Key points for non-progressive brain injury + progressive conditions

Non-progressive brain injuries (5)

• TBI

• Stroke

• Encephalitis

• Anoxia

• Epilepsy

Progressive conditions

• Dementia

• MS

• Parkinson’s

• HD

• Brain tumour

TBI: def, assessment name (1), sequelae (2), int. (1)

• Structural + functional changes to brain arising from mechanical blow

• Glasgow Coma Scale (GCS)

• Cog. deficits

  • Including exec dys.

• Emotional changes

• Focus on functional compensation

Stroke: def, assessment (1), sequelae (1→2, 1→2) , int. (3)

• Disease of blood vessels supplying the brain

• Cog. assessment should be done early

• Cog. impairment

  • Exec function

  • Language

• Psych consequences

  • Depression

  • Anxiety

• Cog. rehab

• Compensatory strats

• Psychotherapy

Encephalitis: def, assessment, sequelae (1→2, 1→2), int. (treatment) (2)

• Inflammation of brain tissue

• Diagnosis of exclusion (patient history, brain imaging etc.)

• Cog.

  • Reduced IQ

  • Exec dysfunction

• Emotional + psych

  • Depression

  • Anxiety

• Let virus run course or antivirals/bacterials/fungals (infectious)

• Immune-modulatory treatments or removal of tumour (if this is the cause) (autoimmune)

  
  

Anoxia: def, sequelae (5), int. (1 w example)

• Reduced or restricted O2 supply to the brain

• Cog.

  • Exec. dys.

  • Memory deficits

• Emotional

  • Depression

  • Anxiety

• Visuospatial/perceptual

• Severe intellectual impairment

• DOC

• Holistic approach

  • E.g. memory aids

Epilepsy: def, sequelae (1), int. (5)

• Characterised by unprovoked + recurrent seizures

• Cog. deficits

• Work systematically through issues

  • Optimise seizure control

  • Optimise psychiatric state

  • Acceptance of cog. deficits

  • Set goals using SOS framework

    • Strategies, outsourcing, social support

  • Monitor + evaluate

Dementia: def, presentations based on type (3), assessment (3), intervention/rehab: theory (2), practice (2)

• Umbrella term for neurodegenerative disorders which result in progressive cognitive decline

• Memory deficits (Alzheimer’s + vascular)

• Behavioural changes (frontotemporal)

• Lang. impairment (semantic

• MMSE, observation, neuroimaging etc.

• Enablement philosophy

• Individualised + goal-oriented rehab

• GREAT program

  • Action-based procedural learning

  • Environmental restructuring

MS: def, presentations (1, 1→2, 1), int.

• Progressing CNS condition arising from irrecoverable loss of myelin, leading to axonal damage + grey matter loss

• Motor

• Cog. (not predicted by disease course/severity)

  • Reduced processing speed

  • Attention

• Psych.

• Attention + memory retraining (more research needed)

PD: def, presentations (1→3, 1→2, 1→3), , int. (1→2, 1→1)

• Loss of dopaminergic cells in substantia nigra

• Motor

  • Tremor

  • Muscle rigidity

  • Gait difficulties

• Cog.

  • Early PD: frontostriatal deficits (attention + exec)

  • Advanced PD: ^^ + memory deficits

• Psychiatric

  • Depression

  • Anxiety

  • Apathy

• Pharmacological

  • Cholinesterase inhibitors for PDD

  • No pharmacological int. yet MCI or prevention

• Non-pharmacological

  • Usual + exergaming

HD: def, presentations (1→2, 1→3, 1→2), int. (2)

• Hereditary autosomal dominant disorder leading to degeneration of striatum

• Motor

  • Chorea

  • Bradykinesia

• Cog.

  • Psychomotor slowing

  • Exec. dysfunction

    • Multitasking

  • Memory

    • Retrieval failure (not amnesia)

• Social + affective

  • Impaired social cognition (emotion rec., ToM)

  • Apathy

• External cueing (for apathy)

• Simplify tasks to avoid multitasking

Brain tumours: def, presentations (1→2, 1→2, 1→2), int. (1, 1→1)

• Abnormal group of cells in the brain or meninges

• Cog. (from tumour focal impact + radiotherapy neurotoxicity)

  • Exec.

  • Memory

• Behavioural

  • Apathy

  • Inappropriate behaviour

• Psychiatric

  • Depression

  • Death anxiety (patient + carers)

• Cog. rehab

• Multidisciplinary community-based approach

  • Making Sense of Brain Tumours Program home-based psychotherapy + rehab (existential stress etc.)