SHS 535 Cog. Exam 1

cognition

refers to mental faculties such as attention, memory, executive functions, and language

T/F: Language is part of one of the cognitive functions

true

attention

a cognitive process that relates to focusing resources to an external stimulus or internal representation or thought

3 types of attention

-sustained

-selective

-divided

sustained attention

maintain attention to complete a task accurately and efficiently over a period of time

selective attention

ability to maintain attention in the presence of distraction

divided attention

ability to respond simultaneously to multiple task demands while maintaining speed and accuracy

memory

representation of information

3 types of memory

-sensory

-working

-long term

4 types of long term memory

-episodic

-semantic (lexical)

-prospective

-procedural

sensory memory

serves to briefly hold stimuli in a raw form so that the stimuli can be registered and attended to

-this stage is unconscious

-decays 200-500 ms after perception of stimulus

-visual: iconic

-auditory: echoic

working memory

temporary storage and manipulation of information necessary to complete complex cognitive tasks such as language comprehension, learning, and reasoning

-holds ~7 items at a time

-decay 10-15 secs

-rehearsal extends retention

-gets input from outside and inside the cog system

-bottom up stimulus driven inputs

-top down executive control and memory driven inputs

episodic memory

memories of conscious events in our lives that have a specific source in time, space, and circumstances

-they are learned

-intentional (try to learn)

-incidental (without trying to memorize)

-episodic learning requires hippocampus and medial temporal lobe

semantic memory

involves concept knowledge, knowledge about the world, about ourselves, and about other people, word knowledge

-form from repeated, similar episodes (generalization;shared representations

-word meaning: pairing of phonological and orthographic representation with concept

prospective memory

the ability to remember and perform an action at a specific time in the future

procedural memory

unconscious memory of skills and how to do things (cognitive skill and motor memory)

-basal ganglia

executive functions

oversees and guides complex human behavior toward meeting a goal

-cold: related to cognitive aspects

-hot: related to emotion

3 executive function foundation elements

-inhibition

-cognitive flexibility

-working memory

8 executive functions

-goal setting (one of the hardest things to do w TBI)

-planning/organizing

-initiation

-self monitoring/self evaluation

-task monitoring

-inhibition

-working memory

-cognitive flexibility

parts of brain for EF

prefrontal cortex and dorsolateral prefrontal cortex

metacognition (EF)

awareness of ones own cognitive processing

model of communication competence

communication is primary domain of focus within a complex interplay of cognitive, linguistic, emotional, physical, personal, and contextual factors

#1 reason for TBI in 75+

falls

TBI hospitalizations and death are most common in __

males

#1 mechanism of injury for TBI in males

suicide

CDC definition of TBI

disruption in the normal function of the brain that can be caused by a bump, blow, blast, or jolt to the head or a penetrating head injury

clinical signs of TBI (4)

-loss of consciousness

-amnesia

-neurologic deficits (vision, balance, speech, etc)

-alteration in mental state (confusion, disorientation, etc)

reasons for TBI hospitalizations and death in men and women (top 2)

-falls

-motor vehicle crashes

classification of TBI is based on: (4)

-mechanism of injury

-type of damage

-clinical signs and symptoms

-prognosis

mechanism of injury classification

-open: object pierces skull

-closed: strong external force

type of damage classification

-focal contusions (swelling or bruising in specific area of the brain)

-diffuse axonal injury (DAI) (wide spread damage to white matter)

-hematomas (bleeding in and around the brain caused by ruptured blood vessel)

coup injury and contrecoup injury (focal contusion)

-coup: contusions under the IMPACT site

-contra: contusion on OPPOSITE side of impact

types of hematomas (4)

-epidural: bleeding into the area between the skull and dura mater

-subdural: bleeding between the dura mater and arachnoid mater

-subarachnoid: bleeding beneath the arachnoid mater

-intracerebral: bleeding into the brain itself

size might not necessarily predict symptoms/severity, its more so the __ of injury

location

areas tested in glasgow coma scale (GCS) (3)

-eye opening (1-4)

-verbalization (1-5)

-motor response (1-6)

*out of 15

GCS score for mild TBI

13-15

GCS score for moderate TBI

9-12

GCS score for severe TBI

8 or less

classification of TBI severity- timing (4)

-LOC

-mental state

-amnesia

-GCS

*imaging

TBI severity: mild (LOC< AOC< PTA

-LOC: 0-30 mins

-AOC: 0-24 hours

-PTA: 0-1 day

-GCS: 13-15

*normal imaging

TBI severity: moderate (LOC< AOC< PTA

-LOC: 30 mins-24 hours

-AOC: >24 hours

-PTA: 1-7 days

-GCS: 9-12

*normal or abnormal imaging

TBI severity: severe (LOC< AOC< PTA

-LOC: >24 hours

-AOC: >24 hours

-PTA: >7 days

-GCS: 8 or less

*normal or abnormal imaging

"complicated" mTBI

meet criteria for a mild TBI BUT have POSITIVE findings on neuroimaging

__% of TBI are mild

80%

mTBI: 4 categories of symptoms

-somatic (e.g. headache-most common, nausea, fatigue, etc.)

