Week 6: Assessment of Cognitive Dysfunction

Question 1

related to sensory events that relies on the posterior brain areas
Involved in selection of relevant sensory information
Involuntary orienting or automatic processing
Performance determined by reaction time in responding to the detection of stimuli

Answer 1

Orienting System

Question 2

Three main functionally and anatomically distinct attentional control subsystems (Posner/Peterson)

Answer 2

Orienting System
Executive System
Alerting or SustainedAttention System

Question 3

Approach of OT to treatment of people with cognitive impairments differs from other
professions because…

Answer 3

Approach of OT to treatment of people with cognitive impairments differs from other
professions in that the focus is improving function and quality of life. This means interventions and evaluations should be focused on occupations, goals should relate to occupations, interventions should relate to natural contexts, and outcomes should document areas of improvement for occupations

Question 4

Views cognition as a product of the interaction among person, activity, and environment

b. Performance of a skill can be promoted by either changing demands of activity or using person’s particular skills to facilitate a task
c. In order to understand cognitive function and occupational performance, one must understand the person, activity, and environment

Answer 4

Dynamic Interactional Approach.

Toglia used the Dynamic Interactional Model to develop the Multicontext Treatment Approach which focuses on teaching a particular strategy to perform a task and practicing this strategy in different settings over time. This approach includes processing strategies (to help client control cognitive and perceptual symptoms), activity analysis, transfer of learning, interventions occurring in multiple environments, and awareness training (to help clients redefine their knowledge of their strengths and weaknesses).

Question 5

Developed by Abreu and Peloquin for those who are cognitively impaired following brain

injury. Includes micro (subskills) and macro (ADLs) perspective.
b. Micro perspective incorporates teaching learning theory (describes how clients use cues to increase cognitive awareness and control), information processing theory (how individuals perceive and respond to environment), biomechanical theory (client’s movement) and neurodevelopmental theory
c. Macro perspective includes lifestyle status, life stage status, health status, and disadvantage status

Answer 5

Quadraphonic Approach

Question 6

Used for adolescents and adults with neurologic and neuropsychologic dysfunction. Focuses on training based on enhancing clients’ remaining skills

Answer 6

Cognitive-retraining Model

Question 7

Applied to those with severe cognitive impairments secondary to brain injuries. Focuses on teaching clients highly specialized compensatory strategies

Answer 7

Neurofunctional Approach

Question 8

When choosing assessments for cognitive deficits…

Answer 8

focus should be on ecologic validity (degree to which cognitive demands of test resemble cognitive demands of everyday environment)

b. Client centered approach is needed.  Can be assessed using COPM or interview.
c. OT uses observation skills to determine which deficits are interfering with functional performance
d. Traditionally, those who work with people who are cognitively impaired use standardized measures of cognitive impairment as the primary outcome measurement.  It is critical that OTs focus on measures of outcome on function and participation as a key outcome
e. Also useful to use self-report or caregiver report for this population as they allow OT to  have something to compare to and a means by which OT can show clients/caregivers progress.
f. FIM measures client’s ability to complete specific self-care activities and mobility tasks. Scoring is based on caregiver burden related to these tasks.

Question 9

Pyramid Model of self awareness includes three intervention-dependent types of awareness:

Answer 9

1. Intellectual awareness (ability to understand that function is impaired)
2. Emergent awareness (ability to recognize a problem when it is actually happening)
3. Anticipatory awareness (ability to anticipate that a problem will occur as result of particular impairment in advance of actions)

Question 10

Compensatory strategies for awareness:

Answer 10

1. Anticipatory compensation (implementation of compensatory technique by anticipating that a problem will occur)
   2. Recognition compensation (strategies that are triggered and implemented because a person recognizes that a problem is occurring)
   3. Situational compensation (compensatory strategies that are triggered by a specific type of circumstance in which an impairment may impact function)
   4. External compensation (strategies triggered via external agent or involves an environmental adaptation, i.e. an alarm)