Cognitive disability Frame of Reference : Hierarchical Levels of cognitive functioning

Question 1

Level 1- Automatic Processing: Individual Characteristics

Answer 1

• Impaired awareness
• Person is conscious
• Has reflexive responses
• Performs basic habits such as eating and drinking
• Primary responses are instinctive

Question 2

Automatic processing : Therapist responses

Answer 2

• Use one word commands
• Provide familiar cues
• e.g. place food within reach, hand individual a fork

Question 3

Level 2- Postural actions : Individual Characteristics

Answer 3

• Awareness of the movements of their own muscle and joints
• Watches movements of others
• Seeks movements that are pleasurable and comfortable
• May be resistive or easily agitated

Question 4

Postural Actions : Therapist responses

Answer 4

• Imitate gross motor actions
• provide simple verbal commands
• e.g. watch me, you try it
• focus is on gross motor movements

Question 5

Level 3: Manual Actions: Individual Characteristics

Answer 5

• Able to attend to external environment
• Tactile cues
• Uses hands to manipulate materials
• Includes seemingly purposeless actions
• Resistive or easily agitated

Question 6

Manual Actions: Therapist Responses

Answer 6

• Imitate manipulation of objects
  e. g. Brushing teeth
• Provide repetitive practice of routine tasks
• Use manually guided instruction

Question 7

Level 4: Goal directed Actions : Individual Characteristics

Answer 7

• Responds to visual motor cues
• Attention is directed one cue at a time
• Actions are more goal directed
• Difficulty correcting errors
• Can attend a 1 hour group

Question 8

Goal Directed Actions: Therapist Responses

Answer 8

• Provide visual demonstration
• Limit instruction to one step at a time
• Make all objects clearly visible
• Provide visual comparisons
• Situation specific training is useful

Question 9

Level 6: Exploratory actions: Individual Characteristics

Answer 9

• Concrete relations are understood, has trouble with abstraction
• Explores
• Trial and error problem solving
• Does not anticipate problems

Question 10

Level 6: Planned actions:

Answer 10

• makes sense of symbolic cues and abstraction
• can plan ahead
• Anticipates error and engages in mental problem solving
• Pauses to think about potential problems

Question 11

Planned actions: Therapist Responses

Answer 11

verbal and written instructions
Diagrams and drawings
Carry out instructions from previous sessions

Question 12

Level 5: Exploratory Actions: Therapist responses

Answer 12

• Visual demonstration with verbal explanation
• select or modify task
• reduce problem solving requirements
• Use concrete examples and explanations
• Assist with planning ahead