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Transcript of Cognitive Strategies 2015.pdf
7/23/2019 Cognitive Strategies 2015.pdf
http://slidepdf.com/reader/full/cognitive-strategies-2015pdf 1/33
7/23/2019 Cognitive Strategies 2015.pdf
http://slidepdf.com/reader/full/cognitive-strategies-2015pdf 2/33
The study of the structure and function ofthe brain
Purpose:
• Assessment of specific cognitive andpsychological processes, and overtbehaviors
• Management and rehabilitation of people who have suffered illness or injury
• Delineate how illness and injury may affectand be affected by psychological factors Difficulties due to brain pathology or as a
consequence of emotional or other (potentially)reversible cause
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1. Encode (take in)
2. Consolidate (store)
3. Retrieve information
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Memory is a complex process requiring manycognitive functions, including:• A) Perception• B) Attention and focus
• C) Speed of thinking• D) Comprehension• E) Intention to remember/effort• F) Flexible thinking
• G) Organization• A breakdown or problem in any of these areas
can result in difficulty in recall
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• Visual, Auditory or
Tactileinformation
• Happensautomatically
Process by which large amounts of
information are held in sensory store for less
than one second after the stimulus has ceased
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Large capacity for unprocessedinformation, but only able to holdaccurate images of sensory informationmomentarily
Information is either transferred or lost
Guided by attention and selection
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Short-term: time-limited storage of
limited amount of information
Time:15-30 seconds
Capacity: 7 plus or minus 2
Increase capacity with chunking
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Involvesneurochemical orelectrical changes
within the brain Temporary storage:
memory lasting fromone hour to up to twodays, most likely tooccur as a result oftraining
Hippocampal Formation
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Immediate memory: information selectedfrom registration is held in storage up to 30seconds for immediate use [easily disrupted
by distraction]
Working memory: “mental scratchpad,”information is available from 30 seconds to onehour
• Think of it as a "conveyor belt," "assembly line," or"workbench"
• http://library.med.utah.edu/neurologicexam/html/mentalstatus_abnormal.html#buffet
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Storing and consolidating information
on a more permanent basis, requiring
structural changes in the neurons• Recent: information stored within hours, days,
or weeks
• Remote: information stored months to years
ago
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Declarative (FACTS)• Episodic: remembering information
about events, facts, or sharedknowledge in relation to an
experience E.g., your last birthday party
• Semantic: information about a factor an item of “academic”knowledge
President’s name, meaning of words Procedural (SKILLS):
remembering “how to” dosomething (e.g., riding a bicycle;driving a car)
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Incidental: remembering without trying Retrospective: recalling past actions, events, or
knowledge Prospective: remembering to do something in
the future• Self-initiated; does not operate directly on external
stimuli• Ex’s: remembering to make phone call; or to take
meds• Event-based prospective memory can be exploited
using deliberate acts that will produce a notableevent at the time that the memory needs to berecalled e.g., setting an alarm
• Prospective memory can be enhanced by ordinaryacts such as making a grocery list or a to-do list
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Difficulty learning new information Difficulty learning a new skill Repeating a question or story to the same
person Forgetting to do things (e.g., appointments,
tasks) Forgetting a change in routine Forgetting where you placed something Getting lost Forgetting to use datebooks and notebooks
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Forgetting someone’s name after just meeting
them Forgetting where you learned new information
Forgetting something you recently saw or did
Confabulation: “filling in the gaps” with
logical guesses or information which you
believe to be correct (but is incorrect) when
memory fails
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Fatigue and sleep – the more tired you are, the
worse your learning and recall will be Stress – being very anxious or stressed can
make it harder to learn or recall information
Substances/medication – alcohol, drugs, and
certain medications (e.g., narcotic pain killers)
can make memory performance worse
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Most of the methods used to help
memory focus on the first step - gettingthe information in• The more severe the memory problem, the more
the patient will need to concentrate on this step
The focus is on the depth of encoding
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Simplify/streamline the information by
eliminating irrelevant information• e.g. getting directions
Reduce the amount of information
• e.g. chunking
Make sure you understand• e.g. repeat information
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Link new information to what you already know
Organize the information (e.g., categorize,
sequence)
Intend to remember (phone pad) Decrease distractions
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Practice or rehearse, following the "little and
often" rule
Test yourself periodically
Write the information down (Take notes!) Multi-modal methods (verbal and visual)
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First letter prompts (alphabeticalsearching, acronyms, tip of the tongue)
Associative information
Develop routines - anchor your memory
with habits and consistency
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State dependent learning: Recall is dependentupon the state you were in when theinformation was learned.
