NBCOT - Cognition & Mental Health

Allen Cognitive Levels

A model that categorizes cognitive functioning into six levels, guiding assessment and intervention for individuals with cognitive impairments.

What are the three stitches that are included the the ACL?

Running Stitch

Whip Stich

Single Cordovan Stitch

Running Stitch

Requires 3 correct stitiches in consecutive holes

Whip Stitch

Requires 3 correct stiches in consecutive holes and recognizing cross-in-back errors and twisted errors

Single Cordoval Stitch

Requires 3 correct SC stiches

Level 1 - Automatic Action

-Arousal to external cues

-Mostly instinctual behavior

Examples of Level 1 of ACL

Swallowing, diverting attention to stimuli

Level of assist for Level 1 ACL

Total Assist

Level 2 - Postural Actions

-Gross movement in response to proprioceptive cues

-Behaviors are driven by comfort vs. discomfort

-Clients are unaware of the effects of their behavior on their surroundings

What would a ACLS Level 2 person look like?

Aimless pacing and wandering

Assist level for ACLS Level 2

Max Assist

Level 3 - Manual Actions

-Clients grasp and use objects

-Increased ability to discriminate the external from self

-Impaired global condition

-May acquire new behaviors (learning) w/ repetitive long-term training

What does a Level 3 ACLS look like?

Lack of concentration and req frequent redirection for tasks

Assist level for Level 3 ACLS

Mod-A; requires 24-hour supervision

Level 4 - Goal-Directed Actions

-Clients can recognize the effects of their actions on their surroundings

-Relies on visual cues to learn and carry out goal-directed activities

-Have difficulty recognizing finer details

-Lack of cognitive skills to identify and problem-solve errors

-No new learning or generalizing of tasks

Assist level of level 4 ACLS

MinA and supervision

Level 5 - Exploratory Actions

-Uses trial-and-error for problem solving

-Learn by emulating demostrated actions

-May apply learning to organize, anticipate, and plan

-Have poor judgement and are impulsive

-Benefits from external cue via SUP for planning

Level of assist for Level 5 ACLS

Stand-by assist

Level 6 - Planned Action

-No global cognitive impairment

-Normal functioning

-Anticipates and prevents error

-May still have physical limitations

-IND

Task-oriented groups

• New behaviors are developed as they complete task

• They make something or do a service but the main focus is group interaction and process

• Learn from social interactions - gain insight and self-awareness into feelings, ideas, and values

• Practice new behaviors with other members

• Example: community garden

Role of an OT in task-oriented groups

Organizing group structure, activity selection, feedback, facilitating discussion, exploring thoughts, feelings, and behaviors

Thematic Group

• Gain skills, knowledge, and attitudes for performingan activity for the chosen theme

• Examples: cooking group, money management, job readiness, e.g. assistive technology and computer use to write resume

• Structure is clearly defined

• Occurs in a simulated environment

Role of an OT in a thematic group

Provide a purposeful activity, feedback in a safe, supportive environment, teach specific skills, and reinforce learning of skills

Topical group

Similar to thematic group, but in real environment, e.g. community

Example: practicing money skills at supermarket

Developmental Group

• 5 stages on continuum

• Members progress or ‘develop’ through stages and buid on previous skills

• Members are on similar level of development

• Focus is on interaction and not the task

Parallel Developmental

• Similar to parallel play

• Members perform short-term tasks

• Minimal social interaciton

Role of an OT in a parallel developmental group

Leader - - purpose, structure, and feedback

Project developmental and role of OT

Members perform short-term task w/ some social interaction — competition and cooperation

OT’s role - leader

Egocentric-developmental group

• Members work together on a task that is multi-sessions

• Experimentation of group roles and management

• Example: Communication, stress management

Cooperative Developmental

• Members share insight into thoughts, feelings, values, and common interests

• No end product in necesseraily produced

• Group is more cohesive

• Examples: art, poetry, music

Role of an OT in a cooporative developmental group

Advisor/participant

Mature Developmental Group and role of OT

• Cohesiveness and harmony of the group is important to achieve goal

• Example: community garden

• OT’s role is to be a member

Instrumental group

• Maintain and preserve a level of health functioning

• No behavioral change

• Assumes memebers are operating at the highest level of function

• Can be physical, cognitive, psychosocial

• Example: senior exercise, social isolation

Role of an OT in instrumental group

Select and design activity

Supervise

Assist as needed, but not effect change

Reminiscene

Discussing past experiences to support identity, engagement, and memory

Reality orientation

Repeatedly reinforcing time, place and person to improve orientation

Sensory stimulation

Using sights, sounds, touch, or movement to increase alertness and participation

Coping skills

Strategies to manage stress, emotion, or daily problems

Best diagnoses for reminiscene groups or therapy

Dementia

Moderate Alzheimer Disease

Psychgeriatric Cognitive Decline

Best diagnoses for reality orientation groups or therapy

Early Dementia

Confusion/Delirium

Mild Cognitive Impairement

Best diagnoses for Sensory Stimulation

Severe Dementia

Advanced Cognitive Impairment

Low Arousal States

Best diagnoses for Coping Skills group or therapy

Depression

Anxiety

Adjustment Disorder

Stress-related Disorders

Common side effects after Electroconvulsive Therapy (ECT)

Short-term memory loss

Confusion right after treatment

Headache

Muscle Aches

Nausea

Temporary fatigue

After a client recieves ECT, OT should report urgent changes such as…

Chest pain

Trouble breathing

Loss of consciousness

Suicidal thoughts

Sudden confusion

Signs of stroke

Restorative/Remedial OT Approach

Improving underlying body functions or skills

Compensatory OT Approach

Adaptive equiptment, environmental changes, or alternative techniques

Preventative OT Approach

Reduce the risk of further problems

Educational OT Approach

Teachs the client, family, or caregivers straegies to support performance

Deficit-Specific OT Approach

Improves the underlying impaired skill or body function directly, such as practicing the neglected side or training perception

Diagnoses for deficit-specific approach

Neurologic deficits like CVA with neglect

Diagnoses for Compensatory Approach

Permanent deficits, such as SCI or severe stroke

Diagnoses for remedial/restore approach

Conditions with potential for recovery, like mild TBE or post-stroke weakness

Diagnoses for biomechanical approach

UE weakness, pain, ROM limits, fractures

Diagnoses for Sensorimotor Approach

Neurologic sensory/motor loss

Diagnoses for cognitive remedation approach

TBI, early/mild dementia, stroke cognitive deficits

Diagnoses for Developmental Approach

Children with developmental delays

Sensorimotor OT Approach

Improves function by addressing the underlying sensory processing and motor control problems, such as, balance, postural control, muscle tone, and coordination

Biomechanical OT Approach

Improves function by increasing strength, endurance, ROM, and joint stability to support activity performance

Clients/diagnoses for a developmental group

Clients who need to build social, emotional, or interaction skills through guided group participation

Clients/diagnoses for directive group

Clients who need clear structure and behavior control

Clients/diagnoses for topical group

Fits clients wanting discussion/education about a shared issue

Clients/diagnoses for task-oriented groups

Clients can work together to complete a specific activity or project, often for motor, process, or social participation practice

Interoception

Awareness of internal body sensations

Feeling your heart racing

Introception

Internalizing emotions/experiences

Turning that anxiety inward

Introspection

Reflecting on your thoughts

Thinking about why you feel anxious

Emotional awareness

Recognizing, labeling, and understanding one’s emotions

Recognizing “I’m anxious”