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SPA 775 > TBI > Flashcards

TBI Flashcards

1
Q

TBI?

A

external physical force to the head that is acquired brain injury, and change in levels of consciousness.

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2
Q

decontextualized approach

A

more control over a single cognitive dimension to isolate and treat cognitive processes independently.

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3
Q

contextualized approach

A

individualized enhance motivation, improve self-awareness and increase the likelihood that strategies will generalize. Used to challenge patients overtime.

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4
Q

prevalence & incidence of TBIs

A

27 million new cases of TBI in 2016
55.5 million people living with TBI in 2016
16.7% for males, 8.5% for females
75% of TBIs with mTBIs
15% of full-time workers with TBIs don’t return to work 4 yrs later
69% moderate TBIs
40% have neuropsychological needs 1 yr post injury

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5
Q

effortful behavior

A

uses many mental resourses.

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6
Q

Categories of CRT

A

Restoration: use of repetition and drill to target cog processes
Calibration: focuses on metacognitive awareness(offline), self awareness
Compensation: external & internal approaches

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7
Q

external approaches

A

journals, smart phones, checklist, calendar

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8
Q

internal approaches

A

visualization, mnemonics, repeating words back to themselves

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9
Q

CRT Cognitive Rehabilitation Therapy

A

evidence demonstrates positive efficacy and effectiveness of CRT for individuals with TBIs.

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10
Q

How should intervention be designed?

A

Tailored to the patient’s neuropsychological profile premorbid cognitive characteristics & goals for life activities & participation.
focus on engaging in meaningful activities for the patient and relevant parties.
be in their environment and applicable to their life.
strategies for generalization.
reassessment of cog performed on regular basis.

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11
Q

cognitive-communication intervention should address what?

A

process of various types of info under ideal conditions in activities/settings
Executive/self-regulatory control over cog, lang, and social skills function.
Modification of comm. and support the competencies of relevant people in everyday environments.
mod. of cog and comm. demands to facilitate better performance.
use of effective compensatory strategies/techniques.
plans for probs other than cog-comm that may occur w/disorder.

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12
Q

why is it important for patients to be included in treatment?

A

People do better when actively involved in the therapy process.
they can decide on goals and priorities together (collab partnership).
think of patients’ own knowledge regarding their deficits.

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13
Q

Types of Medical Intervention

A

Neurosurgical: repair/removal to prevent infection
Pharmacological: Sedation, a medication used for pain, seizures, and behavioral/cognitive issues.
Complementary/Alternative Medicine & Neurotherapy: homoeopathic, herbal meds, acupuncture, and naturopathy.

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14
Q

Continuum of Care

A

Emergency Medical Services: ensure the patient stabilize & prevent further neurological damage.
Acute Care: optimize patient’s medical conditions, and conduct further diagnostics and surgical/medical interventions for stabilization.
Acute Rehab: focus on relearning basic skills for everyday living.
Subacute Rehab: maximize recovery & ensure the safest, most active lifestyle possible when the individual goes home & into the community.
neurobehavioral unit: highly specialized treatment to assist individuals after an injury and adapt to less structured environments.
outpatient rehab: maximize recovery through ongoing support from a variety of agencies and medical professionals.
vocational services: reeducation, training and worksite-related services.
community-based services: continued and ongoing care and support utilized in tandem with or after formal rehabilitation care.

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15
Q

Patient-centred care?

A

Respect for patients’ values, preferences, and expressed needs.
coordination and integration of care.
info, comm, and education.
physical comfort.
emotional support and alleviation of fear and anxiety.
involvement of family and friends.
continuity and transition.
access to care.

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16
Q

Evidence for cognitive rehab

A

Directive Attention Training - sustaining & shifting attention over time
Categorization Training - target abstract thought and decision-making.
Therapy for Impaired Memory - restorative & compensatory tools to improve memory.
Intervention for social comm skills & behavior - changes in social skills related to social isolation.
Intervention for complex activities & problem-solving - goal management training and metacognitive strategy training.

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17
Q

What is generalization

A

TBI patients can learn new info and skills at a slower rate.
reduced mental resources.
reduced ability to be mentally flexible.
challenging to adapt info/skills to new environment.

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18
Q

Spaced Retrieval

A

takes advantage of persevered implicit memory process through errorless learning and large amounts of practice.

