Cognitive Abilities and Executive Function by hcj

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									   Diagnosis and Therapy
    Approaches for the
Speech Language Pathologist
Cognitive Functions

 Domains of Cognitive Function
 1.Attention
 2.Memory Processes :short and
   long term
 3.Verbal language
 4.Categorization :Means of
   incorporating new info and
   organizing info in the brain
 5.Abstract thought

 Constantinidou, Thomas, & Best
  (2004)
1.Attention

 Orienting Network
   Guides the sensory organs to relevant
     locations within the environment so
     that processing of information in
     those locations is enhanced
 Executive Network
     -Central executive” coordinates
working memory, orienting network, and
  processes of the short term memory
 Alerting Network
    Ability to maintain arousal or
     alertness
Orienting Network

 Attentional orienting is closely
  tied to shifting the gaze of the
  eyes to expand the visual field in
  which the organism must
  respond
 Selective, focused , sustained,
  shared, shifted-
 With brain damage this basic
  skill is often affected and
  impedes learning
In terms of survival in the “wild”,
  this impairment may be fatal.
Executive Network

The Executive Network is
 responsible for assessing the
 situation, ensuring the most
 important features are amplified
 and selecting the most
 important responses.
 Prioritizing
List situations where
 Executive Network is
 employed in daily life:
Driving?
Planning dinner
Time schedules
Executive Network
 Flexibility
 Capacity to multitask
 Switch attention
 Organize sequences
 For Word Finding: one may alter
 response selection (if you can’t
 think of the word, you
 sometimes use another in the
 file that you can retrieve that is
 like it)
Alerting Network

 Ability to maintain arousal or
  alertness
 Ability to discriminate the
  presence of distracters
  (vigilance)

 One Cognitive therapy might
 include learning to recognize
 and control adverse
 environmental and personal
 conditions, training the
 person to become resistive to
 distractions
2.Memory Processes in the
Executive Network
 Memory is organized with respect to
  time and contents
 Short term/working memory
 Long term memory
  explicit-
    semantic, experiential event
  Someone with damage to the Explicit
  portion of the Executive Network will
  be disoriented , not remember the space
  or the room where they always have
  therapy , and demonstrate nervous
  behavior
implicit-skills and habits,
             perceptual, conditioning
3.Verbal Language
 Brain injury can result in a generalized
  cognitive disruptions that often affects
  complex linguistic abilities
 Traditional aphasic syndromes are not
  often associated with TBI
 Word finding / lexical retrieval –
  associated in TBI with slower speed of
  information processing along with
  retrieval difficulties
4. Categorization
 Assigning objects or events
  into groups
 Interrelated with other cognitive
  processes
     Object recognition
     Problem solving
     Decision making
     Sustained attention tasks that
      require sorting
     Learning and memory
     Categorization is critical to
      problem solving in order to
      consider solutions
Components of
Categorization
Recognition and Categorization of
 everyday objects involves two
 anatomically and functionally distinct
 pathways.

Brain Injury may cause deficits in both
  identification and categorization
  because the two areas of the brain are
  not communicating.
5. Abstract thought
 Reasoning
 Decision making and
 Problem solving are the highest
  forms of cognition in what we
  think of as human intelligence
 Abstract thought emerges from the
  interaction of all the other
  processes
 Dementia, Degenerative disorders
  and TBI >reduction in abstract
  thinking
Memory processes table
 Attach at the end
TBI, CHI, CVA , Progressive Aphasia , Dementia,
Developmental , Autism spectrum, CP, LD, may each be
faced with challenges:

 Attention
 Organization and categorization
  difficulties
 Learning difficulties
 Memory deficits
 Information processing impairments
 Executive functioning deficits
   Reasoning, decision making, problem
     solving
Psycho social- anxiety and depression
Social-Communication difficulties
Receptive and Expressive Language

