Iconic Imagery

1
Cognitive Rehabilitation Efficacious
Treatment Rick Parente Ph.D. Towson University
2
ProEd Publishers 800-897-3202
3
What Works

• Gradual step-by-step therapy
• Eclectic treatment
• Prosthetic devices
• Academic remediation
• Functional skills training

4
What Works - continued

• Individualized mnemonics
• Changing life-long habits
• Creating incentives and personal relevance of
  treatment
• Using clients to council clients

5
What Works - continued

• Rehearsal training
• Group therapy
• Social skills integration training
• Nonverbal perception
• Concept communication
• Psychosocial memory skills

6
What Does not Work

• Doing nothing
• Short-term treatment
• Most stimulation therapies
• Most insight oriented psychotherapies
• Forcing clients to do things your way

7
The Art of Cognitive Rehabilitation

• Creating appropriate incentives and personal
  relevance
• Translating what the client should do into what
  they want to do
• Client centered treatment
• Creativity flexibility-improvisation

8

• Training and Retraining Cognition

9
The Research Agenda
10
Iconic Imagery

• Idea Increase Iconic span of apprehension
• Training Short duration flashes
• Result Improved performance evidence of
  carryover to reading
• Applications Reading, driving, perceptions of
  warning signs

11

12
Legal
13
(No Transcript)
14
Hurry
15
(No Transcript)
16
Closet Door
17
(No Transcript)
18
Down Town
19
(No Transcript)
20
Down the road
21
(No Transcript)
22
In and out
23
(No Transcript)
24
I will get better
25
(No Transcript)
26
What you see is what you get
27
(No Transcript)
28
References

• Parente, R., Anderson-Parente, J.A., Shaw, B.
  (1989). Retraining the minds eye. Journal of
  Head Trauma Rehabilitation, 4 (2), 53-62
• McClur, J.T., Browning, R.T., Vantrease, C.M.,
  Bittle, S.T. (1994). The iconic memory skills of
  brain injury survivors and non-brain injury
  controls after visual scanning training.
  NeuroRehabilitation, 4, 151-156.
• McClur, J.T., Browning, R.T., Vantrease, C.M.,
  Bittle, S.T., (1997), Iconic memory training with
  stroke patients. Journal of Cognitive
  Rehabilitation, 14, 21-27.
• Hamid, M., Garner, R., Parente, R. (1996).
  Improving reading rate and reading comprehension
  with iconic memory training. Cognitive
  Technology, 1(1),19-24.

29
(No Transcript)
30
Retraining Attention

• Self questioning
• Assigning time
• Ear plugs untimed tests
• Distributed practice
• Forced rehearsal
• Creating incentives
• Personal Relevance
• Changing diet
• Avoiding stimulants

31
Rehearsal Training

• Idea Demonstrate effect of rehearsal and
  determine how many rehearsals are necessary
• Training Card games for maintenance rehearsal
• Result Improves memory so long as the person
  consciously rehearses.

32
References

• Parente, R., Twum, M., Zoltan, B. (1994).
  Transfer and generalization of cognitive skill
  after traumatic brain injury, NeuroRehabilitation,
  4, 25-35

33
Mnemonics and Imagery

• Idea Facilitate cuing and memory retrieval
• Training Provide or develop memory cues
• Result Unique mnemonics that solve a specific
  problem work best
• Applications Work, ADLs, Academics, Training.

34
References

• Parente, R. Anderson-Parente, 1991. Retraining
  Memory Techniques and applications, Houston TX,
  CSY Publishers
• Twum, M. (1994). Maximizing generalization of
  cognitions and memories after traumatic brain
  injury, NeuroRehabilitation, 4, 157-167
• Parente, R., Kolakowsky-Hayner, S., Krug, K.,
  Wilk, C. (1999) Retraining working memory after
  traumatic brain injury, NeuroRehabilitation, 13,
  157-163

35
The Memory TRRAP T ranslate into
your own words R ehearse immediately R elate the
new to the old A picture is worth a thousand
words P ractice output
36
Remembering names

• N otice the person maintain eye contact
• A sk the person to repeat his or her name
• M ention the name in conversation
• E xaggerate some special feature

37
Examples of Working Memory Exercises Making
change mentally Solving anagrams Estimating
costs and benefits Playing logical memory
rehearsal game Scenario generation game
38
Cognitive Mnemonics

