OTH 204 Frames of Reference & Cognitive Approaches PDF

Frames of Reference The Cognitive Models OTH 204 Frames of Reference PARADIGM (PHILOSOPHY, VALUES AND ETHICS, KNOWLEDGE, OCCUPATIONAL THERAPY PRACTICE FRAMEWORK) OCCUPATION-BASED MODELS...

Frames of Reference The Cognitive Models OTH 204 Frames of Reference PARADIGM (PHILOSOPHY, VALUES AND ETHICS, KNOWLEDGE, OCCUPATIONAL THERAPY PRACTICE FRAMEWORK) OCCUPATION-BASED MODELS (OVERARCHING THEORIES) FRAMES OF REFERENCE (PRACTICE GUIDELINES IN SPECIFIC DOMAINS)  Frames of Reference Ann Mosey, 1989, The Proper Focus of Scientific Inquiry in Occupational Therapy: Frames of Reference Theory cannot be directly applied to practice...must be transformed into useable information to provide guidance for dealing with practical problems A FOR provides principles for selecting, synthesizing and reformulating theories into information that can be directly applied to specific practice situations Theories are transformed into FOR's through applied scientific inquiry Scientific inquiry in OT: developing effective, evidence-based FOR's by applying theory directly to practice and using data-based research to develop intervention technology and/or techniques. Mosey, A. C. (1989). The proper focus of scientific inquiry in occupational therapy: frames of reference. The Occupational Therapy Journal of Research, 9(4), 195–201. https://doi.org/10.1177/153944928900900401 Frames of Reference (As defined by Mosey) Conceptual systems that organize applied knowledge in occupational therapy Purpose: Structures scientific knowledge so it may be applied in day-to-day situations Systems of compatible concepts from theory that guide a plan of action for assessment and intervention within specific occupational therapy domains Frames of reference: Enter the reasoning process as the OT thinks about problem areas the client has identified within defined contexts Used to assess occupational skills and guide client choice of appropriate intervention strategies. Mosey’s Frame of Reference Structure Domain of concern (Focus) Theoretical base Function-dysfunction continuum Postulates of change Evaluation and intervention Research Evaluating Frames of Reference Questions we might ask ourselves in order to determine the value and usefulness of a frame of reference for a specific client: ◦ What frames of reference focus upon the areas my client has identified as priorities? ◦ What frames of reference help me to understand the problems my client has demonstrated ◦ What research has been done to validate the basic concepts of this frame of reference? ◦ What assessment tools does this frame of reference provide? What is their reliability and validity? ◦ What concepts guide my thinking when developing intervention strategies? ◦ What specific techniques have been developed to bring about therapeutic change? What evidence exists in the literature that these techniques are effective? Cognitive Frames of Reference Cognitive Frames of Reference Objectives: ◦How cognition is understood ◦How cognitive problems are viewed, assessed, and addressed in therapy ◦Allen’s Cognitive levels ◦Introduction to Toglia’s dynamic interactional FOR ◦Cognitive Behavioral & Social Cognitive Frames Cognitive Hierarchy Primary Cognition - Orientation, attention, and memory Higher-Level Cognition - Reasoning, concept formation, and problem-solving Meta-Processes/Metacognition - Executive functions and self- awareness Basic Cognitive Capacities Examples of basic cognitive capacities: ◦ Attention ◦ Concentration ◦ Memory ◦ Praxis ◦ Recognition of one’s body scheme (i.e., spatial arrangement of one’s body parts) ◦ Awareness of spatial relations ◦ Visual attention and visual scanning of the field of vision Higher-Level Cognitive Processes Awareness/Insight Executive Functions Initiation Self-monitoring Planning, Organizing, & Sequencing Emotional Control (Execution) Task-monitoring ◦ Termination (Completion) Self-awareness Judgement & Safety Inhibition Mental Flexibility (cognitive shift) Problem Solving Abstract Reasoning Motivation/volition Functional Cognition The cognitive ability to perform daily life tasks through metacognition, executive function, performance skills, and performance patterns (Giles et al., 2020) Cognitive problems may include core deficiencies in: Selecting and using efficient processing strategies to organize and structure incoming information Anticipating, monitoring, and verifying accuracy of performance Accessing previous knowledge when needed Flexibly applying knowledge and skills to different situations