Cognitive Dysfunction in NeuroRehab

What is cognition?

Cognition refers to the mental actions of knowing, thinking, learning, judging, and processing information.

What are the components of cognition?

Memory, alertness, executive functions, perseveration, attention, and orientation.

What is perception?

Perception is the interpretation and reasoning of sensory stimuli.

What is neurobehavior?

Any behavioral response resulting from CNS processing, including praxis, attention, memory, spatial relations, sequencing, and problem solving.

Why are cognitive-perceptual impairments important?

They are important predictors of rehabilitation outcomes.

What is the functional (compensatory) approach?

Repetitive practice during functional activities; skills may not generalize to other activities.

When is the functional approach most appropriate?

For clients with poor learning potential and poor awareness.

What is adaptation of the environment?

Modifying aspects of the task or environment when compensation is not possible, used with clients with poor learning potential.

What is the remedial (restorative) approach?

Focuses on restoring a function or skill, often used in acute recovery; benefits may be short-term.

What questions guide approach selection?

Does the patient have learning potential? Is the patient aware of errors and attempts to correct them?

What are paper tests in cognitive assessment?

Contrived, nonfunctional assessments with low ecological validity.

What are performance-based tests?

Assessments that better evaluate neurobehavioral deficits and provide tangible feedback.

What are assessment environment recommendations?

Conduct in quiet, distraction-free rooms and build rapport for motivation.

What are low-level cognitive skills?

Arousal, attention, orientation, recognition, simple command following, memory, initiation.

What are high-level cognitive skills?

Insight, following multi-step commands, mental flexibility, planning, problem-solving, abstraction, new learning, generalization, safety, and judgment.

What does the A-ONE measure?

Impact of neurobehavioral impairment on ADL; requires 5-day training.

What does the AMPS measure?

Motor and process skills in ADL; performance-based.

What does the Kettle Test measure?

Cognitive functional performance; assesses attention, working memory, and executive function.

What does the Catherine Bergego Scale measure?

Unilateral neglect in real-world contexts.

What does the Behavioral Inattention Test measure?

Unilateral neglect using paper-pencil and behavioral tasks.

What are examples of functional screening tools for neglect?

Comb and Razor Test, Fluff Test, Wheelchair Collision, and Baking Tray Task.

What do awareness tools like SAMAS and SADI assess?

Awareness of deficits via self-report or interview.

What do Test of Everyday Attention and Cognitive Failures Questionnaire measure?

Attention in ecologically valid ways.

What does the Executive Function Performance Test (EFPT) measure?

Executive function via occupation-based tasks; evaluates cueing needs for independence.

What does the Multiple Errands Test measure?

Executive function in real-world tasks; several free versions exist.

What does the Behavioral Assessment of Dysexecutive Syndrome measure?

Executive function through a comprehensive test battery.

What does the Rivermead Behavioral Memory Test measure?

Functional recall and memory.

What does LOTCA assess?

Orientation, thinking, visuomotor, praxis, and related cognitive skills.

What tasks are used in the EFPT?

Simple cooking, telephone use, medication management, and bill payment.

What influences cognitive performance?

The environment—OTs should modify it for success.

What is generalization?

Performing a learned skill across multiple contexts.

How can generalization be promoted?

Practice across multiple tasks and environments.

What are the four transfer of learning types?

Near (1–2 changes), Intermediate (3–6 changes), Far (conceptually similar), Very Far (completely different).

What is activity processing?

Therapist and client discuss the purpose of the activity to promote awareness and metacognition.

What is behavior modification?

Use of prompting, shaping, and reinforcement to improve independence in ADLs.

What is the purpose of group therapy?

Encourages peer feedback and self-monitoring.

What interventions address awareness deficits?

Use meaningful, goal-focused tasks with prompts and metacognitive questions.

What is figure-ground discrimination?

Difficulty distinguishing objects from the background.

What are interventions for figure-ground deficits?

Simplify environment, use contrasting colors, and practice sorting tasks.

What is topographical disorientation?

Difficulty navigating familiar environments.

What are interventions for topographical disorientation?

Practice mazes, use visual cues, and fade them as mastery develops.

What is agnosia?

Inability to recognize stimuli through a specific sense.

What are interventions for agnosia?

Increase awareness and use other senses to compensate.

What is apraxia?

Difficulty performing purposeful movements not due to motor or sensory loss.

What are the types of apraxia?

Ideational (misuse/sequence errors) and ideomotor (can’t perform known actions).

How is apraxia evaluated?

Have the client demonstrate or pantomime actions.

What are interventions for apraxia?

Strategy training, errorless training, graded task practice.

What is perseveration?

Repetition of words, phrases, or movements.

How is perseveration managed?

Bring behavior to awareness, redirect attention, introduce new activity.

What are organization and sequencing?

Organization integrates steps toward a goal; sequencing ensures proper order.

What are interventions for organization/sequencing deficits?

Step-by-step instruction, visual aids, simplifying environment.

What are restorative memory approaches?

Rehearsal and strategy training.

What are compensatory memory approaches?

Using aids such as diaries, checklists, or apps.

What are the types of attention?

Selective, sustained, and alternating.

What are interventions for attention deficits?

Gradually increase distractions or time, use checklists, avoid overstimulation.

What is executive function?

Higher-level processes integrating initiation, organization, sequencing, and problem-solving.

What are interventions for executive function deficits?

Modify environment, use compensatory/metacognitive strategies, and train specific tasks.

What are the main cognitive intervention models?

Skill-task-habit training, strategy training, task/environmental modification, process-specific training, graded cueing.

What should OT intervention plans consider?

Client/family factors, environment, outcomes, and collaboration with the team.

What are key family education tips?

Simplify tasks, provide step-by-step guidance, use visual/verbal cues, and maintain organization.

What are five cognitive-perceptual deficits?

Attention deficit, memory impairment, apraxia, unilateral neglect, and impaired executive functioning.

How does attention deficit impair function?

Causes distractibility, inability to follow directions, and unsafe ADL performance.

How does memory impairment impair function?

Leads to forgetting steps, appointments, or safety measures, reducing independence.

How does apraxia impair function?

Causes misuse of objects or inability to sequence actions.

How does unilateral neglect impair function?

Results in ignoring one side of the body or environment, reducing safety.

How does impaired executive functioning impact performance?

Affects planning, organization, and problem-solving, limiting IADL management.

How should a therapist begin addressing cognitive-perceptual impairments?

Perform comprehensive standardized and functional assessments.

What environmental control is important during cognitive assessment?

Conduct sessions in quiet, distraction-free areas.

Why is collaborative goal setting important?

It ensures goals are meaningful and functional to the client’s daily life.

How is treatment approach selected?

Based on client’s learning potential and awareness.

What are examples of compensatory strategies?

Checklists, visual cues, contrasting colors, and context-based practice.

What should client and family education include?

Simplifying tasks, organizing the environment, and using prompts.

Which impairment presents the greatest challenge?

Impaired awareness (anosognosia).

Why is impaired awareness challenging?

Clients don’t recognize their deficits, affecting motivation, participation, and safety.

How can awareness deficits be addressed?

Metacognitive retraining, guided feedback, and external compensations with repetition.