• SOLVE
• S pecify the Problem
• O ptions
• L isten to others advice
• V ary the solution
• E valuate the result
• LISTEN
• L ook at the person
• I nterest in the conversation
• S peak less than half the time
• T ry not to interrupt or change topic
• E valuate what is said
• N otice body language

39
Decision Making
D o not procrastinate Decide to begin E
valuate your options choose those that are
WIN-WIN C reate new options when others wont
do I nvestigate existing policies limit what
you choose D iscuss the decision with others
listen to their advice E valuate your feelings
before acting think twice
40
Incidental Learning

• Idea Learning without awareness
• Training Posters, Computer Reminding Software,
  Screen Savers
• Result Learning occurs within an hour
• Applications Screen savers for teaching memory
  and social skills, posters around the home,
  Auditory reminders for cuing medications.

41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
Incentive and Memory

• Idea Incentives dramatically improve cognitive
  performance
• Training Provide money or personally relevant
  reinforcers to stimulate performance.
• Result Monetary incentives facilitate storage
  and retrieval of information in memory.

45
Using Incentives

• Discover clients current needs and interests
• Manipulated social relationships
• Direct payment
• Addictions as an incentive
• Create goals and chart progress
• Make incentives believable and feasible to
  achieve.
• Contingency management.

46

• Selected Topics

47
Social Skills Training

• Idea Practice appropriate social behavior
• Training Voice inflections, facial expression,
  body language, time management, social memory
• Result Improved social acceptance
• Applications Family, work, training.

48
References

• Parente, R., Anderson-Parente, J.K., Stapleton,
  M. (2001). The use of rhymes and mnemonics for
  teaching cognitive skills to persons with
  acquired brain injury, Brain Injury Source, 5(1),
  16-19.
• Parente, R., Stapleton, M. (1999). Development
  of a cognitive strategies group for vocational
  training after traumatic brain injury.
  NeuroRehabilitation, 13, 12-30.

49
Making yourself clear Listening Eye
contact Controlling Anger Controlling
Impulses Solving problems Making Decisions
50
Retraining Listening Skills

• L ook at the person
• I nterest in the conversation
• S peak less than half the time
• T ry not to interrupt or change topic
• E valuate what is said
• N otice body language

51
Listening Skills

• Listening is the social grace
• Of hearing the words and watching the face
• Good listeners speak less than half the time
• They evaluate the reason and the rhyme
• So open your eyes and close your mouth
• Study the face east-west-north-and south
• Listening is both a skill and a choice
• Choose not to hear the sound of your own voice.

52
Eye Contact

• Maintain eye contact when you speak
• Eye contact tells others that you are not meek
• Notice changes in posture and face
• These signal disgust, awkwardness, or even
  disgrace
• Study the details of the body and face
• Remember, eye contact is a big part of social
  grace.

53
Controlling Anger

• Anticipate those things that trigger your rage
• Never act in anger act your age
• Go through the CALM sequence return assuaged
• Evaluate the situation in retrospect
• Review how you coped - reflect

54
CALM sequence

• Call someone you know
• Allow your emotions to flow
• Leave the situation avoid the fray
• Move about get out of angers way

55
Controlling Impulses
Does what I want to do or say create more
problems than it solves? This question will make
you think, of all that is involved. It quells the
impulse, soothes the urge, it makes you think and
wait. Now ask the right question, while you
hesitate. Does what I want to do or say solve
more problems than it creates? If it does then do
it but if it does not then dont If you follow
this simple rule, then the things you want will
happen - and the things you dont want wont
56
Psychosocial Memory Skills Training

• Remembering to remember others
• Prosthetic reminders of important dates.
• Sending cards for special events
• Remembering likes and dislikes
• Remembering what not to do or say

57
Prosthetic Devices

• Idea Provide a device that obviates the memory
  or cognitive problem
• Training Set up the device for the client and
  teach him or her to use it.
• Result Immediate resolution of the problem.
• Applications Memory and routine cognitive
  processing.

58
Use Prosthetic Devices

• Digital recorders
• Personal Organizers (e.g, Palm Pilot)
• Timex/Microsoft watch
• Sticky note pads
• Personal signs
• Appointment calendars
• Automatic bill payment
• Device controllers for the home
• Cognitive Art

59
Cognitive Art

• Make therapy conspicuous
• Mug designs
• Screen savers
• T-shirts
• Posters
• Artistic creations
• Poetry therapy

60
Neurotraining

• Idea Train concentration via biofeedback
• Training Biofeedback or EEG devices
• Result Task teaches client what it feels like to
  concentrate
• Application ADD training, memory training,
  sustained vigilance.

