Functional Cognition Midterm

What is functional cognition?

-combination of cognition and function

-observable performance of everyday activities resulting from a dynamic interaction between cognitive abilities, activity demands, and the task environment

What is a reductionist model?

-isolates aspects like memory, problem solving, EF

-focuses on deficits and not strengths

Benefits of a reductionist model

-helps explain behaviors

-provide a basis for comparison (good to track recovery from injury)

-strong psychometric properties

Drawbacks of a reductionist model

-does not always translate to performance!

-may not reflect functional abilities

Task considerations for fun cog

-salience

-motivation

-familiarity

Environment considerations for fun cog

-dynamic or static

-familiar or novel

-support or hindrance

Condition considerations for fun cog

-strengths and limitations

-compensations

-awareness

LAUNDRY EX - task considerations

-how often they do it

-location of machine

-separation of colors?

LAUNDRY EX - environment considerations

-location of machine

-social support

-are dirty clothes spread out or in something like a laundry bin

LAUNDRY EX - cognition considerations

-sequencing of task

-number of steps

-timing for when its done

-recognizing mistakes

Attention

- a hierarchical system

- the higher on the hierarchy, the more systems involved, so more likely something is impaired

Attention hierarchy

1) arousal/alertness

2) vigilance

3) selective attention

4) capacity

1) Arousal/alertness

focused attention

-automatic brain systems to extract information from the environment and select a behavior response

-EX: do they turn when you say their name?

2) Vigilance

sustained attention

-ability to maintain alertness over a period of time

-EX: conversation, listening to a lecture

3) Selective attention

-ability to select information necessary for a task (filter)

-EX: listening to professor and not the sound of the keyboard

4) Capacity

alternating and divided attention

-ability to change focus/allocate attentional resources

-EX: cooking a lot of things at once

Reticular activating system (RAS)

-brainstem; automatic

-regulates sleep and wake cycles

-attending to tasks throughout the day

**supports sustained attention + tonic alertness

Thalamus

-sensory information processing

-"filter" for sensory information (what information do we actually need to focus on?)

**supports selective attention

Colliculi

-superior colliculus: visual attention

-inferior colliculus: auditory attention

**supports selective attention and alternating attention

Parietal lobe

-fine tuned filter like the thalamus

-visual + spatial aspects of attention

**supports selective attention and allocation of resources (alternating and divided attention - how much attention we need to give up to each task)

Anterior cingulate

-link between subcortical and cortex

-inhibit over learned responses

-complex behavior selection (what is the appropriate response to this experience)

Frontal lobes

-selection of response (initiate and inhibit)

-selection of info to be held online (in the moment)

-considered EF (higher levels of attention)

Posner and Peterson Model: three systems of attention

-Alerting

-Orienting

-Executive

Alerting system

base level

-vigilance/sustained attention

Orienting system

-prioritizes sensory input

Executive system

-exercises top-down control

-resolves conflicts

-detects sensory info that requires conscious attention

Memory stages

1) attention

2) encoding

3) storage

4) retrieval

1) Attention

process incoming information

2) Encoding

initial stages of memory where information is analyzed

3) Storage

memory is retained, transient memories are moved to a. location of the brain for more permanent recall

*when you know info will be needed in the future

4) Retrieval

Where memories are recalled, locating of existing memories

Retrograde amnesia

-problem with recall

-stage 4

Anterograde amnesia

-problem with encoding/storage

-stage 2 + 3

Atkinson-Shiffrin Model of Memory

Atkinson-Shiffrin Example: ordering pizza

- attention: recognize you are hungry, attending to body

-sensory register: what kind of pizza sounds good; SEEING how many people to buy pizza for

-short term store/working memory: remembering what type of pizza everyone wants

-long term store: memorize pizza number; telling them your address, giving your phone number

Long term memory: declarative (explicit) memory

-semantic memory

-episodic memory

-prospective memory

Semantic memory

general knowledge

-"grass is green"

Episodic memory

past personal experiences

-remembering childhood vacation

Prospective memory

remembering to do things in the future

-taking meds at a specific time

Nondeclaritive (implicit) memory

-procedural memory (skills)

-priming and perceptual learning

-classical conditioning/behavioral learning

Procedural memory (skills)

memory for skills

-typing on a computer

-riding a bike

Priming and perceptual learning

if you see fast food ads all day, you will want a burger not a salad

-color coding notes or planner

Classical conditioning/behavioral learning

response is learned as a result of pairing of two stimuli

-do a behavior because you know what outcome would be

-anxiety when alarm goes off in morning

Baddeley's working memory model

Baddeley's - central executive

-plans future actions

-retrieval of LTM

-integrates new information

Baddeley's - visuospatial sketch pad

-holds visual and spatial information

Baddeley's -phonological loop

-holds verbal and auditory information

Baddeley's - episodic buffer

integrates information with LTM and chunks info based on prior knowledge in order to improve storage and later retrieval

Prefrontal cortex

-most well-established cognitive portion of the brain

-EF, workin memory, abstract thinking, social cognition

-**connected with every functional portion of the brain

Executive functions

umbrella term

-no single behavior can be tied to EF

-abilities that allow a person to adapt to new situations and develop and follow their life goals

-EF is gateway to skill acquisition

Executive function examples!

