2.3 Rehabilitation of Patients with Cognitive Dysfunction

Process of knowing, including awareness, reasoning, judgement, intuition, and memory

Cognition

Includes processes that are associated c perceiving, making sense of, and using info

Cognition

Cognition: Components

Executive function

Attention

Memory

Cognition: __: Capacity to plan, manipulate info, initiate & terminate activities, recognize errors, problem solve, and think, abstractly 

Executive functions 

Cognition: __: Able to select and attend to stimulus while simultaneously suppressing extraneous stimuli 

Attention

Cognition: __: Mental process; Allows an indiv to store experiences & perceptions for recall 

Memory

__: Ability to select stimuli that require attention and action to integrate them c eo and c prior info, and to interpret them

Perception

__: How we perceive smth 

Perception

__: Includes interpretation

Perception

__: Fundamental process; gives the pt the proper route to recover from the functional disability caused by their disease

Cognitive rehabilitation 

__: Adapting the env to the subjects needs and make the pt able to use alternative strategies to overcome residual impairments

Cognitive rehab

Cognitive rehab: 2 approaches

Remedial

Compensatory 

Cognitive rehab: 2 approaches: Proper route: 

Combination of both remedial and compensatory approach 

Theoretical Frameworks 

• Neurofunctional approach 

• Rehab/Compensatory approach (functional)

• Retraining approach (transfer of training) 

• Remedial approach 

Theoretical Framework: __: Pts c acquired brain injury must practice every activity in its true context in order to recover function

Neurofunctional approach 

Theoretical Framework: __:Direct repetitive practice of specific functional skills that are impaired is an efficient means of enhancing the pts indep in specific tasks 

Rehabilitative / Compensatory approach 

Theoretical Framework: __: Proponents of this approach favor addressing the functional problem over & above tx of its underlying cause when working c an adult poststroke population 

Rehabilitative / Compensatory approach

Theoretical Framework: __: Compensation and adaptation

Rehabilitative / Compensatory approach

Theoretical Framework: Rehabilitative / Compensatory:

• __: Change the approach of a task

• __: Modify env

Compensation

Adaptation

Theoretical Framework: Compensatory approach: __: Helps iden the things that they have to do

Labels

Theoretical Framework: Compensatory approach: __: Iden things in the house

Labels

Theoretical Framework: Compensatory approach: __: Can tick off when a task is overdue

Beepers

Theoretical Framework: Compensatory approach: __: Similar to pomodoro 

Beepers 

Theoretical Framework: Compensatory approach: __:Point out what needs to be done 

Signs 

Theoretical Framework: Compensatory approach: __: Flowcharts, diagrams, activities that need to be done

Signs

Theoretical Framework: Compensatory approach: __: Similar to signs 

Symbols 

Theoretical Framework: Compensatory approach: __: Similar to beepers

Alarms

Theoretical Framework: __: Disruption in 1 brain region can have a negative impact on brain functioning as a whole

Retraining approach 

Theoretical Framework: __: Skills learned for 1 task can generalize to others

Retraining 

Theoretical Framework: __: Practice in 1 task c particular cognitive or perceptual reqs will enhance performance in other tasks c similar perceptual demands 

Retraining 

Theoretical Framework: __: Focus on the pts deficits

Remedial

Theoretical Framework: __: Attempt to improve func ability by retraining specific perceptual components of behavior  

Remedial 

Theoretical Framework: __: Aimed at improving specific cognitive skills (attention, memory ,prob solving)

Remedial 

Theoretical Framework: __: Practice and repetition 

Remedial 

Theoretical Framework: Remediation approach: __: Same colors, have pt match

matching

Theoretical Framework: Remediation approach: __: Easiest

Matching

Theoretical Framework: Remediation approach: __: Segregate  

Sorting 

Theoretical Framework: Remediation approach: __: Can get a specific item when asked

Recognizing

Theoretical Framework: Remediation approach: __: Most complex

Identifying 

Remedial vs Adaptive Approach: __: Adult brain has limited potential to repair and reorganize itself p injury 

Adaptive 

Remedial vs Adaptive Approach: __: Intact behaviors can be used to compensator for ones that are impaired 

