Cognitive Impairments

Executive Functioning Impairment

The most complex cognitive processes are those that involve:

  • reasoning

  • planning

  • judgement

  • initiation and

  • abstract thinking (BIAA, 2021).

Collectively, these processes make up what is known as executive functioning. Persons with brain injury often have an impairment with executive functioning processes. Difficulties may arise as problems with areas such as:

  • abstract thought

  • analyzing all aspects of a situation

  • considering all potential solutions to a problem

  • executing those solutions

  • maintaining cognitive flexibility if one solution does not work and

  • self monitoring.

Other behaviors often seen in persons with brain injury include:

  • impulsivity

  • disinhibition

  • hyperverbosity (hyper + verbal) and

  • poor self control of their emotions.

Executive functioning deficits can occur whether brain injury is deemed mild, moderate, or severe and may significantly impact all aspects of life.

 

Cognitive rehabilitation is designed to improve cognitive functioning for patients who have sustained a brain injury or who are otherwise cognitively impaired. Persons with brain injury can be taught to:

  • approach situations in a rational and systematic manner

  • analyze problems

  • consider alternative solutions

  • to prioritize and execute a solution and

  • to review the outcome of their approach to the situation (BIAA, 2021).

Deficits in attention are common for a person who has sustained a brain injury, as the brain's widely distributed attention network is easily disrupted (BIAA).

Causes of these deficits may include:
-->increased sensitivity to internal and external distractors
-->frailties of working memory &
-->decreased processing speed

Attention can be divided into 5 subtypes of attention:

1. Focused attention- requires selection of one source of information while withholding responses to irrelevant stimuli.
2. Sustained attention- is the ability to maintain attention to complete a task accurately and efficiently over a period of time.
3. Selective attention- is the ability to maintain attention in the presence of distractions.
4. Alternating attention- is the ability to shift between tasks that demand different behavioral cognitive skills.
5. Divided attention- requires the ability to respond simultaneously to multiple task demands while maintaining speed and accuracy.

Rehabilitation interventions for attention deficits vary!

The Attention Process Training (APT) program

This program is a component of a hierarchically organized, process-specific approach to cognitive rehabilitation. It begins with sustained attention tasks and progresses to selective, alternating, and divided attention activities (BIAA, 2021).

Tasks are organized by increasing difficulty, and progression to a higher skill level occurs when the easier task is mastered.

Repetition of a task results in a reduction in the amount of effort and attentional control required. The practiced task becomes more automatic and efficient, requiring less cortical resource than deliberate attention processing.

Attention training performed in this manner has been shown to result in improved memory performance for individuals with a brain injury.

Memory

Memory impairments can occur for a deficit in encoding (where perceived information is put in a context that can be stored), storage (stabilization of a memory), and retrieval (the search for, or activation of, a memory) (BIAA, 2021).

Information must be transferred from initial short-term storage to longer-term storage (consolidation). During encoding, only information that is present and accounted for can be stored; and only stored information can then be retrieved. 

Research has demonstrated that persons with moderate to severe brain injury can recall new information, but at a decreased rate than those without injury.

4 main types of memory:

1. Sensory

2. Short-term

3. Working memory

4. Long-term

Sensory- holds information from the senses for a few seconds immediately after the item is perceived. Sensory memory for each of the 5 senses:

  • iconic (visual)

  • echoic (hearing)

  • haptic (touch)

  • olfactory (smell)

  • gustatory (taste)

Short-term memory- enables a playback of information from a few minutes to a few hours. An example would be the color shirt your mother had on as she left the house. A passive process.

Working memory- this type of memory allows an individual to keep note of information while it is pertinent to a specific task. For example, in a scenario where a grocery bill totals $17.54, the clerk might be given a $20.00 bill. The cashier would need to use working memory to calculate that the change needed would be $1.36 (BIAA, 2021). 

Long-term memory- incorporates permanent consolidation and storage of information. Long-term memory can be divided into:

  • explicit memory-(information that can be consciously declared) &

  • implicit memory- (task oriented or cognitive skill memory). 

Processing Speed

Processing speed can be thought of as cognition reaction time or the time it takes a person to gather the information presented, process it, and respond (BIAA, 2021). When greater the delay of processing speed, the greater the margin of error is interferences and distractors to take hold.

Attention Deficits

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