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19
Q

positive routines

A

contextualized, collaborative positive routines, identifying what could prevent negative responses or behaviors and replacing these behaviors with positive ones.

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20
Q

Principles of Cog Rehab

A

Strive for effortless behavior
capitalize on implicit processes through errorless learning
person-centered rehab
awareness deficits
challenge of generalization

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21
Q

CTE?

A

Chronic Traumatic Encephalopathy
sports-related brain injury
neurodegenerative condition

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22
Q

CTE Symptoms?

A

cognitive
behavioral
psychiatric
motor

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23
Q

Aspects of Assessment of social communication

A

Self-assessment and self-observation
Sel-report questionnaires
social problem-solving measures
measures of receptive communication skills
behavioral rating scales
behavioral rating scales for TBI interactions

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24
Q

Aspects of assessment for EF and awareness include functional tasks

A

performance of real-world tasks: specific to their home, vocational, and education contexts.
ongoing self-assessment: journal or log EF performance.

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25
Q

Aspects of assessment for memory with functional tasks

A

ongoing self-assessment: journal or log about memory performance.
observations: recording memory success & lapses.

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26
Q

Memory tasks examples

A

Prospective: remember to reply to an email
episodic: remember dinner the night before
semantic: remember the name of the current/past president
nondeclarative: remember how to tie your shoe.

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27
Q

Aspects of Assessment for attention & processing speed with tasks

A

observation: specific time periods & use of logs
self-assessment: knowledge, attributes, emotion, and impact
Sustained attention: sort items
selective attention: perform I spy
alternate: prepare a meal and do laundry
divide: balance a checkbook while having a conversation

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28
Q

Included in functional assessment measures

A

observational report
discourse analysis
functional, personally-relevant tasks
that may/may not reflect a set of standardized objective procedures.

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29
Q

preferred practice patterns of cognitive-communication assessment?

A

relevant case history
review of auditory, visual, motor, cog & emotional status
patient/client reports of goals & preferences
standardized &/non-standardized methods selected with consideration for ecological validity.
follow-up services to monitor cog-comm status & ensure appropriate intervention & support for individuals.

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30
Q

Static Assessment

A

using procedures designed to describe current levels of functioning within relevant domains.

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31
Q

Dynamic Assessment

A

using the hypothesis-testing procedure to identify potentially successful intervention and support procedures.
interviews
questionnaires
clinical observations

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32
Q

Included Comprehension Exam

A

Case history
nonspeech examination
speech production
language
cognitive communication
swallowing

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33
Q

Considerations for Assessment

A

injury severity
poor performance on formal/informal assessment - motor/sensory-perceptual problems, pre-existing academic difficulties/emotional-behavioral deficits.
use scales to show the change in performance of patient
use assessments that reflect functional performance in the real world.
depression/anxiety
interprofessional collaborations to help evaluations.
repetitive brain trauma

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34
Q

Recovery Period

A

research demonstrates it’s worthwhile to complete treatment for TBI
starts in emergency trauma care
intensive acute
post-acute rehab
neuropsychologist assess while SLP treat.

35
Q

persisting symptoms of mTBI

A

cog: attention, concentration, memory, process speed, EF
beh/emo: depression, irritability, anxiety, aggression, impulsivity, agitation, apathy.
physical: sleep disturbance, fatigue, impaired balance, dizzy, nausea.

36
Q

persisting symptoms of moderate TBI

A

emo: depression, irritability, anxiety
beh: impulsivity, disinhibition, apathy, socially inappropriate behaviors.
cog: attention, processing speed, EF, memory
physical: motor/sensory deficits, balance/coordination problems.

37
Q

RHD vs. TBI?

