Intro to Cognitive Rehab

Cognition

Mental process that allows us to think, plan, learn, and use information for occupational performance

Perception

How sensory input is received and interpreted

Remedial (Restorative) approach

Direct retraining of impaired process with the assumptions that skills will generalize

Examples of remedial (restorative) approach

Attention drills and memory games

Adaptive (Compensatory) approach

Uses external/internal strategies and environmental modifications

Examples of adaptive (compensatory) strategies

Planners, alarms, cue cards

Integrated Functional approach

Combines remediation and adaption within meaningful tasks; challenges impairments during real occupations

Examples of integrated functional approach 

Working on attention during self-feeding

Why would an OTR use the remedial approach?

When there is potential to restore impaired processes.

Why would an OTR use the adaptive approach?

When restoration is unlikely and compensation is needed.

Why is the integrated approach often preferred?

It improves real-life function while also targeting underlying impairments.

What principles of neuroplasticity are important in cog rehab?

Repetition, task specificity, and intensity

Repetition

Skills must be practiced frequently

Task specificity

Skills must be practiced in a way that closely matches real life tasks

Intensity

Enough challenge and dosage are needed to produce brain changes

Strategic approach

Teaching strategies for generalization across contexts; best for clients with good insight.

Task-specific approach

Repetition of a single task until automatic; best for clients with poor insight/learning capacity.

Example of a strategic intervention

Using a checklist for sequencing and attention

Example of a task-specific intervention

Repeatedly making a PB&J in the same setting with the same items

What is the greatest challenge in cognitive rehabilitation?

Generalization of skills to new contexts

Strategies to enhance generalization

Avoid teaching the same activity in the same context every times

Practice strategies across multiple tasks

Include metacognitive training (self-prediction, self-evaluation)

Use meaningful, occupation-based activities

Start where you mean to end

What does “start where you mean to end” mean in cognitive rehab?

Train skills in real environments tied to the client’s actual outcome goals

Top down evaluation

Begins with roles and occupations then identifies barriers to performance

Bottom up evaluation

Begins with impairments then links to activity limitation