Cognitive Retraining

Video

References

Cheney, P., & Rivera-Finnen, L. (2011). www.aota.org. Retrieved from www.aota.org: http://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/PA/Facts/Cognition%20fact%20sheet.ashx

Disorders, E. o. (2013). Cognitive Retraining. Retrieved from Encyclopedia of Mental Disorders: http://www.minddisorders.com/Br-Del/Cognitive-retraining.html

Katz, N. (1992). Cognitive Rehabilitation: Models for Intervention in Occupational Therapy. Stoneham: Andover Medical Publishers.

Klonoff, P. W. (2007) The relationship of cognitive retraining to neurological patients’ work and school status. Brain Injury, 21(11), 1097-1107.

Nadeau, B. (2011). AOTA.org. Retrieved October 17, 2013, from AOTA.org: http://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/Community%20Reintegration%20fact%20sheet.ashx

"Welcome to Encyclopedia of Mental Disorders." Encyclopedia of Mental Disorders. N.p., n.d. Web. 18 Oct. 2013.

Willard, Helen S., Elizabeth Blesedell. Crepeau, Ellen S. Cohn, and Barbara A. Boyt. Schell. Willard & Spackman's Occupational Therapy. 11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009. 739-76. Print.

Zoltan, B. (1996). Vision, Perception, and Cognition: A Manual for the Evaluation and Treatment of the Neurologically Impaired Adult. Thorofare: SLACK Incorporated.

Research

Process

"The relationship of cognitive retraining to neurological patients’ work and school status"

Klonoff, P. W. (2007); Brain Injury, 21(11), 1097-1107.

Retrospective Cohort Study - Level of Evidence: III

• Evaluation
• Screening
• Assessment
• Intervention

Study

Results

Primary Objective:

• To explore the relationship of cognitive retraining performance to discharge productivity status

Method and procedures:

• 101 brain-injured patients from a holistic milieu-oriented work/school re-entry program at The Center for Transitional Neurorehabilitation

Experimental Interventions:

• Initial, last, mean and best cognitive retraining scores
• cognitive retraining behavioral checklist ratings
• working alliance scores

• Most (82.2%) of the sample returned to paid work or school.

• Better performance on two cognitive retraining tasks addressing information processing speed, visual scanning, visuospatial skills and memory were associated with return to the same level of work/school with and without modifications.

• Selected process variables related to the patients’ behavioral approach to cognitive retraining tasks (e.g their use of compensations, organizational and abstraction skills, procedural skills and unassisted task recall) were associated with better work/school outcomes.

• Patients’ positive working alliance ratings related to their behavior approach to cognitive retraining tasks.

This highlights the importance of combining interventions targeting both the therapeutic interactive process and skill remediation to maximize work/school reintegration.

Evaluation

Occupational profile

• If client is unable, close friend or relative
• Identify activities/roles of most concern to patient

Comprehensive cognitive evaluation

• Allen Cognitive
• Lowenstein Occupational Therapy Cognitive Assessment (LOTCA)
• Motor Free Visual Perception Test (MVPT)
• Mini-Mental State Exam

Direct observation of function

• OT-ADL Neurobehavioral Eval (A-ONE)
• Executive Function Performance Test

Intervention

Conclusion

• Begin with lower-level skills which are the foundation for more complex skills
• select activities based on current cognition level of patient (low, medium, or high cognitive level)
• Practice specific cognitive or perceptual skills that are deficient
• use paper and pencil activities/worksheets, computerized exercises, and electronic scanning devices
• Address targeted deficits during functional activities
• Treatment depends on setting

Cognitive Retraining exercises that incorporate both process variables and metacognitive skills, as well as a better working alliance with patients, positively related to return to work and school at the time of discharge from a holistic mileu-oriented program.

Objectives

Cognitive Retraining

"Cognition consists of interrelated processes including the ability to perceive, organize, assimilate, and manipulate information to enable the person to process information, learn, and generalize."

- Abreu and Toglia, 1987 cited in Willard & Spackman

The Cognitive Retraining Model

• Understand cognition and cognitive retraining
• Discuss the role of OT practitioners in cognitive retraining
• Define evaluation approaches and intervention techniques that are appropriate for cognitive retraining and the populations it is used with.

Compensation or Retraining?

• Training is directed at improving impaired cognitive functioning
• Involves systematic and structured training in visual scanning, categorization or classification, sequencing, planning or thinking operations
• Gradually increases complexity of information
• Utilize paper and pencil activities, tabletop and computer activities, and functional activities

Averbuch and Katz, 2005

Katz and Hartman-Maeir, 2005

• Compensation teaches the person to bypass or minimize the effects of the impairment by modifying the method that is used to perform an activity; use of external aid or strategy

• Remediation (retraining) places an emphasis on restoring impaired cognitive-perceptual skills. Focuses on changing the person's underlying skills rather than manipulating the activity demands or context

Indications

OT Role

Diagnoses

• Brain injury
• CVA
• Dementia
• ADHD
• Learning disabilities
• Age-related cognitive changes
• tumors
• infection
• congenital disorders

Impairments

• Orientation
• Attention
• Neglect
• Memory
• Visual Processing
• Executive Function
• Motor planning
• Awareness

• Work as part of an interdisciplinary team
• ST, PT, Neuropsychologist, Rec Therapist

• Use knowledge of occupation, training in activity

analysis, and ability to analyze how cognitive-perceptual symptoms are affected by changes in activity demands and context

• Evaluate ADL, IADL, education, work, play and leisure, and social participation

• Address attentional strategies within the context of self-care, leisure, and community or work activities

Cognitive Retraining

Anna Harris, Jennifer Nanney, Courtney Shankle