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Functional Cognition Assessment & Intervention
Cognitive Skills Screening and Assessments
Routinely used for Cognitive Screening, Non-OT Specific |
Can be Used for Cognitive Testing, OT Specific |
- Mini-Mental Status Examination (MMSE) |
- Cognitive Assessment of Minnesota (CAM) |
- Montreal Cognitive Assessment (MoCA) |
- Lowenstein OT Cognitive Assessment (LOTCA) |
Role of Occupational Therapy in cognition
Occupational therapists focus on functional cognition, or cognition that is necessary within the scope of performing his/her roles, daily occupations within the contexts performed. |
What are Cognitive Skills?
Foundational abilities that make up how we assess functional cognition |
Attention |
Memory |
Problem Solving |
Decision making |
Judgement |
Abstract Reasoning |
Cognitive Skill Hierarchy
Scores on Testing
- Rate cognition mild-severely impaired
- % function impaired—Working Memory is 50% impaired
Best Way to Improve Functional Cognition?
Remediation of Cognitive Skills |
Functional-Based Approach |
Functional Cognition
The interaction of cognitive skills, self-care and community living skills. |
Refers to the thinking and processing skills needed to accomplish complex everyday tasks. |
Where do I begin?
LOW |
MED |
HIGH |
Micro-screens |
Cognition Screenings |
High-level impairment screen |
Basic ADLs |
Basic IADLs (EFPT & PASS |
Complex IADLs (MET & WPCA |
Behavior Ratings (self-report and observation) |
Awareness Questionnaires/Assessments |
Participation Measures (Roles Checklist) |
Tests Chosen are Environment Specific
Learn the scales used in your environment. |
Assess the: |
- Specificity for OT |
- Generalization of scale to function |
- Suitability for goal writing |
If something else needed, implement!!! |
Cognitive Skills Screening and Assessments
Routinely used for Cognitive Screening, Non-OT Specific |
Can be Used for Cognitive Testing, OT Specific |
- Mini-Mental Status Examination (MMSE) |
- Cognitive Assessment of Minnesota (CAM) |
- Montreal Cognitive Assessment (MoCA) |
- Lowenstein OT Cognitive Assessment (LOTCA) |
Cognitive Skill Remediation Intervention
The primary aim of cognitive remediation therapy is to reduce cognitive deficits. “Brain Training” |
Secondary aim is an indirect positive impact on functional deficits affecting everyday life. “TRAIN AND HOPE” |
- Formal or informal computer-based programs |
- Table-top cognitive activities |
- Formal programs, “Attention Process Training” |
Cognitive Retraining or Cognitive Remediation
Systematic practice in activities or exercises that are designed to improve the underlying cognitive skills or impairments |
Computer-based cognitive remedial programs |
Virtual reality and simultaneous to enhance cognitive performance |
Table top or paper/pencil exercises or worksheets |
Brain Plasticity
Brain Plasticity Finding Supports Practice of Focused Skills |
Experience and practice have been found to change the organization and structural connectivity of the cerebral cortex… |
Experience dependent changes can occur at multiple levels of the CNS synaptic level, changes in cortical maps and large scale neural networks |
Neural plasticity mechanisms are enhance by…
Exposure to novelty |
Repetition |
Cognitive challenge |
Active engagement (salience) |
Computerized Cog Rehab
Focused training on specific impairment |
Intensity, repetition, and consistent practice |
Requires adaptive features (trains at the edge of ability – just right challenge!) |
Novel & variability |
Active engagement & motivation |
Feedback is immediate via scores and time |
May be combined with self-awareness strategies using coaching methods to connect to “everyday life” |
How Do We Assess In a Function-Based Approach?
Functional Cognition |
- Skilled Observation |
- Standardized Test of Observed Performance |
Skilled Observation
To measure functional cognition, we need to OBSERVE functional performance during a task. |
How do cognitive strength’s support Dave’s occupational performance in the kitchen? |
Standard Testing of Observed Performance
Performance Assessment of Self-Care Skills (PASS) |
Executive Function Performance Test |
Complex Work Skills |
Contextual Memory Test |
Weekly Calendar Planning Test |
Function-Based Approach
Concepts for a Function-Based Approach
Generalization (intended outcome of learning) |
Transfer of learned information from one setting to another; hard for typical people, very hard for people post brain insult. |
Metacognition |
Ability to evaluate the difficulty of the task based on your current abilities |
Plan to use strategies to make your performance most efficient & effective, |
Clients with cognitive deficits can not choose efficient strategies to match their current level of function |
Cognitive Strategies |
A type of cognitive support that helps you learn or function successfully. |
Strategies can be chosen independently, with support/collaboration or by the treating OT. |
Strategies are generally used across different settings and within different tasks. |
Principles to Enhance Generalization
Plan for generalization from the beginning of treatment. |
- Client-centered goals and activities. |
- Train with the discharge environment in mind. |
- Select strategies that align with previous habits, routines and roles. |
- When possible, vary environments of practice. |
High dose practice and errorless OR errorful learning depending on severity/prognosis of insult. |
Metacognition
Clients with cognitive deficits can not choose efficient strategies to match their current level of function |
Metacognition requires Awareness of Self |
You will not know or agree to use new strategies. Use of strategies requires understanding of shortcomings. |
Poor awareness requires therapeutic focus on awareness in order to advance metacognition. |
Improving metacognition
Pre-task estimation |
Feedback (peer, video, self-based on task outcome |
Check performance as going |
Self-questioning |
- Did I check my work as I went |
- Did I follow my strategies for success |
Advancing Metacognition for Strategy Use
Once you have greater awareness, you can draw in the use of strategies to more efficiently perform tasks. |
Then have client evaluate their use of proper strategies (did they use them when they were supposed to, how were they reminded to). |
Can they use their metacognitive strategies in a variety of environments & with different facilitators? |
Toglia’s View of Cognitive Dysfunction
Cognitive dysfunction is conceptualized in terms of deficiencies in processing strategies and metacognitive strategies rather than by deficits in specific cognitive skills. |
Failures to use self-regulatory or metacognitive behaviors such as anticipating, monitoring, revising |
Failures in prioritizing, sticking to relevant details, keeping track of personal schedules |
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