TBI and cognition Flashcards
Attention
very common to have deficits with TBI
fundamental to functioning
we think of attention in levels:
focused, sustained, selective, alternating, divided
focused attention
respond to one stimuli and ignore others
ex. phone rings - turn to this
sustained attention
maintaining focused attention over time
e.g. read a book / follow TV show
selective attention
maintain attention in the presence of distractions
e.g. focus on presented ignoring background noise
alternating attention
shifting between tasks that demand behavioral or cognitive skills
e.g. stirring pot and reading recipe
divided attention
maintain speed while performing 2+ tasks
e.g. cooking multiple courses at same time ; driving and talking on the phone
attention deficits retraining
Interventions = sharpening the skill with distracters present, as well as training a person with a brain injury to recognize what distracts them and then look for ways to minimize the distractions
Retraining systematically increases the level of distracters in an environment to simulate high-level demands
Attention Processes Training Program
A process-specific approach to Cognitive Rehabilitation
Hierarchically organized by difficulty
Persons progress to a higher level when the easier task is mastered
Begins with sustained attention tasks and progresses to selective, alternating, and divided attention
Shown to result in improved memory performance in persons with brain injuries
Categorization deficits lead to..
poor initiation / performance of ADLs
poor learning of new skills
poor problem solving / decision making
difficulty responding to multiple and complex attributes - respond only to concrete attributes
categorization remediation
categorization program
- aimed at training object categorization relating to decision making
- start with basic attribution and extraction
- progress to higher level constructs and rule-based decision making
memory
encode, store, retrieve
encode: perceived info put into a context that can be stored
store: stabilization of a memory
retrieve: search for a memory or activation of a memory
process of memory types
sensory > short term > working > long term
sensory - hold sensory info for a few seconds for processing (hear, taste, smell, see, touch)
short term - recall of info minutes to hours
working - temporary storage and active processing of info (can be taken info from long term)
long term - permanent consolidation and storage
long term memory divided
permanent consolidation and storage
implicit vs. explicit
implicit long term recall
memory without conscious recall
e.g. skills - driving
explicit long term recall
memory with conscious recall
- semantic - words, concepts
- episodic - personal experience
processing speed
The time it takes to gather info, process, respond
This is targeted across all domains
executive function
complex skill includes reasoning, planning, problem solving, initiation, and abstract thinking
exec. function injury
can result in deficits in abstract thought, considering potential solutions, executing plans, self-monitoring
behaviors associated with exec. function deficits
impulsivity, disinhibition, verbosity, poor emotional control
metacognition
awareness of injury
awareness of deficits caused by injury
awareness of realistic goals
Anosognosia
impaired self perception - do not recognize deficits or disability
impairs rehab potential
Treatment = metacognitive training
metacognitive training
increase ability to internalize awareness to control their own behavior
temporal lobe function
Object categorization Receptive language Emotional responses Language comprehension Memory Face recognition Selective attention Locating objects
frontal lobe function
Emotional control Behavioral control Verbal expression Problem Solving Decision Making Social control Motivation Attention
Parietal lobe function
Tactile performance Spatial orientation Academic skills Object naming Visual attention Eye-hand coordination
occipital lobe function
Visual stimuli processing
hearing loss and cog deficits
An estimated 44% for non-blast injuries and 62% in blast related injuries
Hearing loss contributes to confusion and deficits in attention and memory
vision loss and cog deficits
Prone or susceptible to dysfunction and important to assess
medical stability and cognition
Medical issues, such as metabolic, pulmonary, endocrine, and sleep dysfunction can compromise cognition
impairments in behavior caused by:
Damage sustained directly to the brain
Difficulties adjusting to deficits
Pre-existing psychological factors
A combination of these factors
cognitive rehab
tx = hierarchical and inter-related
- less complex treatments should supersede treatments of greater complexity
- target attention, perception, categorization, abstract thinking, and memory to restore/reorganize impaired cognition
ex: Attention Process Training and the Categorization Program
environmental stimulus approach to cog. rehab
quiet —-> distracting
task complexity in cog. rehab
simple —-> complex
cognitive distance in cog. rehab
concrete —> abstract
efficacy for cog. rehab research
developed in last 10-15 years
who provides cog rehab varies
