Welcome to the Occupational Therapy and Cognition WikiEdit
This Wiki explains the role of occupational therapy in cognitive rehabilitation and lists commonly used cognitive assessments and interventions and is intended to serve as a reference for occupational therapy students, practitioners, and educators. Although occupational therapists can provide cognitive rehabilitation to individuals of all ages, the information provided on this site focuses on the adult population.
• define cognition
• explain how cognitive deficits can impact occupational performance
• apply the OTPF to cognitive rehabilitation
• identify cognitive assessments used in occupational therapy
• identify cognitive interventions used in occupational therapy
Cognition can be defined as information processing functions such as orientation, attention, perception, memory, and problem-solving, which are carried out by the brain (AOTA, 2013).
Cognitive disorders can occur across the lifespan and can be caused by a variety of conditions including stroke, brain injury, congenital conditions, or dementia. Because cognition is essential in learning, retaining, and applying information to daily life, it is presumed that cognitive dysfunction will have an impact on function. Through assessments and interventions targeted toward enhancing occupational performance, occupational therapists can play an important role in cognitive rehabilitation. Treatment domains included overall cognition, attention and executive functions, visuospacial functions, language, memory, and comprehension.
The Occupational Therapy Practice Framework identifies client factors, performance skills, performance patterns, context and environment, and activity demands that occupational therapists must consider throughout the continuum of care. Occupational therapy focuses on occupation-based outcomes. There is a dynamic interaction between cognitive functioning and occupational performance, which warrants the examination of cognition and performance through multiple perspectives. Cognitive rehabilitation can facilitate establishment of cognitive strategies and implementation into both new and routine daily situations impacting occupational performance, self-care, productivity, and leisure.
Occupational therapists can identify cognitive deficits that impact functional performance through standardized assessments and screens. Commonly used assessments include: Mini-Mental State Exam, Allen Cognitive Level Screen, Loewenstein Occupational Therapy Cognitive Assessment, Routine Task Inventory, and Executive Function Performance Test
Mini-Mental State Exam (MMSE): The MMSE is the most commonly used screen for cognitive function. The MMSE examines orientation, attention, learning, calculation, abstraction, information, construction, and delayed recall in the form of a brief 30-point questionnaire test. There is no special training required to administer the assessment, and validity and reliability of the MMSE has been determined, specifically for the diagnosis of Alzheimer's Disease. The MMSE may be ideal for an initial assessment given its proven ability to predict outcomes along with the timeliness and simplicity of administration (Zwecker et al, 2002).
Allen Cognitive Level Screen (ACLS): The ACLS is used to detect cognitive deficits and assess global cognitive processing capacities, learning potential, and performance skills. The screen includes three visual motor tasks (leather lacing activity) which become increasingly complex (running stitch, whipstitch, and Single Cordovan Stitch). Scores are interpreted using the Allen Cognitive levels and modes of performance.
ACLS Video: https://www.youtube.com/watch?v=RKJLfJfPw7A
Loewenstein Occupational Therapy Cognitive Assessment (LOTCA): The LOTCA is a standardized collection of perceptual tests which assess basic cognitive skills. It is broken down into four major categories (orientation, perception, visumotor organization, and thinking operation) with 20 subsets which are related to rehab potential. This is a more comprehensive evaluation of cognitive status which is more directly associated with the detection of cognitive abilities as they relate the performance of activities of daily living. The LOTCA takes approximately 45 minutes to complete.
Routine Task Inventory: The Routine Task Inventory assesses functional performance during everyday activities using self-report, caregiver report, and observation to determine the degree in which cognitive deficits interfere. Areas being scored include: Physical/ADL, Community/IADL, Communication, and Work Readiness.
The RTI Manual is free to download: http://www.allen-cognitive-network.org/pdf_files/RTIManual2006.pdf
Executive Function Performance Test The EFPT uses a top-down method of assessment to examine executive function skills during the completion of four basic tasks determined essential for independent living and self-maintenance (simple meal-prep, telephone use, medication management, and money management/bill payment). Individuals are asked to complete activities related to the aforementioned skills, and are scored by observation of initiation of task, sequencing, safety/judgment, and task completion. Level of assistance is rated using a 0-5 Likert scale (with 0 being independent).
