Cognitive Presentations

Question 1

Cognitive Linguistic Quick Test (CLQT)

Answer 1

• Enables examiner to quickly assess the relative status of five cognitive domains through ten tasks:
• Attention
• Memory
• Language
• Executive Function
• Visuospatial Skills
• Identify strengths and weaknesses in specific cognitive domains
• Provide a “snapshot” of cognitive skills
• Identify areas for direct treatment
• Identify areas needing further evaluation
• Criterion-Referenced

Question 2

CLQT demographics

Answer 2

• English adults 18-89
• TBI, CVA, Dementia, PD
• can manipulate a pen, respond verbally, can be administered bedside, can be given over 2 sessions

Question 3

5 Tasks CLQT 1

Answer 3

• Personal Facts- episodic memory, orientatiton, communication, STM and LTM
• Symbol Cancellation- visual attention, visuospatial skills, scanning, discrimination, and inhibition
• Confrontation Naming- semantica and phonology
• Clock Drawing- sustained attention, working and procedural memory, planning, comprehension, reading & writing numbers, visuospatial skills, concept of time
• Story Retelling- verbal working memory, auditory processing, expressive lang., attention

Question 4

5 Tasks of CLQT 2

Answer 4

• Symbol Trails- attention, EF, visuospatial skills/perception
• Generative Naming- word retrieval, working memory, semantics, phonological knowledge, EF
• Design Memory- working/visual memory without language, visual attention, visuspatial skills
• Mazes-EF, attention, visuospatial skills
• Design Generation- creativity, productivitiy, self-monitoring, rule following, and effective strategies

Question 5

Pediatric Test of Brain Injury (PTBI)

Answer 5

• Children are not little adults, they respond differently to TBIs
• prior to this test they adapted adult verions for kids
• Standardized, criterion referenced test
• English 6-16

Question 6

2 Purposes of PTBI

Answer 6

1. Establish current ability levels
2. Track changes over time
   - To estimate a child’s ability to apply neurocognitive and linguistic skills that are often vulnerable after brain injury yet applicable to functioning in school
   - Item response theory- items are scaled so easier questions have less pts
   - Abilitiy score

Question 7

What does PTBI Measure

Answer 7

1. Attention
2. Memory
3. Language
4. Visuospatial Skills
5. Executive Functions

Same measures as CLQT

*** Can be with children and adolescence 6-16 with TBI or ABI (acquired brain injury)

Question 8

1. Prompt

2. Probe

Answer 8

1. Prompt: neutral form of encouragement (“We have to move along”)
2. Probe- cue for more specific information

Question 9

Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI)

Answer 9

• To provide a systematic method for assessment of cognitive deficits associated with TBI
• adolescents and adults
• Specifically designed to measure the following cognitive processes:
  1. Perception/ discrimination
  2. orientation
  3. organization
  4. Recall of information
  5. Reasoning
• Primarily used with English speakers with a CHI

Question 10

SCATBI- Subtests or scales

Answer 10

1. Perception and Discrimination (includes attention)- 11 testlets (sound, word, color, shape, size, picture, auditory discrimination)
2. Orientation- premorbid questions and post-morbid questions
3. Organization- 8 testlets (identifying picture categories, word categories, sequencing objects, words, events, (time of year, pictured tasks, recall task steps)
4. Recall (Memory) 9 testlets (memory for graphic elements, word retrieval, delayed recall, cued recall of words, cued recall of words in discourse, word generation, immediate recall of oral directions, recall of oral paragraphs)
5. Reasoning- 11 testlets (analogies, convergent thinking, deductive reasoning, inductive reasoning, divergent thinking, multiprocess reasoning)
   - Each scale can be administered independently; the whole test does not have to be administered.
   - Each scale is made up of testlets (small sets of very similar items that vary in difficulty plus a few individual items requiring more than 1 response)

Question 11

Treatment for Problem Solving

Answer 11

• Make the therapy functional and simple
• Individuals with TBI may have difficulty recognizing when there is a problem. When solving problems they may have problems deciding what the best solution is

Functional problem solving and Simple

Simple- parts=whole

Functional- more complex, real life problems

Question 12

Symptoms of deficits w/ problem solving

Answer 12

Behavioral- difficulty drawing conclusions

• inability to figure out and apply rules in problem-solving activities
• difficulty with production and fluency of thought
• inability to learn from trial and error
• poor decisions about behaviors and friends

Question 13

Assessments that look at problem solving

Answer 13

• Ross information processing assessment (RIPA-2)
• PTBI- word fluency (convergent naming)
• CLQT- confrontation naming, symbol trails, generative naming, and mazes
• assessments need to show what the patient’s strengths and weaknesses

Question 14

Treatment at Problem Solving

Answer 14

Steps that allow a clear structure to the intervention process:

1. identifying problems
2. Generating solutions
3. Organizing
4. Sequencing
5. Implementing solutions
6. Managing time
7. Maintaining safety

Question 15

Goals for problem solving therapy

Answer 15

1. Start simple and go more complex
2. Teach compensatory strategies
3. We want the individuals to be able to identify a problem and then take steps to solve this problem

Question 16

Problem Solving Treatment

Answer 16

1. Naming categories (convergent naming and divergent naming tasks)
2. Informal assessments of executive functions (require multiple steps, ask client to plan or prepare, be an observer when the client does a task, cue only when necessary)
3. Work on medical situation problems (what would you do if you cannot remember when to take your medications)
4. Problem solving questions (ask them what the problem is and what should be done)
5. Problem solving worksheet (state the problem, potential solution, and how it worked)
6. Describing specific features (how items are similar or different)
7. Work with client to realize if there is a problem
8. Have worksheets that require them to solve problems

ASHA states that evidence supports using metacognitive strategy instruction using step by step procedures to improve organization and problem solving.

