Assessment of the Level of Cognitive Impairment - Assignment Example

? Psychology of Learning: The level of cognitive impairment after stroke is often very high. One of the impairments oftenobserved is deterioration of executive functioning and attention. Executive function is defined as the mental processes involved in objective-oriented behavior. The Trail Making Test (TMT) is made up of two parts consists of part A and B. The difference in time between the part A and part B is an indication of problems in divided attention. The ratio of time to complete both trails and errors made is the variables of interest. There are several theories on the effect of a stroke on a victim taking the TMT test. Some scholars have found no effect on the TMT test from a left sided stroke victim (Godefroy, 2013) while other scholars have found the TMT B/A ratio is significantly lower in stroke victims. Other observations suggest that Mr. R would have a lower executive functioning performance compared to right-hemisphere stroke victims. Mr. R being a survivor of a left- sided stroke has a high chance of several speech problems such as fluency. Some of the symptoms that Mr. R may present include difficulty in sequencing thoughts to tell a story, difficulty using an appropriate tone of voice among others. In addition to the above mentioned impairments, visual inattention is another common condition associated with stroke patients. Mr. R is likely to present some difficulty in maintaining an interest in events that occur on his right side. Visual inattention is usually in the opposite brain hemisphere that was damaged by a stroke. Mr. R therefore, would present behaviors such as missing food on his right hand side, not noticing people approaching from his right among other symptoms. The line bisection test is a test where Mr. R. is required to estimate and indicate the midpoint of a horizontal line presented on a piece of paper placed in front of him. The test is a measure of the deviation of the bisection from the true center of the line. The line bisection test is used to determine the presence of Unilateral neglect (ULN). As common with most left-hemisphere stroke victims, Mr. R would deviate toward his unaffected right brain side. Auditory discrimination in left-hemisphere-stroke patients is often common. The patient's response is measured by the mismatch negativity (MMN) and the speech comprehension tests. Being a stroke victim Mr. R's stimulus would not match this trace indicating the information about his auditory discrimination inaccuracy. (Andrewes, 2001) The left side of the brain controls the ability to speak and understand communication with other people. Aphasia and language apraxia are commonly caused by a stroke to the left-hemisphere-stroke. Aphasia often leads to problems with speaking, listening and understanding speech. To test aphasia, a speech pathologist would examine Mr. R to understand how he speaks out loud, writes, his listening and reading comprehension. Mr. R is likely to display difficulty in speaking, and his rate of speech would be low. Lastly the fingertip number writing test involves an examiner tracing the numbers 3, 4, 5 and 6 on the palm of Mr. R's hand. Mr. R is then asked to close his eyes and report the number written in a set order on the fingertips of the right and left hands. The score is the determined by the sum of errors made on each hand. The score is then recorded on the ADHD weighting scale. Mr. R is likely to make more errors than a normal patient. References Andrewes, D. G. (2001). Neuropsychology from theory to practice. Hove, East Sussex: Psychology Godefroy, O. (2013). The behavioral and cognitive neurology of stroke (2nd ed.). Cambridge: Cambridge University. Dobkin, B. H. (2003). The clinical science of neurologic rehabilitation (2nd ed.). New York: Oxford Question 4 The California verbal learning test is a neuropsychological test that is used to assess the verbal memory abilities of individuals. In this test the tester normally reads aloud a list that contains common words that the individual has used before. It aims at identifying how many of these items the individual who suffers verbal memory loss can remember. It’s a good tool to use on Mrs. D since she seems to have been forgetting what she had said earlier and was repeating herself. She therefore seems to have the verbal memory loss and should be put through this process. The spatial memory test using the Rey-Osterreith Complex Figure examines the patient by asking them to reproduce a complicated line drawing first by copying and then from memory. The patient is then required to give the shape of diagrams as they had seem them. They are also required to use their memory to draw again the diagrams after a few days. This will be of help in determining the memory of Mrs. D and establishing why she kept on forgetting the list of items that she was to buy in the grocery store. This goes a long way to prove whether she can remember the lines after a few days. Rivermead memory test predicts everyday memory problems in those acquired non progressive brain injury. It’s functioned to test the everyday memory skill of the patient in which subtests conducted include remembering names, appointments, routes used, errands and face recognition. A pass or fail screening score is then given. This test would also be of help to Mrs. D. References Catherine E. Myers. Memory Loss and the brain, Newsletter of the Memory Disorder Project at Rutgers University. 