Week 8 Cognition Learning acquisitions

Understand what cognition encompasses and the overall meaning.

Complex and multifaceted and requires a variety of skills to maximize occupational performance

Attention:

- An active process that helps individuals focus on sensations and

experiences that are relevant to them.

- We receive sensory input, and the nervous system processes it, filtering and identifying the most important information (selectivity)

- Requires several skills: ability to narrow focus to a single target, ability to sustain focus on a target, ability to shift focus from one target to another

- Impacted by consciousness, awareness, and arousal ->affect and motivation -> circumstances that surround the person

Six components of cognition

attention

Memory:

Executive functioning:

Apraxia:

Awareness and self-monitoring:

Language and speech:

Focused attention:

- Directs and orients the individual towards the stimulus of interest

- Physical and mental components

- Mind is free of extraneous thoughts and effort is made to keep sensory channels open to incoming information

Sustained attention:

- Allows an individual to attend to stimuli for an extended period

- Consciously process information despite potential environmental distractors

- Also known as vigilance, and is very sensitive to brain damage

- example: taking an exam for 50 multiple choice questions while not thinking about grocery shopping

selective attention:

- Used when a person ignores irrelevant information and courses attention exclusively on the important stimuli

- Focus on the stimulus to ensure high level processing in the cortex

- This enables goal-directed behavior

- Ex: Enables you to attend to a faculty member presenting information while ignoring side conversations. Goal directed behavior: learning

Alternating attention:

- Also known as attention flexibility

- Allows an individual to shift focus back and forth between two or more tasks

- Ex: Meal preparation, required to chop vegetables while stirring pot on stove with smooth transitions

Divided attention “multitasking”:

- Allows people to do two or more things at once

- Cooking while talking on the phone, driving

- Must attend to multiple factors simultaneously

In general understand the neuroscience and attention.

- Attention is from a network of highly interconnected anatomical areas

- Attention deficits can arise from damage to multiple portions of the brain including:

• Frontal and temporal lobes

• Limbic system

• Subcortical structures (ex: reticular activating system and basal ganglia)

RAS: Reticular Activating System:

mediates alertness and arousal -> Frontal, temporal, and parietal lobes assist with selective attention AND motor control needed to physically direct the eyes and body towards the stimulus of interest -> Limbic system is involved with motivational aspects of attention, meaningful stimuli receive more attention

Understand and explain the impact attention has on occupational performance.

- Attention deficits are common after an Acquired Brain Injury (ABI)

- Deficits can vary and results in:

• Difficulty focusing

• Distractibility

• Difficulty with alternative

attention

- Other signs of impairment in attention:

• Slow processing

• Fatigue

• Irritability

• Complaints of HA when concentrating on a task

• Difficulty staying on task

- Memory, problem, solving, and other higher intellectual functions are all dependent on the ability to focus on relevant information in the environment and ignore less important

What are the three components of memory?

- Encoding

- Storage

- retrieval

Encoding

the act of getting information into our memory system through automatic or effortful processing

strategies that help you with encoding

The type of rehearsal that occurs during working memory determines the success of the process

The process of creating, storing, and retrieving memories simultaneously affects and is

affected by a variety of cognitive skills such as:

• Learning

• Awareness

• Motivation

• Mental state

Describe memory from a holistic perspective, what is included in it?

sensory, working, and long-term memory

Sensory memory:

- Begins with the input of sensations

- Individuals selectively attend to the environment depending on their interests at the time

- This input creates a sensory memory, which is the first phase of an individual’s information processing

- Short in duration

- Allows individuals to process large amounts of info in a short amount of time

- Either transfers for further analysis or degrades

- can last up to an hour and is associated with the temporal lobe.

- Examples include remembering complex numbers or sentences over an hour

Working memory:

- Information that is in our conscious thoughts is stored in this memory

- Allows short-term storage of information

- Mental workshop space that allows information to be manipulated for complex problem-solving

- Can use information from long-term memory

- Example: Calculating the sale price of a piece of clothing

Long term memory:

- From working memory, items are consolidated into this memory

- Allows the new memories to be integrated with existing ones

- Consolidation process can take minutes or hours and results in permanent change to the cell structures in the brain

- The storage of long-term memories does not occur at a single place in the brain

- allows people to remember words, numbers, other people, events and so forth for many years

In general, understand the neuroscience and memory.

- Uses a wide cortical network, including the prefrontal cortex, parietal cortex, medial temporal lobe, and basal ganglia

Explicit/declarative memory:

- Consists of information that can be consciously stated or declared to have been learned

• Semantic

• Episodic

- Neuroscience for Explicit/declarative memory:

• Medial temporal lobe (including hippocampus)

• Limbic system for encoding and consolidation

• Semantic

(facts)involves general facts of knowledge about the self or world.

• Episodic (Events):

consists for knowledge of a previous personal experienced even along with the awareness of understanding that the event occurred in a person’s past

Implicit/procedural memory:

- Refers to the information that is learned or acquired during the development of skills

- It is subconscious

- Allows an individual to carry out an intended action in the future without performing continuous rehearsal of the intention until the appropriate time has occurred

• Event-based:

• Time-based:

Event-based:

running to first base after hitting a baseball

Time-based:

attending a doctor’s appointment at 3 pm on Tuesday

What is orientation and what components are asked when assessing orientation?

