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Cognitive Rehabilitation Therapy Summary
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Summary for the subject CRT
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Broad Perspective on CRTdinsdag 24 oktober 2023 10:35
Chapter 1: Broad Perspective on CRT
Learning Goals:
• The student classifies underlying influencing cognitive and executive parameters enabling an accurate assessment for clients with neurogenic communication disorders.
○ Explain, disentangle, and classify influencing parameters.
• The student integrates these parameters in an appropriate evidence-based assessment strategy.
○ Indicates possibilities/boundaries for cognitive rehabilitation therapy for the client and the proxies considering learning capacity, grieve, and self-awareness.
○ Choose an appropriate evidence-based assessment strategy
○ Motivate and evaluate the choice
1. Check client's medical status
Nature of the ABI
Stroke:
• Stroke
○ Classification:
▪ Ischemic Stroke: responsible for 87% of stroke causes.
▪ Haemorrhagic Stroke: more responsible for deaths.
○ Origin:
▪ Ischemic Stroke: disruptions in the blood supply to the brain. Ischemic strokes are caused by blood clots or blockages, often due to atherosclerosis or emboli.
▪ Haemorrhagic Stroke: caused by the rupture of blood vessels within the brain, often due to aneurysms or arteriovenous malformations.
○ Morphology:
▪ Ischemic strokes: there may be a visible clot or blockage in blood vessels on imaging, and the affected brain tissue can become infarcted (deador damaged).
▪ Haemorrhagic strokes: there may be visible bleeding within the brain, forming hematomas or areas of hematoma expansion.
○ Severity: can vary widely. It depends on factors such as the size, location, and extent of brain damage. Some strokes may result in mild, temporary deficits, while others can
cause severe and lasting neurological impairment.
▪ The National Institutes of Health Stroke Scale (NIHSS) is often used to assess the severity of a stroke, with higher scores indicating more severe strokes.
• Trauma (TBI): brain injury that occurs due to external forces impacting the head.
○ Classification: mild, moderate, or severe, based on the severity of the injury.
▪ They can also be categorized as focal (injury to a specific area) or diffuse (injury spread throughout the brain).
○ Origin: physical trauma to the head, such as a blow, jolt, or penetration injury. The injury can be caused by various mechanisms, including falls, car accidents, sports-related
impacts, or violence.
○ Morphology:
▪ Contusions (bruising of the brain tissue)
▪ Hematomas (collections of blood)
▪ Diffuse axonal injury (shearing and tearing of nerve fibres)
▪ Cerebral edema (swelling of the brain)
○ Severity: mild (commonly referred to as a concussion) with temporary symptoms, to moderate with more prolonged impairment, to severe with significant and long-lasting
neurological deficits.
▪ The Glasgow Coma Scale is often used to assess the severity of a TBI, with lower scores indicating more severe injuries.
• Tumour:
○ Classification: secondary or non-traumatic brain injuries.
○ Origin: originate from the growth and expansion of abnormal cells within the brain, leading to increased pressure and damage to the surrounding brain tissue.
○ Morphology: varies depending on the type and location of the tumour. Tumours can be solid, cystic, or infiltrative, and their appearance on imaging studies like MRI or CT
scans can differ significantly.
○ Severity: mild to severe, depending on factors such as the size, location, and rate of growth of the tumour.
▪ Severe ABIs from tumours can lead to significant neurological deficits and potentially life-threatening conditions if not treated promptly.
• Infection, intoxication, vitamin deficiencies
• Neurodegeneration
Stages Recovery
Neuroscience: Dual Stream model (Hickock & Poeppel, 2007)
• Dorsal stream (unilateral): language production
• Ventral stream (bilateral): language comprehension
Neuroplasticity
• Neural reactivation: previously inactive or dormant neural circuits or pathways become active again.
• Neural adaptation: the brain's ability to adapt and adjust its functioning in response to changes in the environment or internal conditions.
○ Neural reorganisation: the brain's ability to reorganize its neural connections and networks in response to changes in sensory input, learning, or injury. This allows the brain
to compensate for damage or dysfunction by recruiting alternative neural pathways or regions to perform specific functions.
○ Neural compensation: a mechanism by which the brain adapts and maintains cognitive function despite age-related changes or brain pathology.
10 Principles of Experience-based or Therapy-induced Neuroplasticity (Kleim & Jones, 2008)
The 10 principles of therapy-induced neuroplasticity are a set of guiding principles that outline the key factors for promoting neuroplastic changes in the brain through therapy. Here are
the principles along with one concrete example for each:
1. Use it or lose it: Engaging in regular cognitive or physical exercises to maintain or improve brain function.
• For example, practicing memory exercises to enhance memory recall.
