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Copy of Cognitive and Perceptual Assessment and Intervention

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on 28 October 2013

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Transcript of Copy of Cognitive and Perceptual Assessment and Intervention

Cognitive and Perceptual Assessment and Intervention
Wrap-Up
Thank you for your attention!
Summary of your Learning
To develop an understanding of cognition and perception and how cognitive and perceptual impairments influence occupation
To become familiar with the role of the occupational therapist in cognitive and perceptual assessment and treatment
To explore commonly used assessments and generate intervention strategies that address cognitive and perceptual impairments
To apply knowledge acquired throughout the workshop to several clinical case scenarios
Interrelated processes including the ability to perceive, organize, assimilate, and manipulate information to enable the person to process information, learn, and generalize
What we do with the information our senses tell us
Seven components of cognition
How we understand our environment
How we process and interpret information from our senses
Easier to consider what distorts perception
Today's Objectives...
Cognition...
Perception...
Literature suggests there is still no clear distinction
Perception refers to the brain's awareness of the information
Cognition refers to the processing of the information
Cognition and Perception
The Multidisciplinary Team
OT Role in the Multidisciplinary Team
Information Processing Theory
Theory:
Cognitive Rehabilitation
Cognitive Retraining
General approaches to evaluation...
(from an OT perspective, of course)
General approaches to intervention...
(from an OT perspective, of course)
See you in your break-out rooms at 11:00 am
BREAK!
Break out rooms...
Standardized assessment
Direct observation of function
Dynamic assessment
Examples?
Quantifies severity of impairments
Establishes a baseline
Often population-specific

Things to consider...
Evaluates current performance
Difficult to generalize
Relies heavily on verbal skills
Sometimes culturally-biased
Substantial false-negative rates
Standardized Assessments
Identifies underlying processes that contribute to occupational performance issues
Rates task performance and amount of cueing and assistance required

Things to consider...
Impairments may not be apparent in familiar activities
May not be predictive of performance in natural environments
Direct Observation of Function
Uses cues, mediation, feedback, task alterations
Evaluates how performance can be facilitated
Natural link to intervention
Client-centered

Things to consider...
Measurement
Dependence on cues
Dynamic Assessment
(1) Do I need to clarify the presence of a cognitive-perceptual impairment?
(2) Do I need to establish a baseline as a measurement of change or outcome of intervention?
(3) Do I need information to guide intervention?
(4) Do I need to understand the effect of impairments on occupational performance?
Questions to consider when choosing assessments...
Advantages
Change, alter, or structure activity demands or context to maintain or improve client’s function
Designed in collaboration with client
Support to caregivers
Disadvantages
May require ongoing implementation and monitoring
Effects limited to activity or environment that is adapted
Success dependent on follow-through by client and caregivers
Adaptation of Activity or Context
Functional Task Training
Advantages
Task-specific training within natural context via practice and repetition
Possible for clients with minimal awareness of impairments
Taps into procedural or implicit memory
Disadvantages
Takes time
Dependency on cues
Difficulty generalizing
Remedial
Changes underlying skills
Improves core skills to increase generalization
Also known as ‘transfer training’ approach
Taps into brain plasticity
Cognitive Retraining
Remediation and compensation
Improving impairments
Teaches new adaptive strategies
Examples
Paper-and-pencil exercises
Tabletop activities
Functional activities
Multicontext Approach
Toglia’s interactional model of cognition
Awareness, task analysis and feedback, strategies
Facilitates transfer of learning
Examples
Mental rehearsal
self cues
(1) How much change is expected from the client?
(2) How much learning and generalization are expected?
(3) How much do the activity demands or context need to be changed or altered to meet the client’s capabilities?
(4) Is the client responsive to cues?
(5) Is the client aware of his/her difficulties?
Questions to consider when choosing interventions...
Remedial
Restoring cognitive capacities through practice, exercise and stimulation with the expectation that these gains will translate to improvements in tasks and activities
Planning and problem solving behaviour
Broadening a person's ability to manage increasing amounts of information through the use of mental and behavioural strategies
Family and client are members
No single discipline responsible for evaluating and treating cognitive-perceptual impairments
Team goals and specific discipline goals need to be identified
SLP, neuropsychologist, PT, OT
Knowledge of occupations
Task/activity analysis
Analysis of how cognitive-perceptual deficits affect the demands of activities
What information can we provide the team with?
Help the client to see patterns of behaviours across different activities
Help to transfer new skills across activities
Emphasize positive reinforcement
Demonstrate the positive effects of interdisciplinary collaboration
An integrated approach will...
The seven components of cognition...
Judgment
Insight
Memory
Sequencing
Problem Solving
Attention
Orientation
(and a fun way to remember them)
Just
Imagine
Making
Silly
Puns
About
OT
Components of perception
Time awareness
Spatial relations
Vision problems
Visual neglect
Apraxia
Perseveration
What does this mean for OT?
Cognition and perception deficits ultimately affect occupational performance
FUNCTIONAL
FUNCTIONAL
REMEDIAL
REMEDIAL
REMEDIAL
Developed an understanding of cognition and perception and how cognitive and perceptual impairments influence occupation
Developed a familiarity with the role of the occupational therapist in cognitive and perceptual assessment and treatment
Explored commonly used assessments and generated intervention strategies that address cognitive and perceptual impairments in a problem-based environment
Abreu, B.C., Toglia, J.P. (1987). Cognitive rehabilitation: A model for occupational therapy. The American Journal of Occupational Therapy, 41(7), 439-448.

