TBI assessment & treatment

Assessment

100

What is a standardized assessment for a high level TBI patient?

SCATBI

200

What is the BEST way to assess for Executive Function?

Multi-step function tasks for everyday activities

300

What are 3 goals of assessment?

1. accurate picture of cognitive, emotional, interpersonal functioning 2. overview of compensatory strengths 3. establish best ways to facilitate learning 4. determine capacity/readiness for rehab 5. involve functional tasks

400

Describe the progression of assessment tools in regard to TBI (starting with psychometric).

Psychometric Approach (standardized tests) Functionally oriented psychometric measures (still standardized but geared towards functional tasks) Functional rating scales (not standardized; clinician observes pts doing functional tasks and rates their abilities on a scale) Informal (best info in the shortest amount of time)

500

What are the components of a TBI assessment?

1. establish pre-injury background 2. interview both client & family/caregiver 3. medical history 4. behavioral observations 5. informal/formal assessment 6. cognitive strengths & weaknesses 7. long-term & short-term goals that are functional

Treatment Overview

100

What are the two general approaches to treatment?

1. Facilitative tasks (repair or restore) 2. Compensatory tasks (work around deficits)

200

What are the primary goals of cognitive rehab?

1. problem orientation, awareness, and goal setting 2. compensation (tools to function as normal as possible) 3. internalization (make tools more automatic) 4. generalization (extend to various tasks and settings)

300

What are 4 general aspects of treatment? (overview)

-built on client's needs -alliance with family, caregivers & other professionals -help pt to understand strengths and weaknesses -connect with ADLs -goal-oriented

400

How can treatment be generalized?

-get the caregiver/family involved -use a variety of settings -set clear treatment goals with repetition -value of community based approach

500

What are the components of a short-term goal? Provide an example.

1. taks/target behavior 2. level of difficulty/complexity 3. level of cueing 4. strategy 5. accuracy criteria Patient will accurately verbally answer orientation questions in regard to place when asked questions by the speech language pathologist and provided with moderate cues with 95% accuracy across 3 sessions. Using a memory notebook, patient will verbally identify pictures of family members in response to a clinician's question using moderate cueing with 95% accuracy

Treatment (executive function & memory)

100

This type of strategy is best for moderate-severe patients...give an example.

External aids such as memory books, electronics, cue cards

200

What is involved in training an external device?

1. create a positive attitude about it 2. involve the caregivers 3. do task analysis 4. train using errorless learning

300

What is the general sequence for treatment of executive function?

1. anticipate and plan (what would you do if..?) 2. select, try, and self-monitor 3. evaluate outcome and compare to anticipated response (if necessary, change response)

400

What is PQRST for? Describe PQRST.

internal memory strategy P: preview- read headings, introductions, and summaries Q: question- ask questions as you go along (what should you be learning?) R: read- actually read the material S: self-recite- recite the main ideas you read T: test- test & review the material (if necessary, read again)

500

Provide 2 examples of evidence-based memory strategies and describe them.

1. Teach M (task analysis, errorless learning, assessment, cumulative review, high rates of correct practice, and metacognitive strategy) 2. spaced retrieval (longer periods of time that a pt needs to remember something) 3. chaining (using errorless learning and repetition to teach steps in a task whereas the steps are taught dependent of one another) 4. method of vanishing cues (reverse chaining, provide everything except the last step)

Treatment (attention)

100

How should attention be treated?

-HIERARCHICALLY (start where they are weakest) -repetition -lead to generalization & real-world usage

200

What is APT?

-Attention Process Training (can be an assessment as well) -cognitive strategies with repetition drilling based on the notion that one aspect of attention can be used to stimulate another aspect -involves immediate/focused, sustained, selective, alternating, and divided

300

What is TPM & what does the client need in order to participate?

-Time Pressure Management--> cognitive exercises used to decrease the disabilities due to mental slowness; provide compensatory strategies for real life time pressure situations patient needs... -awareness of deficits -ability to identify a time pressure situation -adequate motivation -training that is adjusted to their needs

400

What are the steps involved with TPM?

step one:make the patient aware _use psychometric measures or predict-perform when necessary step two: teach the skill _analyze task for time pressure & ID where strategies may help _learn to ID what can be done before the task _taught to make emergency plans if something goes wrong _learn to self-monitor the performance

500

Provide a memory task for each type of memory.

focused: rote counting sustained: worksheet w/ # cancellation selective: ID auditory stimulus w/ background noise alternating: addition/subtraction worksheet divided: multi-level card sorting

Treatment (pragmatics/ social communication)

100

What are three ways in which social communication can be impaired?

-egocentricity in conversation -inability to recognize one's communication or emotional needs -excessive talking -depression/anxiety

200

What does a typical GIST session look like?

1. reconnect 2. review 3. new topic 4. break 5. practice skills 6. problem solve 7. new hw

300

What is involved in GIST?

engagement:meeting w/ group, discussing history and knowing they are not alone awareness: made aware of their deficits and what techniques can be done to help them goal-setting: family members can observe and provide input on what they think would be a functional, appropriate goal skill-mastery: functional skills develop, practice w/ group, leads to improved social confidence generalization: family is encouraged to participate, at least one session is held in the community

400

Describe the treatment sequence for emotional perception deficits.

1. attaching emotions to events 2. judging static visual emotional cues (drawings to pictures) 3. judging dynamic emotional cues (one modality to multiple) 4. making social inferences based on emotional demeanors (lying, humor, sarcasm)

500

What is a good goal for social communication deficits?

Using a self-monitoring strategy, the patient will independently exhibit topic maintenance within a 2-3 minute conversation in 95% of opportunities.