OT Models for Cognitive Rehab Flashcards
Cognitive retraining approach emphasis
remedial, then adaptive
neurobiological rationale for cog rehab approach
neuro plasticity!!!
repetition
purpose of cog retraining
improve cognitive deficits, focus on treating skills
facilitate ability to transfer and generalize these capacities toward performance of purposeful activities
benefits of cog retraining
- help patient with initial acceptance that problem exists, promote awareness
- satisfaction with treatment outcome
components of eval for cog retraining
- pre morbid cognition/learning patterns (set realistic expectations)
- assess general and specific cognitive perceptual skills
treatment ideas cog retraining
- learning strategies (internalizing and external)
- simple to complex
- tabletop drills/practice, homework
- computer based exercises
goals cog retraining
strengthen remaining cog abilities
create new alternative strategies to process info
(in the context of function)
neurofunctional approach
- targets function, not impairment
- learning by doing
underlying assumptions of neurofunctional approach
- generalization does NOT readily occur
- over learning will occur with practice and progress to automaticity
primary eval of neurofunctional approach
(un)structured observation of ADLs
tx neurofunctional approach
- 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
backward chaining
therapist starts/initiates first step and lets client finish so they get the feeling of finishing something
forward chaining
have patient try first step to work on initiating, then therapist guide through the rest
(good to learn steps in order)
whole-task method
- **most successful with TBI
- forward chaining with reinforcers after each step
- terminal reinforcer should be the strongest
errorless learning
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
shaping
reinforcement of closer and closer approximations to the desired behavior (building on the skill)
goals of neurofunctional approach
- improve real world functioning or QOL
- reestablish habits and routines
dynamic interactional approach
just right challenge
focus on investigating underlying conditions and strategies that influence performance
cognitive dysfunction
- inability to acquire, adapt, apply info
DIA eval
static assessment - quantitative
dynamic assessment - qualitative
assessments of self awareness, provide cues, self perception before during and after task performance
tx DIA
- No generalization!
- practice in multiple situations
- focus on effective strategy
- metacognitive training
multi contextual approach DIA
same processing strategy practiced across activities that gradually change
emphasis on self monitoring and evaluating performance
transfer continuum DIA
near transfer activities: very similar
intermediate transfer activities: somewhat similar to original
far/very far transfer: very different from original
goals DIA
facilitate optimal skill performance by changing activity/environment for maximizing functional capacity
limitations DIA
cannot measure change over time
high level of therapist expertise
