TBI and cognition

Question 1

Attention

Answer 1

very common to have deficits with TBI
fundamental to functioning
we think of attention in levels:
focused, sustained, selective, alternating, divided

Question 2

focused attention

Answer 2

respond to one stimuli and ignore others

ex. phone rings - turn to this

Question 3

sustained attention

Answer 3

maintaining focused attention over time

e.g. read a book / follow TV show

Question 4

selective attention

Answer 4

maintain attention in the presence of distractions

e.g. focus on presented ignoring background noise

Question 5

alternating attention

Answer 5

shifting between tasks that demand behavioral or cognitive skills

e.g. stirring pot and reading recipe

Question 6

divided attention

Answer 6

maintain speed while performing 2+ tasks

e.g. cooking multiple courses at same time ; driving and talking on the phone

Question 7

attention deficits retraining

Answer 7

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

Question 8

Attention Processes Training Program

Answer 8

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

Question 9

Categorization deficits lead to..

Answer 9

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

Question 10

categorization remediation

Answer 10

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

Question 11

memory

encode, store, retrieve

Answer 11

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

Question 12

process of memory types

sensory > short term > working > long term

Answer 12

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

Question 13

long term memory divided

Answer 13

permanent consolidation and storage

implicit vs. explicit

Question 14

implicit long term recall

Answer 14

memory without conscious recall

e.g. skills - driving

Question 15

explicit long term recall

Answer 15

memory with conscious recall

• • semantic - words, concepts
• • episodic - personal experience

Question 16

processing speed

Answer 16

The time it takes to gather info, process, respond

This is targeted across all domains

Question 17

executive function

Answer 17

complex skill includes reasoning, planning, problem solving, initiation, and abstract thinking

Question 18

exec. function injury

Answer 18

can result in deficits in abstract thought, considering potential solutions, executing plans, self-monitoring

Question 19

behaviors associated with exec. function deficits

Answer 19

impulsivity, disinhibition, verbosity, poor emotional control

Question 20

metacognition

Answer 20

awareness of injury
awareness of deficits caused by injury
awareness of realistic goals

Question 21

Anosognosia

Answer 21

impaired self perception - do not recognize deficits or disability

impairs rehab potential

Treatment = metacognitive training

Question 22

metacognitive training

Answer 22

increase ability to internalize awareness to control their own behavior

Question 23

temporal lobe function

Answer 23

Object categorization
Receptive language
Emotional responses
Language comprehension 
Memory
Face recognition
Selective attention
Locating objects

Question 24

frontal lobe function

Answer 24

Emotional control
Behavioral control
Verbal expression
Problem Solving
Decision Making
Social control
Motivation
Attention

Question 25

Parietal lobe function

Answer 25

Tactile performance
Spatial orientation
Academic skills
Object naming
Visual attention
Eye-hand coordination

Question 26

occipital lobe function

Answer 26

Visual stimuli processing

Question 27

hearing loss and cog deficits

Answer 27

An estimated 44% for non-blast injuries and 62% in blast related injuries

Hearing loss contributes to confusion and deficits in attention and memory

Question 28

vision loss and cog deficits

Answer 28

Prone or susceptible to dysfunction and important to assess

Question 29

medical stability and cognition

Answer 29

Medical issues, such as metabolic, pulmonary, endocrine, and sleep dysfunction can compromise cognition

Question 30

impairments in behavior caused by:

Answer 30

Damage sustained directly to the brain
Difficulties adjusting to deficits
Pre-existing psychological factors
A combination of these factors

Question 31

cognitive rehab

Answer 31

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

Question 32

environmental stimulus approach to cog. rehab

Answer 32

quiet —-> distracting

Question 33

task complexity in cog. rehab

Answer 33

simple —-> complex

Question 34

cognitive distance in cog. rehab

Answer 34

concrete —> abstract

Question 35

efficacy for cog. rehab research

Answer 35

developed in last 10-15 years

who provides cog rehab varies