W10 | Cognitive & Perceptive Approaches

Cognitive Approach

• “Top-down” or occupation-based approach that emphasizes assisting the person to identify, develop, and use cognitive strategies to perform daily occupations effectively.

Cognitive Model of Practice

• A framework in which the therapist uses a global problem-solving strategy within which the person discovers specific strategies applicable to tasks he or she needs or wants to perform.

TAEAE

1. Task analysiS

2. Anticipation of the person’s difficulties and challenges

3. Exploration and selection of task-specific strategies

4. Application of a strategy to the task

5. Evaluation of the strategy’s effectiveness

Steps of Cognitive Model of Practice

Task Analysis

• The first step of the cognitive model in which the task is analyzed.

Anticipation of Difficulties and Challenges

• The second step in which the person’s difficulties and challenges during the task are anticipated.

  
  

Exploration and Selection of Task-Specific Strategies

• The third step in which task-specific strategies are explored and selected.

  
  

Application of a Strategy to the Task

• The fourth step in which a selected strategy is applied to the task.

  
  

Evaluation of Strategy Effectiveness

• The fifth step in which the effectiveness of the strategy is evaluated.

Process Questions

• Questions used to help persons discover relevant aspects of the task, examine how they are currently performing, identify where they are getting “stuck,” creatively think about alternative solutions, try solutions, and evaluate them.

Generalization

• The process of transferring and applying learned strategies to other situations and environments. The cognitive approach plans for transfer and generalization of strategies learned

Allen’s Cognitive Disabilities Model (CDM)

• A model associated with Claudia Allen that addresses cognitive impairment and its effects on the ability to perform ADLs and function within communities.

  
  

Claudia Allen

Proponent of Allen’s Cognitive Disabilities Model.

• Level 1: Automatic actions

• Level 2: Postural actions

• Level 3: Manual actions

• Level 4: Goal-directed actions

• Level 5: Exploratory actions

• Level 6: Planned actions

Allen 6 Cognitive Levels

Level 1 — Automatic Actions

• Describes the patient’s arousal to external cues; instinctual behavior is observed.

• Total assistance

Level 2 — Postural Actions

• Patient’s awareness is limited to own postural actions (proprioceptive cues) to move body in space or overcome effects of gravity

• Maximum assistance

Level 3 — Manual Actions

• Global cognition remains impaired, but long-term repetitive training can allow patients to acquire new behaviors by better noting the effects of their actions on objects, sustaining their actions, and utilizing materials for ADLs.

• Moderate assistance

  
  

Level 4 — Goal-Directed Actions

• Goal-directed actions demonstrate an awareness of a familiar end-product but fail to solve new problems, anticipate, or correct mistakes

• Minimal assistance to identify errors, do problem solving, and correct errors.

Level 5 — Exploratory Actions

• Patient can learn new ways of doing things through trial-and-error problem solving

• Standby assistance when therapists adapt a new activity for safe and effective performance.

  
  

Level 6 — Planned Actions

• No global cognitive impairment noted; patient anticipates errors and plans actions to prevent errors

• No supervision is needed; therapist serves as a collaborative consultant.

Perceptual Approach Model of Practice in OT

• Focuses on how a person receives, interprets, organizes, and uses sensory information from the environment to perform meaningful occupations.

  
  

Visual Perception

• The total process responsible for the reception and cognition of visual stimuli.

Visual Attention

• Ability to attend to visual stimuli.

• It involves alertness, selective attention, vigilance, and divided attention.

Visual Memory

• Involves integrating visual processing information with experience (both long-term and short-term).

Visual Discrimination

• Ability to detect distinctive features of a visual stimulus and to distinguish whether the stimulus is different from or the same as others

Object Perception

• Concerned with what things are

• Takes place in the temporal lobe

Form Constancy

• Recognition that forms and objects remain the same in various environments, positions, and sizes.

Visual Closure

• Identification of forms or objects from incomplete presentations.

  
  

Figure-Ground Perception

• Ability to perceive a form visually and to find this form hidden in a conglomerated ground or model

• Differentiation between foreground or background, forms and objects.

Spatial Perception

• Ability to identify where things are in space

• Takes place in the parietal lobe.

Position in Space

• Determination of the spatial relationship of figures and objects to oneself or other forms and objects.

Spatial Relations

• Analysis of forms and patterns in relation to one’s body and space and helps judge distances.

  
  

Categorical Spatial Relations

• Includes concepts of above/below, right/left, on/off.

  
  

Coordinate Spatial Relations

• Specifies location in a way that can be used to guide precise movements.

  
  

Depth Perception

• Determination of relative distance between objects, figures, or landmarks and the observer and changes in planes of surfaces

Topographical Orientation

• Determination and connection of the location of objects and settings and the route to the location.

Cognitive Map

• A map of the environment on which the ability to find one’s way depends.

Visual Receptive Skills

Skills whose development influences visual cognitive skills and ultimately improves the child’s ability to engage in meaningful occupations.

Visual-Motor Integration (VMI)

A visual spatial skill whose development is facilitated by visual discrimination.

Remedial Approach

• Focuses on the impairment underlying the vision problem, following the developmental process.

Adaptive Approach

• Facilitates improved function through compensation using cognition.

Compensation

• Any practical environmental adjustment such as assistance from others, training procedures that are activity- or situation-specific, and strategies and environmental adaptations.

  
  

Remediation

• Goal is to improve deficit skills

• It can involve intervention of underlying causes, or structured practice of specific skills so that these skills can develop and become more automatic

1. Object Perception

2. Spatial Perception

2 Kinds of Visual Perception