Cognition 101. Sheldon Herring, Ph.D. Roger C. Peace Rehab Hospital Greenville Hospital System

Transcription

1 Cognition 101 Sheldon Herring, Ph.D. Roger C. Peace Rehab Hospital Greenville Hospital System

2 Building Community from the Inside Out: 2011 Building support for individuals and giving families hope, inspiration, and the tools to build a support network and get what they need in their local communities. So why Cognition 101?

3 Brain Injury- a journey Personal Professional Personal again

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5 Acquired Brain Injuries Traumatic Non- Traumatic

6 Consequences of Brain Injury

7 Consequences of Brain Injury Physical/Medical Cognitive/Intellectual Behavioral

8 Consequences of Brain Injury Academics Physical/Medical Cognitive/Intellectual Behavioral Work Recreation Social Spiritual

9 Consequences of Brain Injury

10 General Principles Regarding TBI Sequelae

11 Multifactorial any observable behavior can be due to a number of different causes, therefore planning must be individualized on the surface problems may look the same when they are not solutions may not generalize across settings or time

12 Interaction deficits can act synergistically to produce unexpected results difficulties seen in clinic or home or work may be greater than expected based on evals inconsistencies may make planning difficult

13 Dissociation ** the lack of correlation between deficits in different domains or between functions within a single domain can lead to unrealistic expectations don t jump to conclusions

14 Primary and Secondary Deficits Primary deficit is due to damage to the neuro system responsible for that function Secondary deficit occurs when underlying neural system is intact, but negatively influenced by some other factor

15 Consequences of Brain Injury Thinking Skills Memory Attention Communication Spatial Thinking

16 Consequences of Brain Injury Thinking Skills Executive Skills/ Problem Solving Mental Speed/ Flexibility Awareness of deficit

17 Consequences of Brain Injury Physical Skills Fatigue Coordination Balance Spasticity Weakness

18 Consequences of Brain Injury Behavioral Primary changes Secondary or reactive changes

19 Consequences of Brain Injury Behavioral Depression Changes in Personality Irritability Impulsivity Anxiety

20 Range of inter-related deficits Reduce vocational options Reduce vocational performance Reduce vocational mobility

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22 Consequences of Brain Injury Thinking Skills Memory

23 TBI and Memory Pathology Verbal Recalling conversations Therapy sessions New academic materials Visual Geographic disorientation Work related visual details Some academic content Verbal and visual can be impacted differently

24 TBI and Memory Pathology Skills versus facts Ability to say but can t do Ability to do but can t say Time versus facts Remembering an event but not the info Remembering the info but not the event Prospective Memory Remembering to remember

25 Effects of Memory Failure Difficulty learning new information; rate of learning slower Confabulation Disorientation and confusion Irritability Safety risk Need for memory management/compensatory techniques

26 Consequences of Brain Injury Thinking Skills Memory Attention

27 Attention Verbal/auditory attention Ability to screen in or out sounds, voices, noises Visual attention Ability to spot a specific visual target and screen out others Walmart syndrome Problems with regulation of interaction with environment, need for special work environment Information processing speed- can't keep up

28 Consequences of Brain Injury Thinking Skills Memory Attention Communication

29 LANGUAGE AND RELATED FUNCTIONS Aphasias: word finding, poor comprehension Cognitive communication deficits organizing thoughts tangential Saying vs. doing -difficulty seeking assistance/communicate lack of understanding Speech pragmatics - turn taking Awareness of social impact

30 Consequences of Brain Injury Thinking Skills Memory Attention Communication Spatial Thinking

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32 VISUAL SPATIAL PROCESSING Scanning Form and space perception Visual thinking and problem solving

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35 REASONING AND PROBLEM SOLVING

36 REASONING AND PROBLEM SOLVING Deductive reasoning Logical problem solving Difficulty with rule application Thinking outside the box Can't handle out of the ordinary, requiring greater level of supervision

37 AWARENESS ANTICIPATORY EMERGENT INTELLECTUAL

38 AWARENESS WHENEVER? WHEN? WHAT? SO WHAT?

39 AWARENESS ANTICIPATORY EMERGENT INTELLECTUAL = difficult to plan for changes = difficult to adapt to changes = difficult to comprehend changes

40 GENERALIZATION What is generalization? Why is it important in daily life?

41 Challenge of generalization- In therapy- even if we can make a difference in one area will we see it carry over to another? At home, community or work even if a person can perform a given task in one area can they perform in a different setting?

42 Challenge of generalization- Performance impacted by Environmental training setting vs real world different worksites Interpersonal Co-workers Customers Cognitive set Routine sale vs. exceptional situation

43 Challenge of generalization- Performance impacted by Social Impact of co-workers work behaviors/styles Administrative Do more with less

44 Functional Reserve My schedule was simple. My job was not. I was drained. I worked two hours in the morning and spent most of my lunch hour in the Glass Garden, I worked another two hours in the afternoon, then went home as quickly as I could. The intensity and concentration required for these four hours of work consumed all my mental energy, leaving room for nothing else in my life Claudia Osborn

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46 Functional Reserve gap between actual abilities and the underlying cognitive requirements of a task (work or school). can be tapped during times of excess demand in order to maintain normal performance. after TBI may be reduced so that weaknesses only appear under high stress - high demand situations.

47 Functional Reserve The degree to which one's abilities exceed the routine task demands of a given job The capacity to "rise to the occasion" of periodic crises or increases in workload Ability to maintain effort when overall abilities are temporarily decreased secondary to illness, fatigue, depression

48 Characterological Changes

49 Characterological Changes: Adynamia Adynamia, motivation, and attribution Adynamia (initiation/activation impairment; excessive passivity) Apathy Emotional indifference Loss of initiative

50 Organic Factors Characterological Changes - decreased initiative - increased impulsivity

51 Organic Factors Characterological Changes - decreased initiative - increased impulsivity -emotional alterations

52 Organic Factors Characterological Changes - decreased initiative - increased impulsivity -emotional alterations -decreased social perceptiveness & disinhibition

53 Organic Factors Characterological Changes - decreased initiative - increased impulsivity -emotional alterations -decreased social perceptiveness & disinhibition -inability to profit from experience (somatic marking)

54 Consequences of Brain Injury

55 Consequences of Brain Injury Physical Skills Fatigue Coordination Balance Spasticity Weakness