OT Models for Cognitive Rehab

Question 1

Cognitive retraining approach emphasis

Answer 1

remedial, then adaptive

Question 2

neurobiological rationale for cog rehab approach

Answer 2

neuro plasticity!!!

repetition

Question 3

purpose of cog retraining

Answer 3

improve cognitive deficits, focus on treating skills

facilitate ability to transfer and generalize these capacities toward performance of purposeful activities

Question 4

benefits of cog retraining

Answer 4

• help patient with initial acceptance that problem exists, promote awareness
• satisfaction with treatment outcome

Question 5

components of eval for cog retraining

Answer 5

• pre morbid cognition/learning patterns (set realistic expectations)
• assess general and specific cognitive perceptual skills

Question 6

treatment ideas cog retraining

Answer 6

• learning strategies (internalizing and external)
• simple to complex
• tabletop drills/practice, homework
• computer based exercises

Question 7

goals cog retraining

Answer 7

strengthen remaining cog abilities
create new alternative strategies to process info

(in the context of function)

Question 8

neurofunctional approach

Answer 8

• targets function, not impairment

- learning by doing

Question 9

underlying assumptions of neurofunctional approach

Answer 9

• generalization does NOT readily occur

- over learning will occur with practice and progress to automaticity

Question 10

primary eval of neurofunctional approach

Answer 10

(un)structured observation of ADLs

Question 11

tx neurofunctional approach

Answer 11

• training in the same way across functional domains so minimal new learning is required
• reinforcement and skill building
• task analysis
• chaining
• prompts/cues
• errorless learning
• shaping
• debriefing

Question 12

backward chaining

Answer 12

therapist starts/initiates first step and lets client finish so they get the feeling of finishing something

Question 13

forward chaining

Answer 13

have patient try first step to work on initiating, then therapist guide through the rest
(good to learn steps in order)

Question 14

whole-task method

Answer 14

• **most successful with TBI
• forward chaining with reinforcers after each step
• terminal reinforcer should be the strongest

Question 15

errorless learning

Answer 15

errors are prevented from occurring though cues, guidance etc
*best for pts with severe memory impairments
teaching them the right way before they mess up

Question 16

shaping

Answer 16

reinforcement of closer and closer approximations to the desired behavior (building on the skill)

Question 17

goals of neurofunctional approach

Answer 17

• improve real world functioning or QOL

- reestablish habits and routines

Question 18

dynamic interactional approach

Answer 18

just right challenge

focus on investigating underlying conditions and strategies that influence performance

Question 19

cognitive dysfunction

Answer 19

• inability to acquire, adapt, apply info

Question 20

DIA eval

Answer 20

static assessment - quantitative
dynamic assessment - qualitative

assessments of self awareness, provide cues, self perception before during and after task performance

Question 21

tx DIA

Answer 21

• No generalization!
• practice in multiple situations
• focus on effective strategy
• metacognitive training

Question 22

multi contextual approach DIA

Answer 22

same processing strategy practiced across activities that gradually change
emphasis on self monitoring and evaluating performance

Question 23

transfer continuum DIA

Answer 23

near transfer activities: very similar
intermediate transfer activities: somewhat similar to original
far/very far transfer: very different from original

Question 24

goals DIA

Answer 24

facilitate optimal skill performance by changing activity/environment for maximizing functional capacity

Question 25

limitations DIA

Answer 25

cannot measure change over time

high level of therapist expertise