-cognitive (e.g. difficulty thinking, remembering, concentrating, communicating, etc.)

-emotional (e.g. irritable, sad, anxiety, hopeless, etc.)

-sleep (e.g. sleeping less/more, drowsy, trouble falling asleep)

mTBI: 4 categories of dysfunctions observed

-somatic (convergence insufficiency, vestibular dysfunction, headache)

-cognitive (EF, complex attention, cognitive flexibility)

-emotional (anxiety/depression)

-sleep (disturbances)

mTBI recovery for acute-subacute stage (0-3 mo) is ___

7-10 days

mTBI recovery for chronic stage (3 mo post) is__

mo to years (prolonged post concussion symptoms)

___% of mTBI symptoms resolve in 3 mo or less

90%

prolonged concussion symptoms (unclearly) result from: (3)

-neurogenic factors (trauma resulting in physiological changes)

-psychogenic factors (health anxiety)

-behavioral factors (positive reinforcement socially)

*not verifiable on standardized tests

regardless of factors that lead to persistent mTBI symptoms, these symptoms contribute to ____ dysfunction

long term

___% mTBI show prolonged symptoms beyond 3 mo

10-15%

clinical characteristics of mod-sev TBI (3)

-somatic (headaches, pain, visual/auditory impairments)

-emotional (mood disorders, anxiety, disorders of control and drive, personality changes, lack of insight)

-cognitive (attention, EF, and memory deficits)

characteristics of cognitive communication disorders (8)

-simple/shorter sentences

-word finding difficulty

-less efficient in conveying info

-more errors of cohesion and coherence

-stories lack causal/temporal relationships between events

-difficulty turn taking/topic management

-difficulty communicating appropriately in social contexts

-difficulty comprehending complex convos

assessments

MoCa, RBANS, CLQT

assessment goals (3)

-evaluate levels of cognitive and psychosocial functioning

-assess cognitive, neurobehavioral, and environmental factors important to recovery

-outline treatment plan to facilitate return to community participation

example assessment checklist

cognitive communication checklist for acquired brain injury (CCCABI)

discourse analysis examples

-monologic (narratives, story retell, procedural, picture description)

-conversational (topics, open ended)

assessment of pragmatic skills

-command over linguistic forms, styles

-adapt language during interactions (most common reason for referrals)

-adjust language style and content based on situation

-use and interpret non verbal signs

-standardized ex) La Trobe communication questionnaire

cognitive rehab

one component of a comprehensive brain injury rehab program

-focuses on specific cognitive deficits of the individual with brain injury but also on their impact on social, communication, behavior, and academic/vocational performance

goals of cognitive rehab

-improve impaired functions

-empower participation in daily routines/activities

-increase self confidence, self efficacy, and self awareness (improve metacognitive skills)

-cope with distress

cognitive rehab approaches (3)

-process vs skill based

-restorative vs compensatory

-contextualized vs decontextualized

process vs skill based treatments (cog rehab)

-process: focus on improving cognitive domain such as attention, memory, language, or EF (more general); APT

-skill: improve performance of a particular activity such as using a calendar to check appt daily (more specific tasks)

restorative vs compensatory treatments (cog rehab)

restorative: improving, strengthening, or normalizing specific impair cognitive functions (drill work)

compensatory: providing alternative strategies (internal or external)

contextualized vs decontextualized treatments (cog rehab)

decontext: targets specific cognitive processes using artificial treatment tasks

contextualized: addresses cognitive impairments as they disrupt activities and skills

process based cognitive training principles (5)

-tasks organized according to theoretical model

-repetition

-patient performance data to direct therapy

-drills and strategy training

-measure functional goals

strategy (skill) based cognitive training principles (3)

-strategy needs to be thoughtful and systematic

-therapy should provide practice to use strategy

-evaluation of strategy use should determine type and amount of practice

strategies for improving memory (6)

-mnemonics (internal):visual imagery and verbal elaborations

-cueing (internal): vanishing (max to min), forward (min to max)

-chunking (internal)

