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