Adaptive 

Remedial vs Adaptive Approach: __: Can facilitate the substitution of intact behaviors for impaired ones 

Adaptive 

Remedial vs Adaptive Approach: __: ADLs provide training in functional behaviors

Adaptive 

Remedial vs Adaptive Approach: __:Training in specific, essential activities of ADLs is necessary bc adults c brain injury have difficulty generalizing learning 

Adaptive 

Remedial vs Adaptive Approach: __: Functional activities req cognitive and perceptual skills

Adaptive

Remedial vs Adaptive Approach: __: Adaptation and compensation will lead to improved func performance 

Adaptive 

Remedial vs Adaptive Approach: __: The adult brain can repair and reorganize itself p injury 

Remedial 

Remedial vs Adaptive Approach: __: Repair and reorganization are influenced by environmental stimuli 

Remedial

Remedial vs Adaptive Approach: __: Cognitive, perceptual. and sensorimotor exercises provide training in the cognitive and perceptual skills needed for those exercises 

Remedial 

Remedial vs Adaptive Approach: __: In cognitive and perceptual skills will be generalized across all activities req those skills 

Remedial 

Remedial vs Adaptive Approach: __: Func activities req cognitive and perceptual skills 

Remedial 

Remedial vs Adaptive Approach: __: Cognitive and perceptual remediation will lead to improved func performance 

Remedial 

Attention Deficits: Remedial or Compensatory Approach: __: Can use the visual env slowly and systematically 

Remedial 

Attention Deficits: Remedial or Compensatory Approach: __: Set time or speed limits

Remedial 

Attention Deficits: Remedial or Compensatory Approach: __: Provide distraction free env

Compensatory

Attention Deficits: Remedial or Compensatory Approach: __: Amplify critical stimuli

Remedial

Attention Deficits: Remedial or Compensatory Approach: __: Make crucial stimuli noticable

Remedial 

2 tasks done simultaneously 

Divided attention

Memory Impairments: Remedial or Compensatory Approach: __: Organize material to be remembered and make logical associations 

Remedial 

Memory Impairments: Remedial or Compensatory Approach: __: Use of diary, beeper, timer

Compensatory

Approaches for impairments of executive function

Volition

Planning

Purposive action

Effective performance

Approaches for impairments of executive function: __: Voluntarily doing a task 

Volition 

Approaches for impairments of executive function: __: Setting up the task, processing the task

Planning 

Approaches for impairments of executive function: __: Step by step process, also includes making choices

Planning

Approaches for impairments of executive function: __: Productivity and self regulation

Purposive action

Approaches for impairments of executive function: __: Capacity for quality control

Effective performance

Approaches for impairments of executive function: __: Checking quality of tasks and outputs

Effective performance

Executive Function: Remedial or Compensatory Approach: __: Provide structure, feedback and routine

Remedial

Executive Function: Remedial or Compensatory Approach: __: Env modification, beeper, alarm for poor initiation

Compensatory

Unilateral Neglect: Remedial or Compensatory Approach: __: Stimuli that are specialized for the R side of the brain such as shapes, blocks, should be used 

Remedial 

Unilateral Neglect: Remedial or Compensatory Approach: __: Simple verbal instrucs

Remedial 

Unilateral Neglect: Remedial or Compensatory Approach: __:Conduction motor activities (clenching and unclenching fist)

Remedial

Unilateral Neglect: Remedial or Compensatory Approach: __: Use a mirror, env adaptation 

Compensatory 

R & L Discrimination: Remedial or Compensatory Approach: __:  Use distinguishing mark to determine if L or R 

Compensatory 

Spatial Relations: Remedial or Compensatory Approach: __: Give instrucs for pt to pos themself relative to the PT or another object, use obstacle course 

Remedial 

Ideomotor and Ideational apraxia: Remedial or Compensatory Approach: __: Short commands given 1 at a time 

Remedial 

Ideomotor and Ideational apraxia: Remedial or Compensatory Approach: __: Components are taught 1 at a time then practiced as a whole 

Remedial 

Ideomotor and Ideational apraxia: Remedial or Compensatory Approach: __: Use of correctly sequenced photos (diagrams, flowcharts)

Compensatory