SLP654-Katie Flashcards
What are the models cognitive rehabilitation?
- Biomedical
- functional
- environmental
- sociopolitical
what’s biomedical (cognitive rehab)?
TX methods are concerned with changing the individual
What is functional (cognitive rehab)?
Intervention methods are aimed at adapting the function of the individual for meaningful participation
What is environmental (cognitive rehab)?
Intervention is sought to address both physical and social environment of the individual
What is sociopolitical (cognitive rehab)?
Goal for the individual is inclusion, civil right, and equal social status
What are the principles of neuroplasticity?
- use it or lose it
- use it and improve it
- specificity
- repetition matters
- intensity matters
- time matters
- salience matters
- age matters
- transference and generalization
- interference
What is CVA?
-cerebral vascular accident
What is MTBI?
mild traumatic brain injury
- traumatically induced physiologic disruption of brain function as manifested in one of the following
- Period of loss consciousness
- Loss of memory for events before or after the incidence
- Alteration in mental state at time of incident
- Focal neurological deficits
- Normal brain structure on CT or MRI
What is the incidence for mTBI?
estimated 16-25% of people injured do not seek medical so true incidence is likely higher / Mild: 75%
What is GCS?
-Glasgow Coma Scale
What is RHD?
-Right hemisphere dysfunction
-Problems with Pragmatics Apragmatism: may have over normal basic language skills, but have difficulty adapting to communication to specific contexts Memory: short term/ working Attention Executive function Communication Emotion Physcial impairments
What is DOC?
- Disorders of Consciousness
- 315000 ppl in US present with DOC w/ 35000 vegatative state/ 280000 minimally concious state
What is arousal (DOC)?
primitive, involuntary responsiveness to the world
What is awareness (DOC)?
ability to receive and process sensory information and use that info to relate in an intentional way to the outside world
what are the levels of consciousness (DOC)?
Coma: no eye-opening/ no behavior signs of awareness / no vocalizations
Vegatative state: arousal/ no behavior signs of awareness / no purposeful behaviors / no lang comprehension
minimally consciously state: arousal/ response to verbal directive/ verbalizations
What are the DOC sensory intention examples?
- Visual (seeing): mirror/ family pics/ bubbles
- Auditory (hear): recordings of fam/ fav music
- Olfactory(smell): perfume/ shampoos/ spices
- Gustatory (tasting): lemon swabs/ flavors
- proprioceptive/vestibular (movement): move of body
- tactile (touching): preferred textures; smooth/ rough
What is the mechanism of injury for CVA-Stroke?
-Cerebral hemorrhage
15% of stroke compromised of intracerebral and subarachnoid hemorrhage
-Cerebral infarction
Thrombotic
Infarction: damage by lack of blood flow
85% of strokes are ischemic
What is the mechanism of injury for Hypoxic-hypotensive Brain injury?
- Cerebral hypoxia: deprivation of oxygen to brain
- Cerebral hypotension : inadequate perfusion / not enough blood flow
-For types:
Anoxic anoxia: cause by drowning
Anemic anoxia: blood loss severe anemia,
Stagnant hypoxia: reduction of blood flow , cardiac arrest
Toxic hypoxia : toxins such as poisining
What is the mechanism of injury for encephalitis & infection?
- Infection of brain tissue or meninges
- Variety of damage minimal to diffuse
What is the mechanism of injury for cerebral tumors?
- Abnormal tissue growth inside skull
- Deficits depend on size ,tumor type, and location
- Medical TX: surgery, radiation, chemo, immunotherapy
What is the mechanism of injury for degenerative neurological disorders?
- Multiple sclerosis
- Seizure disorder
- Parkinson disease
What is TBI?
- Definition: alteration in brain function caused by an external force
- Adults over 75 have highest death rate related to TBI
-92.7% of children w/ brain injury visit ED
Child abuse strong predictor
Non accidental trauma results in greater than 80% of deaths in ch. under 2
- 59.7% of adults over 65 visit ED
- 0-14yr olds → falls are cause of 50% of TBI
- Firearm TBI deaths → 20-24 yrs and >75yrs
- Motor vehicle death from TBI → 15-24 yrs w/ highest 16-19yrs old
- Fall related TBI death → higher for 75 yr population
Sports Related TBI incidence?
71% of all sports related TBI ED visits : were males
Greatest TBI from : bicycling, football, basketball, playground, and soccer
alcohol TBI incidence?
