Assessment: Cognition, Functional Skills

1. Cognitive Processes 10/29/24

Attention

• Challenge of defining

• Cognitive load

• Alertness

  • Endogenous attention

• Key components:

  • Tonic alertness- general sustained alertness

  • Phasic alertness- we can have heightened alertness when needed

  • Focused attention

  • Sustained attention aka vigilance

  • Selective attention- writing a paper and watching tv

  • Alternating attention

  • Divided attention- driving and talking on phone

• Models of alertness & attention: Reference to Van Zomeren et al. (1984), Sohlberg & Mateer (2001)

• what determines this is where and how big the lesions were

• frontal lobe lesions= trouble initiating and regulating behavior

• language= tied with cognition when dealing with assessment.

• you can test either language or cognition first, both are right

Assessment of Attention

• Cancellation tasks:

  • Task: "Cross out each star."

  • Task: "Cross out each number that immediately follows a letter."

• Sustained Attention (Vigilance)

• Selective Attention- assessed with things like cancellation tasks, paper and pencil, look at a bunch of shapes and cross out each star, for example

• Alternating Attention

  • Various levels of task difficulty; examples provide insight into cognitive load.

  • poor reaction time

Memory

• 3-Stage Models:

  • Sensory Register (Sensory Memory): Lasts 1-2 seconds

  • Immediate Memory (Short Term Memory)

    • Role of rehearsal in retention strategies.

  • Long Term Memory

    • Working Memory

    • Recent vs. Remote Memory

    • recent= event-based memory of recent events

    • remote: event-based memory of far away past events from years ago

    • Retrospective Memory- the ability to remember past events

      • Declarative vs. Procedural

      • Declarative: specific past events

      • Procedural: remembering tasks and habits that are automatic like playing the piano

    • Prospective Memory- the ability to remember to do something in the future

Assessment of Memory

• Retrospective Memory

  • Immediate memory activities: Digit span tasks (Normal: 5-7 digits to remember)

  • Important role of auditory comprehension.

  • you can’t remember things you can’t understand or can’t hear

• Visual Memory assessments:

  • Memory for Designs Test

  • Benton Visual Retention Test

  • drawing stuff from memory or looking at something and remembering what it looked like later

• Prospective Memory:

  • Rivermead Behavioral Memory Test- slide 8

2. Executive Function

• Key Components:

  • Initiating intentional behavior

  • Planning behavioral routines to accomplish goals

  • Maintaining and regulating goal-directed behavior

  • Monitoring and modifying behavior based on situational input

• Relevant Models:

  • Resource allocation models, particularly for brain injury assessments.

Assessment of Executive Function

• Tasks to evaluate:

  • Response flexibility

  • Reasoning (Verbal, Arithmetic, Visuospatial)

  • Abstract Thinking and Problem Solving

    • Example: Raven’s Progressive Matrices

    • Tower test

    • Tinker toy test

  • Categorization/card sorting:

    • Wisconsin Card Sorting Test

• Specific tests include Six Elements Test, Hayling Sentence Completion Test, and BADS.

• Abstract Thinking- explain things like proverbs, card sorting, come up with rules for how cards are assigned, etc.

3. Emotional and Psychological Effects of Brain Injury on Cognition

• Emotional Lability- emotions that are not consistent with the situation you are in. You just start crying or laughing randomly. not good at regulating emotions

• Self-Doubt- not making a decision can be a result of this, they question their own responses

• Concreteness- failure to understand abstract meaning. idioms and metaphors would be tough for them. English is not a literal language. same with sarcasm

4. Functional & Quality of Life Assessment

• Framework based on WHO ICF models, focusing on:

  • Impairment/body structures & functions

  • Disability/activity limitations

  • Handicap/participation

  • functional= it will impact their real life functioning in some way

  • more interest on specific skills to get through their specific life

Functional Communication Rating Scales

• Functional Communication Profile

  • 9-point rating scale completed by knowledgeable individual

• Communicative Effectiveness Index

  • 16 items with a 7-point scale focusing on basic and life skills.

  • limitations/cautions: if you are using interview-based, you need to communicate clearly what you are looking for.

Formal Test: CADL-3: communicating activities of daily living

• 50 items addressing:

  • Reading, writing, & using numbers

  • Social interactions

  • Contextual and Nonverbal Communication

• Designed to simulate daily activities with a comprehensive assessment approach.

Quality of Life Measures

• Generic Measures:

  • Satisfaction with Life Scale

  • Stroke-Specific QOL Scale

  • WHOQOL-BREF

• Communication-Specific Measures:

  • Quality of Communication Life Scale, supplementary to impairment-based assessments.