Influence the POC

Impact learning

Effect safety during mobility

Decrease clients independence

Need more holistic approach to treat pt with cognitive impairment (mine paraphrased)

Restoration of cognitive functions

Compensatory Techniques used when specific cognitive processes cannot be rehabilitated

Visual perceptual impairments

Behavioral deficits

Attention/concentration

Memory/Orientation

Sequencing/organization

Reasoning Problem solving

Executive functions

*Just note that all of these are cognitive process that would be hindered with brain damage

Scaning to pick up objects that are not in you feild of veiw

Glasses with pryazims to redirect eyes

if truely blind may have to use accomidating techinques

Can set up the room so that the pt has to use turn to the side that there is Spacial neglect or set up treatement environment

Cueing for the task (i.e. if the task is walking instead of asking them to walk have them go get a cup from a bed stand or something hoping to evoke a more automatic response that involves walking)

When cueing during the session name things such as can you step with your right foot, no that is your left foot can you step with your right foot. Trying to get them to make the connection again

Sexual

Aggressive

Emotional

Disinhibition (3 types)

Low frustration Tolerance

Depression

Avoidance

Immediate and direct redirecting (otherwise they will not make the connection with what they did is wrong)

Low stimulation environments (light, snd, movement)

Find something that is motivating and meaningful to the patient

Model the appoperiate behavior

Reorient them "i am your physical therapist and I am here to help you"

Give options for tx session all of which would be benificial

Use Therapy activities that are:

Organized from easy to complex

Provide sufficient repetition

activiely facilitate generalization across task/settings

Progresses based on individuals preformance data

How should treatemetn decisions be made?

For a person with: Sustained Attention Deficits how would you organize your intervention session?

Work on tasks for progressively longer periods of time (i.e. time them on how long they can stay focused on an activity before they get distract trying to stay focused longer and longer)

Cognitively simple to cognitively complex activities

Length of time individual can focus on task

Complexity of the task

Amount of cues needed to stay on task

Start tx in a quite area

Progress to treating in busier environments w/ increased distraction

Orienting procedures (Self -cuing (ask them  what they are supposed to be doing right now, environmental supports)

Dual task paradigm

i.e. working on a balance task while carrying on a conversation, gradually increasing the cognitive load

Objective Measures:

Document the number of systems challenged

Document LOB if present with increase cognitive load

COgnitvie tug (Normal TUG with a cognitive task like reading added)

have individual switch from one task to anther (turning around when walking, step off a step and then squat stand up and pick up a cup off the table)

Ask individual to explain the task and then preform it

Time required for pt to switch tasks (this can be really not so the other one can be better)

Number of cues needed for pt to switch tasks

Passive Orientation : who, what when, where, why

Active Orientation: have the individual find his or her way around. (i.e. can you take me to the kitchen)

Yes

learning and permant storage

What is declarative or explicit Memory?

Does this require concious awareness?

What rancho level who this require?

Knowledge of facts or events

Yes, requires concious awareness

Rancho level of 6-7

ability to explicitly report information

No conscious awareness is necessary

Motor Memory

Habit Formation

Best for Rancho Levels of 1-6

Use clear concise instructions

Consistency in tx session

Reduce amount of info to be remebmered

Check for understanding (ask if they know what they are doing)

Distributed practice (few minutes several times/day)

Document the # of exercises that they are able to recall or the # of cues require for them to recall this info

Written planning systems: journaling, writing down imporant parts of the day

Electronic planning systems: cell phone, ipad

Task specific aids: key finders, frocery lists, automatic dial phone , automatic alarm clocks

Require memor to use them

Multiple cognitive deficits make them omre challenging to use

Takes time to train (genrealization takes longer)

What are vanishing cues?

What type of information is this good for?

Gradually withdrawing cues from the patient and they still have to make the correct response

Discrete info: names, Rm #, Passive Orientation

Not abastract info like how are you feeling

Intervention strategies for: Sequencing/ Organization deficits are?

Oranization of physical space

Organization of objects:

Consistency- same place every time

Grouping- by fucntions

Proximity- put things where used most often

Accessibility- put things used most often at hand

Verbal or written cues(i.e. note on the walker to lock brakes, or verbally "push up with hands form the chair)

Use of agenda or calendar

Set up environment to increase or decrease stimulation

Schedule to take advantage of pts most effectvie time of day, build in rest periods

Find task meaning ful to the patient

May need to modify task

break down into singel steps (need to be explicit so client can jusdge when each step is completed

PRovide practice of each step

Routine should be highly motivating to the client (something that they like doing)

Complete a task list (errand completion)

Increase complexity

i.e. from inside to outside the hospital

Increase # on the list

From concrete to more abstact task (treasure hunts outings

Autonomic Stroming: exaggerated sympathetic response thought to be a result of the hgih level of stress on the brain

High rate of vestibular invovlement

Heterotrophic Ossifications

Orthopedic restrictions as a result of traumatic event

To prevent secondary issues such as ulcers, so that when they are able to cognitively do more they can get right to it!

also: tone management i.e. positioning

Patient and fam ed

Early functional mobility (early supported sitting, tolerance to upright positions WBing through LE