Alcohol intoxication at time of injury: 37-51%
In 2010, highest % of drunk drivers: 21-24 yrs(34%), 25-34(30%), 35-44(25%)
Domestic Violence TBI incidence?
67% of women victims of DV showed signs of brain trauma
Military Action TBI incidence?
Incidence ranges from 4.5/1000 (2005) to 1.7/1000 (2009)
During surge in 2007, rate was 83/1000
Prisons TBI incidence?
25-87% inmates report having TBI
Convicted children/teens more likey to have TBI/abuse
Conditions that arise from TBI?
Epilepsy: TBI causes 5% of epilepsy
Sleep Disturbances: 70% of TBI patients
Alzheimers Disease
Chronic Traumatic Encephalopathy
What is traumatic impact - CLOSED (brain injury)?
-Cause by impact to the head
car accident,
sport injury,
assaults
-Coup-contrecoup injuries common w/ this type
-Pathophysiology: Brain contusions Brain lacerations Intracerebral hemorrhage Diffuse axonal injury
What is traumatic impact - OPEN (brain injury)?
- Coup-contrecoup injuries common w/ this type
- FOCAL
-pathophysiology: Epidural hematomas Subdural hematomas Intracerebral hemorrhage Infections
-causes: stabbing falls vehicular accident sport accidence
What is traumatic intertial (brain injury)?
- Commonly result in coup-contrecoup
- DIFFUSE
-pathophysiology:
Diffuse axonal injury
White matter lesions
Hemorrhage
-cause:
falls
vehicular accidence
sports accidents
What is non traumatic (brain injury)?
- damage to brain caused by internal factors such as: lack of oxygen or nutrients to the nerve cells / exposure to toxins/ pressure from tumor or blockage
- both FOCAL & DIFFUSE
-pathophysiology:
White matter lesions
Hemorrhage
-cause: stroke ischemia infection tumor
what are risk factors/ effects of injury?
Injury severity Age of injury Alochol misuse Domesetive violence Military service Sports participation
what are the cognitive domains?
- executive function
- judgement / insight
- reasoning / organization
- problem solving/ sequencing
- memory (short/ long term)
What are the foundational levels (cognitive domain)?
- arousal
- alertness
- awareness
- consciousness
- attention
- concentration
Brain Injury… (incidence/statistics)
- Per CDC Brain Injury is likley to be underdiagnosed and underreported
- Brain Injury is Second Most Prevalent disability in the US;
- 13.5 million americans impacted
- 2.5 million sustained TBI in 2010; of those 75% mild TBI or concussion
-53,000 deaths, has descreased
Why? → improvement in technology, rehab, care safety
- 284,000 hospitalizations
- 2,214,000 ED (emergency department) visits
- Risk of 2nd Injury: 3x GREATER after initial injury
- Risk of 3rd injury: 8x GREATER after 2nd injury
What about dementia?
- syndrome resulting from acquired brain disease. It is characterized by a progressive decline in memory and other cognitive domains
- 36.5 million people live with dementia worldwide
- Prevalence: increases w age ; dobles every 5 years beyond age of 65
- Greater frequency in women
What are the risk factors of dementia?
- Age
- Genetics
- Medical risks
- History of brain injury
- Lifestyle : smoking
what are the protective factors of dementia?
- Education
- Cognitive activity
- Bilingualism
How to assess dementia?
-Subjective & objective
I-nterview
-Observation
-Screening (mini mental status evaluation)
What are the types of dementias?
- Alzheimers dementia (most COMMON)
- Vascular dementia
- Frontotemporal dementia
- Dementia w/ lewy bodies
What is the treatment for dementia?
- Medication
- Behavioral treatment
What is delirium?
- Disturbance in mental abilities that results in confuse thinking and reduced awareness of the environment
- Start can be rapid within hours/ days
What causes delirium?
- Severe illnesses
- Metabolic changes
- Medication
- infection
- Surgery : 11.8% patients developed post surgical delirium
- Alcohol or drug withdraw
What cognitive impairments does delirium cause?
-Memory deficits
‘-Confusion
- Language formulation and processing deficits
- Poor environmental awareness and orientation
What is the SLPs role in Treatment with delirium?
- Education
- Meta cogntive strategy training
- Rehab diaries or memory logs for the patient and staff
- Environmental and routine based intervention
