CVA zorg, topsport voor ons allemaal. Dinsdag 11 april 2017

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1 CVA zorg, topsport voor ons allemaal Dinsdag 11 april 2017

2 CVA: focus op de onzichtbare gevolgen en gedrag Ingrid Brands, MD, PhD Revalidatiearts Blixembosch

3 De impact Stroke: 78% has cognitive complaints 70% experiences mental slowness, 40% memory deficits Hochstenbach 1999, Rasquin 2005

4 De impact Brands baseline one-year follow-up 10 0

5 Cognitive functions Executive functionsns Memory Attention Processing speed Perception Mental energy

6 EF Fatigue Memory Attention Processing speed Perception Mental energy Frequently associated with depression, poor physical fitness, mental slowness Energy management training Physical exercise

7 Neglect NEGLECT EF Predominantly right Memory hemispheric lesions Attention Disorder of attention Processing speed Incidence: 13-81% Perception For all sensory modalities Personal Mental space, energy nearby, far away Associated with worse functional outcome Visual scanning compensation training Prisms / Training on the job

8 Attention Arousal Gerichte of selectieve aandacht Verdeelde aandacht Volgehouden aandacht EF Memory Attention/Pro cessing speed Perception Mental energy

9 Memory KORTE TERMIJN GEHEUGEN = WERKGEHEUGEN» Kortdurend vasthouden» Bewerken» Planning complexe taken met veel executieve controle EF Memory Attention/Proc essing speed Perception Mental energy

10 Memory KORTE TERMIJN GEHEUGEN = WERKGEHEUGEN» Kortdurend vasthouden» Bewerken» Planning complexe taken met veel executieve controle LANGE TERMIJN GEHEUGEN: onbeperkte capaciteit» DECLARATIEF-EXPLICIET-BEWUST geheugen afgeleid uit ervaringen, gebeurtenissen consciousaccess (episodisch, semantisch, prospectief)» PROCEDUREEL-AUTOMATISCH geheugen automatisch leren van motorische en cognitieve vaardigheden no conscious access

11 Attention / Memory Computerized training is an option. DO NOT use standard games Strategy training Adaptation environment

12 Memory Compensatory strategies for mild impairments Internal strategies External strategies Most effective in patients functioning independently, with good insight and motivation Training of specific skills in functional situations for moderate to severe impairments: Errorless learning

13 Executive functions Awareness Goal setting Planning/organisation Initiative and execution Regulation and self-control Flexibility and problem-solving Self-inhibition Strategic behaviour EF Memory Attention Processing speed Perception Mental energy

14 Executive functions Strategies for self-monitoring and self-regulation Problem-solving strategies for use in everyday situations and functional activities

15 Communication COGNITIVE COMMUNICATON PROBLEMS Ramble from one subject to another Missing the context Inappropriate Difficulties with interpretation of non verbal language Difficulties with interpretation of metaphorical language, humour

16 Ziekteinzicht

17 Ziekteinzicht Crosson: Intellectualawareness Emergentawareness Anticipatoryawareness Prigatano: Neurologically based impaired awareness Psychological denial: avoidance or defensive coping Meer inzicht, betere uitkomst revalidatie

18 Gedrag Te weinig Initiatiefverlies/armoede Apathie Verminderde empathie Te veel Versnelde geïrriteerdheid Agressie Eerst analyse, dan pas behandeling

19 Gedrag Belang van structuur en goede energiebalans De kunst van het onderbelasten Omgeving: Managen van verwachtingen Adviezen tav interactie

20 Take Home Message Impact van cognitieve stoornissen wordt onderschat. Bij vermoeden gebruik de signaleringslijst Vraag vanaf vandaag altijd naar taalproblemen Wees zeer alert op aanwezigheid van overbelasting Zeer vaak de oorzaak van problemen in gedrag, stemming