diagnosis and therapy approaches for the speech language pathologist
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Diagnosis and Therapy Approaches for the Speech Language
Pathologist
Cognitive Functions
Domains of Cognitive Function1.Attention2.Memory Processes :short and long term
3.Verbal language4.Categorization :Means of incorporating new info and organizing info in the brain
5.Abstract thought
Constantinidou, Thomas, & Best (2004)
1.Attention
Orienting NetworkGuides 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 NetworkAbility 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 dinnerTime schedules
Executive Network
FlexibilityCapacity to multitaskSwitch attentionOrganize sequencesFor 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 NetworkMemory is organized with respect
to time and contentsShort term/working memoryLong 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. CategorizationAssigning objects or events
into groupsInterrelated with other
cognitive processesObject recognitionProblem solvingDecision makingSustained attention tasks that require sorting
Learning and memoryCategorization is critical to problem solving in order to consider solutions
Components of CategorizationRecognition 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
ReasoningDecision making andProblem 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 tableAttach at the end
TBI, CHI, CVA , Progressive Aphasia , Dementia, Developmental , Autism spectrum, CP, LD, may each be faced with challenges:
AttentionOrganization and categorization
difficultiesLearning difficultiesMemory deficitsInformation processing
impairmentsExecutive functioning deficits
Reasoning, decision making, problem solving
Psycho social- anxiety and depressionSocial-Communication difficultiesReceptive 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 TestCognitive Abilities Screening TestFunctional Communication ProfileLanguage -Cognitive-
Communication WAIS III-Digit Backward and
Symbol SubtestBoston Diagnostic Aphasia Exam-
has subtests which test cognitive functions
Stroop Color Word TestNote: 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 buildingRepetitionStimulus/
Cueing Hierarchies
How do our therapies help the client develop functional skills for life?
Based on the assumption that some abilities may not be restored completely
Develop functional strategies
Brain reorganization and sprouting following injury
Phagocytes clean Out damaged neurons.If the neurons are stimulated, theycontinue to be viablefor new synapse growth.Sprouting constitutesA reorganization of thoseconnections
Damage may cause compression, breakage, cell death and lost function
Sprouts form
Restorative
Improve skills through use of exercises and drills
Good potential for learningOptimizes function through dynamic
,aggressive rehabTreatment 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
Memory Therapy TechniquesRestoration/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 ProgramConstantinidou, 2001A: Recognition and
categorization of common objects
Level 1:Perceptual feature trainingDifferent perceptual featuresLevel 2: same and differentLevel 3 functional categorization Level 4 Analogies
dog:puppy Cat: kitten reserved : personable introvert:?Level 5: abstract categorization opposites, similarities
B New Category learning tasksCategorizing by 2 parameters
Compensatory
Assumes that the client cannot recover completely
With caregiver/familyFunctional strategies calendars list making communication notebook phone usageVerbal Routines
Compensatory
Patient may require cueing to optimize performance
Provide training in those compensatory strategies
Alternate forms of communicationExternal compensatory strategiesInternal compensatory strategiesFor 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 5-6Moderate to severe TBIDegenerative neurological
diseases
Cognitive Functions’ Worse Enemies
Stress and Anxiety
DepressionMetabolic
DiseasesThyroid gland, diabetes, organ failures,
alcoholism
Vitamin B-12 deficiency
InfectionsDrugsADHDHypothyroidi
smAging
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