Cognitive Disabilities Handout PDF

1 Kean University 2018 Theoretical Guides to Practice 1 Cognitive Disabilities Frame of Reference Handouts Claudia Allen developed this frame of reference. She has been developing this FOR since the early 1960s. Her basic premise is that functional behavior is based o...

1 Kean University 2018 Theoretical Guides to Practice 1 Cognitive Disabilities Frame of Reference Handouts Claudia Allen developed this frame of reference. She has been developing this FOR since the early 1960s. Her basic premise is that functional behavior is based on cognition, and that in order to produce more functional behavior, the thinking process must change. In 2005, Allen’s work was updated by Levy and Burns and renamed the cognitive disabilities reconsidered model. Most of this works follows Allen’s original works with additional concentration on dementia. Normal cognitive ability – is viewed as the information processing capacity that can be observed and inferred when people carry out planned motor actions. It involves the physical and cognitive abilities. Cognitive disability – a limitation in sensory motor actions originating in the physical or chemical structures of the brain and producing observable and assessable limitations in routine task behavior. Also defined as a deficit in tasks behavior that occurs as a consequence of an anatomical or physiological defect in the brain. Impairments often cause disabilities. Brain conservation explain why people with normal or unimpaired cognitive ability sometimes function at lower ACL levels while completing tasks. The brain has a certain amount of energy to expel while completing tasks. Familiar tasks such as brushing teeth are practiced routinely so the brain does not use up as much energy. It can save it for harder or new learning that might occur later in the day. Task equivalence identifies daily life skills that have similar physical and cognitive demands based on the task analysis. ACLS used leather lacing as the tool because based on research Allen has found the steps/skills equilvant to many daily tasks. OT’s do many task analysis to find similar tasks to help the client be successful. The environment that the task is accomplished is just as important as the task itself. Example, some people feel more comfortable completing certain tasks in their home environment where it is familiar and safe. Group activities combine assessment and treatment in this approach, and these usually occur concurrently. The focus of therapy is on assessment and management. Management of the client involves two aspects: assistance from caregivers and adaptation of the environment. 1. Adapt the environment so the person can function more effectively (remove dangerous objects from view in their home)  2 2. Facilitating, probing, and observing and rescuing are 4 ways that cognitive assistance can be provided. There is a hierarchy of six cognitive levels. The occupational therapist will evaluate the client and place them in-groups that are appropriate for each person’s cognitive level. Level 1 – Automatic Actions (Comatose)  In most cases person is bedridden  Is conscious but responds mainly to internal or subliminal cues  Behavior is mostly reflexive  Most daily needs are completed by caretakers Level 2 – Postural Actions  responds best to proprioceptive cues (moving a client’s hand to reach for a railing or hand over hand to walk towards the bathroom)  can imitate gross motor actions but needs a lot of cuing  can assist the caretaker in bathing, dressing and grooming  may follow others but person also wanders and paces  can feed themselves although it is usually messy  OT should perform lower cognitive level tasks such as: ask the client to watch you as you clap your hands three times loudly. Client at level 3 can do it and client at level 2 may clap 2 times or clap softly. Level 3 – Manual Actions  Client performs manual actions (movements with their hands) in response to tactile cues (touch) and demonstration of one step at a time  Actions based on interest in objects found within arm’s reach may be repeated many times  Attention can be maintained up to 30 minutes  Repetitive work can be done with cuing (stuffing envelops, folding laundry)  No new learning is achieved  Be careful of dangerous items and keep them out of reach or locked away as the client cannot discriminate items by their intended use  Tools (hammer, knives) must be supervised  With proper instruction, familiar repetitive actions can be fairly skilled such as using a peeler to peel a potato or a paring knife to cut an apple Level 4 – Goal – directed Actions (4.6 is the minimal requirement to be left alone or independent living)  Not as dependent on others; this is a major step towards independent functioning.  Person responds to goal directed activity that is identified and remembered  Basic living skills are intact (grooming, dressing, tolieting, bathing and feeding)  Clients perform goal directed tasks in response to verbal and visual cues (see the toothbrush in the bathroom will remind them to brush their teeth)  3  Can follow demonstration of several steps at a time  Pays attention to what is visible but does not notice what is not in plain view or may get lost in all the clutter of a room  They are able to ask for assistance which helps to keep them safe  Can concentrate for about 1 hour.  Can follow a well established routine but cannot problem solve unexpected events Level 5 – Exploratory actions 5.6 is level where clients begin to have insight and become aware of social and physical consequences of their actions  Use of trial and error is important at this level; but they have to do it to see if it works  Can learn new information  Clients can imitate new procedures and remember several steps at a time  Clients are concrete thinkers and have difficulty understanding long term consequences of their actions  Can begin to plan ahead  Lack of abstract thinking prevents these clients from understanding the nature of their illness or the impact of medications Level 6 – Planned Actions  Highest level and represents the absence of disability  Clients are able to use deductive reasoning (can think on an abstract level)and plan ahead  Future events are anticipated and behavior is more organized Things to assess during a task analysis 1. cues 2. attention 3. action/activity 4. speed Role of the Therapist 1. Assess the cognitive level of the client 2. Observe for behavior changes 3. Identify and make available activities and environmental conditions in which the client can succeed. Evaluation An occupational profile is necessary in determining past and present performances ACL – Allen Cognitive Level Test, an assessment of cognitive levels, assesses the current level of functioning, it detects the presence of cognitive disability ADM- uses standardized craft projects to assess the client’s cognitive level. ADM includes a manual containing guidelines and rating sheets for dozens of crafts projects. RTI-2 – Routine Task Inventory – determines client’s ability to perform routine tasks of life. Scores are validated by self report- therapist observation and caregiver report.  4 Source: Cole, M.B., & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach. Thorofare, NJ: Slack.