2. Use it and improve it: Focusing on specific skills or functions to actively enhance them.
• For instance, practicing fine motor skills through activities like painting or playing a musical instrument.
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, • For instance, practicing fine motor skills through activities like painting or playing a musical instrument.
3. Specificity: Tailoring the therapy to target specific areas of the brain or functions.
• For example, using speech therapy to improve language skills in individuals with aphasia.
4. Repetition matters: Repeating therapeutic exercises or activities to reinforce neural connections.
• For instance, repeatedly practicing a specific movement pattern in physical therapy to improve motor function.
5. Intensity matters: Increasing the intensity or difficulty level of therapy to challenge the brain and promote neuroplastic changes.
• For example, gradually increasing the weight or resistance in strength training to build muscle strength.
6. Time matters: Allowing sufficient time for the brain to adapt and reorganize through therapy.
• For instance, giving the brain time to recover and heal after a stroke through rehabilitation therapy.
7. Conspicuousness of Exercise (it stands out): Making therapy meaningful and relevant to the individual to enhance engagement and motivation.
• For example, using real-life scenarios and tasks in occupational therapy to improve daily living skills.
8. Age matters: Recognizing that neuroplasticity can occur at any age, but may differ in capacity and rate.
• For instance, adapting therapy techniques to suit the developmental stage of a child with a neurological condition.
9. Transference: Applying skills or gains made in therapy to real-life situations and contexts.
• For example, using problem-solving strategies learned in therapy to navigate challenges in everyday life.
10. Interference: Identifying and minimizing factors that may hinder neuroplastic changes or rehabilitation progress.
• For instance, addressing pain or discomfort that may impede physical therapy progress.
→ Be able to name 5/10, but know 10/10
Cognitive Rehabilitation Therapy focuses on:
How to optimize neural and functional plasticity?
Hot to optimize client's level of self-awareness?
Location of the ABI
• Frontal Cortex
• Execution of movement
• Programming of movement
• Regulation, verification of movement
• Temporal Cortex
• Reception of auditory information
• Language Comprehension
• Integration of info into real, conscious perception
• Parietal Cortex
• Reception of sensory information
• Integration of sensory information
• Integration info into real, conscious perception
• Occipital Cortex
• Reception of visual information
• Integration of visual information
• Integration of info into real, conscious perception
• Subcortical Structures / Limbic System
• Memory, emotion, personality
• Brainstem
• Hunger, thirst, sleep, vigilance, reflexes
• Cerebellum
• Coordination
2. Examinate client's cognitive capacities
Attention
Needed to carry out a task efficiently:
• Focus on relevant facts
• Filter irrelevant facts
• Influencing factors:
• Time (pressure)
• Surroundings
• Working speed
• Information load
➢ Localisation: cortex - frontal - parietal
Subsystems involved with attention:
1. Alerting (Primary Survival System): "fight or flight"-mode. It prepares us for immediate action when there's a perceived danger. This system is crucial for our survival as it allows us
to respond quickly to threats or unexpected situations.
2. Orienting (Direction of Attention): helps us filter and direct our focus towards relevant information while ignoring irrelevant stimuli. It allows us to prioritize what is most
important in our environment, helping us make sense of the world.
3. Executive (Control of Attention): controls our attention, determining when to release our focus from one task and attach it to another. It also plays a role in reconnecting our
attention to previously disregarded information when necessary.
4. Arousal - Awareness: is there any imminent danger? Or whether our environment requires heightened attention. It is closely tied to our overall state of alertness and
consciousness.
5. Focused Attention: concentrating on a specific task or stimulus to the exclusion of all else. It can be impaired in conditions like neglect, where the brain fails to attend to certain
parts of the visual field, often due to damage.
6. Sustained Attention: maintaining focus on a particular task or stimulus over an extended period. It's related to our mental endurance and workload capacity. It's the ability to stay
engaged and attentive in tasks that require ongoing concentration.
7. Selective Attention: choose what information or stimuli are most relevant to our goals at a given moment. It helps us tune in to important details while ignoring distractions or less
important information.
8. Alternating Attention: the ability to switch focus from one task or stimulus to another efficiently. It's crucial for tasks that require shifting between different demands or rapidly
changing situations.
9. Divided Attention (Multitasking): attending to multiple tasks or stimuli simultaneously. This is a complex cognitive process that often has limitations, as our attentional resources
are finite, and attempting to divide them among multiple tasks can lead to decreased performance in each task.
Evaluated by:
• Focus on function (ie. cancellation task)
• Focus on activity/participation (ie. test of everyday attention)
• Focus on external factors (ie. adequate use of devices)
Info processing
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