Bagg, S., Barr, L.G., Benton, J., Brown, G., Bruggenkate, I., Carques, T.,...Leduc, L. (2010). Heart&Stroke Tips & Tools for Everyday Living A Guide for Stroke Caregivers. Canada: Heart and Stoke Foundation of Ontario.

Beery, K.E. (1997). Administration, Scoring, and Teaching Manual for the Beery-Buktenica Developmental Test of Visual-Motor Integration with Supplemental Developmental Tests of Visual Perception and Motor Coordination. New Jersey: Modern Curriculum

Colarusso, R.P., & Hammill, D. D. (1972). MVPT: Motor-free visual perception test manual. Novato, CA: Academic Therapy Publications.

Canadian Psychiatric Association. (2007). Schizophrenia: The journey to recovery - A consumer and family guide to assessment and treatment. Retrieved from http://www.schizophrenia.ca/CPAGuidelinesFinalE.pdf.

Canadian Stroke Network. (2008). StrokEngine assess: Motor-free visual perception test (MVPT). Retrieved May 4, 2012, from http://www.medicine.mcgill.ca/strokengine-assess/module_mvpt_indepth-en.html

Cicerone, K. et al. (2005). Evidence-based cognitive rehabilitation: Updated review of the literature from 1998 through 2002. Archives of Physical Medicine and Rehabilitation, 86(8), 1681-1692

Koh, C. J., Lu, W. S., Chen, H. C., Hsueh, I. P., Hsieh, J. J., & Hsieh, C. L. (2011). Test–Retest Reliability and Practice Effect of the Oral-format Symbol Digit Modalities Test in Patients with Stroke. Archives of Clinical Neuropsychology, 26, 356–363.

Mairs, H., Bradshaw, T. (2004). Life skills training in schizophrenia. British Journal of Occupational Therapy. 67(5), 217-224.

McColl M. A., Law M., Stewart D., Doubt L., Pollock N. and Krupa T.. (2003). The Theoretical Basis of Occupational Therapy (2nd ed.). Thorofare, NJ: SLACK Incorporated.

Smith, A. (1973). Symbol Digit Modalities Test. Los Angeles, CA: Western Psychological Services.

Wang, P., Ennis, K., & Copland, S. (1992). Cognitive Competency Test manual. Mount Sinai Hospital, Toronto, ON.
References
BK 4

Functional
Remedial

Examples?
ADLs, IADLs, education, work, play, leisure, social participation
Examples?
NK 3014
Terapi Carakerja Neurologi
Full transcript