-memory notebook (external): acquisition, application, adaptation

-PQRST: preview, questions, read, state, test

-spaced retrieval training (SRT): test recall with increasing length of retrieval

metacognitive strategy instruction for improving executive func

-regulate their own behavior by breaking complex tasks into steps (goal management training)

goal management training (GMT) (3)

-awareness training (client needs to know what their goal is)

-strategy training (stop!, define, list, learn, execute, check)

-maintenance and generalization

cognitive rehab guiding principles (6)

-therapeutic alliance

-resilience

-multifactorial complexities and personalized education

-collaboration

-functional goals

-realistic expectations

cognitive rehab framework

PIE: plan, implement, evaluate

basic steps and key questions for planning cog rehab

steps:

-key learner characteristics (cog func, physical func, sensory abilities, psych status, social connection)

-treatment targets

-treatment strategies (internal/external)

-desired outcome (comm competence)

-goal writing (target, approach, context, practice, measure, criterion, independence, realworld/generalization)

T/F: A multicenter cohort analysis from the UK Rehabilitation Outcomes Collaborative found that specialist rehabilitation was cost-effective even for TBI patients with a reduced lifespan.

true

T/F: Most pediatric patients with mild TBI recover within 1-3 months.

true

How has the classification of TBI evolved over time?

shifted from a purely clinical approach to incorporating imaging and biomarkers

What are the 7 themes reported by patients and families during the study's information-gathering workshops with respect to the burden imposed by TBI noted in the reading: The Scope and Burden of Traumatic Brain Injury?

1. importance of a strong connection to at least 1 provider

2. comprehensive plan for next steps

3. little to no support after hospital discharge

4. disconnect between symptoms doctors were attending to vs the symptoms that most heavily impacted the client/families

5. need of advocate present

6. navigtating insurance

7. research needed for integrating patient and family experiences

8. benefits of clinical research programs

Why is a comprehensive classification system important for TBI?

it helps determine insurance coverage

What behavior reflects habitual responses triggered automatically in individuals with executive dysfunction?

Perseveration, stimulus-bound responding, and distractibility

What is the relationship between vestibular symptoms and recovery from concussion?

The presence of vestibular symptoms may predispose the individual to a prolonged recovery (beyond 1 month).

What is the primary role of executive functions?

Mediate and regulate behavior in a purposeful and goal-directed fashion

Which aspect of language comprehension is commonly affected in TBI patients?

Comprehending long or complex utterances and conversational inference.

What is the typical timeframes for resolution of clinical and cognitive features of concussion/mild TBI?

Immediate resolution is expected.

What aspect of social cognition is directly relevant to communication and social skills?

Empathy and understanding of others' emotions

After a concussion/mild TBU, patients may experience increased symptoms of anxiety or depression due to:

Both the effects of injury on neuronal function and the injured person's reaction to it.

'Frontal lobe syndrome' in TBI patients is

A consequence of diffuse pathology affecting distributed networks and subcortical pathways

Convergence insufficiency can lead to increased symptoms during which type of activities?

Near-point activities, such as reading

What is the nature of self-appraisal in TBI patients?

They frequently exhibit a lack of insight and unrealistic self-appraisal.

What is a notable feature of conversation in some TBI patients?

They may exhibit insensitivity to social cues and engage in inappropriate humor.

How do people with severe TBI perform on complex cognitive tasks over extended periods?

Their speed and accuracy both decrease

Which cognitive function is crucial for time-based prospective memory tasks?

Active monitoring of the passage of time

What is metacognition?

The ability to think about cognitive processes, evaluate progress, and modify goals based on feedback

What is the purpose of using additional measures individualized after the clinical interview in the speech-language assessment?

To tailor the assessment to individual needs

What are the two core measures utilized at MIBH for assessing executive functioning?

Behavioral Rating Inventory of Executive Functioning-Adult (BRIEF-A) and Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES)

What does the LaTrobe Communication Questionnaire (LCQ) assess?

Initiation/conversational flow, conversational effectiveness, and partner burden

What does the term "blast-plus" refer to?

A combination of blast waves and an impact to the head

Which two interventions are not recommended for use outside of research settings as behavioral treatments for attention deficits in people with brain injuries?

-transcranial stimulation (rTMS and tDCS)

-mindfulness-based meditation techniques

What are the six new recommendations put forth by INCOG 2.0 regarding intervention strategies for addressing attention and executive function deficits?

EX FUNC:

-music therapy

-virtual therapy

-telerehabilitation-delivered metacognitive strategies

-group-based telerehabilitation

ATTN:

-transcranial stimulation

-herbal supplement