Vision and Cognition Flashcards
The individual’s capacity to acquire and use information in order to adapt to environmental demands
Cognition
What is the roll of an OT in a medical team when working with a patient with cognition impairments?
Cognition in occupation, of course! Usually a TBI
T/F: The modern day approach to cognition is moving away from the idea that cognition can be divided into specific subskills
True!
What are the 3 levels of the cognitive hierarchy
- Primary cognitive capacities
- Orientation
- Attention
- Memory
- Higher-Level thinking abilities
- Problem-solving
- Reasoning
- Concept Formation
- Metaprocessing Abilities
- Executive functions
- Self Awareness
The lowest level of the cognition hierarchy
Primary Cognitive Capacities (Orientation, Attention, Memory). Seen as prerequisites to higher-level thinking abilities and to influence meta-processing.
What are the subsections within the Primary Cognitive Capacities?
- Orientation: Awareness of self in relation to person, place, time, and circumstance (X4)
- Attention (Limited Capacity)
- Sustained
- Selective
- Divided
- Alternatining
- Memory: Information storage and retrieval
- Sensory registers -> Short-term memory -> Long-term memory
Awareness of self in relation to person, place, time, and circumstance (X4)
Orientation. It is one of the primary cognitive capacities along with attention and memory
Deployment of mental resources for concentration
Attention. It is one of the primary cognitive capacities along with orientation and memory
The capacity to maintain attentional performance over time
Sustained attention
Concentrates on one set of stimuli while ignoring competing stimuli
Selective attention
Allows person to respond to more than one task at a time-more complex
Divided attention
Flexibly shifting attention between multiple operations
Alternating attention
Four types of attention
Sustained, selective, divided, alternating. Attention is one of the three primary capacities along with orientation and memory
Information storage and retrieval
Memory. Sensory registers to short-term memory to long term memory
Problem solving, reasoning, and concept formation are all…
Higher level thinking abilities. Middle of the cognitive hierarchy after primary capacities and before metaprocessing abilities
T/F: Higher-Level thinking abilities depend on Metaprocessing abilities
False. Higher-Level thinking abilities depend on primary cognitive capacities.
Identifying the problem, defining the problem generating possible solutions and select one, implement the preferred solution, and evaluate the outcome against the desired goal are all under the umbrella of…
Problem solving. One of the higher-level thinking abilities along with reasoning and concept formation
The three higher-level thinking abilities are…
- Problem-Solving
- Reasoning
- Concept formation (ability to analyze relationships between objects and their properties.)
Why is it useful to assess problem-solving in a client?
Helpful in identifying where client may be having difficulty. But, everyday problem-solving does not always follow a specific sequence. Use a sequence to organize your observations rather than as “right” sequence
This cognitive ability allows you to draw inferences or conclusions from known or assumed facts and involves sequencing, classification and deductive and inductive reasoning
Reasoning. One of the three higher-level thinking abilities along with problem solving and concept formation.
The ability to analyze relationships between objects and their properties
Concept formation. One of the three higher level thinking abilities along with problem solving and reasoning
T/F: Executive functions and self-awareness are both primary cognitive capacities
False! Executive functions and self-awareness are metaprocessing abilities. Orientation, memory, and attention are primary cognitive capacities.
Self-awareness is necessary for the successful performance of unstructured multi-step occupational tasks and roles
False. Executive Functions are necessary for the successful performance of unstructured multi-step occupational tasks and roles
The four components to executive function are…
Volition, planning, purposive action, and effective performance.