2006 Lu PH, Boone KB, Cozolino L, Mitchell C. "Effectiveness of the Rey-Osterrieth Complex Figure Test and the Meyers and Meyers recognition trial in the detection of suspect effort". Clin Neuropsychol 17 (3): 426–40. (2003). ? Question 5 The Wisconsin Card Sorting Test (WCST) is a test used to assess persistence and abstract thinking and is regarded as a measure of executive function due to its sensitivity to dysfunction in the frontal lobe. This test is important due to its ability to help identify particular sources of difficulty in conceptualization and failure to maintain focus as well as distinguish between frontal and non-frontal wounds when used with other ability tests. The instructor usually sitting opposite the patient can observe and evaluate cognitive skills of the patient. A patient with any frontal lobe lesion perform poorly at the test showing reduced cognitive functions. The Trails test is an effective test which uses a series of connecting dots to test the patient’s ability to hold several tasks in mind at the same time as well as task switching. It consists of two parts where the patient is supposed to connect the dots as quickly as possible while maintaining accuracy. It is important due to its ability to evaluate the flexibility and speed of the brain. Error rate is reflected in the time taken to finish the test and this shows the level of cognitive skill of the subject. The picture arrangement test from the WAIS III Battery test is a test of the ability to plan, interpret and anticipate events within a certain context. It is sensitive to brain damage in right anterior temporal lobe areas that disrupt non-verbal skills and low scoring patients in this test tend to have difficulty making decisions and planning ahead, process information slowly and have problems in social relationships. A subject’s inability to choose correctly would be proof of damage to the frontal lobe. Some of the orbitofrontal injury-caused social problems include cognition problems and behavior. Decreased memory which would cause an individual to repeat questions severally or forget instructions would be a major challenge to the individual as well as his relatives, teachers and colleagues at school. Impulsivity, poor judgment and acting without forethought would most likely put lives in danger for the trauma victim and people around him. Social inappropriateness as a result of the trauma could also be a major social problem as a result of trauma, and this would cause embarrassment to the individual himself, his friends and family. Some of head trauma patients need surgery to remove or repair ruptured blood vessels or bruised brain tissue and disabilities due to trauma brain injury would depend on the severity and the location of the injury as well as the age and health state of the patient. Common disabilities include problems with sensory processing, cognition, communication and mental health while more serious injuries would cause stupor, a semi- unresponsive state, coma, or a vegetative state. Treatment of trauma symptoms includes graded resumption of activity, antidepressant medication and cognitive restructuring (Varney, Nils R. 1999). First, therapy evaluations would be used to identify strengths and weaknesses in Mr. S to focus on deficit to be remedied and identify assets that could be developed and strengthened. His medical status would be continually monitored to reduce risks of undetected seizure disorders, visual disturbance and balance problems among other problems. Mr. S would then be helped to develop effective behavior control by changing his caregiver and even his environment before addressing cognitive skills. He would be assisted to acquire a tight structure in his daily life to which would reduce the need to continually make decisions and ultimately reduce the burden on the caregiver. Lastly, additional risk would be minimized by reducing exposure to toxic materials and ensuring a balanced diet to meet nutritional needs of the individual without supplementation. References Tombaugh, T.N.T.N "Trail Making test A and B: Normative Data Stratified by Age and Education". Archives of Clinical Neuropsychology: The Official Journal of the National Academy of Neuropsychologists 19 (2): 203–214. (2004). Retrieved 2012-01-10. Mattson, A. J.; Levin, H.S. "Frontal lobe dysfunction following closed head injury. A review of the literature". Journal of Nervous & Mental Disorders 178 (5): 282–291. (1990). Blissitt PA (September 2006). "Care of the critically ill patient with penetrating head injury". Critical Care Nursing Clinics of North America 18 (3): 321–32. Varney, Nils R., and Inc. Net Library. The evaluation and treatment of mild traumatic brain injury. Mahwah, N.J.: Lawrence Erlbaum Associates, 1999 University. Read More