Question 17

Reasoning- Abstract and Mathematical

Answer 17

• patients may think more concretely and only reason literally and logically
• inability to understand relations between two or more elements
• Difficulty with understanding figurative lang, sarcasm, and slang
• trouble with calculations, understanding numerical concepts, comparisons of numbers, and arthimetical symbols
• loss of calculation can be due to deficits in memory, attention, problem solving, sequencing, organization, and language

Question 18

Abstract reasoning treatment

Answer 18

• Add to category- complete a list with a similar word (helicopter, wasp, robin…)
• Wrong category- which item does not belong with the other four?
• multiple definitions- provide two definitions for the words
• analogies
• word deduction- describe what object the three clue words are describing

-proverb and expression- explain the meaning
(don’t make a mountain out of a mole-hill)

• Comprehend figurative language- explain meaning
• interpreting emotions, personal feelings

Question 19

Mathematical Reasoning Treatment

Answer 19

Math basics:
1. Counting- forewards, backwards, skip counting, roman numerals

2. Reading and writing numbers- order on timeline, place value
3. Comparing numbers- >, <, =
4. Adding and subtracting- tasks with money
5. Multiplication

Functional tasks:

1. Telling time- elapsed time problems
2. Money (adding/subtracting coins, bills, salary, budgeting, and shopping)- matching coins to money values
3. Cooking (measurements)

Question 20

Orientation Therapy

Answer 20

Orientation- a person’s conscious awarenes of self, time, place, and situation

1. Person- knowing basic information about oneself (name, age, birthdate)
2. Place- knowing one’s present location (city, state, facility)
3. Time- current temporal information (date, month, season, year, day of the week, time of day)
4. Purpose- knowing relevant events

Alert & oriented x 4= A&Ox4

Question 21

Purpose of orientation therapy

Answer 21

• Decrease patient’s confusion

- lead patient to understand they need knowledge about themselves and their environment

Question 22

Therapy for orientation:

Answer 22

1. Client questionaire (orient to self)
2. Work on questions that help with orientation to immediate environment and recent happenings
3. Multiple choice questions about immediate environment and recent happenings
4. yes/no immediate environment and recent happening questions
5. Yes/ no temporal orientation
6. Answer temporal orientation skills
7. Spatial orientation, ask questions based on hospital map, hotel lobby or house layout photo

Question 23

Organization therapy

Answer 23

When treating:

• Focus on sequencing the patient’s day
• sequencing automatic tasks
• categorization of items
• work/ school space and deadlines
• time management- social activities
• Money

Question 24

Organization

Answer 24

• organization deficits are some of the most common
• Sequential- Organizing through sequencing tasks
• Categorical- Organizing through common attributes
• Expressive- Organizing your thought process so you can complete a divergent naming task

Question 25

Treatment of organization | 1. Sequential

Answer 25

1. Process of going to the grocery store 2. Organizing a picnic 3. Organize your morning routine 4. Driving safety 5. Organizing a narrative- story grammar 6. Sequencing functional tasks (setting a table, making a sandwich, making a bed)

Question 26

Treatment of organization | 1. Categorical

Answer 26

1. Alphabetical- ask them to organize books alphabetically 2. Food categorization in a grocery store 3. Laundry categorization by color 4. Naming categories- convergent naming

Question 27

Treatment of organization | 1. Expressive

Answer 27

1. Divergent naming task, fill the category in 15 seconds (has to do with word retrieval and semantic network organization)

Question 28

Treatment of Organization | 1. Functional tasks

Answer 28

- planners, folders - create a weekly choir chart - organize space- bedroom, desk, backpack, and kitchen - organize medications - use checklists/ timers - organize money (balance a checkbook)

Question 29

Treatment Approaches for Functional Activities Grocery shopping

Answer 29

- work with clients on going to the grocery - create a budget - assess what you have in the pantry - balance checkbook (how much do you have after paying the bills) - practice writing checks

Question 30

Treatment approaches for functional activities Cooking

Answer 30

- Find a recipe - see if you have all the ingredients - Follow the directions - set timer so food is cooked properly - process of cleaning up and washing dishes

Question 31

Treatment approaches for functional activities Medications

Answer 31

- pill sorting activity - make sure client can follow instructions and is capable of handling their medications - medication form

Question 32

Additional functional activities

Answer 32

- Reading the newspaper - Home safety - Dressing, self care

Question 33

Community reintegration after TBI

Answer 33

TBI can affect pyschosocial functioning - psychological - social - 50% - 60% of TBI survivors struggle to gain permanent employment - many individuals will need workplace accommodations - Assessing readiness to work- severity of injury, duration of coma, length of hospitalization, RLAS on discharge, neuropsychological tests, history of alcohol abuse, age, and amount of education

Question 34

Instructional and environmental modifications

Answer 34

****In therapy work on strategies that will help them adjust when they go back. Teach them to be an advocate for themselves and request the modifications they need - written materials should be clear - presenting a model is helpful - projects and worksheets may need to be shortened - make sure the client is paying attention prior to speaking - pre-teach information - use verbal and visual cues - see if it is possible for the patient to rest during the day - create routines