Module 2: Lesson 5: The Neurofunctional Approach

Question 1

What is the neurofunctional approach (NFA)?

Answer 1

A performance based skill/habit based training approaches that involve:

• Client centered real life relevant goal development
• Understanding the limitations to learning imposed by the brain injury
• Use of repetitive practice of skills

Question 2

What are some target populations for NFA intervention?

Answer 2

• TBI
• Stroke
• Other forms of neurobehavioral disability
• Lack of insight associated with cognitive impairment from neurobehavioral disorder

Question 3

What diagnoses was NFA intervention initially designed for?

Answer 3

Individuals with severe to profound cognitive impairments arising from traumatic brain injury and associated disorders.

• Shown to improve ADL/IADL in those with less profound impairments like TBI, stroke, lack of insight from neurobehavioral disorder

Question 4

What population is least appropriate for NFA intervention?

Answer 4

• Mild impairment
• Intact self awareness
• The ability to benefit from trial and error learning

Question 5

What population is most appropriate for NFA intervention?

Answer 5

• Severe impairments of memory, attention, EF
• Impaired trail and error learning
• Lack of insight or impaired awareness of cognitive impairment

Question 6

Which population described below is more appropriate for NFA interventions?

• Severe impairments of memory, attention and EF. Impaired trial and error learning. Lack of insight or impaired awareness of cognitive impairment.
• Mild impairment. Intact self awareness. The ability to benefit from trial and error learning.

Answer 6

The first option listed with sever impairments

Question 7

What type of approach is the NFA?

Answer 7

Performance based

Question 8

What tasks can be trained with NFA?

Answer 8

• Simple IADL
• ADL
• Some more complex IADL can be altered so they can be made routine
• Repetitive social routines

Question 9

True or false:

Home management activities are challenging for persons 1 year after TBI especially for OA and those with more severe cognitive impairment.

Answer 9

True

Question 10

Describe explicit memory system.

Answer 10

• Declarative memory: Individual knows that they know something.

Question 11

Describe implicit memory systems

Answer 11

• Evolutionary older
• About “doing”

Question 12

What memory system is described below:

• Memory system:
  
  • STM/WM
  • Episodic memory (STM, days weeks, or longer years)
  • Semantic memory (knowledge, facts, dates, etc.)
• Neuroanatomical correlates: Primarily ventrolateral prefrontal cortex (STM), hippocampus and medial temporal structures (episodic memory), wide distribution in neocortex (semantic memory).

Answer 12

Explicit Memory System

Question 13

Describe the Explicit Memory System

Answer 13

• Memory system:
  
  • STM/WM
  • Episodic memory (STM, days weeks, or longer years)
  • Semantic memory (knowledge, facts, dates, etc.)
• Neuroanatomical correlates: Primarily ventrolateral prefrontal cortex (STM), hippocampus and medial temporal structures (episodic memory), wide distribution in neocortex (semantic memory).

Question 14

What memory system is described below:

• Nondeclarative learning
• Memory systems involved:
  
  • Perceptual priming: Object identification
  • Conceptual priming
  • Motor skill learning/procedural learning
  • Associative conditioning, “habit learning”
  • Habituation
  • Sensitization
• Neuroanatomical correlates: Modality specific cortex, BG and cerebellum, limbic cortex

Answer 14

Implicit memory system

Question 15

Describe the implicit memory system.

Answer 15

• Nondeclarative learning
• Memory systems involved:
  
  • Perceptual priming: Object identification
  • Conceptual priming
  • Motor skill learning/procedural learning
  • Associative conditioning, “habit learning”
  • Habituation
  • Sensitization
• Neuroanatomical correlates: Modality specific cortex, BG and cerebellum, limbic cortex

Question 16

Name some prerequisites for procedural memory transfer

Answer 16

Necessary factors
- High level of practice
- Consistent mapping (when Y happens do only X)
- Attention to task/DO the task

Helping factors
- Verbal labels (mnemonic strategy of saying along with doing)
- Goal consistency (assists attention)
- Variable practice for stimulus generalization (near transfer)

Question 17

What approach is described below:

• Addresses ADL and simple IADL skills and can be used during PTA
• Occupation based for tasks in the “real world”
• Learning by doing
• Training in situ
• Development of habitual routines/automatic functioning/competencies in areas the client has identified as important
• Far transfer of skills (generalization) not expected

Answer 17

The Neurofunctional approach

Question 18

Describe the neurofunctional approach.

Answer 18

• Addresses ADL and simple IADL skills and can be used during PTA
• Occupation based for tasks in the “real world”
• Learning by doing
• Training in situ
• Development of habitual routines/automatic functioning/competencies in areas the client has identified as important
• Far transfer of skills (generalization) not expected

Question 19

What approach is described below?

