Cognitive-perceptual approaches (ch 13)

Question 1

what is perception?

Answer 1

the integration/interpretation of sensory impressions received from the environment into psychologically meaningful information

Question 2

what is cognition?

Answer 2

the ability of the brain to process, store, retrieve, and manipulate information. It involves the skills of understanding and knowing, the ability to judge and make decisions, and an overall environmental awareness.

Question 3

cognitive-perceptual deficits occur as a result of multiple pathologies including…

Answer 3

CVA, TBI, neoplasms (tumor), acquired diseases, psychiatric disorders, and/or developmental disabilities

Question 4

functional impairments of cognitive-perceptual deficits

Answer 4

-impaired alertness/arousal, astereognosis, impaired attention, ideational apraxia, motor apraxia/ideomotor apraxia, long term memory loss, short-term memory loss, impaired organization/sequencing, right-left indiscrimination, body scheme disorders, spatial relations impairment, asomatognosia, topographical disorientation, unilateral body neglect, unilateral spatial neglect, figure/ground dysfunction, anosognosia, perseveration, acalculia, alexia, agraphia, impaired problem-solving, disorientation, anomia, Broca’s aphasia, Wernicke’s aphasia, global aphasia, agnosia, executive dysfunction (or dysexecutive syndrome)

Question 5

what is ideational apraxia?

Answer 5

breakdown in the knowledge of what is to be done or how to perform; lack of knowledge regarding object use.

Question 6

what is anosognosia?

Answer 6

unawareness of motor deficit; may be related to lack of insight regarding disabilities.

Question 7

what is perseveration?

Answer 7

continuation or repetition of a motor act (premotor perseveration) or task (prefrontal perseveration)

Question 8

what is alexia?

Answer 8

the acquired inability to read.

Question 9

what is agraphia?

Answer 9

the acquired inability to write

Question 10

what is dysexecutive syndrome?

Answer 10

impairments related to multiple specific function; such as decision-making, problem solving, planning, task switching, modifying behavior in the light of new information, self-correction, generating strategies, formulating goals, and sequencing complex actions.

Question 11

what is visual acuity?

Answer 11

the clarity of vision both near and far

Question 12

what is visual field?

Answer 12

the available vision to the right, left, superior, and inferior.

Question 13

what is ideomotor apraxia?

Answer 13

loss of access to kinesthetic memory so that purposeful movement cannot be achieved because of ineffective motor planning although sensation, movement, and coordination are intact.

Question 14

what is somatagnosia?

Answer 14

inability to correctly identify/orient parts of own or others’ body. person attempts to dress therapist’s arm, may attempt to brush teeth of his mirror image, etc.

Question 15

Allen Cognitive Level test

Answer 15

Used with psychiatric disorders, acquired brain injury, and/or dementia; used as a screening tool to estimate an individual’s cognitive level. Levels 1-6. 3 leather lacing stitches progressing in complexity.

Question 16

Arnadottir OT Neurobehavioral Evaluation (A-ONE)

Answer 16

Use with adults presenting with cognitive/perceptual (neurobehavioral)deficits by evaluators who’ve completed A-ONE training. Structured observations of BADL and mobility skills are performed to detect underlying neurobehavioral dysfunction. A system of error analysis is utilized to document the underlying performance components (neglect, spatial dysfunction, body scheme disorder, apraxia) that have direct impact on daily living skills.
Scoring: Functional Independence Scale 0=unable to 4= independent; Neurobehavioral Specific Impairment Scale with 0= no problem to 4= unable to perform.

Question 17

Assessment of Motor and Process Skills (AMPS)

Answer 17

age 3+, any diagnosis, only OTs trained in AMPS. Examine’s person’s functional competence in 2-3 familiar and chosen BADL or IADL tasks; patient chooses activities from list of 80 standardized tests; OT observes and documents the motor and process skills that interfere with task performance. 1= deficit to 4= competent.

Question 18

Behavioral Inattention Test

Answer 18

Used with adults presenting with unilateral neglect. Examines the presence of neglect and its impact on functional task performance; 9 activity-based subtests, 6 pen/paper subtests.

