hypoaroused fatigue (is characterized by a lack of energy, motivation, and concentration) & Hyperaroused fatigue (anxious, irritable, and agitated, even when they are physically exhausted)

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17
Q

What are Hypoaroused fatigue & Hyperaroused fatigue? and does the hypothalamic pituitary adrenal (HPA) axis increase or decrease?

A

‘Hypoaroused fatigue’ associated with increased daytime sleepiness, HPA axis activity decreased.

‘Hyperaroused fatigue’ characterised by difficulties falling asleep, exhaustion, HPA axis activity increased

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18
Q

True or false: vitamin D deficiency post-TBI may also contribute to fatigue

A

True

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19
Q

True or false: Sleepiness and fatigue are considered as separate constructs?

A

True

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20
Q

What are the potential targets for intervention for post-stroke fatigue according to Wu et al. (2014)?

In other words, by addressing which factors, healthcare providers may be able to help stroke survivors manage their fatigue more effectively?

A

Depression, anxiety, maladaptive coping responses and external locus of control.

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21
Q

What are some of the biopsychosocial factors associated with fatigue following an ABI?

A

Sleep disturbance, pain, cognitive impairments, locus of control, coping styles, social support, lack of acknowledgement from others, depression, anxiety, maladaptive coping responses.

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22
Q

What does the clinical model for understanding responses in regards to fatigue of Malley, Wheatcroft and Gracey (2014) propose?

A

Improving awareness and self-monitoring of indicators of fatigue will enable people to take action before energy levels become fully depleted

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23
Q

What is the purpose of identifying an individual’s vulnerability factors and triggers in the clinical model proposed by Malley et al. (2014)?

A

To identify strategies to reduce effort and improve pacing of activities.

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24
Q

When selecting fatigue scales, it is important to be aware that they address…?

A

Different aspects of fatigue (e.g. characteristics, severity, consequences), over different timescales, and they may include
confounding factors

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25
Q

….. therapy was found to reduce fatigue. …. therapy is thought to impact by reducing daytime sleepiness, increasing vigilance and improving mood.

A

Short wave (blue) light
Light

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26
Q

Medications such as neurostimulants, dopaminergic drugs, and antidepressants have been used to alleviate fatigue, the evidence is limited/ growing.

There is limited/ growing evidence for the use of specific psychosocial interventions for fatigue following an ABI

A

Limited

Limited

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27
Q

What should fatigue management aim to do?

A

Fatigue management should aim to develop a shared understanding of the individual’s experience: support in recognizing personal indicators of fatigue, use behavioral experiments to identify ways to “recharge,” maximize skills and strategies to reduce effort, support a healthy lifestyle, identify medical factors, and offer psychological intervention

28
Q

True or false: It is likely that one scale can fully represent the lived experience of fatigue

A

False

29
Q

Verschuren et al. (2010) developed a conceptual framework of sexuality in chronic disease, differentiating two core aspects of sexuality:

A

Sexual functioning, including physiological aspects of sexual performance (e.g. sexual arousal, orgasm);
and sexual well-being, referring to a person’s subjective experience of sexuality (e.g. satisfaction, perceived sexual appeal).

30
Q

How does brain injury affect sexuality?

A

TBI frequently causes damage to limbic structures, including the hippocampus, septal complex, amygdala and hypothalamus, and the thalamus, cingulum and frontal lobes – all of which have been shown to be involved, either directly or via hormonal mechanisms, in the regulation of sexual responses.

31
Q

What sexual functions are reportedly compromised in TBI survivors?

A

Sexual drive, arousal and ability to orgasm

32
Q

What factors were found to be associated with greater sexual dysfunction in TBI survivors?

A

Older age, female gender, more severe injury, being depressed, having lower self-esteem

33
Q

What is the focus of the DISF-SR and what does it not capture?

A

The DISF-SR focuses on sexual functions and does not capture other factors associated with sexuality, such as the quality of relationships and self-confidence.

