neuropsych issue in rehab

neuropsych

• the study of the relationship between brain function and behavior

• focus on cognitive, emotional, behavioral changes resulting from the brain injury or neurological conditions

neuropsych assessments

• cognition

• emotion

• social

• behavior

cognition assessing

• attention

• processing speed

• memory

• visuospatial

• language

• executive functioning

• insight

emotion

• mood

• coping response

• psychosis

• substance use

• other mental health

• health beliefs

• illness perception

social

• support system

• discharge destination

• access to healthcare

• access to community resources

behavior

• pain expression

• sleep

• therapy engagement and participation

• barriers to treatment

interventions

• cognition: cognition rehab

• behavioral: behavioral plans

• family: education, problem-solving, support

• emotion: psychotherapy

• team: co-treatment, ongoing collaboration

orbital fronal cortex

• impulse control

• decision making

• emotion regulation

• social behavior

amygdala

fear and pleasure

• emotional bank

hippocampus

retrieval of emotional memories

• contextualizes experiences

basal ganlia

voluntary motor control, reward system

behavior

a function of the person and their environment

• form of communication

  • unmet needs or desires

common behaviors in rehab

1. verbal/physical aggression

2. sundowning

3. agitation

4. apathy

5. hallucinations

6. delusions

7. anxiety

8. depression

9. irritability

10. disinhibiition

11. motor restlessness

hallucinations

• sensory perceptions that occur in the absence of external stimuli

• auditory, visual, olfactory, tactile, gustatory

delusions

• false beliefs that are not based in reality

• resistant to change despite evidence to the contrary

• persecutory, jealousy, erotomania, grandeur, other bizarre beliefs

anxiety

muscle tension, nervousness, restlessness, rumination, avoidance, seeking constant reassurance, social withdrawal

depression

tearfulness, sadness, loss of appetite, anhedonia, feeling unworthy

behavioral factors

• type, severity, location of brain injury

• medical status

• time since injury

• course of illness

• age

• vocational status

• pre-injury personality and coping style

• feelings, perceptions, attitudes about disability

• social and financial resources

DICE approach

• describe

• create

• investigae

• evaluate

• designed to work with individuals with cognitive deficits for behavior

describe

• play by play description of the presenting behavior

• identify antecedents

• describe the specifics of the incident

• uncover the context, potential underlying contributing factors

how to prioritze behavioral targets

1. danger to self and others

2. interferes with therapy

3. socially unacceptable, makes others feel uncomfortable

investigate

• underlying causes

• internal states

• caregivers

• environment

possible underlying causes to behavior

• sleep disturbances

• medical conditions

• changes in funcitional abilities

• sensory changes, response to meds

• cognitive impairment severity

• prior/current psych

internal states

• personality patterns and characteristics

• loss of inhibition

• psychosocial stressors

• litigation

• grief and loss

• depression, anxiety, stress, trauma

• feelings of inadequacy, helplessness

• changes in role

caregivers

• communication style

• (un)realistic expectations

• over/underestimate of person’s abilities

• caregiver fatigue, stress, depression, well-being

• prior relationship status

• coping resources/abilities

• cultural factors

environment

1. over/under stimulating

2. predictability/pleasure of activities

3. safety

4. access to objects

create

• collaborate to create and implement a treatment plan

• brainstorm interventions

• generalized and targeted strategies

• include patient’s interests and incorporate isight about their personality and preferences

evaluate

• were strategies implemented effectively, correctly, consistently

• any unintended side efffects or consequences

• any change in the patient’s status that made implementation difficult

• which strategies were implemented

• did the behaviors change

types of interventions

• environmental

• verbal

• nonverbal

• behavioral

• physical

• pharmological

environmental interventions

• lighting

• sounds

• open/closed doors

• clutter

• sensory stimulation

• scheduling, routine, structure

verbal de-escalation

• tone, volume, rate of speech, inflections

problem-solving

• problem indetification

• generationg solutions

• decision making

• taking action

substitution

• redirecting behavior

• understand the triggers

• replace with a positive behavior

• reinforce and reward

response blocking

physically or verbally preventing or interrupting an undesire behavior

• physically blocking

• verbal redirection

• environmental modification

• reinforcement of alternative behaviors

redirection

• redirecting attention/behavior to something else

• helps refocus attention

• de-escalate behaviors

• can change mood/emotional state

• verbal, physical, cues

interventions for sundowning

1. Routine

2. Limit stimulating activities

3. Calm environment

4. Encourage physical activity during the day

5. Monitor caffeine

6. Ensure a comfortable sleep environment

7. Relaxation techniques

relaxation exercises

1. Deep Breathing

2. Guided Imagery

3. Progressive Muscle Relaxation

4. Body Scan

5. Mindfulness exercises

confabulation

Provoked vs. spontaneous confabulation

Reorientation

Acknowledge feelings, not content

Build trust and rapport

Memory aids

Redirection