Interdisciplinary Base ◦Neuroscience ◦Neuropsychology ◦Psychology (learning theory, cognitive, information processing concepts) Theoretical Foundations of Cognitive Models Models and theories of cognitive rehabilitation differ from each other in: ◦ Perspectives on learning and the ability to generalize information ◦ Areas targeted for change or emphasized in intervention Theoretical Foundations of Cognitive Models There are five main approaches: ◦ Remedial ◦ Functional ◦ Allen Cognitive Levels ◦ Neurofunctional Approach (Functional Task Training) ◦ Metacognitive cognitive strategy ◦ Dynamic Interactional FOR (Cognitive Rehabilitation) ◦ Cognitive Orientation to Occupational Performance Model (CO-OP Model) ◦ Combined approaches ◦ Health promotion and prevention Remedial Approaches Evaluating and restoring impaired cognitive perceptual skills. Identifying and targeting underlying deficits or skills Assumes that repetitive training on impaired tasks stimulates neuroplasticity Improvement in underlying cognitive or perceptual deficits is thought to promote recovery or reorganization of the impaired skill Insufficient evidence that demonstrates the impact of such intervention on everyday functioning Should be combined with other intervention approaches if used  Functional Approaches: Cognitive Disability Model/Allen’s Cognitive Levels (ACL) Developed by Claudia Allen in 1985 Focuses on task or environmental adaptations Function is organized into six ordinal levels of global functional cognitive capacities, ranging from normal (Level 6) to profoundly disabled (Level 1) Modes of performance within each level further qualify behavior variations and allow for more sensitive measurement of the person’s global functional capacity. Most frequently applied to persons with mental health conditions, hospitalized and community-dwelling older adults, and those with dementia. (Gillen, G., & Brown, 2023) Focus ACLs apply to all occupations of the OTPF (ADL's, IADL's, education, work, play, leisure and social participation) Focuses on the role of cognition (a process skill), the role of habits and routines, the effect of physical and social contexts, and the analysis of activity demand. Diagnoses that include cognitive deficits include dementias, acquired head injuries, chronic mental illness, chronic diseases affecting the nervous system (MS, HIV, Huntington's, etc.), and developmental disabilities. Limitations in cognitive ability create predictable safety issues in daily occupations...can be used to guide decisions regarding the client’s ability to live independently, demonstrate autonomy/self-direction, and show competence in managing their own affairs. ACL Theoretical Base Functional Cognition Brain Conservation Task Equivalence & Analysis Task Demand Task Environment Just-Right Challenge Information Processing Model: o Extrinsic Factors o Intrinsic Factors Levy’s Cognitive Disabilities Reconsidered Model Sensory Perceptual Memory Working Memory Long-Term Memory oExplicit Memory Stores oImplicit Memory Stores Levy’s Cognitive Disabilities Reconsidered Model ACL Function & Dysfunction Allen cognitive levels serve as a function-dysfunction continuum. Allen defines six cognitive levels and 52 modes of performance to define the range of cognitive function and disability (scale of 0.8 to 6.8). Below level 1 is basically comatose, and above level 6 is considered normal functioning. Allen (1999) has identified ACL 4.6 as minimal for living independently, with the condition that dan-gerous items in the environment are removed or disabled and some supervision is available. The six ACLs will be reviewed here as general categories All the ACLs and modes have names that describe a defining feature of that level ACL Function & Dysfunction  ACL Function & Dysfunction Level 0: Coma 0.0-0.8- unconscious, no response to stimuli or only reflexive responses Level 1: Automatic actions 1.0- able to use protective responses; attends to all five senses with focus on survival Level 2: Postural actions 2.0- able to move the body for sitting, standing, walking and balance, attends to barriers in environment and large objects Level 3:Manual actions 3.0- able to handle objects, follows one step cues within the context of familiar activity, hand repeat/learn movement patterns; attention to gross hand use and size, shape and function of familiar objects ACL Function & Dysfunction (cont.) Level 4: Goal directed learning 4.0- able to complete a goal, perform self care independently, and comply with directions; attention to eye-catching visual cues, familiar