Cognitive Rehabilitation -Therapeutic Strategies for Effective Intervention – Jerry Hoepner

Outline

Cognitive-Linguistic Assessments

• Screening tools
• Cognitive evaluations (standardized and non-standardized)
• Language assessments (standardized and non-standardized as they apply to cognitive assessments)
• Rating scales (provider and consumer)

Cognitive Rehabilitation Techniques

• Remediation / Compensation / Adaptation
• Therapy decision-making (dynamic/ongoing assessment; patient centered; goal directed)

Documentation of Skilled Services

• Justification for skilled, necessary and reasonable therapy
• ICD-9 / ICD-10 codes pertinent to SLP intervention
• SMART goals
• Outcome measures
  • FIMS
  • NOMS
    • Relevancy to G-Codes
    • A guide for developing LTG’s
• Key elements required for:
  • Daily notes
  • Progress notes

Attention

• Posner’s Theory of Attention
• Anatomic substrates of the attention system
• Attention subtypes
• Functional manifestations of inattention
• Interventions strategies for promoting improved attention across recovery continuum
  • Remediation
    • Wakefulness (stimulation management programs)
    • Reduced agitation (validation therapy, environmental modification, positive psychology)
    • Increased function (direct attention training with reflection)
  • Compensatory strategies (partner-based supports, environmental interventions)
  • Adaptation techniques (assisted prompting)
• Goal writing for attention deficits

Memory

• Anatomy of the memory systems
• Memory types
• Encoding / Consolidation / Retrieval
• Interventions for facilitating recall
  • Remediation
    • Utilization of preserved systems (spaced retrieval, routines, implicit learning)
    • Adaptation techniques
  • External aids
  • Task-specific learning
  • Goal writing for attention deficits

Executive Functions (EF)

• Anatomic substrates of the EF system
• McCloskey’s Executive Functions
• Executive functioning hierarchy
  • Self-activation
  • Self-regulation
  • Self-realization
  • Self-determination
• Functional manifestations of EF impairments
• Specific focus areas for EF’s
  • Functional problem solving
  • Awareness / Insight
• Strategies for reducing the effects of executive dysfunction
  • Remediation (Reflection, video self-modeling, Ylvisaker’s Goal-Plan-Do-Review)
  • Compensation (routines, environmental interventions, partner-based interventions)
  • Adaptation (cognitive prosthetics)
• Goal writing for EF and problem solving

Visual Perceptual Function

• Anatomy of the visual system
• Warren’s Visual Perceptual Hierarchy
• Functional manifestation of visual perception deficits
• Therapeutic strategies specific to:
  • Low vision
  • Hemispatial neglect
  • Remediation (known quantities, metacognitive/self-regulatory interventions)
  • Compensation (environmental interventions, partner-based interventions, edgeness and bookness)
  • Adaptation (visual/attentional prosthetics)
• Goal writing for visual perceptual impairments

Special Considerations

• Delirium
  • DSM-5® criteria for delirium
  • The neuroscience of delirium
  • Diagnosing delirium
  • Protective, predisposing and precipitating factors for delirium
  • Reversible causes for delirium
  • Treatment techniques for delirium
• Depression
  • Clinical manifestations of geriatric depression
  • Medications which can cause depression
  • SLP role in the management of depression
• Right Hemisphere Dysfunction (RHD)
  • Assessment tools specific to RHD
  • Clinical manifestations of RHD
    • Left hemispatial neglect
    • Pragmatic impairment
    • Reduced awareness / insight
    • Cognitive impairment

Specific Therapy Activities

Case Studies