Cognitive-Perceptual Approaches

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Cognitive-Perceptual Approaches
2013-07-24 16:46:45
eval intervention

eval & intervention
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  1. loss of awareness of body parts, as well as relationship of the body parts to eachother & objects
    Includes body neglect & asomatognosia
    Body scheme disorders
  2. Asomatognosia
    body scheme disorder that results in diminished awareness of body structure & failure to recognize body parts on one's own body.  
  3. an unawareness of motor deficits
    may be related to lack of insight regarding disability
  4. lack of knowledge of person, place, time
  5. What 4 areas must be evaluated in order to differentiate perceptual dysfunction & visual systems dysfunction
    • 1. Visual acuity-clarity of vision near & far
    • 2. Visual fields-available vision right, left, superior, inferior
    • Ex field loss: homonymous hemianopsia
    • 3. Oculomotor function-control eye movements
    • 4. scanning-systematically observe & locate items in env.
  6. Pop: 3+yrs.
    Focus: test occ. perf. that is app. for those living with variety of impairments including cognitive & perceptual impairments
    Examines fun. competence in 2 or 3 familiar & chosen BADL or IADL tasks (choose from 80 standardized tasks)
    Scoring: observes & documents the motor & process that interfere with task perf.  
    Final scores: account for task difficulty & severity.
    • Assessment of Motor and Process Skills
    • (AMPS)
  7. Pop: adults with cognitive/perceptual (neurobehavioral) deficits.
    Method: structured observations of BADL & mobility skills
    Scoring: system or error analysis to document underlying perf. components (neglect, spatial) that have direct impact on daily living skills.
    Arnadottir Occupational Therapy Neurobehavioral Evaluation (A-ONE)
  8. POP: 16 yrs + experiencing visual-perceptual deficits after head injury or stroke
    Method: 16 perf. tests that assess form & color constancy, object completion, figure-ground, body image, inattention, & spatial awareness.  
    Utilizes deficit-specific tasks in isolation from ADL
    Scoring: accuracy of task completion & time taken
    Rivermead Perceptual Assessment Battery
  9. POP: adults with unilateral neglect
    Focus: presence of neglect & its impact on fun. task perf. 
    Method: 9 activity-based subtests (picture scanning, menu reading, map navigation, address & sentence copying, card sort, article reading, telephone dialing, coin sort, telling/setting time).
    6 pen/paper (line crossing, star cancellation, letter cancellation, figure/shape copying & line bisection.
    Behavioral Inattention Test
  10. Pop: stoke, TBI, tumor
    Focus: measures basic cog. functions that are prereq for managing everyday tasks.  
    20 subtests in 5 areas
    orientation, visual, spatial perception, visualmotor organization, thinking operations,
    Lowenstein Occupational Therapy Cognitive Assessment (LOCTA)
  11. Pop. ind w memory dysfunction
    Focus: initial eval of memory fun & indicates app. tx areas.  Monitors memory skills.  
    Method: 11 categories with 9 subtests
    0-9 severe, 10-16 mod, 17-21 poor, 22-24 normal
    Rivermead behavior memory test
  12. Assess executive fun. deficits during perf. or real-world tasks (cooking oatmeal, making call, managing meds, paying bills)
    Method: structured cueing & scoring system to assess initiaiton, organization, safety, task completion & develop cuing strategies
    Executive Function Performance Test
  13. Focus: explores, quantifies, & describes perf. in central areas of brain-behavior relations: consciousness, orientation, attention, language, constructional ability, memory, calculations, reasoning
    Cognistat Neurobehavioral Cognitive Status Examination
  14. Focuses on restoration of components to increase skill
    Deficit specific
    Targets cause of symptoms
    Imp. in performance components will increase skill
    cerebral cortex is malleable & reorganizes
    Interventions strategies: table top & computer act. as tx modalities
    -memory drills, block designs, parquetry
    Remediation/Restorative/Transfer Training Approach
  15. Repetitive practice of fun. tasks person needs/wants
    -BADL, IADL, work, leisure
    Emphasis on modifications
    Emphasis on intact training
    Treats symptoms, not cause
    Techniques related to env. adaptation & compensatory strategies
    Compensatory/Adaptive/Functional Approach
  16. Provides info on how the ind. approaches the task
    Investigates how perf. changes w cueing
    Standardized cues are given to determine their effect on perf.