34
Q

What were the factors that participants with TBI attributed to sexual changes in the Downing et al. (2013) study?

A

Fatigue, decreased mobility, pain, lowered self-confidence, and feeling unattractive

35
Q

How can strokes impact sexuality?

A

Physical impairment, depression, medication, fatigue, neurological weakness, neuroendocrine dysfunction, decreased blood flow to genitalia, decreased libido, fear of rejection, body image changes, and relationship changes.

36
Q

What may sexual problems be related to after frontotemporal injury?

A

They may be related to behavioral disinhibition.

37
Q

What is the aim of Positive Behaviour Support (PBS) for people with TBI?

A

The aim is to shape adaptive social behaviors, promote independence and self-management. (PBS has limited evaluation)

38
Q

Studies suggest that …. are significant contributors to declining quality of sexual drive and behaviour

A

low self-confidence, emotional and relationship problems, and stress

39
Q

What are the challenges in providing therapy to individuals with limited cognitive capacity?

A

The challenges include adapting therapy to incorporate shorter sessions, using visual cues, and written notes.

40
Q

The techniques of Neurologic Music Therapy (NMT) address the four core areas of cognitive rehabilitation:

A

Attention, memory, executive function and psychosocial function

41
Q

How do the content and functional structure of Neurologic Music Therapy exercises compare to cognitive tasks in daily life?

A

The content of NMT exercises is different from cognitive tasks in daily life, but their functional structure simulates the structure of non-musical tasks and functions. So even though the exercises themselves are music-based, they can still help with cognitive rehabilitation in real-life situations. -> Potential for transfer effects

42
Q

What is Musical Sensory Orientation Training (MSOT)?

A

A technique that uses musical stimuli to access basic attention mechanisms in patients with disorders of consciousness, dementia, Alzheimer’s disease, or severe levels of developmental disabilities.

43
Q

What are the three levels of Musical Sensory Orientation Therapy?

A

Sensory stimulation; arousal and orientation; attention maintenance and vigilance (oplettendheid).

44
Q

What is Musical Neglect Training (MNT)?

A

An application of music to cognitive training that addresses hemispatial neglect and uses active performance exercises on musical instruments and receptive music listening to stimulate hemispheric brain arousal.

45
Q

What have studies shown about the effectiveness of Musical Neglect Training in addressing hemispatial neglect?

A

Studies have shown that MNT can dramatically alter unilateral neglect, enhance visual awareness, and improve attention and arm movement toward the neglected side.

46
Q

What is the thought behind Musical Neglect Therapy?

A

The arousal effect of music on the right brain hemisphere, which is lesioned in visual neglect states, and the link between arousal and neglect in general.

47
Q

What is hemispatial neglect?

A

When a person fails to attend to stimuli in one side of their visual field

48
Q

What is echoic memory and how long does it last?

A

Echoic memory is the earliest stage of auditory memory formation and operates as a perceptual entry-level sensory register, holding auditory information for immediate recall and to assign meaning to sounds in speech processing

Echoic memory refers to the brief sensory memory that allows us to retain auditory information for a short period of time - lasting anywhere between two to four seconds.

49
Q

What is the main focus of Auditory Perception Training (APT) and what components of sound does APT aim to identify and discriminate?

A

APT focuses on auditory perception and sensory integration. Exercises are directed to identify and discriminate different components of sound, such as time, tempo, duration, pitch, rhythmic patterns, and spatial location, as well as complex speech sounds.

50
Q

Which target audience has shown improvement in EF after music-based training?

A

Improvement of EF after music-based training in children with ADHD, healthy older adults suffering from age-related cognitive decline, and persons with TBI.

51
Q

What are the causes of auditory perception disturbances?

A

Neural impairment, genetic causes or a variety of developmental delays.

52
Q

Who are the target populations for Auditory Perception Training?

