8/25/2017 THE ESSENTIAL BRAIN INJURY GUIDE Neurocognitive Issues Section 4 Education & Brain Injury Presented by: Rene Carfi, LCSW, CBIST Outreach Alliance of Manager Connecticut Certified Brain Injury Specialist Training – October 26 & 27, 2017 This training is being offered Presented by Brain Injury Alliance of Connecticut staff: as part of the Brain Injury Rene Carfi, LCSW, CBIST, Education & Outreach Manager Alliance of Connecticut’s & ongoing commitment to Bonnie Meyers, CRC, CBIST, Director of Programs & Services provide education and outreach about brain injury in an effort to improve services and supports for those affected by brain injury. Contributors Lisa A. Kreber, PhD, CBIS Drew A. Nagele, PsyD Christina Peters, MSc Ed, BCBA, CBIS Chris M. Schaub, MS ED MJ Schmidt, MA, CBIS 1
8/25/2017 Cognitive Complications Learning Gain an Be able to describe the understanding types of deficits in of the concepts attention frequently Objectives involved in observed in persons cognitive who have sustained a rehabilitation brain injury Be able to articulate the Be able to explain type of damage factors that interfere sustained by TBI that with cognitive results in delays in rehabilitation information processing Be familiar with Be able to distinguish the 5 subtypes of between the 4 types attention of memory Over 5 million Americans experience disabilities due to brain injury Long-term care and supervision may be required for persons with brain injury due to cognitive and communication dysfunction, leading to increased caregiver burden and cost of care 2
8/25/2017 What is Cognition? It is a complex collection … It is a process … Cognitive Skills and Processes Alertness Comprehension Maintenance of Retention Association Decision-making temporal order of Selective Attention Insight stimuli Attention Attention Span Learning Memory Stimuli Awareness Maintenance of Organizing Recognition Categorizing sequential goal- Planning Stimuli directed Problem-solving Discrimination behavior with Reasoning Synthesis of self-correction Information Thinking Cognitive Skills and Processes Identified by ASHA and ACRM. Domains of Cognitive Functioning Categorization DIVIDED Attention ALTERNATING SELECTIVE SUSTAINED Because we do not have unlimited FOCUS USED processing resources, attention helps us to best allocate these resources These subtypes of attention are viewed in levels. 3
8/25/2017 Subtypes of Descriptions Examples Attention Focused Selecting one source of information (i.e., Responding to pain; Turning to see a stimulus) while withholding responses to loud sound behind you Attention irrelevant stimuli Sustained Maintaining attention to complete a Reading a book; Watching a TV show; task accurately and efficiently over a Listening to a presentation Attention period of time Selective Maintaining attention in the presence of Focusing on the presenter at a distractions conference while ignoring others Attention talking outside; Studying while music is playing Alternating Shifting between tasks that demand Reading a recipe and stirring a pot; different behavioral or cognitive skills Filing and answering the phone Attention Divided Requires the ability to respond Driving and talking on the phone; Attention simultaneously to multiple task demands Cooking multiple courses at the same while maintaining speed and accuracy time Categorization Individuals with brain injuries tend to base decisions about category membership according to a single attribute and have difficulty responding to more complex and multidimensional stimuli. Memory Memory Where perceived Stabilization of a The search for a information is put memory memory or activation in a context that of a memory can be stored 4
8/25/2017 Memory Processes Hearing Vision Touch Taste Smell Rehearsal Sensory Short Term Working Long Term Memory Memory Memory Memory Retrieval Hold lds sensory Enables bles recall ll of f Temporary Permanent info formation for a info formation storage and active consoli lidation and few seconds after lasting a few processing of f storage of f perception minutes to hours info formation info formation Long Term Memory Processing Speed 5
8/25/2017 Executive Functions Create useful Hold info in mind to strategy for complete task; Update & functional use manipulate info Move freely from one Age appropriate insight of strengths activity to another; Consider more than one & weaknesses solution when problem solving Impulse control; Spontaneous planning of Manage distractions; new tasks; Anticipate Delay responses future events; Prioritize Independently assess Intermediate and long behavior; Respond to and term goal setting, make changes as needed appropriate to ability Independently initiate new activity; Seek and search for new information; Persist; Conceive new ideas Metacognition 6
8/25/2017 Metacognition Metacognitive Strategy Anosognosia Training Diminished self-awareness and Used to enhance an individual’s failure to recognize a personal ability to internalize awareness and disability control over behaviors Reductions in self-awareness can The primary goal of metacognitive have important consequences for strategy training is to enhance a outcomes, including: person’s ability to internalize Compliance with rehabilitation awareness and control over their behavior Ability to return to independent living Frontal Parietal Systems Systems Limbic Systems Temporal Occipital Systems Systems COGNITIVE FUNCTION Fro rontal Lobe Pari Pa rietal Lobe Emotional control Tactile performance Behavioral control Spatial orientation Verbal expression Academic skills Problem Solving Object naming Decision Making Visual attention Social control Eye-hand Motivation coordination Attention Occipital Lobe Visual stimuli processing Temporal Lobe Memory Object categorization Face recognition Receptive language Selective attention Emotional responses Locating objects Language comprehension 7
8/25/2017 Common Factors that Interfere with Cognitive Function Following a Brain Injury Hearing Vision Communicative Functions Medical Stability Emotional and Behavioral Control Comorbid Conditions It is important to consider all factors (physical, language and speech, neurologic, and emotional/behavioral) when providing cognitive rehabilitation. MODELS PRINCIPLES COGNITIVE REHABILITATION Models of Cognitive Rehabilitation Compensatory Approach Restorative Approach Assumes certain cognitive Repeated exposure and repetition functions cannot be recovered of stimulation through experience due to damage can change brain’s circuitry and reorganization of the brain can Focuses on development of occur strategies to accommodate limitations. For example, external Uses therapeutic exercises devices such as planners, designed to reestablish or checklists, smart phones strengthen specific cognitive skills or processes A functional application is essential 8
8/25/2017 Overall Principles Environmental Stimulus Approach Overall Principles Task Complexity Overall Principles Cognitive Distance apple Line Word Spoken Color Black & White 9
8/25/2017 Neurobehavioral Complications Learning Be able to distinguish Be able to describe the between positive and principles of applied negative reinforcement behavior analysis and Objectives how they apply to this population Be able to identify and Be able to explain crisis Be able to discuss define common common prevention & behavior neurobehavioral neurobehavioral management strategies complications of brain treatment interventions for individuals with a injury brain injury Be able to Be familiar with factors Gain an understanding of articulate the that influence the de-escalation techniques concept and type and extent of to consider when purpose behind behavioral difficulties individuals with brain a functional an individual may injury are demonstrating analysis demonstrate after a increased frustration and brain injury agitation Common Neurobehavioral Changes after Brain Injury Aggression Emotional changes including Agitation/irritability, poor flat/restricted emotions, lability, frustration tolerance dysphoria, depression Poor initiation/apathy Impulsivity Denial of deficits/poor self- Poor judgment and reasoning awareness Psychosis - delusions, euphoria, Disinhibition/inappropriate hallucinations sexual behavior Nighttime disturbances Eating disturbances Anxiety 10
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