Memory Intervention Techniques Quiz

Neurocognition: Assessment and Intervention

• The presentation is about neurocognition, specifically assessment and intervention.
• The presenter is Megan Mueller, OTD, OTR/L, BCPR.
• The year of the presentation is 2024.

Class Objectives

• Explain the unique view and role of occupational therapy (OT) in assessing and addressing functional cognition.
• Compare and contrast different models for cognitive intervention (e.g., DIM, NFA, CDM).
• Describe common top-down and bottom-up cognitive assessments.
• Examine common interventions for awareness, attention, memory, and executive functioning.
• Analyze strategies to incorporate functional cognition into acute care settings.
• Evaluate interventions to support clients with dementia and their caregivers.

Cognition

• Cognition is the brain's ability to process, store, retrieve, and manipulate information.
• It includes skills of understanding, knowing, judging, decision-making, and environmental awareness.
• Functional impairments can include impaired alertness/arousal, decreased response to environmental stimuli, anosognosia (unawareness of a deficit), impaired attention, disorientation, memory loss (short and long term), and impaired organization/sequencing, perseveration, impaired problem-solving.

Unique Perspective on Cognition

• Functional cognition is defined as the ability to use and integrate thinking and performance skills for everyday complex activities, including instrumental activities of daily living (IADLs).
• It relates to available resources utilized by the client to meet daily living requirements for ADLs and IADLs.
• Functional cognition evaluates a client's capacity to manage everyday challenges.
• It emphasizes the dynamic interplay between client, activity, environment, and context.

Unique Perspective on Cognition (Continued)

• OTs are focused on improving participation and quality of life for clients with cognitive impairments.
• Examples of this approach include working on a math equation worksheet to address organization, or paying credit card bills to improve organizational skills that stem from executive functioning or memory impairments.
• Cognitive interventions should address the client's specific needs, and are tailored to various tasks and contexts while acknowledging the importance of generalizability.

Evaluation and Assessments

• Evaluations focus on client performance in relevant occupations.
• The MOCA score and corresponding impact on occupations are evaluated.
• Goals should relate to improving occupational performance.
• Examples of goals include increasing sustained attention to 10 minutes in a shopping task, or increasing functional and/or cognitive skills in various domains for which the client demonstrates deficits.

Interventions

• Cognitive interventions typically focus on graded relevant occupations in natural settings and on the use of cognitive models and strategies.
• Interventions should appropriately address attention skills, including manipulating size, shape, and color of materials while also gradually increasing task demands for client engagement.

Outcomes

• Clients may experience improved performance in occupational areas, as evidenced by improved MMSE scores.
• Improvements may also occur in the ability to organize novel medications using cognitive strategies in low-stim environments.

Out of Date Perspective

• It was once assumed that remediation from identified impairment(s) would automatically resolve into improvements in functional daily activities, based on repetition or practice in isolation from contextual activities.
• This assumption has been found not to be supported by empirical research, and therefore interventions are better focused on independent living, purpose, and quality of life despite cognitive impairments.

Models Guiding Cognitive Intervention

Dynamic Interaction Model (DIM)

• Cognition is the result of the interaction between the person, activity, and environment.
• A targeted treatment strategy is practiced across varied tasks and diverse situations.
• This approach emphasizes metacognitive awareness-to aid in client awareness of strengths and deficits, estimate task difficulty and foresee outcomes.
• The goal is to transfer learned skills in one context to other contexts (generalization).

Neurofunctional Approach (NFA)

• An approach to compensate for cognitive impairments.
• Focuses on retraining real-world skills related to cognitive impairments rather than focusing on cognitive perceptual processes.
• The goal is to improve and restore the specific deficits in a functional context.
• Intervention focuses on the functional limitation without targeting the underlying causes.
• Repetition and context are key.
• Use of routines, cues, and errorless learning.

Cognitive Disabilities Model(CDM)

• Cognitive functioning is viewed on a continuum (level 1-level 6).
• Adaptive intervention adjusts the activity itself to accommodate cognitive levels.
• Cognitive restoration isn't the goal
• Strengthening residual abilities is the goal.
• The approach emphasizes establishing the current cognitive level and maintaining or restoring the highest levels of function through adaptive techniques and caregiver involvement.

