Curiosity, Dialogue, and Knowledge
MIRBI (Mini Inventory of Right Brain Injury)
RIPA (Ross Information Processing Assessment)
RICE-3 (RIC Evaluation of Communication Problems in Right Hemisphere Dysfunction 3)
Sustained attention – focusing on one thing for a long time
Selective attention – focusing on one thing when distractions are around
Alternating attention- switching between two things
Divided attention – attending to two things at the same time
Arousal, vigilance, and orienting
What are the effects on conversation?
Bumping into walls?
Eating from one side of the plate?
Failing to dress or groom one side of the body?
Bilateral simultaneous stimulation tasks
Line bisecting tasks
Draw or copy symmetrical objects such as:
Clock, a person
Self-regulating daily schedule
Synthesizing information from different sources
Tied to higher level attention processes
|Cognitive function problems||
Sohlberg and Mateer levels of attention
Sustained – performing one task over time
Selective – performing one task in presence of distraction
Alternating – alternating attention between two tasks one at a time
Divided – dividing attention between two tasks simultaneously
Behavioral intervention focused on Reaction time (RT) – Patient must respond as fast as possible to stimuli that is auditory or visual, these are computerized
The use of computerized tasks is preferred with easy ability to increase time between stimulus presentation and other variables while simultaneously tracking data. Non computerized tasks are also viable and include: a series of yes/no questions, a series of simple addition problems, putting together a simple puzzle, and other such simple tasks – these reduce cognitive demands to focus treatment on ability to simply maintain attention over time.
The patients must select target stimuli from a series of targets and foils which can be auditory or visual, i.e.- the patient taps their fingers every time a number is repeated in a series of numbers read by the clinician. This same task can be made into an alternating task by switching the number the patient is to tap on.
Have the patient sort playing cards by number, then stop and sort them by suit, then stop and sort by color, then stop and sort by face cards, etc. Or use the above task from selective attention and you have an auditory task as well.
Have the patient count out loud to 100 while completing a cancellation task. Also, sort playing cards and answer questions at the same time. Combine other activities as appropriate to the patients intact perceptual skill sets.
Neglect causes a failure to respond to any stimuli on that side of the body (left for RHD). They can bump into things, not eat on the left side of their plate, not respond to someone talking to them from the left, and they will not read or comprehend anything on the left side.
Social disconnection- reduce awareness of the social purpose served be communication and of the bonds that tie the self to people, events and objects in the environment.
RHD Patient may seem distant, remote, less engaged in communication interactions, less responsive to communicative context, have difficulty assessing listener needs, and make less use of conventions for conversation.
Conversational convention tasks:
1. Video tape conversations
2. Didactic phase – review tape with Patient, discuss targets
3. Recognition phase – Patient reviews tape for target behavior
4. Training phase – patient is given cues – at each instance of failure to use target behavior during taped conversation
5. Transition phase- conversations move to situations outside of therapy
Theory of mind task
Patient is presented with a paragraph length story followed by questions which test the patient’s ability to adopt the perspective of a story character
1. Picture/story headlines
a. Patient generates titles for short stories, news, or pictured scenes
2. Story Continuations
a. Patient provides his/her own story ending or chooses an ending from a multiple choice format based on story context
3. Comprehension of individual inferences
a. Patient reads a simple story and answer questions about explicit and implicit information
1. Sentence/picture arrangement
a. Patient orders a set of sentence or pictures into a meaningful arrangement to tell a story
b. Puzzle and object arrangements
i. Patient arranges simple puzzle pieces into a pattern according to a model or object
c. Recognizing commonalities
i. Patient arranges stimuli by a theme
Divergent Reasoning Level I: Increasing Informative Content
1. Patient states and supports an opinion in a brief monologue (less than a min) the clinician tapes and then provides a written transcript of the monologue which is then scored and discussed with Patient based on the targeted dimension
2. Divergent Reasoning II: increasing Efficiency
a. Repeat activity for divergent reasoning I, place particular emphasis on efficiency
3. Recognizing the dimensions of informative content
a. Patient reads a paragraph level informative or opinion piece on a given topic that contains errors in the dimensions of relevance, completeness, efficiency, and or relatedness. Choose error types consistent with those the patient makes.
4. Increasing tasks specificity
a. Patient tells personal stories about past events, clinician provides written transcript to patient and reviews them with the patient noting instances of unreferenced pronouns.
1. Word associations
a. The patient finds two out of three words that can be grouped together (e.g.- tramp, hike, and scamper are all ways to describe moving through the woods).
2. Resolving lexical ambiguities
a. The patient provides two meanings for ambiguous lexical entities (book titles with double meanings, or multiple meaning words with use in different sentence constructions)
3. Inference revision
a. The patient states the outcome or answers multiple choice questions about two sentence stories in which the first sentence is misleading.
4. Semantic relationships
a. Patient is presented with a sentence in which the final word has more than one meaning, Patient selcts the most closely related word from a list of words which vary in the degree in which they are related to the final word this should be done as rapidly as possible.
5. Sentence interpretation: explaining alternatives
a. Clinician reads a pair of pointed sentences aloud and the Patient selects appropriate interpretation from multiple choices. Patient explains inappropriateness of the other choices.