The EFPT manual is free to download after contacting the author to report reason for use.
Through cognitive training interventions, occupational therapists can improve functional skills. Cognitive interventions include: meta-cognitive training and awareness approaches, specific task training, mental practice, adaptations and modifications, assistive technology, and cognitive retraining embedded in functional activity.
Meta-cognitive training and awareness approaches: Meta-cognition can be defined as "knowing about knowing." A meta-cognitive approach to OT treatment is based on the principle that enhancing awareness of skill and process limitations through self-assessment and self-monitoring can be used to improve independence in self-selected activities (Skidmore et al., 2012). In OT treatment, these activities often include activities of daily living (ADL) such as bathing, dressing, grooming, and functional mobility. Meta-cognitive treatments focus on increasing the individual's awareness and encouraging self-selection of specific compensatory strategies (see mental practice and compensatory strategies).
Mental Practice The use of mental practice or mental imagery is a form of cognitive remediation technique which has been found successful in multiple studies. This technique includes encouraging the individual to rehearse specific tasks in their mind, prior to physically completing the action. This can enhance awareness and facilitate increased occupational performance.
Compensatory Strategies Adaptations and modifications can be used to improve the match between the individual's abilities and the demands of an activity. Compensatory techniques to enhance performance in functional tasks may include: use of social environmental cues, use of physical environmental cues, use and verification of written checklists, reference to personal preferences, or generation of mental images or checklists. Various technologies may also be used to assist individuals with cognitive deficits.
Specific Task Training: This type of cognitive intervention aims to assist individuals with a particular activity. By breaking down the task and allowing the individual to complete the task repetitively, they can learn a routine that decreases the interference of cognitive deficits. Throughout specific task training, errorless learning, or minimization of errors throughout various stages of learning, can be used to improve cognitive skills (AOTA, 2013). Strategies to reduce error during task specific training may include modeling the steps of the task and immediately correcting errors. The amount of cues and prompts decrease as the steps of the task are successfully performed, with the ultimate goal of independent task completion.
Cognitive retraining embedded in functional activity: Addressing cognitive deficits within the context of a functional activity can improve cognitive processes required to carry out the task (AOTA, 2013). For example, providing problem-solving skills during a dressing task vs. a preparatory activity may increase the likelihood of carryover to future dressing tasks.
Benefits of Cognitive Rehabilitation Video: https://www.youtube.com/watch?v=BMHYA5OdcYk
American Occupational Therapy Association (2013). Cognition, cognitive rehabilitation, and occupational performance. American Journal of Occupational Therapy, 67, S09-S31.
Skidmore, E., Holm, M., Whyte, E., Dew, M. A., Dawson, D., & Becker, J. (2011). A case report examining the feasibility of meta-cognitive strategy training in acute inpatient stroke rehabilitation. Neuropsychological Rehabilitation, 21(2), 208-223
Zwecker, M. Shalom, L., Fleisig, Y., Zeilig, G., Ohry, A., Adunsky, A. (2002). Mini-Mental State Examination, Cognitive FIM Instrument, and the Lowenstein Occupational Therapy Cognitive Assessment: Relation to functional outcome of stroke patients.
Additional Web-Based Resources:
• Alzheimer’s Society: http://www.alzheimers.org
• American Occupational Therapy Association: www.aota.org
• American Stroke Association: Cognitive Challenges after Stroke http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/EmotionalBehavioralChallenges/Cognitive-Challenges-After-Stroke_UCM_309904_Article.jsp
• Brainline: Cognitive problems after traumatic brain injury http://www.brainline.org/content/2010/03/cognitive-problems-after-traumatic-brain-injury_pageall.html
• Occupational therapy assessment index: http://mh4ot.com/resources/ot-assessment-index/
• Society for Cognitive Rehabilitation: http://www.societyforcognitiverehab.org/patient-family-resources/what-is-cognitive-rehab.php
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