TBI EXAM 2

Rancho Level I-III charactersitics

· Beginning to follow 1 step directions

· May recognize family members

Rancho Level I-III tx focus

o Shape responses into meaningful communication opportunities

o Establish yes/no response

o Most transparent modality

o Follow simple 1-step motor commands

o Discriminate between 2 or more objects by name & function

Rancho Level IV-VI characteristics

· Agitated

· Visual & auditory processing impaired

· Distracted, difficulty focusing on task

· Speech may emerge

Rancho Level IV-VI tx focus

- Provide structure/routine to maximize processing info & accuracy of response

- Increase reliable yes/no

- Increase ability to convey wants and needs

- Increase initiation & participation in familiar tasks

- Establish & maintain response modality

- Provide ongoing DX & TX to accommodate changing needs and abilities

Rancho Level VII-VIII characteristics

· Not regain fully functional speech due to motor speech impairments (acute recovery)

· AAC focus community reentry and meeting long term communication needs

Rancho Level VII-VIII tx focus

- Executive functioning

- Increases ability to convey needs and ideas about different topics across partners and settings

- Teach strategies to increase accuracy and efficiency of communication

- Increase participation in school, work, and in the community

restorative approach is recommended for

post-acute stages

restorative approach - APT

Attention process training (APT) is recommended for those with sustained attention, concentration sufficient to participate in tx (vigilance)

restorative approach - DTT

Dual-task training (DTT) is recommended for individuals with divided attention difficulties and metacognition. Focuses on helping clients do 2 things at once

compensatory strategies are recommended for

middle stages of rehab

compensatory strategies

· External memory aids

· Reacquisition of previously learned material

· Reacquisition of cognitive processes

accommodations are recommended for

early stages of rehab

focus of accommodations

recovery of basic ADLs and physical recovery

multisensory stimulation

· Auditory, visual, kinesthetic tactile

· Rancho Level I-III

A&O x1

oriented to person

A&O x2

alert and oriented to person and place

A&O x3

alert and oriented to person, place, and time

A&O x4

alert and oriented to person, place, time, and event

communication symptoms of TBI

· Verbal learning and memory

· Word-finding: Relate to general memory and retrieval problems

· Discourse: Relate to organization, memory, and problem solving issues

· Meta-linguistics/Abstract and indirect language: Understanding irony, deception, language of mental states and intentions, multiple meanings

· Effective reading of others' mental states: Poor perception of mental states of communication partners

· Social communication: Working memory issues

· Behavior self-regulation: General impulsiveness, Disinhibition, aggression, immature behavior, rigidity, awkward social interaction, depression, social withdrawal, poor reasoning

Cognitive symptoms of TBI

· Dissociation between thinking and acting

· Concrete thinking and impaired reasoning

· Weak organization and planning

· Impulsiveness and disinhibition

· Difficulty generalizing information from one situation to another

· Impaired working memory

Components of calibration

· Metacognitive strategies are crucial to all aspects of cognitive communication intervention

· Ex: LSVT loud = most important components is teaching client low vs loud voice

· Metacognition is an underlying mechanism for most therapy approaches

· Self-monitoring and self-awareness are essential components of metacognitive skills

· Feedback is also essential to patient success in these skills

direct measures

involve standardized cognitive assessments and batteries that target specific cognitive domains

executive functioning direct measures

o Functional Assessment of Verbal Reasoning and Executive Strategies (MacDonald, 2005)

o Behavior Rating Inventory of Executive Function (BRIEF)

o Behavioral Assessment of the Dysexecutive System (BADS) (Wilson et al., 1996)

attention direct measure

Test of Everyday Attention (Robertson, Ward, Ridgeway, & Nimmo-Smith, 1994)

memory direct measure

Rivermead Behavioural Memory Test Third Edition (Wilson, et al., 2008)

auditory comprehension direct measure

Discourse Comprehension Test (DCT) (Brookshire & Nicholas, 1993)

general cognitive/linguistic abilities for TBI direct measures

o The Brief Test of Head Injury (Helm-Estabrooks & Hotz, 1991)

o Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI) (Adamovich & Henderson, 1992)

o Measure of Cognitive-Linguistic Abilities (MCLA) (Ellmo, Graser, Krchnavak, Hauck, & Calabrese, 1995)

o Ross Information Processing Assessment - Second Edition (RIPA-2)

functional tasks/real-world tasks

evaluate how cognitive and language impairments impact a person's ability to perform daily activities. These assessments often require the use of various language modalities (auditory comprehension, verbal expression, reading, writing) as well as cognitive and motor skills.

Assessment of Language-Related Functional Activities (ALFA):

· This tool assesses 10 functional subtests:

o Telling Time

o Counting Money

o Addressing an Envelope

o Solving Daily Math Problems

o Writing a Check/Balancing a Checkbook

o Understanding Medicine Labels

o Using a Calendar

o Reading Instructions

o Using the Telephone

o Writing a Phone Message

o ALFA is designed for ages 16-0 through 95-0 and typically takes 30 minutes to 2 hours to administer.

Communication Activities of Daily Living, Second Edition (CADL-2):

· This assessment evaluates functional skills across seven areas:

o Reading

o Writing

o Using Numbers

o Social Interactions

o Contextual Communication

o Nonverbal Communication

o Sequential Relationships

o CADL-2 is for ages 18 through 95+ and has a testing time of 30 minutes. It can also be a standardized test used in discourse sampling.

basic principles of family training/community reintegration

o Entire family "survives" TBI

o REHAB must include family members and indivudals in the community

o Burden to family persists for years

family training is:

an integral component of TBI management

SLP role in family training/community reintegration

o Provide education to families about TBI symptoms across all aspects of cog and communication.

o Develop compensatory strategies and teaching the strategies to both the client as well as the caregiver

o Train caregiver on ways to promote independence, cueing levels, and symptom management.

common problems of family members

o Denial

o Isolation

o Stress

o Psychological problems

interdisciplinary approach

o Care coordination and accommodations should be planned with the

o interdisciplinary team.

o Compensatory strategies may be facilitated to increase independence and safety functional tasks.

o For example: OT safety precautions for cooking can be complimented with

o cognitive strategies for executive functioning and memory.

o Strategies should help reduce contextual barriers and facilitate life participation.

considerations for reintegration

· Goal is to identify demands in each domain and match them to the clients' skills.

Domains to consider:

o Physical environment (e.g., transpiration, noise level)

o Cognitive demands/complexity of required tasks

o Environmental Context (e.g., Job expectations and routines)

o Social cognition (e.g., Workplace culture/rules, community culture, making acquaintances)

o Safety requirements

o Basic skills needed (e.g., reading/writing, speaking)

o Acquisition and Maintenance (e.g., skills to maintain the job or grades, interviewing skills, pragmatic demands)