Allen's Cognitive Disabilities Groups wk.6

Framework Focus

Used to measure and monitor client’s problem solving ability and safety while performing daily
activities in any occupations
 Match and adapt individual’s functional cognitive capacities with activity demands and context

Assessment

Leather lacing tool to eval cognition

highly valid and reliable

use results as guidelines for planning initial activities or discharge

initial screening important before setting groups

Enabling best ability to function

Two aspects: environmental adaptation and providing assistance

Cognitive Disability

limitations in sensorimotor actions
originating in physical or chemical structures of brain and
producing limitations in routine task behavior

Task Analysis

Determine the complexity of the task by breaking it into steps
 Look at physical and cognitive abilities needed

Allen’s functional Info processing system

Cues

Attention

Action/activity

Speed

Categories related to cognition that impact task performance

Attention

Motor Actions

Conscious Awareness

6 Cognitive Levels 

 Level 1 – Automatic actions
 Level 2 – Postural actions
 Level 3 – Manual actions
 Level 4 – Goal directed actions
 Level 5 – Exploratory actions
 Level 6 – Planned actions

Cognitive Level 1

Automatic actions

often bed ridden

respond mainly to internal cues (ex. hunger)

behavior is largely reflexive or habitual

OT should provide sensory stim. to elicit motor response

Cognitive Level 2

Postural Actions

can respond to proprioceptive input via postural changes

can imitate gross motor actions

can assist caregiver with ADLs

can feed themselves but messy

24 hr nursing care needed

can benefit from exercise group NOT interactive groups

Lower Cognitive Level Test

Ask client to watch you clap your hands three time loudly – if they can wait and then imitate they may be level 3

Cognitive Level 3

Manual Actions

 Perform manual actions in response to tactile cues
 Actions based on interest in objects near by
 Attention maintained up to 30 minutes
 Basic grooming tasks may be done independently
 Can walk to familiar places without getting lost
 Need supervision for some ADLs such as meal prep, following schedule, using phone, etc
 Supervise tool use; put dangerous objects out of reach
 Steps in a task can be imitated one at a time

Cognitive Level 4

Directed Actions

Goal directed in this level; this makes activity more purposeful
 Able to ask for assistance
 Basic living skills intact (ie dressing, grooming, bathing, feeding)
 Respond well to visual cues; verbal or written directions not
followed
 Non visible properties in the environment may pose danger (ie.
heat, electricity, etc)
 Need assistance with coping with new events, anticipating needs,
managing money
 New routines must be reinforced with practice and repetition
 Aware of goal and can ask for assistance – helps keep them safe
and functional

Cognitive Level 5

Exploratory Actions/Independent Learning 

Use of trial and error learning in this level
 Able to use inductive learning (learning from examples); capable of new learning
 Imitate new procedures; remember several steps at a time
 Novelty sought; variations explored
 Choices may be given to client
 Deficits in functions that require anticipation and planning
 Concrete thinkers; trouble imagining long term consequences
 Clients do not take preventative measures
 Social relationships may be impaired
 OT can focus on increasing social awareness, reciprocation in
relationships and accepting supervision to avoid negative
consequences

Cognitive Level 6

Planned Actions

No disability
Can use deductive reasoning

Can plan ahead
Organized behavior
Verbal and written directions followed
Can use symbols

Function and Dysfunction

Cognitive groups focus on learning the optimal environmental conditions necessary for safe purposeful activity participation
 No cut off cognitive level defining competence
 Competence is related to the activity the client intends to do

Change and Motivation

If change in cognitive process is irreversible OT can still make
changes in adaptive responses by manipulating the environment
 Strategies include
 Cultural considerations
 Adding social
 Providing choices
 Placement and storage of items
 Lighting
 Seating
 Facilitate available
 Assistance
 Change the task supplies, steps or instructions
 Just right challenges

 Reinforcers can include: Task success and Socially positive responses

Cognitive Disabilities Group Intervention

Homogenous groups
Level 2 and above
Some clients will move up the levels; some will plateau

Role of Leader

 Directive
 Often uses group to evaluate client
 Chooses task or provides limited choices
 Focus on the following:
 Task analysis
 Controlling and adapting Environment
 Instructing members in task
No more than 8 members
 Need to be able to observe task performance of each member for
ongoing assessment
 Lower level groups may need more assistance
 Higher level groups will need help with discussion

Structure and Goals: Level 2/3 

movement activities; should be pleasurable

 Ie touching toes or passing ball

 Clients may be disruptive

 Motor skills may be limited

Structure and Goals: Level 3

 Manipulation and repetition

 Ie simple wood working, tile use, bead stringing

 Clients are not goal directed; process must interest them

 Timing difficult; decreased ability to know where to begin and end

 No longer than 30 minute groups

Structure and Goals: Level 4

Goal directed; better at problem solving in order to reach the goal
 Attention limited; group should be no longer than 1 hour
 Group should be no longer than one hour
 Ie craft strategies such as 3 piece woodworking set
 Have finished sample available as visual cue
 Verbal and written cues not helpful
 Demonstration is helpful
 Probing questions are helpful if they get stuck
 Remove unnecessary items to decrease distraction
 Clearly mark supplies
 Assistance needed with processes that are not visible (ie. drying paint, heating food, etc.)

Structure and Goals: Level 5

Focus on safety
 Difficulty with impulsivity and lack of planning
 Tasks can have more complex directions
 Support needed for safe tool use
 Ie cooking, grilling, multi-piece woodworking,etc

Leadership

Introduction

Activity

Sharing

Processing

Generalizing

Application