- Refers to knowledge about different aspects of self and the environment (time and physical)

- Typically assess person, place, time and situation

- After brain injury, orientation to time appears to be the most sensitive

Describe executive functioning and what it is responsible for.

- Refers to the variety of skills that coordinate and control other aspects of cognition, allowing us to complete a number of tasks, including setting and accomplishing goals

- Necessary during non-routine tasks

- Disorders of executive function are most apparent during novel, complex

and/or unstructured situations

supervisory control system responsible is for:

• Planning

• Correcting errors

• Directing attention

• Processing information

• Inhibiting habitual responses

- allows for effective adaptation and accommodation to changing environment tasks

 Essential to complete higher-level activities, such as ADLs, IADLs, driving

 Tied to the frontal lobe and basal ganglia

What is metacognition?

- People’s understanding and manipulation of their own cognitive and perceptual processes

- These self-regulating processes are thought to begin developing during early childhood and are dependent on maturation and integrity of the prefrontal cortex

- Example of metacognition

ability to evaluate a task’s level of difficulty in relation to one’s strengths or weakness and predict success

Why is executive function and occupational performance important? What impact does executive function have on occupational performance?

- An important indicator of functional return

- Executive function is important to assess in the hospital!

- Often can go unnoticed and negatively impact occupational performance including work

Please identify some treatment ideas when working with individuals with executive functioning deficits.

Modify the environment

• Clutter

• Location

• Consider visual impact upon performance

• Simplify the task

• Establish routines

• Clear directions

• Cues

Praxis

a complex system that enables people to plan and then perform tasks involving motor actions in coordinated and effective manner

Ideomotor apraxia:

- inability to imitate gestures or perform purposeful motor tasks on command, even though the client fully understands the idea of the concept (the breakdown in motor planning occurs at the execution stage rather than the conceptualization)

Ideomotor apraxia example

client may not be able to follow verbal commands to transfer from bed to wheelchair and require the assistance of two people. However, the same person may be able to physically get up when they need to use the restroom.

Ideation apraxia

- Cause by disruption of the conception rather than execution of the motor act

- People do not understand how they are to move and how to interact appropriately with objects in the environment

- Loss of knowledge, tool function and difficulty sequencing events

Ideation apraxia example

if a person is given a comb and told to brush their hair, the client with this apraxia may instead attempt to use the comb to brush their teeth.

What are other influences on cognition. 

- Self-awareness is the ability to judge the abilities needed to complete a task. They need to make judgments about the difficulty of the task and their own ability

- Self-monitoring encompasses and individuals’ ability to evaluate and regulate their performance

- People’s cognitive skills do not function in isolation

- Reasoning, remembering attending and all cognitive skills happen when people are engaging in activities in all types of environments

- We must consider the impact the environment has with individuals with cognitive impairment (ex: noisy, busy).

Dysarthria:

- speech disorder characterized by dysfunction of the phonations, articulation, resonance or respirations aspects of speech

- Naming, word choice and understanding are intact, but speech is slurred

Broca’s aphasia:

- Caused by lesion in the inferior frontal gyrus in the dominant hemisphere (Broca’s area)

- Impaired ability to produce intelligible sounds and to assemble words into meaningful sentences

- Patient has difficulty naming objects

- Repetition is impaired but comprehension of spoken language is normal

- Client is usually aware of the deficits and appropriately concerned about it

Wernicke’s aphasia:

- Wernicke’s area is located in the posterior part of the superior temporal gyrus

- Have fluent but unintelligible speech sounds

- Repetition and comprehension are impaired

- Often have difficulty naming objects

- Usually do not appear concerned, or may not be aware, of their speech disorder

Global aphasia:

- Nonfluent aphasia, both repetition and comprehension are severely impaired

- Often caused by occlusion of the carotid or middle cerebral artery

What did you learn about current research and cognitive assessments in the hospital?

While standardized screening tests and neuropsychological assessments are useful as a first-level evaluation to identify the need for further services, these tools often fall short in establishing direct associations with real-world performance because of their limited ecological validity

What is ecological validity and why is it important?

- the ability of an assessment or measure, collect, and/or record behaviors or occupational performance that would be observed or is required in a typical daily living context of the environment

- relates to the generalizability of study findings to other similar events or activities in daily life.

way to remember function for cranial nerves

1. some

2. say

3. money

4. matters

5. but

6. my

7. brother

8. says

9. big

10. brains

11. matter

12. more

some: olfactory nerve

smell

Say: optic:

vision

Money: oculomotor:

blinking and adjusting pupil width

4. Matters: trochlear

moving eyes up and down

But: trigeminal:

sensations in eyes, face, and mouth. Chewing food

6. My: abducens:

moving eyes left to right

Brother: facial:

controlling facial muscles, and taste

8. Says: vestibulocochlear:

hearing and balance

9. Big: glossopharyngeal:

taste, swallowing

10. Brains: vagus:

homeostasis, breathing, main nerve PNS

11. Matter: accessory:

shoulder and neck movement

12. more: hypoglossal:

tongue movement, speaking