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Behavior FOR 5 components

 the person controlling reinforcement “controls” behavior
i. When a given stimulus elicits a new response, learning has occurred
ii. Uses behavioral strategies to “control” behavior
1. Rewarding or encouraging behavioral
2. Giving time-outs
3. Negotiating written/verbal contracts
4. Writing behavioral goal statements
iii. Adaptive behaviors contribute to skills in one’s living environment
1. Performance skills are considered behaviors
iv. Maladaptive behaviors create obstacles to function, and result from faulty learning, not disease
v. Skill/behavioral repertoire – skills that one has learned and has available in a given situation


Behavior FOR what is behavior? methods of assessment and assessment instruments

vi. Behavior
1. is what a person *does*
2. is learned
3. Can be overt or covert
4. Can be measured by three dimensions:
a. intensity
b. frequency
c. duration
vii. Methods of assessment
1. Structured interview
2. Behavior rating scales
3. Batteries of structured task experiences
4. Observation in simulated settings
5. Observation in natural setting
viii. Assessment Instruments
1. Behavioral Database
2. Behavioral Self-Inventory
4. Comprehensive Occupational Therapy Evaluation
5. Bay Area Functional Performance


Cognitive behavioral approach 3 components and hallmarks

i. Seeks to change the thoughts believed to influence behavior and to develop a knowledge base for problem solving
ii. Changing the thoughts  will change the behavior  will improve daily functioning
1. Improved self-knowledge and self-efficacy gives more confidence for handling new situations
iii. Result of OT’s selecting cognitive and behavioral concepts and relating to Allen’s cognitive disability theory
iv. Hallmarks
1. Broadening client’s knowledge
2. Improving the application of knowledge in skill building
3. Improving problem solving ability


Cognitive behavioral approach Types of CBT and assessment instruments

1. Coping skills training
2. Problem-solving strategies
3. Rational Emotive Therapy
a. Cognitive methods used to dispute beliefs, cognitive homework, use of new self-statements
4. Beck’s Cognitive Therapy
a. Affect and behavior are determined by the way he/she thinks about the world, which is based on internal/external, past/present experiences
5. Meichenbaum
a. The way we talk and interact with other changes the way we think and behave
b. Think aloud protocol: ask self FOUR questions to help plan and monitor behavior
i. What is my problem?
ii. What is my plan?
iii. Am I using my plan?
iv. How did I do?
6. Assessment Instruments
a. Task Checklist
b. Beck’s Depression Inventory
c. Rotter’s Internal-External Scale


Who founded the cognitive disability approach and what is it 2 components?

c. Cognitive Disability  Claudia Allen,
i. Describes the nature of cognitive processing impairments that effect normal function
1. Cognitive and behavior changes of mental illness result from biological changes in the brain
ii. Appropriate with chronic mental illness as well as central nervous system disorder


Cognitive levels of cognitive disability



Instruments used for cognitive disability

ix. Assessment Instruments
1. ACLS/LACLS: appropriate for 3.0-5.8. Not for those confused or at a very high level
2. Lower Cognitive Level Test
3. Routine Task Inventory
4. Cognitive Performance Test
5. Allen Diagnostic Modules


What is psychoeducational

i. Seeks to establish a knowledge base and change the client’s thoughts about themselves from incapable to capable


Psychodynamic three components

i. Psychological constructs are believed to account for one’s occupation/social behavior – concerned with “inner life”
ii. Definition: provides an explanation for how mental processes influence one’s selection of, participation in, and satisfaction with occupation
iii. Based on Freud’s theories
1. Psychoanalysis is the interpretation of the patient’s behavior
2. Conscious, unconscious, subconscious
3. Three aspects of personality


Psychodynamic id, ego and superego

a. Id: non-logical, cannot tell difference between reality and fantasy
b. Ego: organizer of personality -- strives to satisfy, bring pleasure, deal with reality
i. OT’s purpose is to build or reconstruct a more healthy ego
ii. Psychoses occur when ego’s function is impaired
iii. The more impaired the ego, the less one can control behavior or make sound judgments
1. When patient is psychotic, OT must attend to:
a. Safety
b. Structure of task environment
c. Reduce demands of decisionmaking
c. Superego: inner voice that parents, evokes guilt or pride


Psychodynamic assessment instruments

1. Azima Battery
2. Shoemyen Battery
3. Goodman Battery
4. Barbara Hemphill Battery
5. Human Figure drawing
6. Build-a-City


ACL running stitch score

a. Running Stitch
3.0 Grasps leather or pushes it away. May not attempt to grasp the lacing or may grasp the leather lacing when handed to the person and moves leather lacing in a random manner.
3.2 Pushes needle through at least one hole, which can be the wrong location. May skip holes.
3.4 Completes at least 3 running stitches with no more than two demonstrations. Does not skip holes


