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Toglia's Dynamic Interactional Approach

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Cassie Rubley

on 9 December 2014

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Transcript of Toglia's Dynamic Interactional Approach

Toglia's Dynamic Interactional Approach
Nermin Soliman
Cassie Rubley
Alison Schubert
Also known as...
The goal of cognitive rehabilitation
is to restore functional performance
for persons with cognitive
dysfunction by specifically
targeting the following

Visual processing
Motor planning
Occupational behaviors

Toglia's Dynamic Interactional Approach
Cognitive Remedial Approach
Kielhofner: "Cognitive Perceptual Approach"
Bruce & Borg: "Dynamic Interactional Model"
Population: used with all types of acquired brain injury and some mental health and developmental disability populations

Goal: to restore functional performance for persons with cognitive dysfunctions

Concerns: previously identified as orientation, attention, visual processing, motor planning, cognition, occupational behaviors, and effort
Theoretical base
The foundation of this approach is neuroscience and its application guidelines are within the theory of occupation
Information processing occurs in three stages:
1. Registration of the stimulus event
2. Analysis
3. Hypothesis formation
Systems approach
Brain plasticity
The brain's structural and functional capacity
OT concepts that form the basis of the dynamic interactional approach include aspects of the person, the activity, and the environment
let's see WHAT you remember...
1. What individuals does Toglia’s dynamic interactional approach serve?

2. What are the three concepts that form the basis of the dynamic interactional approach?
Great job

Three people may answer this question and you cannot ask Dr. Leto for help... I can’t wait to see your dance moves!!!
The person
Personal context
On-line awareness (and no, I don’t mean internet awareness!)
Processing strategies
Surface level, deep level
Strategies may be internal or external
Strategies that are nonspecific
The Activity
Activity demand
Tasks that are familiar and predictable
Regardless of the difficulties, activities should be analyzed
Transfer of learning
The environment
Social context
Zone of proximal development
Cultural context
Physical context
Can you name one concept of the person?
Can you name one concept of the activity?
Can you name one
concept of the environment?

Cognitive function
Helping clients adjust to cognitive changes that have occurred
Client’s with brain injury are often unaware of their limitations in cognitive ability and are, therefore, unable to make good judgments about what tasks they should or should not attempt
Skills in the therapeutic use of self may be necessary when dealing with barriers and self-awareness
Structured logs or journals of daily activities can increase self-awareness
enabling transfer
of learning
Transfer of learning is increased through practice of cognitive strategies within multiple contexts
In a multicontextual approach, treatment progresses along a horizontal continuum that gradually places more demands on the ability to transfer and generalize use of the targeted strategies
1. Near Transfer
2. Intermediate transfer
3. Far transfer
4. Very far transfer
The multicontextual approach involves careful analysis of what parameters will change from one situation to another