• A structured, multidimensional, eight stage rehabilitation process
• A unique combination of elements in the context of the application of learning principles

Answer 19

The Neurofunctional Approach

Question 20

Name the 8 steps of the Neurofunctional approach

Answer 20

1. Development of a positive therapeutic relationship. Focused on the client’s perspective and goals, and what he or she wants to do.
2. Gathering information
3. Observation - of performance in everyday situations w/ reference to the nature of the task, the client characteristics, environmental resources and constraints.
4. Case formulation - formulation of the client’s goals and a reconciliation of these with resources available and current constraints.
5. Operational performance goals - goals that can be translated into retraining programs (i.e. I want to be able to….).
6. Skill retraining program - developed from analysis of the person, activity and environment. A task analysis for each individualized retraining program.
7. Development of automaticity, generalization and the maintenance of skills in the clients everyday life.
8. Feedback - to encourage progress

Question 21

When does automaticity occur?

Answer 21

Consistent response to a specific stimuli

Question 22

What are the types of behaviors that can become automatic?

Answer 22

• Consistent mapping
• Variable mapping

Question 23

True or false:

Practice does not produce automaticity with inconsistent responses to stimuli.

Answer 23

True

Question 24

What is central to learning?

Answer 24

Practice

Question 25

There is increase evidence that practicing tasks leads to what?

Answer 25

Cortical restructuring

Question 26

Stimulus & response similarity and Task transfer

Answer 26

* Task stimuli is same, response required is same = transfer to automaticity is high * Task stimuli is different, response required is different = transfer is none * Task stimuli is different, response required is the same = transfer is positive * Task stimuli is the same, response required is different (but similar) = negative transfer

Question 27

What type of transfer is seen with the task stimuli and response required written below: * TS: Same * RR: Same

Answer 27

High (positive)

Question 28

What type of transfer is seen with the task stimuli and response required written below: * TS: Different * RR: Different

Answer 28

None

Question 29

What type of transfer is seen with the task stimuli and response required written below: * TS: Different * RR: Same

Answer 29

Positive

Question 30

What type of transfer is seen with the task stimuli and response required written below: * TS: Same * RR: Different (but similar)

Answer 30

Negative

Question 31

Describe the development of automaticity

Answer 31

- Conscious engagement in behavior/self directed learning and (i.e. wanting to learn how archery, going out to do by themselves). OR stimulus driven (unintentional learning, what we need to do for our patients) we put patient in situation and cue them through situation on what they need to do , leads to: - Consistent engagement in activity, which leads to: - Decrease in conscious decision making - Automaticity of behavior - Decrease in situation cues

Question 32

What term is described below: - First, the organism makes a series of discrete response, often interrupted by incorrect ones. - Once errors are dropped out and the sequence of behavior becomes relatively stable...the various components of the total behavior required in the situation are "integrated"

Answer 32

Chunking

Question 33

What is another term for performance integration?

Answer 33

Chunking

Question 34

Describe an example of a situation of "chunking".

Answer 34

Brushing teeth broken into various steps - Pick up toothbrush - Pick up toothpaste - Put toothpaste on toothbrush - Brush teeth - Top right - Top left etc..... **Australian study: Average # of treatments that resulted in improvements: 14

Question 35

Name some key steps to documenting the neurofunctional approach.

Answer 35

- Use of a retraining program - Aras of ADL/IADL being addressed - Clients level of support in terms of PA and cues - Program steps carried out independently - Progress made from last documentation in terms of reduced cueing and increased independence

Question 36

What type of approach is the NFA?

Answer 36

Performance based

Question 37

What types of tasks can be trained in the NFA?

Answer 37

- Simple IADL - ADL - Repetitive social routines

Question 38

Read info

Answer 38

- Global strategy: Plan, do , check - Doman specific strategy: memory strategy - Specific task

Question 39

The following are apart of the explicit or implicit memory system? - STM/working memory - Episodic memory - Semantic memory A person knows that they know

Answer 39

Explicit

Question 40

The following are apart of the explicit or implicit memory system? - Perceptual priming - Conceptual priming - Motor skill learning - Associative conditioning - Habituation - Sensitization Does not require the person to know that they know. Based on practice

Answer 40

Implicit

Question 41

What is another term for implicit learning?

Answer 41

- Non declarative - Procedural learning

Question 42

What are some necessary factors as prerequisites for procedural transfer?

Answer 42

- Consistent mapping (i.e. when y happens do only x) - Attention to task/do the task - High level of practice Helpful factors: - Verbal lables - Goal consistency - Variable practice for stimulus generalization (i.e. bath in variable environments/contexts)

Question 43

What concept is central to learning?

Answer 43

Practice

Question 44

True or false The is poor evidence that practicing tasks leads to cortical restructuring.

Answer 44

False - increasing evidence