    Cues or feedback used to draw attention to relevant features of the task
    Investigative questions are used to provide insight to underlying deficits.
    Information Processing Approach
  17. 1. Transfer info from 1 situation to another
    2. Utilizes varying tx env. 
    3. Practice of targeted strategy w varied tasks & situations (multicontextual)
    4. Metacognitive skills (Self-awareness of strengths & needs)
    5. Transfer of learning must be taught from 1 situation to the next & doesnt occur aoutomatically
    6. Transfer learning occurs through graded series (visual neglect: scan to find items in refrigerator to scanning to cross road)
    person's processing abilities & self-monitoring are sued to facilitate learning
    7. Therapist uses awareness questioning (How do you know that's right?) to help ind. detect errors, estimate task difficulty, & predict outcomes.
    Dynamic Interactional Approach
  18. 1. Based on remediation, information processing & teaching/learning theory
    2. Micro-perspective: eval of management of performance component skills (attention, memory, motor planning, postural control)
    3. Macro-perspective: evaluation includes use of narratives, interview & real-life occupations (shopping, cooking)
    4. Makes use of several theories: info processing, teaching/learning eval, neurodevelopmental eval, biomechanical eval
    Quadraphonic Approach
  19. 1. Based on learning theory
    2. Used for ind. w acquired neurological dysfunction/dementia
    3. Retrain real world skill rather than cog-perceptual processes.  
    4. adaptive approach but incorporates some remediation
    5. TX: train specific fun. skills in true contexts
    Neurofunctional Approach
  20. 1. Ind. w psychosocial, neurological & dementia
    2. Describe cog. fun on scale 1-6.
    3. Each level describes the extent of disability & diff. in perf. occupations
    4. Routine tasks presented once level is identified and/or adapated tasks 
    5. Focus on adaptive approaches & strengthening residual abilities.
    Cognitive Disabilities Model
  21. Intervention strategies for Impaired alertness or arousal
    • 1. Increase env. stimuli
    • 2. use gross motor act.
    • 3. Increase sensory stimui
  22. Intervention for motor/ideamotor apraxia
    • 1. utilize general verbal cues opposed to specific
    • 2. decrease manipulation demands
    • 3. provide hand-over-hand tactile-kinesthetic input
    • 4. utilize visual cues
  23. Intervention for ideational apraxia
    • 1. Provide step-by-step instructions
    • 2. hand-over-hand guiding techniques
    • 3. provide opportunities for motor planning & motor execution.
  24. Intervention for perseveration
    • 1. Bring perseveration to a conscious level & train the person to inhibit the behavior
    • 2. redirect attention
    • 3. engage ind. in tasks that require repetitive aciton
  25. Intervention for spatial neglect
    • 1. graded scanning techniques
    • 2. grade simple to complex
    • 3. use anchoring techniques to compensate
    • 4. utilize manipulative tasks in conjunction with scanning act.
    • 5. use external cues; colored markers & written directions
  26. Interventions for body neglect
    • 1. bilateral act. 
    • 2. guide affected side through the act. 
    • 3. increase sensory stimuli to affected side
  27. Interventions for aphasia
    • 1. Decrease external auditory stimuli
    • 2. give the ind. increased response time
    • 3. use visual cues & gestures
    • 4. use concise sentences
    • 5. investigate the use of augmentative communication devices.
  28. Intervention for sequencing & organization
    • 1. use external cues (written directions, daily planners)
    • 2. grade tasks that are increasingly complex in terms of number of steps required
  29. Interventions for spatial relations dysfunction
    • 1. utilize act. that challenge underlying spatial skills
    • 2. utilize tasks that require discrimination of right/left.
  30. Intervention for memory loss
    • 1. use rehearsal strategies
    • 2. Chunk information
    • 3. utilize memory aids (alarm watches, timers)
    • 4. Utilize temporal tags, focusing on when the event to be remembered occurred
  31. Method of providing a cue on the side contralateral to the brain damage, in the presence of unilateral neglect
  32. Anchoring is a technique used in what approach
    Compensatory functional
  33. Awareness questioning is used in what approach
    Dynamic interactional approach
  34. You ask a client how he knows that the items that he found during a scanning act. are correct.  What approach are you using?
    Dynamic Interactional approach-using awareness questioning to help ind. identify successes, detect errors, estimate task difficulty, & predict outcomes.
  35. What skill is important to consider when looking at a dynamic interactional approach
    auditory processing