Cognitive approaches

Question 1

cognitive performance assessments

Answer 1

• interviewing client, and others to determine previous level of functioning and interests
• cognitive screening tools
• performance based assessments
• environmental assessments
• specific cognitive assessment measures

Question 2

Cognition model approaches

Answer 2

• Compensatory/Adaptive approach
• Cognitive disabilities model
• Neurofunctional approach
• Cognitive rehabilitative model
• Dynamic interactional approach
• -multicontext approach

Question 3

Compensatory/Adaptive approach

Answer 3

Top-down approach

• aims to capitalize on person’s assets in order to improve occupational performance
• reduce activity limitations and participation restrictions; minimize barriers,
• activity demand is altered

lower demands of cognition because we want them to participate. modify so they can participate

occupation is the primary focus

Question 4

Cognitive disability model

Answer 4

Suggests cognitive remediation is not a reasonable goal for people with serious cognitive impairments.

Dementia, TBI, Severe Mental Health Disorders

Interventions focus on providing activities to create situations for client’s success.

Goal is an environment which allows client least restrictions while maintaining safety.

Allen battery of assessments

6 hierarchical levels of cognitive functioning

Question 5

cognitive disability levels of function

Answer 5

1) automatic actions- spending a majority of time in bed, have positioning needs, may need assessment for swallowing, work on turning head to locate stimuli, reflex types of movements may be seen.
2) Will be able to initiate some sitting, standing, and walking. May grab objects to prevent their fall. May wonder aimlessly (gross motor is big here)
3) Have perform familiar tasks, make sure we give them cues to initiate (getting them to start, continue, and getting them to stop the task)

4) Working on focusing on one task, task initiate, task completion, work on familiar task can throw in card playing, making a sandwich. They will be operating at a slow pace due to difficulty processing. May ask therapist for help. Have difficulty with problem solving.
- one step at a time instruction.
- visual demonstration

5) Using trial and error with tools, actions, procedures with client. Make sandwich and offer a knife or spoon. May not be able to complete complex tasks (cleaning, shopping, preparing a meal, spending money) tend to be selfish and impulsive.

6) Can start planning new activities. Have them help us plan goals. They can anticipate potential problems. Anticipate the effects of their actions. They are a lot more independent, can use their judgement cause they understand abstract concepts.
- can carry out instructions from previous sessions.

Question 6

Neurofunctional approach

Answer 6

Focus is retraining real-world skills or the functional task.
-Developed for people with independent living goals after TBI, can be used with people after stroke and other required neurological impairments.

*client centered goal development

Emphasis is on functional task training not retraining cognitive processes.

Mastery of functional skills through practice.

• only focused on one task at a time,
• best in a natural context to encourage generalization and manage the dynamic nature of environment.
• Strive for behavioral automaticity. Becoming a habit which will eventually become a routine.
• works on increasing generalization
• use task analysis, reinforcement, chaining

Question 7

Cognitive rehabilitation approach

Answer 7

Focuses on the impairment underlying a client’s disability.
-Aims to change, promote, enhance brain recovery and reorganization.

Want to improve skills-bottom up

• Goals is to improve or restore cognitive skills.
• for those with minimal to moderate specific cognitive deficits.

Intervention-

• graded cognitive exercises
• Pencil and paper tasks
• computer-based training.

Essential-

• repetition
• rehearsal

Rehab model-
go from simple to complex to bring them to a higher functional level.
-increase complexity of tasks with learned strategies, then practice strategies in real-life situations.

• Enhancing remaining abilities
• Use remedial cognitive-training strategies
• Develop learning strategies
• Procedural strategies

Question 8

Dynamic interactional approach

Answer 8

• developed for persons with stroke, tbi, but also good for those with cognitive dysfunction.
• Occupation based model.
• interplay between person, task, and environment and how different relationships work.

-reflective- Do they know their strengths and their weaknesses. Self awareness.

Self-monitoring- can they predict what is going on. feeling tired I don’t know if I will remember the steps I need so I will use this to help me complete the task.

Question 9

Multicontext approach

Answer 9

extension of dynamic interactional model.
- Overall goal to help client gain control over symptoms and develop effective strategies for independence.

-working with client who is working with themselves.

Question 10

Strategy training

Answer 10

facilitates transfer of learning from one situation to next.
-clients practice using a targeted cognitive strategy across occupation-based activities.

So they are able to do a task in multiple environments.

Use cognitive strategy with increasing demands of task.