Cognition ch.7

Week 4

Cognition

Mental processes associated with perceiving, making sense of, and using information

3 primary components: attention, memory, executive function

Attention

Efficiently using cognitive resources to take in information needed
to accomplish a task

Automatic and Controlled 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)

Selective Attention

Sorting out and focusing on relevant sensory stimuli
A component of nearly everything we do
Distracters can be external or internal
Filter theory vs. attenuation theory

Selective Attention 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
o How does this work?
▪ Alternating
▪ Automatic vs. controlled
▪ Coordinated execution

Divided Attention Strategies

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

Vigilance

Ability to sustain attention through time
o Fatigue is a significant barrier to vigilance
o Quality of attention can decrease over time

Vigilance Strategies

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

Semantic Memory

Facts
o Tends to be created and forgotten easily
o Methods for remembering
▪ Shallow rehearsal = repeating information
▪ Deep processing = finding meaning in facts

Episodic Memory

Events that have happened to you

organized temporally

Procedural memory

How to do something

Takes longer to create

Less susceptible to errors

OTPs help people establish procedural mems

Short Term Memory

Held for a matter of seconds or minutes
o Lost in about 20 seconds if not rehearsed
o Most adults have capacity for about 7 items
o Can recall more by chunking info and remembering as 1 item (e.g., a phone number

Long Term Memory

Accumulation of information during a lifetime

Capacity unknown

Memory Strategies

Chunk items together

Creare mnemonics

Ask questions about the information

Apply information to oneself

Use memory aids

Executive Function

Controlled, conscious efforts

Working Memory

Short-term memory storage and active manipulation of new information
o Holding several bits of info at once to process
o Not used to memorize or remember but accomplish a temporary activity
o Strategies: simplify tasks, use devices to assist in manipulation of info

Concept Formation and Cetegorization

Putting things into groups
o Concrete vs. Abstract Concepts
o Concepts are grouped into categories
o Mostly done implicitly but may need to be made explicit for people with cognitive impairments
o How do concepts and categories apply to daily life activities?
o Strategies: cue sheet with categories and exemplars, real world experiences

Schemas

Mental representations that structure related concepts

Scripts

Kinds of schemas that describe a sequence of events for a familiar activity

Helps 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

Problem Solving Steps

Can happen implicitly but made explicit for people with cognitive impairment
1. Recognize the problem
2. Understand the problem
3. Identify strategies or solutions
4. Evaluate the strategies
5. Select and carry out a strategy
6. Evaluate the outcome

Problem Solving Strategies

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

Decision Making

Heuristics - rule of thumb that helps with quick decision making

Representativeness

Availability

Anchoring and adjustment

Decision Making Strategies

Limit options, teach about biases in decisions-making, teach to step back and think through decisions, ask other for input

Functional Cognition

The application of cognition within the context of everyday activities
o What OTPs are most concerned with, because assessing the components is not necessarily predictive of function
o Functional cognition collectively considers all the components, strategy use, habits and routines, and the environment

Metacognition Strategies

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

Cognition Assessments

Allen Cognitive Level Screen

Cognitive Performance Test

Contextual Memory Test

Do-Eatg

Executive Function Performance Test

Menu Task

Multiple Errands Test

Weekly Calendar Planning Activity

Allen Cognitive Level Screen

Used with adults with psychiatric disorders, dementia, or disruption in cognition
o 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

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
• 28 subtests that include paper-and-pencil and motor tasks
• Administration time= 30-45 min

Do-Eat

Used with children ages 5-8 (chronological or behavioral)
• Measures task performance, sensory motor skills, and executive function
• 3 tasks: make a sandwich, prepare chocolate milk, fill out a certificate of performance
• Administration time= 20 min

Executive Function Performance Test

Used with adults with neurological or psychiatric conditions
• Measures executive function and capacity for independent functioning/level of assistance needed
o Initiation
o Organization
o Sequencing
o Judgment
o Safety
• Administered in a setting with cooking space
• Administration time= 60-90 min
• 4 subtests: cooking, telephone use, medication management, and bill paying

EFPT Cue Chart

No Cues

Indirect Verbal Cues

Gestural Cues

Direct Verbal Cues

Physical Assistance

Multiple Errands Test

Used for adults with brain injury, stroke, or psychiatric conditions
• Measures executive function in a natural environment
o Rule breaks
o Inefficiencies
o Task failure
o Interpretation
• Administered in a shopping center (MET) or hospital (MET-R)
• Administration time= 30-45 min
• 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

Remediation vs. Compensatory

Remediation = improving a skill

Compensatory = adapting the environment, task, or adopting compensatory strategies

Cognitive Remediation

Improving or restoring specific cognitive skills
• Neuroplasticity = the brain can adapt and change
• Repetition + Rehearsal
• Activities target areas of impairment
o Just-right challenge
o Increase in difficulty
• Evidence for use with schizophrenia, eating disorders, and mood disorders
• Can only be generalized when used in conjunction with other interventions that target occupational participation and performance

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
• 1st 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
• Environmental adaptations: Using a calendar to organize appointments

CO-OP: Cognitive Orientation to Daily Occupational Performance

Uses problem-solving strategies for acquiring motor-based skills
• Four step strategy
1. Goal – What do you want to do?
2. Plan – How will you do it?
3. Do – Carry out the plan
4. 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

Metacognitive Reflection and Insight Therapy: MERIT

Focused on the therapeutic relationship as a means for addressing everyday problems

1. Agenda
Insertion of therapist’s mind
Eliciting the narrative episode
Defining the psychological problem
2. Process elements

Reflecting on the therapeutic relationship

Reflecting on progress

3. Superordinate elements

Stimulating self-reflection and awareness of others

Stimulating mastery

Cognitive Disabilities Model

An adaptive approach (when a 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
o Can do (cognitively realistic)
o Will do (interesting and desirable)
o May do (supported by the environment)
• Cognitive levels may be related to other cognitive measures, social competence, and community living status
• Frequently used by OTPs to create groups based on cognitive level

Cognitive Disabilities for Dementia

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 (e.g. Alzheimer’s
disease, schizophrenia, intellectual and learning disabilities)

Training is structured so mistakes are minimized or eliminated
1. Task is broken down into simple components
2. Training starts with simple task with high likelihood of success
3. Increasingly difficult tasks are added with the addition of prompts and
guided instruction until proficiency is reached
4. Performance at each level is overlearned using repetition, success, and
positive reinforcement