actions that accomplish a goal, possessions, and errors Level 5: Independent learning 5.0- able to explore new actions and make fine motor adjustments; attention to surface properties, spatial properties, feeling; remembers the effects of previous actions to learn new activities Level 6: Planned activities 6.0- able to think about actions before performing them; considers the needs of others; and tends to abstract cues, the potential outcome of an action, safety hazards, and social expectations  ACL Change & Motivation Cognitive changes occur because of changes in brain chemistry, brain physiology, and brain plasticity. The ACLs can assist therapists in monitoring change through observation of client engagement in ADL. Occupational therapists can influence the client’s ability to engage in occupations through instructions, cues, and assistance and by adapting the environment. ACL Change & Motivation Change occurs through caregiver assistance and adapting the environment: Assistance oObserving oCueing oProbing oRescue Adapting the task environment Allen defines the usable task environment differently for each cognitive level ACL Evaluation ACL Screen/Large ACLS Videos - Allen Cognitive Group Routine Task Inventory Cognitive Performance Test Allen Diagnostic Module, 2nd ed. ACL Intervention No clear distinction between assessment and intervention Each level requires different task environment Creating safe environments Levels of wellness  Functional Approaches: Neurofunctional Training Developed by Gordon Muir Giles Designed primarily for people who are unlikely to develop self-care or community independence skills spontaneously (clients with severe cognitive impairments, TBI; Behavior Disorders) Emphasizes the use of task-specific training or rote repetition of specific tasks or routines within natural contexts to develop habits or functional behavioral routines. Uses two main strategies: Training clients in highly specific (task and/or context) compensatory strategies Specific task training to assist clients to perform a given functional behavior Emphasizes cognitive overlearning Repeated short practice sessions in a controlled environment until it becomes habituated Uses activity analysis and behavior techniques of cueing, chaining, and reinforcement Emphasizes avoiding errors because the clients targeted by this approach do not learn from mistakes and thus perpetuate their errors (errorless learning) ◦ Generalization in not expected Metacognitive Cognitive Strategy Approaches Use structured metacognitive processes within the context of occupational performance and focus on cognitive strategies rather than discrete cognitive skills. Requires metacognitive skills such as the ability to assess task demands or recognize when a strategy is needed, monitor performance, detect errors, make adjustments, and self-evaluate performance Focus on methods to enhance strategy use, learning, and performance within everyday activities. Dynamic Interactional Frame of Reference (Toglia & Abreu) Cognitive Orientation to daily Occupational Performance (CO-OP) Dynamic Interactional Frame of Reference Focus Target population: oBrain injury, including trauma and stroke oSome mental health and developmental disability populations oSupport ◦ Perceptual processes ◦ Cognitive processes Goal: Restore functional occupational performance for persons with cognitive dysfunction Dynamic Interactional Frame of Reference: Theoretical Base 1- Neuroscience ◦ Information Processing research ◦ Systems approach ◦ Brain Plasticity ◦ Structural Capacity 2- Occupation-based approach ◦ Person ◦ Activity ◦ Contexts The Dynamic Interactional Frame of Reference Problems with processing and learning Person are understood by analyzing the dynamic interaction between the person, the context, and the activity Dynamic As the activity or context changes, so does the cognitive strategy. Context Activity Toglia, 1998 The Dynamic Interactional Frame of Reference: Person Personal context Self-awareness ◦Self-efficacy ◦On-line awareness (metacognition) Processing strategies The Dynamic Interactional FOR Occupational Focus: The Activity Activity demand Self-monitoring skills Activity analysis Transfer of learning The Dynamic Interactional FOR Occupational Focus: The Environment Environmental analysis Social environments Zone of proximal development (Vygotsky, 1978) Cultural context Physical environments The Dynamic Interactional FOR Function & Dysfunction Cognitive functioning Higher-level cognitive skills (Katz and Harman-Maeir, 2005) oAnticipatory