Patients we have known:?
Adults *
Children- different but may show cognitive
 deficits during development
Approaches to Diagnosis
   We obtain functional information in
   a good New Client / caregiver
   interview
   1. Static -quantitative diagnostics:
  tests one point in time/normed
   Cognitive Linguistic Quick Test
   Cognitive Abilities Screening Test
   Functional Communication Profile
   Language -Cognitive-Communication
   WAIS III-Digit Backward and Symbol
     Subtest
   Boston Diagnostic Aphasia Exam-has
     subtests which test cognitive functions
   Stroop Color Word Test
  Note: on many of the test, especially the
     WAIS III, the premorbid intellect
     measures may affect the performance
Approaches to Diagnostics
 2.Qualitative: observation of behaviors
  during tasks performance . Provides
  info on how task is performed
 3.Dynamic assessment: not a single
  packet or procedure but a model and
  philosophy that :
 All people are capable of some degree of
  learning (stimulus/cueing
  hierarchies)
Diagnostic therapy is dynamic
  assessment: the assessor actively
  intervenes with the goal of intentionally
  inducing changes
*2 & 3: Viewed as an addition to the other
  approaches but not a substitute for
  existing procedures
Differential Diagnostics
 Differential Diagnosis of Aphasia ,
  Cognitive disorders and
  progressive disorders, Dementias
 Conditions may co-occur
  [Think of your caseload and
  identify aspects of language vs.
  cognitive function. How does one
  effect the other?]
 The functions may be located in
  different areas of the brain
 If they do not interact well =
       cognitive disorders
Approaches to Therapy
What do we know about how learning and
behavior are indicators of what is going on
neurologically?
Restorative            Compensatory
 Skill building
 Repetition            Based on the
                         assumption that
 Stimulus/Cueing
                         some abilities
  Hierarchies
                         may not be
                         restored
                         completely
 How do our            Develop
  therapies help         functional
  the client             strategies
  develop
  functional skills
  for life?
Brain reorganization and
sprouting following injury
                     Damage may
                     cause
                     compression,
                     breakage, cell
                     death and lost
                     function
Sprouts form


                Phagocytes clean
                Out damaged neurons.
                If the neurons are
                stimulated, they
                continue to be viable
                for new synapse growth.
                Sprouting constitutes
                A reorganization of those
                connections
 Restorative

 Improve skills through use of exercises and
  drills
 Good potential for learning
 Optimizes function through dynamic
  ,aggressive rehab
 Treatment may integrate multiple
  functional tasks and can involve more than
  one discipline
 Few environmental modifications are
  required
 For CVA, mild TBI, Brain tumor, reversible
  Dementia, stage 3 dementia
Restorative
 • Skill Building
 • Repetition
 • Stimulus/cue hierarchies
      • Major skill is
        maintaining attention
        with out distraction
        and with distraction
   – In a young child: attending
               following simple commands
                Listening to a story
                initiating interaction
   – In an older child or teen –
     finishing a written task
   – In an adult- making a grocery
     list
Memory Therapy
Techniques
 Restoration/Traditional Model
    Chunking: grouping things
    Organization –Categories, semantic
     meaning, similarities, visual
     images(notebook of pictures)
    Rehearsal
       Sequences, places, facts, situations
   Elaboration/linking
       Taking what one already knows and linking it
        in some way to what one wants to remember
        (say out loud)
Categorization Program
Constantinidou, 2001
 A: Recognition and categorization of
 common objects
   Level 1:Perceptual feature training
    Different perceptual features
   Level 2: same and different
   Level 3 functional categorization
   Level 4 Analogies
     dog:puppy Cat: kitten
     reserved : personable introvert:?
   Level 5: abstract categorization
            opposites, similarities
 B New Category learning tasks
   Categorizing by 2 parameters
Compensatory
 Assumes that the client cannot recover
  completely
 With caregiver/family
 Functional strategies
       calendars
        list making
        communication notebook
 phone usage
 Verbal Routines
Compensatory


 Patient may require cueing to optimize
  performance
 Provide training in those compensatory
  strategies
 Alternate forms of communication
 External compensatory strategies
 Internal compensatory strategies
 For Alzheimer’s Disease, TBI,
  Degenerative neurological, Dementia
 stage 4+
Adaptive
 Focus of the treatment is on adaptation
 of the environment and caregiver
 education

 Identifies strategies to prevent further
  dysfunction

 For Dementia stage 5-6
 Moderate to severe TBI
 Degenerative neurological diseases
Cognitive Functions’ Worse Enemies

 Stress and      Vitamin B-12
  Anxiety          deficiency
 Depression      Infections
 Metabolic       Drugs
  Diseases        ADHD
    Thyroid      Hypothyroidism
     gland,       Aging
     diabetes,
     organ
     failures,
 alcoholism

								
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