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Canada (158,171)
Psychology (9,565)
PSYC31H3 (100)
Chapter 11

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University of Toronto Scarborough
Zachariah Campbell

Chapter 11: Prognosis and Treatment Planning Prognosis: ability to forecast or predict the long-term pattern of recovery following injury or disease • Estimation of individuals ability to return to premorbid level of functioning Treatment plan: following brain injury or disease, the process by which one or more professionals formulate a specific plan of action or treatment to ensure the most comprehensive or complete pattern of recovery for the patient Premorbid Patient Factors Intellectual Abilities Premorbid functioning: level of functioning of any ability of the individual that was present prior to the injury and now may have been lost or changed Crystallized intelligence: refers to acquired skills and the use of the knowledge in activities such as work or hobbies • These usually decline less with age, accident, or illness • People tend to practice over these • Related to formal education and life experiences • According WAIS-III Vocabulary, Information, Comprehencion, and Arithmetic show the least decline with age • Higher levels of crystallized intelligence may be a protective factor or a cognitive resource against dementia Fluid intelligence: involves novel reasoning and use of information to deal with unfamiliar problem or to gain new types of knowledge • Tends to decline with aging Brain size: it’s been found that brain size contributes to ability level which is also related to academic achievement – modest correlation however • Does not prove that nature is more important in nature vs. nurture debate • Brain disease or injury does reduce brain tissue and in turn reduces mental abilities and social skills Have found a consistent relationship between estimated/known premorbid ability and level of cognitive impairment after disease/injury • “Brain reserve capacity” – amount of BRC represents structural or physiological brain advantages or disadvantages o Advantage: higher education levels, higher test scores both premorbid/postmorbid, and better level of functioning of brain after diease/injury Education has effect – more education = better score on neuropsychological tests, even with impairment • More control over processing • Greater conceptualization ability = more cognitive reserve Illiteracy can affect development of cognitive abilities, processing strategies, processing pathways, and functional brain organization • Normative data often doesn’t include people who are illiterate More intelligence + more education = potentially greater cognitive reserve after brain impairment = potential to sustain more damage and be able to function well afterward • Research has shown that those with lower premorbid intelligence or education tend to place themselves in situations where they are more likely to incur damage • Those with higher levels are more likely to understand goals of rehabilitation and have motivation to follow them • Better educated tend to complain more about difficulties Personality Factors Personality can have effect on how people cope after injury • Affect quality of adjustment • Possible handicaps • Ability to benefit from any rehab • Level of expectation of recovery Some injuries can increase premorbid personality (short temper before injury, very very short temper afterwards) Effects of premorbid personality may not become apparent until patient needs emotional or social support outside a hospital • Those that are more stable are more likely to be offered help • Those that are antisocial may not have developed a social network or friendships that would be useful after injury Social Support Network In order for an individual to make as positive a recovery as possible from a central nervous system difficulty, it is necessary to have support from others. • Support has to be positive in order for this to work Has been shown to reduce physiological and neuroendocrine responses to stress. Warm social contact can release oxytocin, which may be linked to lower stress response. Age 1. Age that injury was sustained is important 2. Certain ages where people are more at risk for certain types of central nervous system difficulties and trying to prevent those is crucial 3. Normal course of aging is explored to compare to factors that may be accident or disease related Often thought that there exist two particularly important age periods for central nervous system. Central nervous system is generally thought to not be adequately developed from birth to age 5. New research is saying that development may continue until the 20s – adolescents still have structural growth going on • Corpus callosum thickens – improves information processing o May be thicker when teens resist peer pressure • Cerebral cortex does not finish maturing until 18-25 Patient that receives injury or disease at young age may not be able to complete all development • However, children show less behavioural affects and recover faster from difficulties • Seems to be due to plasticity: flexibility of the brain which allows the individual to recover from some type of injury because other parts of the brain take over the lost function o More widespread in children, more limited in adults Ages 15-24, tends to engage in more risky behaviours. • May be experimenting with drugs or alcohol and then engaging in riskier behaviours Normal aging • It’s not normal to get dementia – however, more cases of the difficulty arise in older populations • Technology is allowing people to live longer o Are issues just coming from age or from a disease? Central nervous system changes with age – gets slower. Major changes are not expected and may be symptom of issue. Normal changes: • Decline in brain volume • Cortical atrophy – larger sulci, narrower gyri, thinning of cortical mantle, increasing dilating of the ventricles, changes in temporal lobes Those who scored higher on intelligence scores were less likely to develop dementia Gender Who’s better – very controversial • Motor skills – men (target throwing and catching); women (fine motor skills) • Spatial analysis – men (spatial rotation, spatial navigation, geographical knowledge); women (spatial memory) • Math – women (computational); men (mathematical reasoning) • Perception – women (sensitivity to sensory stimuli, perceptual speed, sensitivity to facial and body expression, visual recognition memory) • Verbal abilities favoured women in area of fluency and verbal memory Male brain are larger than female brains, even when accounting for different body sizes. • Men have more gray matter • Women’s gray matter is organized differently Lateral symmetry is less pronounced in women Lateral asymmetry: comparable areas of either brain hemispheres which do not have similar functions or structure • Men have more L.A. in the planum temporal – left larger than right • Men have more asymmetry in the Sylvian fissure o These two may lead to a sex-difference in organization of language- related functions • Women may have more interhemispheric connections • Women have larger
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