A

Pragmatics are the same
Prosodic is different - RHD: aprosodia, TBI: interprets emotional prosody.
Executive Functions are the same
The site of lesion is different
etioloy is different
Extent of damage for RHD is focal and TBI is diffuse

38
Q

Rancho Los Amigos Scale (Neurobehavioral Recovery)

A

10 levels in acute phase of recovery
1: no response
4: patient is alert, disorientated & agitated
6: patient is concussed
8: patient is purposeful
10: patient is purposeful

39
Q

Outcome Measures

A

Glasgow Coma Scale
Functional Independence Measure (FIM)
Functional Communication Measure
Rancho Los Amigos Scale of Cognitive Level

40
Q

Neurobehavioral Concerns

A

Personality changes: apathy, impulsivity
psychiatric disorder: depression 49%, PTSD, new psych disorder 48%, anxiety, sleep disorder, psychotic syndromes

41
Q

Behaviors

A

Transient: Temporary - screaming, aggression, agitation, poor arousal
Modifiable: can be corrected with compensatory strategies - aggression, lack of social skills, sexual inhibition
Chronic: does not resolve but can still use compensatory strategies - episodic dyscontrol and lack of initiation

42
Q

Neuroplasticity

A

greatest during the development of an immature brain.
it occurs in injured and noninjured brains

43
Q

Prognosis indicators for TBI

A

loss of consciousness
duration
Glasgow coma scale to measure coma/impaired consciousness
PTA
retrograde amnesia
anterograde amnesia
Galvenston Orientation and Amnesia Test GOAT

44
Q

Penetrating head injury

A

high velocity penetrating brain injury (bullets)
low-velocity penetrating brain injury (knife)

45
Q

non-acceleration head injury

A

moving object striking the skull causing deformation (swinging bat)

46
Q

acceleration/deceleration head injury

A

moving head striking stationary/moving object or head being shaken violently

47
Q

Closed head injury

A

more frequent
brain moved around the skull

48
Q

open head injury

A

scalp, skull, and dura mater penetrated.

49
Q

Cell death

A

Diffuse Axonal Injury DAI can be delayed 12-24 hours or immediately.
gliosis: phagocytes permeate the area and are in charge of disposing of nonfunctioning tissue.
glial cells then permeate the area that was vacated. provide nutrients for regenerating axons/ form scar tissue.

50
Q

Severe TBI

A

loss of consciousness: more than 24 hours
Glasgow: 3-8
Imaging: normal/abnormal
PTA: more than 7 days

51
Q

Moderate TBI

A

loss of consciousness: 30 to 24 hours
Glasgow: 9-12
Imaging: normal/abnormal
PTA: 1-7 days

52
Q

Persisting symptoms of moderate TBI

A

Cog: attention, memory, EF, processing speed
Beh: impulsive, disinhibition, apathy
physical: motor/sensory deficits, balance, coordination
emo: depression, anxiety, irritability

53
Q

mTBI

A

loss of consciousness: 0-30 mins
Glasgow: 13-15
Imaging: normal
PTA: 0-1 day

54
Q

Persisting symptoms of mTBI

A

cog: attention, concentration, memory, EF, process speed
beh/emo: depression. irritability, anxiety, aggression, impulsive
physical: sleep disturbance, fatigue, impaired balance, nausea

55
Q

Recovery period

A

Adults: within 14 days post-injury
Children: within 1 month

56
Q

Risk factors

A

Males, low SES, unemployment, low education level, drug/alcohol abuse

57
Q

Concussion

A

disruption of ions, potassium going out of cells while sodium and calcium flood into cells.
glutamate is released with no place to go.
results in toxic synapses and slowed comm between neurons.

58
Q

after injury

A

the brain goes into a hyperactive state followed by a 7-10 day decrease in cerebral blood flow and hypometabolism.
DAI happens by axons begin to stretch and break due to force.
impaired synaptic comm and result in increased dysfunction in the frontal lobe, cerebellum and corpus callosum.
unmyelinated cells are more susceptible to damage and change thalamus, (used for sensory input, alertness, consciousness, language and working memory.
edema can occur.

59
Q

TPM (Steps, goals, strategic)

A

Time Pressure Management
Steps: identify the problem
teach the strategy
generalization
Strategies: must be fitted to the patient’s needs, personality & abilities.
must fulfil an obvious & apparent need that personally is felt by the patient & must fit the personal inclination & attitudes of the patient.
must be easy enough that patient can supply it automatically & effortlessly.
Goals: bring awareness to how mental slowness impacts daily activities.
to assist TBI patients in creating strategies to prevent or manage time pressures created by slowed mental processing.

60
Q

APT Attention Processing Training

A

Core tenants: grounding treatment in a hierarchical organization & theoretical models of attention.
Providing the opportunity for practice & repetition.
Using client data to drive treatment decisions.
Individualizing treatment & promoting generalization to daily living tasks.

