Cognitive perceptual approaches: eval and intervention Flashcards
perception
the integration and interpretation of sensory impressions received from the environment into psychologically meaningful information
cognition
the ability of the brain to process, store, retrieve, and manipulate information
involves the skills of understanding and knowing, ability to judge and make decisions, and overall environmental awareness
cognitive-perceptual deficits
occur as a result of multiple pathologies including CVA, TBI, neoplasm, acquired diseases, psychiatric disorders, developlemtnal disabilities
acalculia
inability to perform calculations
ex: calculating change at a grocery store
agraphia
inability to write
ex: cannot sign name
impaired alertness or arousal
decreased response to environmental stimuli
ex: needs tactile or verbal cues to stay awake during an eval
tx: increase environmental stimuli, gross motor activities, sensory stimuli
alexia
inability to read
ex: cannot read a menu despite being literate
anomia
inability to name objects or retrieve names of people
ex: person knows what to do with an apple, but cannot name it
anasognosia
unawareness of a deficits
may be related to lack o insight
ex: person is unaware they have hemiplegia
aphasia
loss of language
tx: decrease external auditory stimuli, increased response time, visual cues and gestures, concise sentences, comm devices
apraxia
ideational (does not know how to do something/use an object) and ideomotor (loss of kinesthetic memory to carry out a task)
tx: general verbal cues (not specific), decrease manipulation demands, hand over hand tactile cues, visual cues, step by step instructions
astereognosis
inability to recognize objects, forms, shapes, and sizes by touch alone
impaired attention
inability to attend/focus on specific stimuli
sustained, selective, dividing, alternating
ex: background noise distracts them from the task at hand
body scheme disorders
loss of awareness of body parts, relationship of the body parts to each other
- right left discrimination
- somatoagnosia (inability to recognize body parts as their own)
- unilateral body neglect
disorientation
lack of knowledge of person, place, and time
figure-ground dysfunction
inability to distinguish foreground from background
ex: cannot locate a bar of soap on a white sink; key in a messy drawer
impaired organization and sequencing
inability to organize thoughts with activity steps properly sequenced
ex: person dons shoes and socks before pants
tx: external cues (directions, planners), grade tasks with decreasing # of steps required
perseveration
continuation or repetition of a motor act or task
ex: person continues to pull up a sock even though it is already on the foot
tx: bring it to a conscious level, train person to inhibit the behavior, redirect attention, engage in tasks that require repetitive action
impaired problem solving
inability to manipulate knowledge and apply this info to new or unfamiliar situations
ex: cannot figure out why a w/c is not moving when the breaks are on
spatial relations impairment
difficulty relating objects to each other or to the self secondary to a loss of spatial concepts (up/down, front/back, etc)
ex: person puts shirt on backwards
tx: activities that challenge underlying spatial skills and that require discrimination of L/R
ex: wrapping a gift, making a bed, “dress your left arm first”
topographical disorientation
difficulty finding one’s way in space secondary to memory dysfunction or an inability to interpret sensory stimuli
ex: cannot find their hospital room
unilateral spatial neglect
inattention to stimuli presented contralateral to lesion
not a visual deficit
tx: bilateral activities, guide affected side, sensory stim to affected side
scanning
anchoring (red tape on left side of sink)
bright colors, external cues
visual foundation skills
must be evaluated to differentiate perceptual dysfunction and visual system deficits
- visual acuity: clarity of near and far
- visual fields: left and right, up and down
- oculomotor function: control of eye movements
- scanning: locate items in environment
- tracking, convergence, etc
non-standardized screening for cognitive and perceptual impairments during ADLs
observation of performing routine tasks
look for all skills defined previously
allen cognitive level test
- psychiatric disorders, brain injury, dementia
- performs 3 leather lacing stiches progressing in complexity
- 6 level scale of cog function (1=automatic actions to level 6=planned actions)
arnadottir occupational therapy neurobehavioral evaluation (A-ONE)
- with adult pop with cog/perceptual deficits
- requires a training
- structured observations of BADL and mobility skills
- system of error analysis (can they perform or unable to perform)
assessment of motor and process skills (AMPS)
requires training
ages 3 and up
examines functional competence in 2-3 familiar ADLs from a list
16 motor and 20 process skills are scored for each task performed
1 = deficit to 4 = competent
behavioral inattention test
for adults presenting with unilateral neglect
9 activity based subtests(picture scanning, menu reading, map navigation, coin sorting, etc) and 6 pen/paper subsets (star cancellation, figure shape copying, line bisection)
catherine bergego scale
checklist to detect presence and degree of unilateral neglect during observation of everyday life situations
scale also measures self-awareness of behavioral neglect
cognistat neurobehavioral cognitive status exam
level of consciousness, orientation, language, constructional ability, memory, calculations, reasoning
executive function performance test (EFPT)
tasks: cooking oatmeal, making a phone call, managing medications, paying a bill
structured cueing system/scoring
lowsenstein occupational therapy cognitive assessment (LOTCA)
stroke, TBI, or tumor
measures basic cognitive functions
20 subtests in 5 areas: orientation, visual, spatial perception, VM organization, thinking operations
1 = low ability to 4 = high ability
mini mental state examination (MMSE) or Holstein test
30 point questionnaire to screen for cog impairment
commonly used for dementia
montreal cognitive assessment (MoCA)
screening for mild cog dysfunction
takes 10 min
rivermead behavioral memory test
people with memory dysfunction
11 categories, 9 subtests
memorize/recall
used for initial eval, indicates tx areas, monitors memory skills throughout rehab
rivermead perceptual assessment battery
16 years or older
visual perceptual deficits after head injury or stroke
form and color constancy, object completion, FG, body image, inattention, spatial awareness
remedial/restorative/transfer of training approach
- focuses on restoration of components to increase skill
- deficit specific
- targets cause of symptoms
- emphasizes performance components
- assumes improvements in performance will result in increased skill
- cortex is malleable
- uses tabletop and computer activities
compensatory/adaptive/functional approach
- repetitive practice of functional tasks
- emphasizes modification
- treat symptoms, not the cause
- environmental adaptation, compensatory cognitive strategies
- task specific
- activities that are meaningful to the client
information processing approach
- provides info on how the individual approaches the task
- standardized cues: “try re-reading” “try saying the steps”
- investigative questions: “why do you think it took so long to get dressed?” - insight
dynamic interactional approach
- emphasizes transfer of information from one situation to the next
- varying treatment environments
- targeted strategy with varied tasks
- metacognitive skills (self awareness)
“how do you know this is right?”
quadraphonic approach
- based on remediation
- information processing theory
- teaching and learning theory
- neurodevelopment evaluation
- biomechanics evaluation
neurofunctional approach
- based on learning theory
- acquired neuro impairments (TBI, CVA)
- retraining real world skills rather than cog processes
- adaptive approach with some remediation
- training specific functional skills in true contexts
cognitive disabilities model
- psychosocial dysfunction and some neuro pts
- cog fx on a continuum from level 1 (profoundly impaired) to level 6 (normal)
- after level has been established, routine tasks are presented so the person can perform or adapt them
- strengthen residual abilities
memory strategies
- rehersal
- “chunk” information (phone number by 3 groups)
- memory aids (alarms)
- “temporal tags” - focus on when the event to be remembered occurred
