Chap.17 Cognitive Interventions Chap.32 Vision

Guiding Topics

1. Theories for cognitive approaches

• Info Processing – input–process–output.

• Learning Theory – constructivist, social learning, scaffolding.

• Dynamic Systems – person–environment–occupation interaction.

• Cognitive Psych/Neuropsych – brain–behavior link.

• Motor Learning – feedback + practice.

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2. Definitions

• Cognition – mental processes (attention, memory, problem-solving).

• Metacognition – thinking about thinking; self-monitoring & adjusting.

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3. Cognitive intervention key points

• Client-centered, top-down.

• Strategy-based, promotes generalization.

• Active engagement, guided discovery.

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4. OT application of cognitive strategies

• Remediate skills.

• Compensate with aids/strategies.

• Adapt tasks/environments.

• Teach metacognition in real-life tasks.

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5. CO-OP: 7 key features

1. Client-chosen goals (COPM).

2. Dynamic Performance Analysis (DPA).

3. Global strategy: Goal–Plan–Do–Check.

4. Guided discovery.

5. Enabling principles.

6. Parent involvement.

7. Structured intervention format.

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6. CO-OP evidence in peds

• Improves performance in DCD, ASD, brain injury.

• Skills generalize to untrained tasks.

• Boosts self-efficacy + motivation.

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7. CO-OP clinical example
Child sets bike goal → uses GPDC → therapist prompts, not tells → parent supports → skill transfers to scooter.

Theoretical Foundations

Vygotsky – Zone of Proximal Development (ZPD); learning happens with guidance just beyond current ability.

Luria – Added social & cultural environment to cognitive development.

Meichenbaum – Focused on speech & adult guidance for learning/self-regulation.

Bandura – Linked metacognition with empowerment; observational learning.

Adult Guidance – Instruction from a master/expert of the skill; the adult demonstrates, models, and directs based on their own high competence.

Scaffolding – Support that may come from someone not fully mastering the skill; focus is on structuring the task so the learner can progress toward independence.

Cognitive Strategies

Scaffolding – Guided support that builds internal dialogue → helps learn new skills.

Discovery Learning – Kids construct knowledge through trial & error; education-based.

Instrumental Enrichment – Cognitive performance can improve through intentional, mediated interventions.

Rationale

Motivation – Internal/external drive to start, persist, and complete a task.

Generalization & Transfer – Applying learned skills/strategies to new tasks or environments.

Lifelong Development – Cognitive skills can grow and adapt throughout the lifespan.

Cognitive Orientation to Daily Occupational Performance

CO-OP Objectives

• Skill Acquisition – Learn new performance skills.

• Cognitive Strategy Use – Apply problem-solving methods (e.g., GPDC).

• Generalization – Use skills in trained tasks.

• Transfer of Learning – Apply skills/strategies to untrained tasks.

• Focus on Cognition – Use thinking as a tool to support performance.

Take Home Points

• Cognitive Approaches – Develop strategies to accomplish a chosen task.

• Cognition – Acquiring knowledge/understanding through thought, experience, and senses.

• Cognitive Interventions – Variety of methods to improve thinking and problem-solving.

• Cognitive Strategies – Implicit mental processes that guide learning.

Importance of Vision for Occupation – Undetected/untreated vision problems can limit:

• Reading

• Copying from the board

• Writing

• Playing

• Sports

Important Terminology

Visual Acuity – Clarity/sharpness of vision.

Myopia – Nearsightedness; can see close objects clearly, far objects blurry.

Amblyopia – “Lazy eye”; reduced vision in one eye due to abnormal development.

Pursuits – Smooth tracking of a moving object.

Saccades – Quick eye movements between two points.

Strabismus – Eye misalignment (e.g., inward, outward, up, or down turn).

Two Primary Models of Vision

1. Three-Component Model

• Visual Integrity – Eye health, refractive status, visual acuity.

• Visual Efficiency – How well the eyes move/focus (e.g., pursuits, saccades, accommodation).

• Visual Information Processing – How the brain interprets visual input (perception, memory, discrimination).

2. One-Component Model

• Focuses only on Visual Integrity (clarity & eye health).

Three Eye Care Professions

Opticianry – Fits and dispenses glasses/contact lenses; does not diagnose or treat eye disease.

Optometry – Examines eyes, prescribes lenses, diagnoses & treats some eye conditions (non-surgical).

Ophthalmology – Medical doctor specializing in eye health; diagnoses, treats, and performs surgery.

Common Visual Impairments in Children With Varied Diagnoses

Children with CP – Common vision issues:

• Refractive error – Blurry vision from focusing problems.

• Strabismus – Eye misalignment.

• Eye movement issues – Poor pursuits/saccades.

• Accommodative problems – Trouble shifting focus near ↔ far.

Children with Down Syndrome & Autism – Common vision issues:

• Refractive error

• Accommodative problems

• Strabismus

• Autism only – Additional convergence issues (eyes working together).

Vision Screening

Symptom Questionnaire – Checklist of vision-related symptoms impacting daily activities.

Near Point Rule – Tool to measure near point of convergence or accommodation.

Near Point of Convergence – Closest point eyes can maintain single vision before double vision occurs.

NSUCO Eye Movement Test – Assesses pursuits & saccades; scores accuracy, head movement, and body movement.

Developmental Eye Movement Test (DEM) – Measures saccadic eye movements & automaticity in reading-like tasks.

TVPS (Test of Visual Perceptual Skills) – Assesses visual-perceptual abilities without motor involvement.

VMI (Beery–Buktenica Visual–Motor Integration) – Assesses how well visual perception & motor coordination work together.

OT Vision Evaluation

• Overall Development – Assess motor, cognitive, sensory, and perceptual skills.

• Skilled Observation – Watch for functional impacts during real tasks.

• Impact on Quality of Life – Identify how vision limits participation in meaningful occupations.

OT Intervention for a Child With Visual Impairments

OT Interventions – Child with Visual Impairments

• Improve manipulation & fine motor skills.

• Maximize use of functional vision.

• Encourage socially appropriate behaviors.

• Support language & concept development.

• Strengthen cognitive skills.

• Maximize auditory perceptual abilities.

OT Role in Vision Skills

• Saccades – Train quick eye jumps (e.g., reading drills, scanning games).

• Pursuits – Practice smooth tracking (e.g., follow moving ball).

• Laterality – Build right/left awareness (e.g., movement games).

• Visual Discrimination – Improve ability to tell objects/symbols apart.

• Figure–Ground – Find objects in busy backgrounds.

• Closure – Identify incomplete forms/pictures.

• Visual Memory – Recall visual info after brief view.

• Visual–Motor Integration – Coordinate vision with motor output (e.g., handwriting, copying).