In this dynamic approach, no distinction is made among establishing or restoring function, making adaptions, or utilizing compensatory strategies
The emphasis on learning effective strategies motivates the client to recognize and overcome cognitive difficulties
OT’s teach clients to be self-directed in checking their own performance, shifting emphasis away from actual task outcome, and focusing on their ability to apply cognitive strategies
guidelines for intervention
guidelines for intervention
First developed as a cognitive rehabilitation approach for TBI treatment
Early 1980s
Toglia & Abreu
Continued research in generalization of learning
Renamed "multi-contextual" in the 1990s
Usually needs to occur beyond the clinical setting
Helps fully understand the cognitive issues of clients
Client's cognitive potential not accurately measured by psychological assessments or standardized tests
Dynamic assessment describes a wide range of methods
Toglia suggests that OT assessment begin with observation of client's engagement in actual tasks and include the following components:
Self perception prior to task performance
Facilitating changes during task through cues or strategy teaching
Self perception of performance during and after task
Published assessment tools include:
Contextual memory test (CMT)
Toglia category assessment (TCA)
Dynamic object search
True or false?
In this model, clients should be evaluated in a clinical setting.
Often cannot be separated from assessment
Begins with identifying a client's baseline
Strategies for increasing self-awareness
Self-prediction about difficulty of the task and own ability to do it
Self-checking and self-evaluation through checklists or interval monitoring
Role-reversal: therapist demonstrates client dysfunctional behaviors and client identifies the error or lapses
Strategies for improving task performance
Verbal mediation
Stimuli blocking
Memory notebook
Cognitive strategy that compensates for deficits in attention and short term memory
Client and therapist work together to decide
Why? When? What?
Reinforcement is important
Notebook quiz
individual vs. group
Some strategies are best individual; some as a group
Best individual when client has cognitive disability in certain environment
Usually need to begin with individual for baseline
Group intervention
Learning/using cognitive strategies along the multicontextual transfer of learning continuum
Role-playing problem situations
Comparison of different strategies for the same task
What is a memory notebook and what is something that it is used for?
The brief dynamic assessment, developed for this study,
provided an opportunity to observe the client's ability to incorporate strategy training and feedback across visual search tasks. The assessment approach has the potential to characterize learning profiles and to guide intervention decisions.
Multivariate analysis of covariance indicated significant
differences between groups on the object search task, with
reduced unilateral neglect in the dynamic group. Greater
initiation of left-sided search, strategy use, and near and
intermediate transfer of learning were observed in the
dynamic group.
Forty adults with right cerebrovascular accident were randomly assigned to a control or dynamic group. Both groups were administered standard pre- and post-tests of unilateral neglect including:
Line Crossing Test
Star Cancellation Test
The dynamic group received cues, strategy training, and feedback during an object search task
Object Search Task
Okay, I will take
it easy on you...
Cognitive function is the ability to receive, elaborate, and monitor incoming information and the flexibility to use and apply one’s analysis of information across task boundaries
Traditional OT interventions address attention, memory, and perception
Katz and Hartman-Maeir (2005) include the higher-level cognitive skills necessary for performing occupations, also called metacognitive skills or executive functions

The ability to anticipate a problem
and strategize a plan
Knowledge of one's own deficits
Identification and organization of steps needed
to reach a goal, the power to concentrate,
the capacity to control impulses, and the ability to be flexible in decision-making
The ability to continually judge one’s
own performance, to self-correct,
and to regulate performance
Forming the idea
of doing something
Dynamic Assessment and Prediction
of Learning Potential in Clients with Unilateral Neglect

This study investigated the application of dynamic assessment in examining learning potential for adults with right hemisphere stroke and unilateral neglect
Cognitive disability
According to Toglia (2005), cognitive disability involves core deficiencies in the following abilities:
To select and use efficient processing strategies to organize incoming information
To anticipate, monitor, and verify accuracy of performance
To access knowledge when necessary
To flexibly apply knowledge and skill to a variety of situations
In the research article, both the dynamic and control group were administered standard pre- and post-tests of unilateral neglect... Name and describe one of those tests.
Please name and describe one metacognitive skill.
Toglia, J. P., Golisz, K. M., & Goverover, Y. (2014). Cognition, perception, and occupational
performance. In B. A. B. Schell, G. Gillen, & M. E. Scaffa (Eds). Willard and Spackman's occupational therapy (12th ed., pp. 781-791). Philadelphia: Lippincott Williams & Wilkins.

Toglia, J., & Cermak, S. A. (2009, September). Dynamic assessment and prediction of learning
potential in clients with unilateral neglect [Electronic version]. The American Journal of Occupational Therapy, 63(5), 569-579. doi:10.5014/ajot.63.5.569

Cole, M. B., & Tufano, R. (2008). Toglia's dynamic interactional approach. In Applied theories in
occupational therapy: A practical approach (pp. 175-183). Slack.

Zlotnik, S., Sachs, D., Rosenblum, S., Shpasser, R., & Josman, N. (2009). Use of the dynamic
interactional model in self-care and motor intervention after traumatic brain injury: explanatory case studies. American Journal of Occupational Therapy, 63, 549-558.
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