Cognition

Automatic and Controlled Processing

Automatic processing: unintentional, done without conscious awareness, does not interfere with other mental activity

• automatic tasks are highly familiar and practiced, controlled tasks can become automatic with practice

• some psychiatric conditions can make it difficult (schizophrenia, intellectual disabilities) or impossible (late stage alzheimer’s) to establish automaticity

Strategies

• target tasks that have potential for automatic processing, simplify tasks and incorporate opportunities for consistent practice

Selective Attention

• sorting out and focusing relevant sensory stimuli

• a component of nearly everything we do

• distracters can be external or internal (auditory hallucinations or if it’s bright outside)

• filter theory vs. attenuation theory

Strategies:

• remove irrelevant stimuli, enhance and intensify important information, auditory and visual cues, address internal distractions like anxiety and auditory hallucinations

Divided attention

• ability to pay attention to more than one task at a time

• how does this work?

  • alternating

  • automatic vs. controlled

  • coordinated execution

Strategies:

• separate tasks, work towards making one or more tasks automatic, practice doing two tasks together

Vigilance

• ability to sustain attention through time

• fatigue is a significant barrier to vigilance

• quality of attention can decrease over time

Strategies:

• incorporate breaks, slow down presentation of info, make stimulus easy to detect, schedule difficult tasks when individual is well rested

Semantic memory

facts, tends to be created and forgotten easily

Episodic memory

events that have happened to you

Procedural memory

how to do something, take longer to create and is less susceptible to errors

Short-term memory

held for only a matter of seconds or minutes, can be lost within 20 seconds

Long-term memory

accumulation of information during a lifetime

Strategies:

• chunk items together, create mnemonics, ask questions about the information, apply information to oneself, use memory aids

Working memory

short-term memory storage with active manipulation of new information

Strategies:

• simplify tasks, provide devices to assist in information manipulation

Executive function: Concept formation and categorization

concrete vs. abstract concepts, concepts are grouped into categories

Strategies:

• provide cue sheet with categories and exemplars, provide real world experiences

Executive function: Schemas and scripts

Schemas: mental representations that structure related concepts

Scripts: kinds of schemas that describe a sequence of events for a familiar activity

Both help us to integrate information and organize memories

Strategies:

• write out or use pictures to show steps, create simple maps with steps, order objects in sequence, repeatedly practice the sequence

Executive function: Problem-solving

Steps to problem solving:

• recognize the problem

• understand the problem

• identify strategies or solutions

• evaluate the strategies

• select and carry out a strategy

• evaluate the outcome

Strategies:

• provide and practice problem-solving heuristics, prevent or eliminate common problems

Executive functioning: Decision-making

Heuristics- rules of thumb that help with quick decision-making

• representativeness

• availability

• anchoring and adjustment

Strategies:

• limit options, teach about biases in decision-making, teach to step back and think through decisions, ask others for input

Functional Cognition

• the application of cognition within the context of everyday activities

• what OTPs are most concerned with, because assessing the components is not necessarily predictive of function

• functional cognition collectively considers all the components, strategy use, habits and routines, and the environment

Metacognition

thinking about thinking, an awareness of what you know and what you don’t

Strategies:

• create questions to ask before engaging in a task, have individual evaluate their performance after a task

Test of Everyday Attention (TEA)

• used for adults with neurological or psychiatric conditions (can be used for children 6-16)

• measures selective, sustained, alternating, and dividing attention while engaging in everyday tasks

• administration time = ~1 hour

• 8 subtests:

  • map search, elevator counting, elevator counting with distraction, visual elevator, elevator counting with reversal, telephone search, telephone search while counting, and lottery

Multiple Errands Tests

• used for adults with brain injury, stroke, or psychiatric conditions

• measures executive function in a natural environment

  • rule breaks, inefficiencies, task failure, interpretation

• administered in a shopping center (MET) or hospital (MET-R)

• administration time = 30-45 minutes

• person is given rules to follow while performing tasks like making a purchase, finding out information about a service, or getting to an identified location at an identified time