External state (environmental context)• try to be in the same environment as where
information was learned
• picture the information, where you saw it
• come up with as many details as you can
Internal states• anxiety (e.g., draw a blank)
• substances (e.g., caffeine, nicotine)
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Pts should be encouraged to be honest
about their injury and their functionaldifficulties
This will put others at ease and set the
tone for the interaction
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Repeating questions, stories,
or jokes to the same people
Not recognizing people orrecalling their names
Appearing to be untruthful
(confabulation)
Appearing to be unreliable,appearing not to payattention, or avoiding or withdrawing from socialinteraction
Not getting all the informationbecause someone is speakingtoo fast
Ask, "Did I tell you this
already?"
Use mnemonic strategies tolearn new names; don'tavoid asking for name again
Say: "I don't remember" or"I'm not sure."
Acknowledge your memoryproblem ahead of time andshow that you have ways ofcompensating
Say, “Could you [repeat that/ slow down], I want to besure and get this right.”
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Usually semantic info or episodicmaterial (except for maybe accident or afew weeks, months ago, or a new skill
acquired just before accident) is notforgotten
Most pts have problem with STM which
leads to problem with long term memoryThese memories are needed to guide our
daily lives at home (groceries) and work
(deadlines, content of meetings)
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It is critical to establish habitual routines
Plan how you will be reminded
Decide when would be the best time to get thereminder
Make sure your written note is detailed enough
Check datebook routinely
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Use a back-up cue (e.g., set a needed object in
a conspicuous place)
Complete task ahead of time, when possible Schedule a specific time to do the task, if
necessary
Use change in routine to remind you of a
special situation
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Independence:• Definition: freedom from the control, influence,
support, aid, or the like, of others
Compensations:• Facilitate independence
• Can make it possible not to have to rely onothers for day to day functions
• Reduce feelings of being overwhelmed, whichleads to difficulty processing and problem-solving
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Datebook (the complimentary brain)• Advantages:
Verbal and visual
Helps with encoding and retention
Reduces strain on executive functions
Assists with planning and problem-solving
Eg planning entries
Located in one place
Assists with organization
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• Datebook can hold: Food records, work notes, medical
information, questions to ask professionals,meetings, etc…
• What about a PDA?Research indicates power and value in writing information downMore complicated devices can be confusing
Recommend at CTN: try to use Datebookfirst and supplement with PDA, or transitionto PDA with further recovery
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Checklists• Purpose: find out where the breakdown is and
develop a strategy or procedure list for
successful task completion Comprehensive (eg work)
Specific (eg laundry)
• Functionally: Executive Function: assists with initiation, planning,
organizing Memory: log to indicate what activities need to be
and have been completed
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Datalink watch• Watch that is updated via computer• Compatible with Microsoft Outlook• Easy to program
• Can tailor to daily, weekly, week day, weekend,etc. Potential problems: hearing, attention Around $70
Posting signs• Visual cues
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Medication devices• Weekly
• Daily
• Programmable
Medication card Other tools:
• Lists
• Maps (eg grocery store)
• Expense tracking• Budgeting
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1) Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the UnitedStates: emergency department visits, hospitalizations, and deaths. Atlanta (GA):Centers for Disease Control and Prevention, National Center for InjuryPrevention and Control; 2004.
2) Defense and Veterans Brain Injury Center (DVBIC). Washington (DC): U.S.
Department of Defense; 2005.
3) Ivins BJ, Schwab K, Warden D, Harvey S, Hoilien M, Powell J, et al. Traumatic braininjury in U.S. army paratroopers: prevalence and character. Journal of TraumaInjury, Infection and Critical Care 2003;55(4): 617-21.
4) Thurman D. The epidemiology and economics of head trauma. In: Miller L,Hayes R, editors. Head trauma: basic, preclinical, and clinical directions. New
York (NY): Wiley and Sons; 2001.
5) Thurman D, Alverson C, Dunn K, Guerrero J, Sniezek J. Traumatic brain injury inthe United States: a public health perspective. Journal of Head TraumaRehabilitation 1999;14(6):602-15.