-initiation (starting behavior)

-response inhibition (stopping behavior)

-planning/organization (sequencing + timing behavior)

-multitasking (more than one task)

-goal-directedness (intentionality)

-task persistance (maintaining behavior)

-awareness (monitor+modify own behavior)

-problem solving (solutions + choices)

Common symptoms of executive DYSfunction

-impulsivity

-confabulation (unintentionally recalls false mems and thinks they are accurate)

-difficulty planning

-euphoria

-poor sequencing

-lack of insight

-apathy

-disinhibition

-aggression

-perseveration (invol repetition of thought or behavior)

-poor decision making

Shallice's Supervisory Attention System

four hierarchical levels of behavior

-action units

-schemata

-contention scheduling

-supervisory attentional system

Shallice - action units

basic abilities

-reaching for an object

Shallice - schemata

part of a task

nest of action units closely associated with each other through repetition and practice

-reaching for water AND taking a drink

Shallice - contention scheduling

routine + whole task

basic interface between incoming stimuli (or thoughts_ and schemata

quick selection of routine behaviors in well-known behaviors

-what we are used to (route home)

Shallice - supervisory attentional system

conscious cognitive controlled processing

-taking a different route home because of flooding)

Levels of awareness

-intellectual (most basic)

-emergent

-anticipatory

Intellectual

"self awareness"

-knowledge that they have limitations

Emergent

"on-line monitoring"

-ability to recognize that they are having a problem while it is occurring

Anticipatory

"on-line monitoring"

-ability to anticipate problems before they occur

Reliability

-consistency of test takers scores, under similar testing conditions

Validity

tests measures what it is supposed to measure - performance on test relates to what is being assessed

**many different types

Construct validity

tests what concept it says it is testing

Convergent validity

how well it correlates with other measures

Divergent validity

a measure that is uncorrelated with different measures

Content validity

how comprehensive it is in that construct

Face validity

if it looks believable

Concurrent validity

extent it correlates with another well assessed measure of the same construct at the same time

Predictive validity

how well it predicts an outcome

Sensitivity

test identifies the true positive, actual positives are correctly found

*** ability of test to determine individuals WITH condition

Specificity

test identifies true negative, individuals without cognitive impairment are correctly identified

*** ability of test to determine individuals WITHOUT condition

Cognitive Functional Evaluation (C-FE)

Revised

1. Occupational history/narrative

2. Cognitive factors

(3, 4, 5 can go in any order after 1 + 2)

3. Occupational performance

4. Self-awareness and beliefs

5. Environmental factors

Evaluation methods for C-FE

-Interviews

-Self reports and informant reports

-Performance based assessments

Occupational history

-saliency (what is important to the client?)

-novel vs procedural/habitual (how familiar are they with certain tasks)

-motivation (what motivates them?)

tools: semi structured interview, GAS

Cognitive factors - cognitive screening

Cog screening

-baseline of where to start

-should not be the sole basis for treatment plan (only preliminary data)

tools: MMSE, short blessed, MOCA, SLUMS, TMT

Cognitive factors - neurocognitive testing

designed to measure isolated constructs to localize brain lesions and serve as diagnostic tool for supporting diagnosis

tools: BIT, TEA, TBMT

Occupational performance

performance based testing + functional observation

tools: weekly calendar, multiple errands, EFPT, EFPTe, PASS, actual reality, AMPs

Self-Awareness and Beliefs

-clients own understanding of their cognitive profile

-self awareness and beliefs can be observed at any point in the C-FE

Environmental factors

-safety

-accessiblity

-social support

-resources

tools: home occupational environmental assessment, safety assessment of function and the environment for rehabilitation

True negative

someone WITHOUT the condition NOT being identified with the condition

True positive

someone WITH the condition being identified WITH the condition

False negative

someone WITH the condition NOT being identified with the condition

False positive

Someone WITHOUT the condition being identified WITH the condition

Positive predictive value (PPV)

-percentage of individuals with a positive test that are accurately identified (they have condition)

**closer to 100%, the better

Negative predictive value (NPV)

-percentage of individuals with a negative test that do not have the condition

**closer to 100% the better

EFPTe

Executive functioning in IADLs and home activities (cooking, phone, bills, meds)

-initiation, organization, sequencing, judgment and safety, completion

-used for higher PLOF (EFPT for lower)

EFPTe scoring criteria

cues-based

have to do two cues in each section to move onto next

cue levels: verbal guidance, gestural guidance, verbal direct, physical assistance, do for participant

EFPTe population

mild cognitive impairment

higher PLOF

**NOT APPROPRIATE for severe cognitive deficits

EFPTe settings

home

outpatient

CTPA

** working in library

inventory and phone messages

-work based tasks

CTPA scoring criteria

inefficiencies, rule breaks, interpretation failure, task failure, inventory control accuracy

CTPA population

people who want to return to work

higher cognitive functioning

NOT APPROPRIATE FOR: retired, not working

WCPA

weekly calendar planning activity

3 versions varying by difficulty (2 most common)

WCPA scoring criteria

accuracy, total time to complete, number of rules followed, strategy use (number and frequency), planning time

WCPA settings/population

lots of settings, even adolescent versions, seen more in OP, HH, IPR

-not appropriate for: super severe cognitive deficits, motor impairments w dominant hand impacted, visual impairments

PASS

26-task related assessment focuses on ADL, IADL, and functional mobility skills that a client may have

PASS scoring criteria

safety, independence, adequacy (process + quality)

PASS settings/populations

a lot of them; some subtests better for diff populations

not appropriate for children

PASS cueing structure

9 cues

1. verbal encouragement

2. verbal indirect

3. verbal direct

4. gestural

5. task/environmental rearrangement

6. demonstration

7. physical guidance

8. physical support

9. full assist/do it for them)