ACL whip stitch score

b. Whipstitch
3.6 - Does at least one whipstitch in the correct location; no skipped holes.
3.8 - Does not recognize twist, cross errors in back when cued. Does recognize running stitch error, but is unconcerned about error. May continue until out of space. May say, "Am I done?"
4.0 - Does recognize twists or the cross in back as an error when pointed out. Does not attempt to correct twist or cross errors. Corrects running stitch errors on back when pointed out.
4.2 - Corrects twists by redoing the last stitch. Does not untwist while lacing is still in the hole. Corrects errors in cross in back.
4.4 - Can untwist at least one whipstitch without pulling it out. Stops after 3 stitches.


ACL single cordovan score

c. Single Cordovan
5.8 - Completes 3 single cordovan stitches without a demonstration or a verbal cue by examining the sample stitches and using trial and error.
5.6 - Completes 3 single cordovan stitches without a demonstration but requires a cue (verbal or pointing to location of error) to do the stitch correctly.
5.4 - One (but only one) demonstration is given. Corrects errors in directionality, tangled lacing, or tightening in sequence without a second demonstration by altering actions two or more times.
The following scores are after Second Demonstration is Given:
5.2 - Corrects errors in directionality, tangled lacing, or tightening in sequence with a second demonstration. The loops are tightened in sequence; the tension may be a little loose but no other errors remain.
5.0 -Corrects errors in directionality, tangled lacing, or tightening in sequence but cannot replicate solutions. A little improvement or alteration occurs with a second demonstration but errors remain.
4.8 - Lacing is not tightened in sequence (hole then loop), just pulls on needle, may or may not recognize error. Little to no improvement is noted with first or second demonstration.
4.6 - Right/left orientation of lacing and needle are incorrect when going through the loop. Little to no improvement is noted with first or second demonstration.
4.4 - Goes from front to back through the hole (like the whipstitch) but inserts needle through loop from the back as if it were one step. (Lacing is under loop but does not wrap around it.) Or, directionality goes front to back through the hole but back to front through the loop or vice versa. Does not benefit from first and second demonstration.
4.2 - Repeats the whipstitch or does the whipstitch followed by an attempt to do a second unrelated step. Does not benefit from first and second demonstration.


MOHO assessment instruments and interviews

viii. Assessment Instruments
1. Self-Report
a. Role checklist
b. Interest checklist
c. Occupational questionnaire
d. Self-assessment of occupational functioning
2. Interviews
a. Occupational Case Analysis Interview and Rating Scale
b. Assessment of Occupational Functioning
c. Occupational Performance History Interview
d. Worker Role Interview


Cognitive level 1

Automatic actions Impaired awareness, but person is conscious & has reflexive responses. Can perform only basic habits – eating & drinking. Responses instinctive.Grooming, bathing, dressing, & other care must be provided. Patient often restricted to bed. Seen in patients with head trauma, stroke, & severe dementia


Cognitive level 2

Postural actions Aware of movements of their muscles & joints. Watches movement of others. Seeks movements that are pleasurable or comfortable. May be resistive or easily agitated. May be able to assist caregivers in some self-care tasks. May follow others, pace, & wander. Seen in patients with severe psychosis, head trauma, CVA, & dementia


Cognitive level 3

Manual actions (ACLS administered here*) Able to attend to the external environment – tactile cues. Can use hands to manipulate things. May includes actions that seem purposeless. Easily distracted. Engages in repetitive actions. May need much reminding in order to complete a task. 24-hour supervision suggested. Seen in patients with dementia, acute mania, toxic psychosis, & acute schizophrenia


Cognitive level 4

Goal-directed actions Can respond to visual motor cues. Attention is directed to one cue at a time. Actions are sequenced into goal directions that can be identified & remembered. Can carry out familiar routines, but unable to problem solve in new situations. Difficulty correcting errors. Can attend to 1-hour group. Pays attention to the visible, does not notice what is out of sight. Cannot cope with unexpected events. Requires caregiver assistance. Seen in patients with mild dementia, acute manic episodes, & chronic schizophrenia


Cognitive level 5

Exploratory actions Concrete things are understood, abstract are difficult. Use trial & error problem-solving. Does not anticipate problems. New learning occurs. ADLs can be performed without difficulty.Some difficulty with IADLs. Seen in patients with affective disorders, personality disorders, schizophrenia


Cognitive level 6

Planned actions Can make sense of abstract concepts & symbolic cues. Can plan ahead. Anticipates errors & uses problem-solving strategies, thinks about potential problems. The absence of disability. Behavior is organized.