Formulate goal or intention to act, plan (identify and sequence steps to move toward goal or end point), translation of intention into productive, self-serving activity…initiate, maintain, switch and stop sequences of complex behavior in orderly and integrated manner, monitor and self-correct
The ability to process information about the self and compare it to a longstanding self-evalution
Self-Awareness. One of the metaprocessing abilities along with executive functions
T/F: Observations of cognition during occupation are standardized
False. Observation of cognition during occupation should be non-standardized
In this assessment, a client performs 4 IADL activities with graded cues. The level of independence recorded and categorized into 5 executive function constructs (initiation, organization, sequencing, judgment and safety, and completion
The Executive Function Performance Test Assessment. E.g., client is asked to cook oatmeal while given cues
This assessment rates for independence, safety and adequacy and includes 26 core tasks, categorized into 4 functional domains (functional mobility, self care, IADL with cognitive emphasis and IADL with physical emphasis)
Performance Assessment of Self-Care Skills (PASS)
This treatment approach has an emphasis on self-discovery and is a performance-based, problem-solving, intervention approach
The CO-OP approach. Clients learn best when they succeed according to their OWN goals. Assists clients to develop an individualized approach to therapeutic treatment. Enables skill-acquisition (strategy use and guided discovery)
This intervention approach was developed as an alternative to motor interventions that focused on remediation of deficits
CO-OP. It is a combination of contemporary task-orientated motor theory with learning theory. Teach thinking patterns that will support desired behaviors. Develop self-instructional training: Executive strategy (goal plan do check), use of self-talk, metacognitive training: reflect, evaluate, change goal/plan
Goals of CO-OP
- Skill acquisition
- Cognitive strategy use
- Generalization of learning
- Transfer of learning
This intervention approach looks at the right fit (Person, environment, occupation) for each client
Co-Op. Looks at environmental supports/barriers and identifies performance problems and possible strategies. Therapist needs a baseline knowledge of the performance skill
Domain specific strategies for the Co-Op approach
Body Position, attention to task, task specification/modification, supplementing task knowledge, feeling movement, verbal mnemonic, verbal script, mental imagery, relaxation techniques
This assessment involves a work-simulation in a library
The Complex Task Performance Assessment. The primary task is inventory control and the secondary task is taking down phone messages. Delayed intentions include telling time and giving the examiner a message
This is a screening tool with 11 questions related to: calculation, abstraction, orientation, attention, learning, information, construction, and delayed recall.
The Mini-Mental State Examination (MMSE). Scores range from 0 to 30 with scores lower than 24 indicating possible cognitive disorders. It takes 5-1- mins to administer. What city, state, county are we in? What day is it? Where are we? Spell “World” backwards. Count back by 7’s from 100.
T/F: The Mini-Mental State Examination (MMSE) is a good screening tool, but bias towards verbal items and insensitive to right-sided brain damage and mild cognitive deficits
True
This assessment is a microbattery with 20 subtests. Looks at orientation, perception, visuomotor operations, and thinking operations
The Lowenstein Occupational Therapy Cognitive Assessment (LOTCA). It takes 30-45 minutes to administer. Examples include showing client objects and asking what they’re for, showing pictures and asking what they are, asking client to construct model based off picture
T/F: The Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) is sensitive towards clients with mild injuries and has a measure of memory.
False. The LOTCA gives a snapshot of a number of cognitive capacities, but is not sensitive towards clients with mild injuries and does not have a measure of memory
This assessment is a microbattery of 17 subsets and includes areas of: money and math skills, planning and abstract reasoning, problem-solving, attention, memory, orientation, neglect, and following directions
Cognitive Assessment of Minnesota (CAM). It takes 45 minutes to administer. Examples include remember these three words-I’ll ask you to repeat them later, match the two items that are the same, Repeat certain body positions back to me
Which cognitive assessment provides an overview of cognitive functioning but has little literature on its use in rehab and also has possible ceiling effect for mild or subtle cognitive deficits?
The Cognitive Assessment of Minnesota (CAM)
This cognitive assessment is a one page 30-point test that includes short-term memory recall, visuospatial abilities, executive function, verbal abstraction, attention, concentration, working memory, orientation, and language
The Montreal Cognitive Assessment (MoCA). Takes 10 minutes to administer.