Dynamic Lowenstein Occupational Therapy Cognitive Assessment

• used for adults with brain injury or psychiatric conditions

• measures orientation, perception, visual motor abilities, thinking, and ability to learn

• administration time = 30-45 mins

• 28 subtests that include paper and pencil and motor tasks

Executive Function Performance Test

• used with adults with neurological or psychiatric conditions

• measures executive function and capacity for independent functioning/level of assistance needed

  • initiation, organization, sequencing, judgment, safety

• administered in a setting with cooking space

• administration time= 60-90 minutes

• 4 subtests: cooking, telephone use, medication management, and bill paying

• no cues, indirect verbal cues, gestural cues, direct verbal cues, physical assistance

Do-Eat

• used with children ages 5-8 (chronological or behavioral)

• measures task performance, sensory motor skills, and executive function

• administration time = 20 min

• 3 tasks: make a sandwich, prepare chocolate milk, fill out a certificate of performance

Allen Cognitive Level Screen

• used with adults with psychiatric disorders, dementia, or disruption in cognition

  • LACLS used when there is a visual impairment

• measures global cognition and affects on occupational performance

• administration time = 10-20 min

• leather lacing task that involves following verbal and/or visual directions

What is the remediation approach?

improving a skill

What is the compensatory approach?

adapting the environment, task, or adopting compensatory strategies

Cognitive Remediation

• improving or restoring specific cognitive skills

• neuroplasticity= the brain can adapt and change

• repetition and rehearsal

• activities target areas of impairment

  • just right challenge

  • increase in difficulty

• evidence for use with schizophrenia, eating disorders, and mood disorders

• may include drills/paper and pencil tasks but can be generalized when used in conjunction with other psychiatric rehabilitation approaches

Dynamic Interactional Approach

• considers the interplay of the person, activity, and environment with a focus on functional information processing capacity

• interventions target processing strategies and self-monitoring skills

• attends to an activity’s familiarity, directions, distinctive features, degree of detail, contrast, background, context, amount, and arrangement

• facilitates generalization by applying a strategy across different activities

• developed for people with TBI but also used with schizophrenia and ADHD

Cognitive Adaptation

• strategies to adapt the environment or task to compensate for impairments

• first step: activity analysis and environmental assessment

• cognitive adaptation training makes task and environmental modifications based on apathetic vs. disinhibited behaviors

• task adaptations

  • using pre-measured or pre-chopped ingredients when cooking

  • using automatic bill paying systems to simplify money management

• environmental adaptations

  • using a calendar to organize appointments

  • using a checklist for home management routines

  • using an alarm to remember medication times

Cognitive Orientation to Daily Occupational Performance (CO-OP)

• uses problem-solving strategies for acquiring motor-based skills

• four step strategy

  • goal: what do you want to do?

  • plan: how will you do it?

  • do: carry out the plan

  • check: did it work? does it need to be modified?

• developed for children with developmental coordination disorder but applied for ADHD, developmental disabilities, and neurological conditions

Cognitive Disabilities Model

• an adaptive approach (when remediation is not reasonable)

• preceded by a thorough evaluation to determine cognitive level

• intervention focuses on creating the best fit between the person and their occupations/environment

  • can do, will do, may do

• cognitive levels may be related to other cognitive measures, social competence, and community living status

Cognitive Disabilities Reconsidered Model

• revision of cognitive disabilities model that applies to dementia

• allen cognitive levels are reconceptualized to align with the decline associated with dementia

• each level is associated with one’s ability to participate in ADLs and IADLs and type of assistance required

• intervention focuses on maximizing strengths and creating an enabling environment

Errorless Learning

• used for people who have difficulty learning new information, recognizing mistakes, and adjusting performance based on feedback (alzheimers, schizophrenia, intellectual, and learning disabilities)

  • Level 4 allen cognitive would benefit from errorless learning

• training is structured so mistakes are minimized or eliminated

  • task is broken down into simple components

  • training starts with simple task with high likelihood of success

  • increasingly difficult tasks are added with the addition of prompts and guided instruction until proficiency is reached

  • performance at each level is over-learned using repetition, success, and positive reinforcement