Question 19

Catherine Bergego Scale

Answer 19

Standardized checklist to detect presence and degree of unilateral neglect during observation of everyday situations; also measures self-awareness of behavioral neglect. Functional scale consisting of 10 items related to neglect in everyday life is used (dressing, washing, eating, communicating, exploratory activities and moving around).

Question 20

Cognistat Neurobehavioral Cognitive Status Examination

Answer 20

explores, quantifies, and describes performance in central areas of brain-behavior relations. Includes level of consciousness, orientation, attention, language, constructional ability, memory, calculations, and reasoning. Usually less than 45 minutes is needed for administration.

Question 21

Executive Function Performance Test (EFPT)

Answer 21

Assesses executive function deficits during the performance of real-world tasks (includes cooking oatmeal, making a phone call, managing medications, and paying a bill). A structured cueing and scoring system is used to assess initiation, organization, safety, and task completion and to develop cuing strategies.

Question 22

Lowenstein Occupational Therapy Cognitive Assessment (LOTCA)

Answer 22

For patients with stroke, TBI, or tumor; measures basic cognitive functions that are prerequisite for managing everyday tasks; consists of 20 subtests in 5 areas: orientation, visual, spatial perception, visual motor organization, and thinking operations. Abilities scored 1= low ability to 4= high ability.

Question 23

Mini-Mental State Exam (MMSE) or Folstein Test

Answer 23

Brief 30-point questionnaire test used to screen for cognitive impairment (commonly dementia).

Question 24

Montreal Cognitive Assessment (MOCA)

Answer 24

A screening for mild cognitive dysfunction; assesses different cognitive domains (attention/concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking calculations, and orientation. 10 minutes to administer. Total possible score= 30 points, 26+ is normal.

Question 25

Rivermead Behavioral Memory Test

Answer 25

Used for patients with memory dysfunction; offers initial eval of person’s memory function; indicates appropriate tx areas; monitors memory skills throughout the rehab program; contains 11 categories with 9 subtests. Score: 0-9= severely impaired memory; 10-16= mod impaired memory; 17-21= poor memory; 22-24=normal

Question 26

Rivermead Perceptual Assessment Battery

Answer 26

For patients age 16+ who are experiencing visual-perceptual deficits after head injury or stroke; consists of 16 performance tests that assess form and color constancy, object completion, figure-ground, body image, inattention, and spatial awareness. Utilizes deficit-specific tasks in isolation from aDL tasks; scoring based on accuracy of task completion and the time taken to complete each task.

Question 27

Cognitive-Perceptual Intervention:

Remedial/Restorative/Transfer of Training Approach

Answer 27

• focuses on restoration of components to increase skill
• deficit specific
• targets cause of symptoms
• emphasizes performance components
• assumes improvements in performance components will result in increased skill
• assumes the cerebral cortex is malleable and can reorganize
• utilizes tabletop and computer activities (example: memory drills, block designs) as tx modalities.

Question 28

Cognitive-Perceptual Intervention:

Compensatory/Adaptive/Functional Approach

Answer 28

• involves repetitive practice of functional tasks
• emphasizes modification. (example: modifying clothing closures by using Velcro instead of buttons)
• activity choice driven by tasks the person needs/wants to perform.
• emphasizes intact skill training
• treats symptoms, no cause
• utilizes techniques of environmental adaptation (example: list of morning routine activities for person with memory loss).
• use of compensatory cognitive strategies requires a level of awareness of deficits.
• enviro modifications may be caregiver driven.
• tx is task specific
• utilizes functional tasks that patient wants/needs to do.

Question 29

Cognitive-Perceptual Intervention:

Information Processing Approach

Answer 29

• provides info on how the patient approaches the task
• investigates how performance changes with cueing
• standardized cues are given to determine their effect on performance (example: “try re-reading the recipe”)
• cues or feedback are utilized to draw attention to relevant features of the task
• investigative questions (example: “why do you think it took so long to get dressed?”)