Examples: Draw line from 1-A-2-B; what animal is this; recreate drawing of box shape; tap your hand on table when I say “A”; repeat these words back to me
This is a screening tool which identifies mild cognitive problems with tasks including simple math computation, naming animals, recalling facts, and drawing the hands on a clack
St. Louis University Mental Status Exam (SLUMS). It is administered in approximately 7 minutes and as a one page, 30-point test
Flexible assessment that measures occupations and helps clients describe IADLs, leisure activity, social activities. Assists in building routines of meaningful and healthy activities for clients
Activity Card Slot
This is a standardized, performance based assessment that assesses 6 areas of ADL tasks, for which the information-processing requirements can be systematically varied: dress, shop, toast, phone, wash, travel
Cognitive Performance Test (CPT). Administration is based on occupational therapy principles of task analysis and adaptation. The test involves the sequential elimination or inclusion of sensory cues as difficulty with performance is observed. Put pills in pill box according to dosages needed, find hardware store in yellow pages and call for info, choose a belt that is the right size and you have enough money for, etc.
T/F: The Cognitive Performance Test is based on Allen Cognitive Disability Theory and was originally designed for the objective evaluation for people with Alzheimer’s disease
True
This cognitive assessment is useful to OTs as a performance measure of executive function and allows evaluation of complex task performance, strategy use, self evaluation of performance, and error patterns
Weekly Calendar Planning Activity (WCPA). It can be utilized to crease intervention strategies and is used across a variety of pupulations
What does the hierarchy for visual perception look like?
(Occulomotor control, Visual fields, Visual acuity) -> (Attention=Alert and attending) -> (Scanning) -> (Pattern recognition) -> (Visual Memory) -> (Visuocognition) -> (Adaptation through vision)
Integrates vision, visual perception, and cognition. Skills at bottom are foundation for each successive level. Higher level skills evolve from foundation skills and depend on complete integration of lower skills for their development.
What are the three visual foundation skills at the bottom of the visual perception pyramid?
Visual Acuity (assures the accuracy of information sent to the brain), Visual Fields (let brain know what’s going on in the environment), Oculomotor control (ensures efficient eye movements
The ability to respond to stimuli on all paras of the retina-ability of the eyes to make what is seen sharp and clear and adjust for near/far
Visual Acuity. One of three visual foundation skills along with Visual Fields and Oculomotor control
T/F: All visual perceptual or cognition assessments must be performed before any visual foundation skills
False! All visual foundation skills must be performed/assessed before any visual perceptual or cognition assessment. You need to know if someone can see before you asses his/her ability to interpret what he/she is seeing. Also need to know if visual fields are intact in order to identify a problem with visual neglect
How do you screen for visual acuity?
The Snellen Eye Chart. The numerator denotes the distance at which the client recognizes the stimulus, and the denomenator is the distance at which it would be recognized by someone with normal vision. A person with 20/200 vision is able to recognize a stimulus ant 20 feet that a person with normal vision would see at 200 feet.
Ability to see objects in various levels of contrast and how he/she will perform functionally
Contrast sensitivity. poorer acuity=more contrast required
This visual foundation skill allows you to register an entire visual scene
Visual Fields (other visual foundation skills include visual acuity and oculomotor control). Let brain know what's going on in environment, register visual scene and ensure that CNS receives complete visual information 60 degrees superior 75 inferior 60 degrees nasal 100 degrees temporal
Testing for Visual Fields has been proven to be reliable on its own
False. Testing for visual field should be used in conjunction with functional observations, because if done alone, have been proven to be unreliable through research.
This visual foundation skill ensures efficient eye movements and ensures quick and accurate scanning
Oculomotor Control.
Eye alignment, converge, accomodation, visual tracking (smooth pursuits), saccades are all important aspects of…
Oculomotor Control. The therapist screens for binocular vision, including eye alignment and convergence, and accommodation, smooth pursuits, and saccades
This is generally measured by observation of the reflection of light on the cornea.
