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585-18
Executive Functioning & Brain Tumor
| Term | Definition |
|---|---|
| motor execution brain areas vs. performance brain areas | Primary motor cortex & somatic sensory cortex vs. Primary motor cortex, somatic sensory cortex, SMA |
| schema | Collection of movements occurring together Needs perception, motor components, and intact EF In L hemisphere |
| schema due to verbal instruction pathway | 1. Primary auditory cortex 2. Wernicke's area 3. Posterior parietal cortex 4. Premotor cortex 5. Primary motor cortex |
| schema due to internal motivation pathway | 1. Start at prefrontal cortex 2. Posterior parietal area 3. Motor cortex |
| parent schema vs. sub-schema | Defines the goal of action, a collection of schemas Ex. boil water vs. Set of specific schema to achieve goal. Will depend on individual habits. Ex. fill kettle, switch on, water hot |
| errors in motor planning | Intention Omission Perseveration Object selection Temporal Spatial |
| intention vs. omission errors | When wrong goal is triggered. Most serious error, they do something else vs. Occurs at transition points, occurs in parent schema |
| perseveration vs. object selection errors | Repetition of action at transition points, person keeps doing certain motor programs again and again vs. Choose the wrong object |
| temporal vs. spatial errors | Error in sequencing or timing vs. Error in body parts as a tool. Like using finger to stir tea |
| apraxia | Disorder of learned movements Unable to execute movement w/o weakness, incoordination, sensory loss, inattention Takes long time to regain the learning pattern |
| dyspraxia | Disorder that affects sensory stage of willingness to move Need sensory integration techniques for kids Sometimes less severe form of apraxia |
| limb apraxia | Associated primarily w/ L hemispheric pathology Planning & executing limb movement sequences Not able to execute movement with their own limbs Split into ideational or ideomotor |
| ideational apraxia | Person not knowing how to do something/ concept of tool that they would have known before the injury Damage in L parieto-temporo-occipital junction Can name objects but can't sequence Intact imitation- tx by copying Creates functional deficits AD |
| ideomotor apraxia | Problem in producing movement. Know the task & how to do it, can't produce mvmnt Schema Can't use tools Cannot do requested skills but can self initiate Less problem in familiar env |
| assessing apraxia | LOTCA Rivermead perceptual assessment battery Limb apraxia Constructional apraxia |
| apraxia functional testing methods | Command to tool use & nonverbal communication Imitation Response to tools/ tool use Tool selection task Judging movements Comprehension Serial acts |
| tx principles for apraxia | Practice basic motor mvmnt Follow developmental sequence- proximal to distal, large items to small Functional and motor activities used Consider other cognitive functions by breaking down tasks into small steps, use verbal guidance |
| OT apraxia tx | Task specific/ errorless learning Block practice at start to use neuroplasticity, random practice later in rehab Practice in familiar context for ideomotor Use imitation for ideational Hand over hand guidance, less verbal Mental practice |
| executive function | Ability to control and organize behavior Seen in task performance and socializing Frontal lobe damage following TBI or stroke impairs EF |
| elementary vs. high order EF components | Switching, inhibition, wm vs. Planning, problem solving |
| key elements of EF | Initiation Planning Sequencing Inhibition Problem solving |
| initiation vs. planning | Start task at appropriate time w/o reliance on prompts vs. Perform efficiently & prepare space |
| dorsolateral prefrontal cortex | Supplied by MCA For attention, working mem, decision making, procedural sequence, goal selection, planning, sequencing, shifting, self-monitoring, self awareness Damage called dysexecutive syndrome |
| medial area of frontal lobe | Supplied by ACA Decreased drive, initiation, motivation, & interest Apathetic or reduced affect Damaged will have slow response and attention deficits |
| orbitofrontal cortex | Supplied by ACA & MCA Inhibition, impulse control, socially appropriate behaviors Need to do risk ax & eval home safety w/ damaged Pts will have personality or behavioral changes |
| association areas | 1. Projections that at primary sensory areas (except motor) 2. Send input to association areas of brain 3. Association areas send to prefrontal lobe L & R hemispheres aren't equivalent |
