Cognitive Rehabilitation

Pie - Plan

• Assess the client
  • Learn client priorities
  • Generate hypotheses
  • Define treatment aims and targets
  • Develop SMART goals

Pie - Implement

• Teach skills using evidence-based methods
• Provide practice, feedback, cueing, and instruction
• Support acquisition, mastery, and maintenance

Pie - Evaluate

• Determine if treatment is working
• Measure progress toward targets and aims
• Modify treatment based on data

Pie is _______ not _________, meaning evaluation informs future planning

cyclic, not linear

RTSS helps clinicians understand

how treatment creates change.

3 components of RTSS

All of the above

RTSS - Targets

What you want to change

RTSS - Ingredients

What the clinician does

RTSS - Mechanisms of Action

How change is believed to occur

RTSS Formula

Ingredients → Target Change → Functional Outcome

Psychological Mindedness is the ability to

• reflect on thoughts, feelings, and behaviors

• Understand emotional influence on rehabilitation

• Increase motivations and engagement

• Develop self-awareness

T/F Psychological Mindedness applies to just psychologists?

False - PM applies to all rehabilitation professionals

Treatment Aim

Broad functional outcome

Treatment Target

Specific behavior or skill changed in therapy

Target or Aim? - Return to work

Treatment Aim

Target or Aim? - Use planner daily

Treatment Target

Target or Aim? - Remember appointments

Treatment Aim

Target or Aim? - Use memory strategy

Treatment Target

ORS Classification

Organ Functions, Mental Representations, Skills and Habits

ORS - Organ Functions

Physiological functions of the body such as attention or memory

ORS - Mental Representations

Knowledge, beliefs, awareness, attitudes, motivation such as understanding memory strategies and awareness of deficits

ORS - Skills and Habits

Actual performance behaviors such as using planners and following routines

Most cognitive rehabilitation addresses both __ and __targets

R and S

Every ___ target requires practice

S

Match Ingredients to Targets: R targets

Education, Discussion, Reflection, MI, Pros and Cons

Match Ingredients to Targets: S targets

Practice, Modeling, Cueing, Feedback, Errorless learning

Systematic Instruction is

A structured approach used to help individuals:
• Learn information
• Retain information
• Apply information
• Generalize learning

Neuroplasticity is

The brain's ability to change and reorganize through experience and practice

What RTSS principle is most important for S targets?

Practice

Specificity

Practice should match the desired outcome.

Salience Matters

Meaningful activities produce stronger learning.

Time and Age Matter

Learning and improvement occur across the lifespan.

Use It or Lose It

Unused skills decline

Use It and Improve It

Practice strengthens skills.

Repetition Matters

Repeated practice drives change.

Intensity Matters

Higher practice intensity often improves outcomes

Interference Matters

Competing learning may reduce success.

Transference

Learning can generalize to related tasks.

Therapeutic Alliance refers to

Collaborative relationship between clinician and client

3 core values of therapeutic alliances

Congruence, Unconditional positive regard, Empathetic understanding

Congruence refers to

Be authentic and genuine.

Unconditional Positive Regard refers to

Accept clients without judgment.

Empathic Understanding refers to

Accurately understand the client's experience.

3 activities that build alliance

Agreement on goals, Agreement on therapy tasks, Development of personal bond

Cognitive Behavioral Therapy (CBT)

Focus: Thoughts → Emotions → Behaviors

Goals of CBT

Identify unhelpful thoughts, Replace negative thinking, Improve self-efficacy

Motivational Interviewing (MI)

Purpose: Increase motivation and readiness for change.

Motivational Interviewing (MI) RULE

R = Resist the righting reflex
U = Understand motivation
L = Listen
E = Empower

Motivational Interviewing (MI) OARS

O = Open-ended questions
A = Affirmations
R = Reflections
S = Summaries

________ are the core communication skills of MI

OARS

Acceptance and Commitment Therapy (ACT)

Focus: Helping clients live meaningful lives despite challenges

Key ACT concepts

Values-guided actions, Acceptance, Mindfulness, Psychological flexibility

SMART Targets

S
Specific
M
Measurable
A
Attainable
R
Relevant
T
Time-Based

Goal Attainment Scaling (GAS)

Measures multiple levels of success

The _____ the score the higher the expected

higher

3 phases of implementation are

Acquisition, Mastery, Maintenance

Acquisition

Learning the skill

Characteristics:
• Error control
• Massed practice
• Extensive cueing
• Immediate feedback

Mastery

Using the skills consistently

Characteristics:
• Distributed practice
• Increased independence
• Variable practice conditions
• Self-monitoring

Maintenance

Keeping the skill long term.
Characteristics:
• Natural supports
• Environmental cues
• Booster sessions
• Follow-up monitoring

ACT connects rehabilitation goals to _______ values

personal

Implementation Memory Aid

Learn → generalize → maintain

Evaluation → Acquisition

Can the client do it?

Evaluation → Generalization

Can the client do it in real-life settings

Evaluation → Maintenance

Can the client keep doing it?

Evaluation → Impact

Did it improve everyday function?

What score on the GAS means expected outcome?

0

What is the difference between an aim and a target?

A target refers to changing a specific behavior or skill, whereas an aim refers to a general and broad functional outcome

What RTSS principle is most important for S targets?

Practice

What are the three RTSS components?

Targets, Ingredients, Mechanisms of Action

What does ORS stand for?

Organ Functions, Mental Representations, Skills and habits

Systematic Instruction

A structured approach used to help individuals:
• Learn information
• Retain information
• Apply information
• Generalize learning

Systematic Instruction is useful for

All of the above

Using Direct Instruction and _______ Instruction typically leads to the best outcomes

Strategy

What Are Volition Ingredients?

Intervention strategies designed to increase:
Motivation, Engagement, Self-efficacy, Persistence

What are the three pillars of evidence-based practice?

Client preferences, Research evidence, Client performance data

Massed Practice

Repeated practice opportunities provided in close succession

The __________ data provide the strongest
evidence for ongoing treatment decisions.

client's performance

Distributed Practice

Practice spaced over time

Distributed practice is _______, Masses practice is ________

Mastery, Acquisition

PM should be incorporated in which phases of PIE?

All