Cognitive Strategies 2015.pdf

7/23/2019 Cognitive Strategies 2015.pdf

http://slidepdf.com/reader/full/cognitive-strategies-2015pdf 1/33



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



1. Encode (take in)

2. Consolidate (store)

3. Retrieve information



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



• 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



Large capacity for unprocessedinformation, but only able to holdaccurate images of sensory informationmomentarily

Information is either transferred or lost

Guided by attention and selection



Short-term: time-limited storage of

limited amount of information

Time:15-30 seconds

Capacity: 7 plus or minus 2

Increase capacity with chunking



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



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

http://library.med.utah.edu/neurologicexam/html/mentalstatus_abnormal.html






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



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)



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



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



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



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



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



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



Link new information to what you already know

Organize the information (e.g., categorize,

sequence)

Intend to remember (phone pad) Decrease distractions



Practice or rehearse, following the "little and

often" rule

Test yourself periodically

Write the information down (Take notes!) Multi-modal methods (verbal and visual)



First letter prompts (alphabeticalsearching, acronyms, tip of the tongue)

Associative information

Develop routines - anchor your memory

with habits and consistency



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)



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



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.”



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)



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



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



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



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



• 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



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



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



Medication devices• Weekly

• Daily

• Programmable

Medication card Other tools:

• Lists

• Maps (eg grocery store)

• Expense tracking• Budgeting



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.

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