| motor association | Signal sent to premotor to primary motor cortex |
| posterior association cortex | Usually assosicated w/ post parietal lobe which coordinates sensory stuff Can result in unilateral neglect, ideational apraxia, and prosopagnosia |
| psych & frontal damage | Neuro disorder has higher prevalence psych deficits 1/3 develop psych disorder post mild TBI Depression, anxiety, PTSD Aggression, inhibition Personality, emotional, neurobehavioral deficits Substance use may lead to damage too |
| conversion disorder | Pt reports that there is a physical symptom, but upon ax no actual problems Affects more women Usually total arm/ leg w/o facial paralysis Refer people to mental health |
| confabulation | Unconscious process Create false info, pt usually amnesiac In pt with acute BI or stroke, in early phase of recovery |
| self report for EF | Dysexecutive questionnaire Behavior rating inventory of executive function (BRIEF) |
| performance based EF ax | Multiple errands test Hotel task Executive function performance test Performance ax of self care skills Ax of motor & process skills |
| OT observation with EF | Observe... Goal setting Self initiating Self monitoring Planning Organizing Flexible problem solving |
| for severe EF use tx | Task specific, with errorless, spaced and chaining External compensatory- cuing and assistance |
| for mild EF use tx | Use metacognitive approach Continue to use external strategy with assistance if needed |
| metacognitive strategy training | Assumes cognition can be learnt Understand the deficits, practice strategies, transfer strategies into real life situations Teach & develop plans so they can problem solve themselves |
| co-op vs. goal management training | Goal- plan- do- check vs. 5 steps 1. stop 2. define task 3. list steps 4. learn steps & do it 5. check |
| time pressure management | Severe head injury results in deficits in speed info processing. Feel like info overload Teach pts to give self enough time to deal with daily tasks |
| specific time pressure strategies | Self instructional training Enhance awareness of errors Rehearse task steps Modify task environment |
| organize environment vs. decrease distractions | Labeling systems, calendars vs. Keep workspace clear, reduce background noise, avoid multi- tasking |
| external cueing devices | Use assistive tech Alarm watches, organizers Auditory signals as cuing, timers |
| gliomas | Both benign & malignant groups of tumors Come from glial cells (often astrocytes) Takes up part of them in the brain |
| grade 1 vs. grade 4 | Benign, grows very slow vs. Metastatic carcinoma, 60% of all brain tumors. Managed by surgery |
| 1. meningioma 2. pituitary adrenomas 3. acoustic neuroma | 1. Come from meninges 2. Affects optic tract, endocrine disturbance 3. Develops into main nerve leading from inner ear to your brain |
| prognosis of brain tumors | Poor prognosis Difficult to remove benign tumors Very close to part of the brain w/ important functions No clear boundary between tumor tissue and normal brain substance |
| removal of brain tumors | Complete or partial removal of brain tissue Creates a permanent lesion and resembles brain injury Consider compensation and train alternative strategies |
| OT ax pre- brain operation | Physical, cog, perceptual exam to get baseline Identify where in brain & other age & health factors Need external aids, provide training before surgery Think of extent & probability of post op complications |
| OT ax post- brain operation | Identify needs & deficiency Behavioral problems, thinking, feelings, self image Consider what activities are done on daily basis Need home modification or equipment Eval vision, cog, perception, OPI |
| OT ax for chemo | Vital signs, med stability, tolerance Measure functional abilities- compensation, training, d/c planning Karnosky Performance Status Scale |
| physiological chemo reaction | Concentration Eye fatigue Hypersensitivity Dizzy Nausea Weight gain |
| motor deficits of chemo | Muscle weakness Endurance Balance Assistive device Mobility devices |
| considerations for tx with chemo | Pt ability to participate in OT session due to fatigue and flexibility Psychological challenges like depression and anxiety, mood changes |
| OT brain tumor tx | Light activities to recondition, tolerance Remedial/ functional training on motor/ cog Optimize functional abilities, meaningful lifestyles |
| d/c planning for brain tumor | RTW Flexible work schedule Working at heights or heavy machines not good Stress coping Feel annoyed, frustrated, helpless, driving |
Created by:
craftycats_
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