Cognitive Abilities and Executive Function
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Transcript Cognitive Abilities and Executive Function
Diagnosis and Therapy
Approaches for the
Speech Language Pathologist
Cognitive Functions
Domains of Cognitive Function
1.Attention
2.Memory Processes :short and
long term
3.Verbal language
4.Categorization :Means of
incorporating new info and
organizing info in the brain
5.Abstract thought
Constantinidou, Thomas, & Best
(2004)
1.Attention
Orienting Network
Guides 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 Network
Ability 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 dinner
Time schedules
Executive Network
Flexibility
Capacity to multitask
Switch attention
Organize sequences
For 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 Network
Memory is organized with respect to
time and contents
Short term/working memory
Long term memory
explicitsemantic, 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. Categorization
Assigning objects or events
into groups
Interrelated with other cognitive
processes
Object recognition
Problem solving
Decision making
Sustained attention tasks that
require sorting
Learning and memory
Categorization is critical to
problem solving in order to
consider solutions
Components of
Categorization
Recognition 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
Reasoning
Decision making and
Problem 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 table
Attach at the end
TBI, CHI, CVA , Progressive Aphasia , Dementia,
Developmental , Autism spectrum, CP, LD, may each be
faced with challenges:
Attention
Organization and categorization
difficulties
Learning difficulties
Memory deficits
Information processing impairments
Executive functioning deficits
Reasoning, decision making, problem
solving
Psycho social- anxiety and depression
Social-Communication difficulties
Receptive 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 Test
Cognitive Abilities Screening Test
Functional Communication Profile
Language -Cognitive-Communication
WAIS III-Digit Backward and Symbol
Subtest
Boston Diagnostic Aphasia Exam-has
subtests which test cognitive functions
Stroop Color Word Test
Note: 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
Skill building
Repetition
Stimulus/Cueing
Hierarchies
How do our
therapies help
the client
develop
functional skills
for life?
Compensatory
Based on the
assumption that
some abilities
may not be
restored
completely
Develop
functional
strategies
Brain reorganization and
sprouting following injury
Damage may
cause
compression,
breakage, cell
death and lost
function
Sprouts form
Phagocytes clean
Out damaged neurons.
If the neurons are
stimulated, they
continue to be viable
for new synapse growth.
Sprouting constitutes
A reorganization of those
connections
Restorative
Improve skills through use of exercises and
drills
Good potential for learning
Optimizes function through dynamic
,aggressive rehab
Treatment 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
• Skill Building
• Repetition
• Stimulus/cue hierarchies
• Major skill is
maintaining attention
with out distraction
and with distraction
– In a young child: attending
following simple commands
Listening to a story
initiating interaction
– In an older child or teen –
finishing a written task
– In an adult- making a grocery
list
Memory Therapy
Techniques
Restoration/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 Program
Constantinidou, 2001
A: Recognition and categorization of
common objects
Level 1:Perceptual feature training
Different perceptual features
Level 2: same and different
Level 3 functional categorization
Level 4 Analogies
dog:puppy Cat: kitten
reserved : personable introvert:?
Level 5: abstract categorization
opposites, similarities
B New Category learning tasks
Categorizing by 2 parameters
Compensatory
Assumes that the client cannot recover
completely
With caregiver/family
Functional strategies
calendars
list making
communication notebook
phone usage
Verbal Routines
Compensatory
Patient may require cueing to optimize
performance
Provide training in those compensatory
strategies
Alternate forms of communication
External compensatory strategies
Internal compensatory strategies
For 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 5-6
Moderate to severe TBI
Degenerative neurological diseases
Cognitive Functions’ Worse Enemies
Stress and
Vitamin B-12
Anxiety
Depression
Metabolic
Diseases
Thyroid
gland,
diabetes,
organ
failures,
alcoholism
deficiency
Infections
Drugs
ADHD
Hypothyroidism
Aging