Hum Occ ch 22

Behavioral impairments 

Staff needs to remain calm and provide consistent, client specific, direct feedback, as arguing with the client may exacerbate the situation

Retention

of information improves when information is repeated and manipulated; have patient read aloud, write information, and practice

Short term memory

relies heavily on attention

Working memory

actively using information with the intention of retaining it (example: retaining rules while playing a game or dialing a telephone number)

Procedural memory

recall of procedures or motor skills (example: riding a bicycle or dressing) 

Visual agnosia

Failure to recognize common items that can be seen

Visual discrimination deficits

includes discrimination by form, depth perception, figure-ground perception and spatial relations (all of the above)

Figure ground perception:

- ability to distinguish an object from its background

- Treatment strategies: practice finding objects and gradually increase the complexity

Attention functions Includes: 

-Sustained attention (focusing)

- Alternating attention (attention between 2 or more tasks)

-Divided attention (attending to more than one task simultaneously)

-Concentration (focusing)

-Attending to a task under distracting circumstances

Attention functions 

- Distracting environment causes increased difficulty

- Find optimal environment for attention, and then increase distractions

- Music may promote attention, keep chatter to a minimum

Specific mental functions 

- Higher level cognitive functions: insight/judgement, concept formation, metacognition and cognitive flexibility.

- Attention: sustained, selective alternating and divided.

- Memory: short à long term, working, procedural, prospective, semantic and episodic.

Orientation: being conscious of one's surrounds and is classified as:

-A & O X 1 – alert and oriented to self 

-A & O X 2 – alert and oriented to self and place 

-A & O X 3 – alert and oriented to self, place, and time 

-A & O X 4 – alert and oriented to self, place, time, and situation 

Apraxia:

inability to plan and perform the motor acts needed to complete a task although there is no motor weakness

ideomotor apraxia

inability to plan or perform a motor skill; may be able to do a skill spontaneously but not at will; less debilitating

Ideational or conceptual apraxia

inability to comprehend the concept of required movement to do a task; inability to do the skill on command or spontaneously

Treatment of ideational and Ideomotor apraxia

- Break task down, and teach steps separately

- Guide the patient through movements

- Intermittent tactile and proprioceptive input

- Short instructions

- Grade complexity and number of steps

Two intervention approaches

- remedial: establish or restore cognitive skills to PLOF.

- adaptive: modifying or adapting a task or the environment to enhance occupational performance.

- OTPs may use one or the other of these approaches, or both simultaneously.

Remedial Approach: Cognitive rehabilitation is goal oriented, and while problem focused, builds on strengths.

-Involves engagement in tasks that are intended to enhance recovery from an acquired brain injury (ABI) or other cognitive impairment

-May involve occupations requiring cognitive or process skills, or brain exercises (often online) to promote cognitive performance

-Transfer of training approach: the brain can reorganize itself after an ABI and new learning can occur; uses various cognition based activities and are introduced at a level just above the client's current cognitive level

-Clients are encouraged to challenge their thinking and aspire to a higher level of performance

-Environment can be graded to include distractors during activities

-Key is to transfer skills to real life situations

-Also used with meaningful real life tasks such as cooking or money management

-A client centered approach, and occupation based interventions produce more satisfying and effective results

Adaptation Approach: functional approach

-Compensates for deficits using intact cognitive skills

-Client engagement in meaningful occupations is essential

-Strategies of adapting to, or working around deficits are used when impairments are likely to be long term in order to maximize outcomes

-Written and visual cues, and if-then strategies can assist with problem solving for certain situations

-Best outcomes result from context specific adaptations; may need to be reassessed and adapted to changes in client's context

-Intervention may involve shifting roles, reducing activity demands, and having fewer responsibilities for the client to remain engaged and productive

-Establish basic routines for successful participation in daily tasks