61
Q

APT Treatment

A

Evaluation step: evaluation of adaptive functioning & understanding of impacts in daily activities.
must plan for the generalization stage before therapy begins.
Training Step: identify targets & setting task parameters during this step and initiate generalization tasks.
Generalization: formal training phase to actively facilitate generalization.

62
Q

DTT Treatment in Action

A

Identify real-world dual tasks that are important to the client/family that is challenging
Once tasks are identified, they are put into order from most important to least by participant & family/caregiver.
possibly use a motor task with challenging attention speaking task.

63
Q

DTT Dual-Task Training Implementing treatment

A

first, target each component within dual-task separately, then simultaneously.
home exercise program implemented to target these tasks at home as well.
use self and clinician-guided reflections (can be done with questions at end of each task).

64
Q

Memory Comprehension Internal Aids

A

compensation approaches comprised of mnemonic/imagery techniques.
association techniques/organization & elaboration techniques.

65
Q

Memory Comprehension External Aids

A

provide reminders of the need to recall info/storage and display of info that needs to be recalled.
From a simple notepad to smart phone

66
Q

Memory Compensation 4 phrases

A

Assessment/anticipation
acquisition
application
adaptation

67
Q

GMT Goal Management Training 5 stages

A

Stop: what am I doing
Define: think about and outline the goal of the task
List: learn to identify & outline steps needed to complete the goal.
Learn: seeks to retain goals & subgoals outlined in prior stages.
Check: am I doing what is planned?

68
Q

SMART Strategic Memory Advanced Reasoning Training

A

Strategic Attention: reduce a load of incoming details by inhibiting less relevant info.
integrated reasoning: having the patient combine important facts by integrating explicit content with preexisting knowledge to form a more global, gist-based representation.
innovation/cognitive flexibility: teaching patient process of evaluating info from different perspectives.

69
Q

CFAT Construction Feedback Awareness Training

A

Step 1: pre-task analysis - identify real-world task during the feedback stage, SLP will evaluate the task, and then have the patient do self-evaluate.
Step 2: task implementation & feedback - construct feedback during/ after the task, provide methods of feedback, pause-prompt-praise.
Step 3: question-answer session analysis of the task, self-evaluate again, video feedback possible.

70
Q

SCT Social Communication Training

A

Step 1: establish baselines - get baselines, then see social abilities, raise awareness of social comm difficulties, and identify specific goals.
Step 2: educate - learn the training, home practice expectations, and use opportunities to practice learned strategies in a natural environment with hw.
Step 3: train - treatment starting social comm and emotion perception observed in interaction.
Step 4: refine & plan for the transfer - review info and techniques previously taught, revise if needed, and engage in the intentional practice, patients should improve awareness of how both participants in conversation contribute to interactional exchange.

71
Q

errorless learning

A

immediately correct them so they cannot make an error. using fewer mental resources.

72
Q

ecological validity

A

how generalizable the results are.

73
Q

number one cause of TBIs in all age groups?

A

falls

74
Q

Physical concerns

A

headaches, fatigue, seizures, nausea, prone to falling

75
Q

Cognitive concerns

A

orientation, arousal, awareness and theory of mind, attention, memory

76
Q

Poor scores on Glasgow and Rancho Los Amigos have concerns of?

A

Swallow concerns
41-65% getting dysphagia

77
Q

Symptoms that go along with CTE

A

behavior (aggression)
psychiatric
personality (impulsivity)
motor and cognition

78
Q

Why do TBI patients have difficulty with generalization?

A

difficulty with mental capacity and mental resources
reduced mental flexibility
hard to take in new info and use on new challenges.

79
Q

DTT targets? Describe how?

A

Attention and motor
start off walking and talking with SLP and then add in more familiar people and then progress to outside followed by adding in strangers.

80
Q

Apathy prevalence in TBI

A

20-72%

81
Q

50-80% of individuals with TBI suffer from?

A

posttraumatic fatigue PTF

82
Q

Visual concerns in people with TBI

A

30-85%

83
Q

What percentage of individuals with TBI have self-awareness impairments?

A

97%

84
Q

What percentage of people with TBI report persistent memory problems

A

75%

SPA 775 (1 decks)

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