CSDS 220: Exam #3 Chapter 1

Levels of recommendations

Practice standard

Practice guideline

Practice option

Practice standard

Based on evidence from at least one well-designed class I study with an adequate sample, with additional support from class II or class III studies, providing substantive evidence to support a recommendation

Practice guideline

based on one or more class I studies with methodological limitations, or well-designed class II studies with adequate samples, providing fair evidence for the probable effectiveness of an intervention

Practice option

based on class II or class III studies that directly address the effectiveness of a treatment, providing additional evidence to support the possible effectiveness of an intervention

Intro of brain in cognitive rehab

inform assessment and cognitive rehabilitation

inform not only assessment but also the types and sequence of cognitive rehabilitation strategies utilized

Organization of the brain

External word

Intermediate cognitive processing

Planning and execution of response

Internal milieu

Four types of behavior

External word

The brain manages sensory input from the external world

1-Primary or idiotypic cortex

2-Association cortices

Intermediate cognitive processing

3-multimodal or heteromodal cortex

Planning and execution of response

What we need to do to survive, adapt, and achieve goals

Internal milieu

Five major areas comprising the paralimbic areas

1-Orbitofontal cortex

2-Insula

3-Parahippocampal cortices

4-Primary olfactory cortex

5-Cingulate complex

Four types of behavior

1-Memory and learning

2-The channeling of emotions nda ffilliative beahvior

3-The linkage of visceral state, immune responses, and endocrine balance to mental state, and

4-The perception of pain, smell, and taste

Neural Networks

Spatial Awareness network

Language Network

Explicit memory and emotional network

Face and Object recognition network

Executive functions network

Spatial awareness network

frontal eye field

right posterior parietal gyrus

Cingulum

Frontal eye field

supports spatial-motor exploration of the external environment and eye movements and also regulates vigilance, attention, and orientation to the surrounding space

Right posterior parietal gyrus

integrates a spatial representation or map of the extra-personal environment and therefore provides a spatial context for movement

Cingulum

coordinates an ever-changing general map of expectation, relevance, and space orientation according to one's own position in space and intent

Language Network

Broca’s area and Wernicke’s area

Angular gyrus

Broca’s and Wernicke’s Areas

coordinate verbal output (oral/written ability) and sensory-acoustic integration of soundsf

Angular Gyrus

integrate sensory information to support reading and writing

Explicit Memory and Emotional Network

Hippocampus & Amygdala

Hippocampus & Amygdala

serve declarative or explicit memory

support learning and recognition of sensory information that needs to be acquired for later recollection

Face and Object Recognition Network

Middle temporal gyrus

Temporal pole

Fusiform temporal gyri

Inferior temporal gyri

Object agnosia

Prosopagnosia

Object agnosia

See an object and can’t name it or don’t know how to use it

Prosopagnosia

Inability to recognize faces

They also have trouble discriminating facial expressions/gestures - impact pragmatics

Executive Functions network

Higher-cognitive processes: purposive action & effective performance

Self-initiation

Goal setting and planning

Working memory

Problem solving

Anticipation

Abstract reasoning

Self-awareness

Self initiation

If you have self-initiation, it helps you to seek help

Goal setting and planning

In therapy, it helps if the client sets their own goals so they buy in to treatment

Working memory

temporary memory for use

Impairment of these executive functions is often

not at all obvious on routine clinical assessment and many of our tests are insensitive to executive function impairment

Clinical setting provides a type of insulation and structure

Traditional measures of executive functioning were mostly focused on the cognitive tasks of problem solving and working memory

Sampling of Neuropathology

TBI

Stroke

Intracranial tumors

Hypoxic encephalopathy

TBI can result in

Diffuse or multifocal brain injury (multifocal - multiple areas of damage)

Focal areas of brain damage through contusion (focal - a defined area of the brain, contusion - bruising of the brain)

Range of severity of TBI

No matter where the head receives the first impact, the resulting clinical signs and disturbances become "diffuse" and "always” involving

The most common cognitive and behavioral syndrome following TBI includes

attention, memory, and executive functions

Pecentage of TBI

One of the most common patient populations in rehabilitation settings

75% mild/concussion

Males > females

Ages from 1-4 and 15-19

Causes of TBI injury

Motor vehicle accident (MVA)

Fall

Combat (blast injury)

Assault

Penetrating injury/Gun-shot wound (GSW)

Types of Acquired brain injury

Brain injury (BI)

Closed head injury (CHI)

Open head injury

Strokes

Hemorrhagic Stroke

Obstructive ischemic stroke

Thrombotic stroke

Embolic stroke

78% have a post-stroke cognitive impairment

Intracranial tumors

Primary (direct grown) vs. Secondary (metastatic) tumors

Benign vs. Malignant tumors

Hypoxic encephalopathy

Relatively diffuse or multifocal brain damage also follows from, especially, hypoxic, and ischemic encephalopathies, which often but do not necessarily co-occur

Hypoxic

no enough oxygen

Anoxic

complete deprivation of oxygen

Either of these cases can contribute to cognitive impairments

Ex: near drowning, carbon monoxide poisoning

Ischemic encephalopathy

not enough blood flow (so the brain isn’t receiving enough oxygen)

Clinical implications

Cognitive functioning is not packaged in the brain in discrete modules that can be isolated and treated as intrinsically homogeneous within and between individuals

A syndrome of impairments emerges from each injury

The framework presented can serve to assist in knowing what questions to ask, which then can drive assessment, which then influences treatment intervention decisions