Question 30

Cognitive-Perceptual Intervention:

Dynamic Interactional Approach

Answer 30

• emphasizes transfer of info from one situation to next
• utilizes varying tx enviros
• practice of targeted strategy with varied tasks/situations
• emphasizes metcognitive skills (ex. self-awareness of deficits) as basis of learning and generalization of learning
• transfer of learning must be taught- not automatic; occurs through graded series of tasks that decrease in similarity
• person’s processing abilities and self-monitoring techniques are used to facilitate learning for different tasks/enviros
• OT utilizes awareness questioning to help the patient detect errors and predict outcomes.

Question 31

Cognitive-Perceptual Intervention:

The Quadraphonic Approach

Answer 31

• based on remediation; and information processing theory and teaching/learning theory.
• micro-perspective includes eval of management of performance component subskills such as attention, memory, motor planning, postural control, and problem solving.
• macro-perspective eval includes use of narratives, interview, occupations.
• makes use of several theories (info processing, teaching/learning eval; neurodevelopmental eval; biomechanical eval).

Question 32

Cognitive-Perceptual Intervention:

Neurofunctional Approach

Answer 32

• based on learning theory
• specifically used for patient’s with acquired neurological impairments
• focuses on retraining real world skills rather than cognitive-perceptual processes
• utilizes an overall adaptive approach but incorporates some remediation components
• tx focused on training specific functional skills in true contexts.

Question 33

Cognitive-Perceptual Intervention:

Cognitive Disabilities Model

Answer 33

• originally developed for use with patients with psychosocial dysfunction; currently also used with patient with neurologic dysfunction and dementia
• describes cognitive function on continuum from level 1 (profoundly impaired) to level 6 (normal).
• each level describes the extent of person’s disability and difficulty in performing occupations
• after level has been established, routine tasks are presented that the person can perform or that have been adapted to he can perform them
• focus is placed on adaptive approaches and strengthening residual abilities

Question 34

Intervention strategies for impaired alertness or arousal

Answer 34

• increase enviro stimuli
• use gross motor activities
• increase sensory stimuli

Question 35

Intervention strategies for motor-ideomotor apraxia

Answer 35

• utilize general verbal cues as opposed to specific.
• decrease manipulation demands
• provide hand over hand tactile-kinesthetic input
• utilize visual cues

Question 36

Intervention strategies for ideational apraxia

Answer 36

• provide step by step instructions
• use hand over hand guiding techniques
• provide opportunities for motor planning and motor execution

Question 37

Intervention strategies for perseveration

Answer 37

• bring perseveration to a conscious level and train the person to inhibit the behavior
• redirect attention
• engage the person in tasks that require repetitive action

Question 38

Intervention strategies for spatial neglect

Answer 38

• provide graded scanning activities
• grade activities from simple to complex
• use anchoring techniques to compensate (ex: a strip of red tape placed on the left side of sink to draw attention to left hemi-field)
• utilize manipulative tasks in conjunction with scanning activities
• use external cues (ex. colored markers; written directions

Question 39

Intervention strategies for body neglect

Answer 39

• provide bilateral activities
• guide the affected side through the activity
• increase sensory stimulation to the affected side

Question 40

Intervention strategies for aphasia

Answer 40

• decrease external auditory stimuli
• give the person increased response time
• use visual cues and gestures
• use concise sentences
• investigate the use of augmentative communication devices

Question 41

Intervention strategies for sequencing and organization deficits

Answer 41

• use external cues (written directions, daily planners)

- grade tasks that are increasingly complex in terms of number of steps required

Question 42

Intervention strategies for spatial relations dysfunction

Answer 42

• utilize activities that challenge underlying spatial skills (ex: orienting clothing to your body during dressing, wrapping a gift, making a bed.)
• utilize tasks that require discrimination of right/left (ex. use cues like “dress your left arm first”)

Question 43

Intervention strategies for memory loss

Answer 43

• use rehearsal strategies
• “chunk” information
• utilize memory aids
• utilize “temporal tags”, focusing on when the event to be remembered occurred