Best Practices
facilitate brain recovery, help compensate, support people who have lost abilities, and encourage life and social participation
what are the purposes of tx?
decrease demands on impaired cognitive systems, spare intact cognitive strengths, use meaningful stimuli, recruit family, minimize factors that contribute to cognitive-impairments
what are the principles of tx for dementia?
used to encompass intervention to facilitate cognitive-communication recovery following brain injury; training, teaching, coaching, modeling, and counseling
what is cognitive retraining therapy?
provide feedback during completion of a task or immediately after, review performance before moving on, ask them to plan how to complete a task and predict how they will do , discuss how affects day-to-day functioning, and incorporate family
what are tx approaches for awareness in RHS?
to achieve the highest level of independent function for participation in daily living: capitalize on strengths & address weaknesses, facilitate activities & participation (new strategies/skills), and modify contextual factors that serve as barriers
what are goals of tx for TBI?
edema decreases, reperfusion, areas surrounding infarct improve, neighboring neurons regrow, increased nerve signals, and other pathways activate to compensate
How the brain recovers
maintain safety, increase ability to do basic ADLS, increase ability to make needs known, decrease frequency of responsive behaviors that increase stress, use time meaningfully, provide social opportunities
what are functional goal areas for dementia?
cognitive deficits may have an impact on communication and everyday life
what is the rationale for CRT?
pragmatic deficits, (coaching, role-playing, visual and verbal feedback, video modeling) target conversational skills (by increasing appropriate use of convo conventions and decrease barriers), and prosodic deficits
what are the areas of language tx for RHS?
identifying disorder labels that apply or do not apply to an individual according to evaluation of body structure and function
what is differential diagnosis?
1) likelihood of benefit for defined POPULATION, 2) likelihood of benefit to an INDIVIDUAL
what is efficacy (1) and effectiveness (2)?
memory books, spaced retrieval, errorless learning, reminiscence therapy, compensatory strategies, Montessori approach
what are possible tx approaches for dementia ?
1. recruit resilience. 2. cultivate the therapeutic alliance 3. acknowledge multifactorial complexity 4. use the team 5. focus on function 6. promote positive expectation for recovery
what are the 6 guiding principles for CRT?
DIRECT APPROACHES: like computerized attention training or cancellation tasks. METACOGNITIVE AND COMPENSATORY STRATEGIES: maintain predictable routine and structured environment, one task at a time, minimize distractions, alternate tasks of high and low interest
what are tx approaches for attention in RHS?
1. breaking down task into smaller units 2. provide models before performance 3. avoid guessing 4. correct errors immediately 5. fading prompt
what is errorless learning in TBI?
how productive tx is in minimum amount of time
what is efficiency
use one-idea sentences, ask questions that do not place demands on recent memory, speak @ normal rate w/o exaggerated intonation, use forced convo management and repair, eliminate distractions
what are compensatory strategies for dementia?
1. personalized education 2. cognitive strategy training 3. assistive technology 4. direct tx of cognitive processes 5. training specific tasks 6. environmental modifications
what are 6 tx approaches to CRT?
METACOGNITIVE/COMPENSATORY: problem-solving systems, devices to serve as reminders, and systems to set & accomplish goals. ENVIRONENTAL: materials and items stored where they will be used, labeling, color-coding
what are tx approaches for executive functioning in RHS?
focuses on improving deficit awareness, self-monitoring, and self-regulation to facilitate better recognition of problem situations and identification of functional strategies that facilitate success
what are metacognition skills?
embrace communication as fundamental human right, recognize assessment is ongoing, person-centered, includes family, have clear purpose and goals, encourage communication w unfamiliar listeners, embrace cultural-ling differences, self-coaching, and encourage life participation
what are some of the best practices for tx?
Face to face, orientation, continuity, unsticking, structure, exchange, direct
using materials or specific actions that increase function (to-do list, alarms, reminders) or develop adaptive patterns of thinking to increase function (semantic elaboration, mnemonics, visualization, rehearsal)
what are external and internal compensatory strategies for CRT?
highlighting or reading guide, tasks that require scanning across entire visual field, verbal or physical cues, leftward scanning by stimulus, VR/computer programs
what are unilateral neglect tx approaches for RHS?
training communication partners, select highly specific and personal goals, situational coaching prior to challenging situation, increase self-monitoring, and counseling to help identify sense of self that includes positive social interactions
what are tx approaches for social communication for TBI?