A

Developmental disorders (ADHD), intellectually disabling conditions, aetiologies of hearing disorders/hearing loss/cochlear implants, central auditory processing disorders (CAPD), and autism spectrum disorder.

53
Q

Why may music-based exercises offer an advantageous for APT over non-musical sensory integration approaches?

A

Because of favored brain responses to music over spoken auditory stimulation in certain populations, such as children with autism.

54
Q

What is Musical Attention Control Training (MACT)?

A

MACT is a training program that uses musical stimuli to guide attention in structured active or receptive exercises to address various forms of attention, such as sustained, selective, divided, alternating, and focused attention.

55
Q

Who are the target populations for Musical Attention Control Training (MACT)?

A

TBI, stroke, autism, dementia, Parkinson’s disease, brain tumour, multiple sclerosis, and other neurological conditions affecting attention.

56
Q

What is the concept of Musical Echoic Memory Training (MEM) based on?

A

The concept of MEM is based on Baddeley’s model of working memory, proposing a phonological loop for auditory information processing, with music being an independent part of the phonological loop.

57
Q

Where has the storage for auditory sensory memory been found?

A

In the primary auditory cortex contralateral to the ear of presentation.

58
Q

What is the purpose of Musical Mnemonics Training (MMT)?

A

To enhance memory for non-musical materials.
By linking information to a memorable tune, the brain can form stronger associations and recall the information more easily

59
Q

How does Music Memory Therapy affect neural activity and what are the advantages of music as a memory assistance?

A

Enhances bilateral frontal low-alpha band synchronization (brainwave activity). –> This type of synchronization is thought to reflect a state of focused attention, mental relaxation, and readiness to process information

  • Temporal structure for sequencing: Music has a structure with clear beginnings, middles, and ends. This structure helps to organize information in a way that is easier for the brain to process and remember
  • Chunking of information: Music often groups information into small chunks.
  • Use of small tonal alphabet: The limited tonal alphabet helps to create a sense of predictability and order, making it easier for the brain to remember musical patterns
  • The organization into redundant units: Music often has repeating patterns
60
Q

What is the purpose of Associative Mood and Memory Training in Music (AMMT)? and what are the three ways that Associative Mood Memory Training enhances memory processes?

A

It is a method of improving memory by creating a link between emotions and memories. Associative Mood Memory Training enhances memory by:

Creating a similar emotional state during learning and recall, which helps the brain retrieve information more easily.

Stimulating the connections between mood and memory networks in the brain, which can improve memory recall.

Promoting a positive mood both when learning and remembering, which can help the brain process and recall information more effectively.

61
Q

True or false: musical memory can still be preserved in advanced stages of Alzheimer’s disease.

A

True

62
Q

What did Simmons-Stern et al. (2010) show about memory performance and what are the two possible explanations for better memory performance?

A

Better memory performance for song lyrics than for spoken lyrics in persons with AD compared to healthy older adults. Heightened arousal through music facilitates better memory and there is preferential sparing of brain areas subserving music processing compared to speech processing.

–> meaning certain regions of the brain that are involved in processing and understanding music are less affected by the cognitive decline associated with Alzheimer’s disease than the corresponding regions involved in processing speech

63
Q

What is Musical Psychosocial Training and Counselling (MPC) and what is it used for?

A

It involves incorporating music into counseling sessions to help clients express their emotions, reduce anxiety, and improve overall well-being.

MPC is used for individuals with neurologic disorders for issues such as mood control, coping skills, affective expression and adjustment, cognitive coherence, reality orientation, and appropriate social interaction skills.

64
Q

What is the difference between restorative and compensatory treatment strategies in neuro-rehabilitation?

A

Restorative approaches aim to restore function and decrease impairments, while compensatory approaches aim to compensate for loss of function.

65
Q

In what stage of recovery is it most effective to use restorative approaches?

A

Restorative approaches are most effective in the early post-acute stage, within a limited therapeutic time window, such as around three months in stroke

Innovations in Neuropsychology (10 decks)

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