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Functional Cognition Assessment & Intervention
Cognitive Skills Screening and AssessmentsRoutinely 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 cognitionOccupational 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 CognitionThe 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 SpecificLearn 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 AssessmentsRoutinely 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 InterventionThe 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 RemediationSystematic 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 PlasticityBrain 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 RehabFocused 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 ObservationTo 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 PerformancePerformance 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 ApproachGeneralization (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 GeneralizationPlan 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. |
MetacognitionClients 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 metacognitionPre-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 UseOnce 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 DysfunctionCognitive 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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