awareness oIntellectual awareness oIntention oPlanning oMonitoring Cognitive dysfunction The Dynamic Interactional FOR Cognitive Impairments A decrease in efficient use of processing strategies to select, discriminate, organize, and structure incoming information (Toglia & Finkelstein, 1991). A person with cognitive problems “may not automatically attend to the relevant feature of a task, group similar items together, formulate a plan, or break the task down into steps” (Abreu & Toglia, 1987) The Dynamic Interactional FOR Cognitive Impairments (cont.) Cognitive problems may include core deficiencies in: Selecting and using efficient processing strategies to organize and structure incoming information Anticipating, monitoring, and verifying accuracy of performance Accessing previous knowledge when needed Flexibly applying knowledge and skills to different situations The Dynamic Interactional FOR Change & Motivation Self-awareness Enabling transfer of learning Self-directed strategies The Dynamic Interactional FOR Evaluation Contextual Memory Test Toglia Category Assessment Dynamic Object Search Test of Visual Processing The Dynamic Interactional FOR Dynamical Assessment Problem-discovery and problem-solving Toglia (2005) indicates that dynamical assessment includes: ◦ Determining the client’s self-perceptions of performance ◦ Therapist observes and seeks to facilitate changes in performance by using cues, strategy teaching, and changes in task ◦ After task performance, asking clients for perceptions of their own performance The Dynamic Interactional FOR Intervention Assessment and intervention often cannot be separated Cognitive strategies for increasing self-awareness Applying the multicontextual approach Using a memory notebook Individual vs Group Intervention The Dynamic Interactional FOR Treatment/Intervention Four approaches 1. Functional approach 2.Remediation 3. Multicontextual 4.Quadraphonic The Dynamic Interactional FOR Strategies for Transfer of Learning ◦Multiple contexts: application of learning increases when cognitive strategies are practiced in a variety of situations. ◦Near to far transfers: OT interventions progress along a continuum which gradually places more demands on the use of targeted strategies. The Dynamic Interactional FOR A Remedial or Restorative Perspective Therapy should target and improve impaired information processing capacities Seeks to retrain or restore specific cognitive skills Ability to transfer learning from one situation to another. The Dynamic Interactional FOR Adaptive or Compensatory Perspective ◦Capitalize on their existing potentials ◦Use strategies to substitute or compensate for limitations The Dynamic Interactional FOR Treatment/Intervention Two approaches for when the capacity for learning is restricted: Cognitive Disabilities: ◦ Adapt tasks and the environment accordingly. ◦ Assumes that task involvement does not change functional capacity Neuro-functional: ◦ Specific compensatory strategy or training in a specific functional task Cognitive Orientation to daily Occupational Performance (CO-OP) The Cognitive Orientation to Occupational Performance (CO-OP) Approach (Polatajko & Mandich) ◦ emphasizes the use of cognitive strategies in the development and acquisition of motor skills and daily living skills ◦ uses a combination of a global strategy “Goal, Plan, Do, Check” and domain-specific strategies to acquire skills that will support the person’s daily functioning Structure: self-selected goals, performance analysis, metacognitive strategy training, guided discovery, and caregiver training ◦ Goal ◦ Generate goals via COPM ◦ Plan ◦ Strategize means to accomplish goal ◦ Do ◦ Perform task ◦ Check ◦ Evaluate own performance of task and modified plan Combined Approaches Different treatment approaches may be used at different points along the recovery trajectory or to address different problem areas or goals. Simultaneous combination of treatment methods requires further study and investigation Health Promotion and Prevention Focus on health promotion and prevention in healthy populations and in people with non-neurological condition Broad, holistic approach that combines, cognitive adaptation and supports, compensatory cognitive strategies, or metacognitive strategies, with exercise, lifestyle modifications, self-management, or behavioral interventions. In Class Activity Review the following case studies and name the cognitive intervention model used in each case: CO-OP Cognitive Rehabilitation [ACL] Dynamic Interactional Frame of Reference Neurofunctional Training