Assessments

• Occupational therapy embraces performance-based assessments and acknowledges the necessity of tools which may involve cognitive assessments based on facility reporting.
• A range of cognitive assessment tools is available depending on the setting and client needs (e.g., BCAT, BCRS, BIMS, MOCA, MMSE, The Mini-Cog, etc.)
• The Confusion Assessment Method for the ICU

Non-Standardized Structured Observation

• Observation skills are utilized to discover underlying cognitive deficits which impair performance.
• Errors in performance are acceptable if safe and not severe.
• Observation looks for impairments in several key areas, such as attention, memory, insight, organizational skills, initiation, termination, decision-making, problem-solving, planning, self-correction, sequencing complex actions, and judgment.

Cognitive Assessment Summary

• Most cognitive assessments are pen and paper/tabletop assessments; however, there is a growing demand for assessments that align with the demands of daily activities and participation.
• Ecological validity of assessments emphasizes the degree to which the demands of the assessment resemble real-world functional and meaningful tasks. High ecological validity will identify difficulty performing real-world functional and meaningful tasks.
• Various assessments are highlighted, such as the Modified Barthel Index, the SLUMS, the Mini-Mental State Examination (MMSE), and the Multiple Errands Test (MET).

Attention

• Attention is essential for other higher-level cognitive functions, like memory and executive functions.
• Common attention deficits after brain injury include problems with arousal, selective attention, sustained attention, attentional switching, and divided attention.
• Attention deficits are often observed in tandem with other cognitive deficits.

Attention Intervention

• Interventions can include systematic training with progressively increasing demands to improve attentional skills.
• Reducing environmental distractions and educating clients regarding self-pacing can be helpful.
• In some cases, a physician-prescribed medication may be necessary.
• Specific skill training may help client relearn functional tasks.

Memory

• Memory involves encoding, storage, and retrieval of information.
• Important terminology includes short-term memory (STM), long-term memory (LTM), encoding, storage, retrieval, and types of memory (declarative, implicit, episodic, semantic).
• Memory impairments can utilize mnemonic devices, rehearsal strategies, and temporal tags to improve.

Memory Intervention

• Errorless learning can promote improvement of memory performance.
• Errorless learning does not allow for errors, and there is a focus on how to perform the task successfully from the beginning, minimizing the opportunity to learn the incorrect task performance.
• Memory notebooks/technology, mnemonics, and rehearsal strategies are helpful in addressing memory impairments.
• Temporal tags are utilized to enhance focus on associated times and locations for memories.

Executive Functioning

• Executive functioning consists of cognitive processes, such as decision-making, problem-solving, planning, task switching, and modifying behavior.
• The abilities often appear to be more difficult for individuals who are required to complete novel tasks than through well-rehearsed or practiced routine.
• Common executive dysfunction symptoms include problems with judgment, impulsivity, apathy, poor insight, and poor organization, planning, and decision-making.
• Metacognitive training, goal management training, and implementation of strategies for managing time pressure are helpful for clients experiencing executive disfunction.

Topics in Cognition

• Cognitive impairments, like memory, attention, and executive functions impact everyday life.
• Specific interventions can be used for each component and require careful assessment of impairments in each specific cognitive domain.

Acute Care

• Determining discharge environment and next level of care; it is important for the OT to consider what elements of the cognitive assessment impacts functional performance to determine appropriate level of care.
• Assessments used in the context of acute care settings are discussed in detail, including those focusing on general information, executive functions, memory, and self-care skills.

Dementia & Behavioral Intervention

• The aim of dementia interventions is to emphasize remained strengths, maintain physical and mental activity, reduce caregiver stress and strive to keep the client in their least restrictive setting.
• Communication strategies, sleep functioning, and behavioral interventions to mitigate specific deficits.
• Sensory perceptual functioning and home modifications, as well as caregiver involvement and training can maximize client-centered outcomes.

Dementia & Caregivers

• Caregiver involvement and training are essential components of dementia care.
• Caregiver training aids in skill development; addressing common experiences such as providing hands-on training, and identifying the most stressful demands.
• New codes support reimbursement for caregivers, now enabling the most appropriate treatment codes and support. It's important in cases of caregiver training without the patient's presence to ensure that the caregiver training directly targets the patient's goals and outcomes.

Alzheimer's Disease Intervention

• Interventions for Alzheimer's disease should focus on errorless learning, cognitive stimulation, and specific practice interventions; reminiscence interventions, monitoring and communication, activity and modification, and psychoeducation, education, and skill training.

Test your knowledge on various memory intervention techniques and their applications. This quiz covers key strategies, stages of memory processes, and the brain structures involved in memory. Challenge yourself and enhance your understanding of compensatory techniques and memory systems.