Eye alignment screening. Light reflection should be in the same position in both eyes
Client follows a target moving slowly toward and away from the face
Convergence. (double vision normally occurs when the target is within 2-4 inches of the face, and recovery of a single image takes place at 4-6 inches)
This occurs when your eyes don’t work together while you’re trying to focus on a nearby object. When you read or look at a close object, your eyes need to turn inward together (converge) to focus. This gives you binocular vision, enabling you to see a single image.
Convergence insufficiency
The ability to adjust the focus of vision at a range of distances, such as the automatic focusing of the eyes when you look at the speedometer and back at the road while driving
Accommodation
Eye movements that maintain continued fixation on a moving target
Visual tracking (smooth pursuits).
T/F: If smooth pursuits are impaired, acuity is impaired when motion is involved
True
Quick eye movements that change fixation from one point to another and allow us to redirect our line of sight
Saccades
Identify features of an object (before memory), identifies both configural/hollistic aspects and details
Pattern recognition. In order to identify features, you must be able to scan. To scan, you must be alert and able to attend. Depends on visual attention and global attention
Global Attention
Global attention to the environment is controlled by the arousal sequence (sleep, awake, alert, and attending) mediated through brainstem reticular formation
Visual attention is a specific skill that can be influenced strongly by…
Global attention. Global attention to the environment is controlled by the arousal sequence (asleep, awake, alert, and attending) mediated through brainstem reticular formation
This is the highest level on the visual perception hierarchy
Visual Cognition. The ability to mentally manipulate visual information and integrate it with other sensory information to solve problems, formulate plans, and make decisions
The ability to mentally manipulate visual information and integrate it with other sensory information to solve problems, formulate plans, and make decisions
Visual Cognition
What must you address first before treating higher level visual perception skills in order to be effective?
Treatment of higher level skill would be be effective unless underlying deficits in visual attention/visual field losses were addressed first
What visual component must be intact in order to retrieve and visually manipulate memories
Visual memory
Is defined as the ability to perceive differences among and positional aspects of objects
Form Discrimination
This allows one to recognize shapes in slightly different forms e.g., smaller, bigger, darker, same
Form Constancy
Both Form Discrimination and Form Constancy are types of…
Pattern Recognition
Pattern recognition, visual memory, visual closure, spatial relations, position in space, figure-ground, unilateral Neglect are all related to…
Visual Perception
The ability to visualize a complete whole when given incomplete information or a partial picture.
Visual Closure
The ability to perceive self in relation to other objects
Spatial Relations
Ability to distinguish foreground from background
Figure-Ground
T/F: Unilateral Neglect is most commonly caused by a lesion in the left hemisphere
False. Unilateral Neglect is most commonly caused by a lesion in the R hemisphere; it does occur following left brain damage, but it is not as severe
Neglect of one side of the body or space
Unilateral Neglect. It is either perceptual (input, or attentional) or motor (output or intentional).
T/F: Unilateral neglect is considered a severe Visual Field Deficit
False. Unilateral neglect is separate from visual field deficits
This assessment looks at 3 areas of visual function (visual perception, visual neglect, and visual processing time) and is a static assessment of visual perception (decontextualized)
The Motor-Free Visual Perception Test (MFVPT). It is a general screening instrument with no subtest scores. Instructions are precise; no clues allowed; no feedback other than ok or good. Read the instruction and record the response. It measures spatial relationships, visual discrimination, figure-ground, visual closure, visual memory measures: item response time=perceptual time plus motoric response saying or pointing. Raw score, standard score (can be used to compare with other testing), percentile rank, age equivalent: never use that
T/F: The Motor Free Visual Perceptual Test (MFVPT) reflects a more contemporary model…dynamic assessment, contextual assessment
False. The MFVPT is a decontextualized static assessment of visual perception while the BiVABA is a more contemporary model
This test is guided by 4 principles emphasizing the significance of functional performance to testing, interpretation and treatment planning and tests visual foundation skills, visual attention with scanning
The BiVABA. Rather than norms, offers test interpretation guidelines. Suggests modifying test administration to determine nature of problem and strength. Based on contemporary perspective (dynamic, functional, contextual)
