Show Menu
Cheatography

Functional Cognition Assessment & Intervention Cheat Sheet by

Functional Cognition Assessment & Intervention

image

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”
(neuro­plastic approach)

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
(OT specific)

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
           
 

Comments

No comments yet. Add yours below!

Add a Comment

Your Comment

Please enter your name.

    Please enter your email address

      Please enter your Comment.

          Related Cheat Sheets

          Paediatric Respiratory Assessment Cheat Sheet
          Functional Cog Intervention Cheat Sheet
          Foundation of Cognition Cheat Sheet

          More Cheat Sheets by prinsam98

          Introduction to Vision Cheat Sheet
          Low Vision Evaluation & Intevention Cheat Sheet
          Intro to Oculomotor Function and Visual Perception Cheat Sheet