61
What Is Neurotherapy

• EEG and biofeedback monitoring
• Client learns to recognize specific
• EEG patterns
• EEG or biofeedback correlated
• with performance

62
http//www.wilddivine.com/
63
http//www.playattention.com/
64
http//www.thoughttechnology.com/software.htm
65
http//www.mindmodulations.com/prodthou.html
66
http//www.other90.com/
67
Applications

• Seizure control
• ADHD
• Substance abuse
• Anxiety disorders
• Mood disorders
• Memory training

68
Efficacy

• Generally positive findings
• Generally efficacious for seizure control
• Few class 1 studies
• Few standardized measures or paradigms

69
Issues

• Still in experimental stages
• Efficacy similar to CRT Generalization?
• Insurance reimbursement issues
• Training for therapists
• Equipment availability

70
Evaluation

• Clients can learn to control EEG and Physiology
• Cognition correlated with EEG
• Equipment relatively inexpensive
• Efficacy not yet established
• No standard treatment models
• Equipment not generally available

71
Maintaining Hope After TBI

• Rebecca Wilber MA
• Rick Parente Ph.D.
• Towson University

72
Maintining Hope After Traumatic Brain Injury

• The level of hope that clients exhibit upon
  exiting therapy correlates with prognosis, level
  of functioning after therapy, clients potential
  for suicide and relapse (Cutcliff, 2002 Kuyken,
• These findings suggest that it is possible to
  increase a clients hope and that these
  improvements may determine prognosis and outcome
  outside of therapy.
• Although there are several operational
  definitions, scales, and measures of hope, there
  is very little research on the efficacy of
  specific techniques to improve hope levels in
  clients.

73
What is Hope?
Possible synonyms for hope self-efficacy,
problem-solving, self-esteem, learned optimism,
attachment perspective, and subconscious goal
setting (Irving et al. 2004 Shorey et al. 2002
Snyder, 2002). The core of hope theory The
obstacles a person faces in life modifies his or
her behavior but that hope derives from the
potential success of the goals that one sets to
overcome these obstacles (Irving et al. 2004
Snyder 2000 Snyder, Harris, Anderson, Holleran,
Irving, Sigmon, 1991). Two elements of Hope
Pathways belief that he or she will be able to
implement a solution and Agencies the
demonstrated motivation to implement these
strategies.
74
Correlates of Hope

• Clients who lack hope and exhibit high levels of
  depression have correspondingly high levels of
  suicidal thoughts and will often develop
  elaborate plans for their suicide (Cutcliffe,
  2002).
• Snyder et al. (1991) reported that hope was
  inversely related to depression.
• Hopelessness describes depression, and mediates
  its course through inhibiting the persons
  ability to generate adaptive beliefs and
  solutions to problems, (Kuyken, 2004 p. 632).

75
What Is Hope?

• Two components of Hope, goals are attained
  through pathway thinking, and agency perception.
• Teaching Pathway Thinking teach clients to learn
  new skills and options to use while pursuing a
  goal.
• Teaching Agency Perception Put clients through a
  procedure that actually implements possible
  pathways and evaluates their outcome.
• First Step Determine if clients understand the
  concept of pathways and Agencies.
• Result Clients do not understand these
  concepts. They do understand Options (Pathways)
  and Actions (Agencies)

76
Ratings and Rankings

• Treatment Hope Options Actions
• Functional Skills 1 1 1
• Procedural Learning 2 7 6
• Attn-Concen 2 6 3
• Social Skills 2 1 2
• Rehearsal 3 2 4
• Prosthetics 3 5 8
• Memory 4 2 5
• Academics 4 2 5
• Incidental 5 4 6
• Process 6 6 7
• Neurotraining 7 9 9
• Nutrients-Drugs 8 3 8
• Stimulation 9 10 10
• Domain-Specific 10 8 11
• Iconic 11 11 12

77
Continued Hope Research

• What CRT procedures create hope?
• What other factors create hope?
• To what extent does trained hope
• - improve outcome?
• - generalize?