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32 terms

NBCOT-CH11-Cognitive Perceptual Approaches: Evaluation and Intervention

STUDY
PLAY
Astereognosis
AKA tactile agnosia
- Inabil. to recognize objects, forms, shapes and sizes by touch alone
- Sensory testing (tactile and prop.) intact
Ideational apraxia
- Breakdown in knowledge of what is to be done or how to perform
- Lack of knowledge re: object use
Motor apraxia/ideomotor apraxia
- Loss of kinesthetic memory
- Purposeful mvmt cannot be achieved due to ineffective motor planning although sensation, mvmt and coord. are intact
Asomatoagnosia
Body scheme d/o that results in diminished awareness of body structure and a failure to recog. body parts as one's own
Anosognosia
Unawareness of motor deficit
Acalculia, Alexia, Agraphia
- Acalculia: inabil. to perform calculations
- Alexia: inabil. to read
- Agraphia: inabil. to write
Anomia
Loss of abil. to name objects or retrieve names of people
Broca's aphasia vs. Wernicke's aphasia
- Broca's: loss of expressive lang.
- Wernicke's: deficit in aud. comprehension that affects semantic speech perf., manifested in paraphasia or nonsensical syllables
Agnosia
Loss of ability to recognize objects, persons, sound, shapes or smells while the specific sense is not defective nor is there any sig. memory loss
Obs. during daily activ. signaling impaired alertness/arousal; intervention
Req. sensory cues to maintain arousal (loud voice, tactile stim., vestib. input, appears lethargic, falls asleep during ADL)
- I: inc. environ./sensory stimuli, GM activities
Obs. during daily activ. signaling motor/ideomotor apraxia; intervention
Clumsy, diff. crossing midline, diff. w/manipulation activ., awkward grasp pattern to answer phone, diff. w/bilateral activ.
- I: general verbal cues (not specific), dec. manipulation demands, hand-over-hand, visual cues
Obs. during daily activ. signaling ideational apraxia; intervention
Uses objects incorrectly, cannot seq. steps of task, does not engage in task
- I: step-by-step instructions, hand-over-hand, opportunities for motor planning/execution
Obs. during daily activ. signaling perseveration; intervention
Repeats same motor act such as continuing to wash one arm, diff. terminating a hand to mouth pattern when the plate or bowl is empty, repeats same task (dress, undress, dress, undress)
- I: bring to conscious level and train person to inhibit bx, redirect attn., tasks that req. repetitive action (knitting?)
Obs. during daily activ. signaling spatial neglect; intervention
Cannot find food (usually) L side of plate, cannot balance check book (number 1,550.00 may be perceived as 50.00), gets lost easily (only responding to one side of environ.)
- I: graded scanning activ., grade from simple to complex, use anchoring activ. to compensate (yellow tape on sink), manipulative tasks in conjunction w/scanning activ., external cues (colored markers, written directions)
Obs. during daily activ. signaling body neglect; intervention
Does not dress (usually) L side of body/shave L side of face, etc., does not incorporate involved limbs in activities
- I: bilateral activities, guide affected side through activity, inc. sensory stim to affected side
Obs. during daily activ. signaling sequencing and organization deficits; intervention
Steps of task not in logical order or steps left out
- I: external cues (written directions, daily planner), grade tasks that are increasingly complex in terms of # steps req.
Obs. during daily activ. signaling spatial relations dysfunction; intervention
Diff. w/dressing such as orienting shirt to body, undershooting or overshooting (reaching for glasses, spilling when pouring), diff. aligning/moving body in space during transfer
- I: activ. that challenge underlying spatial skills, tasks that req. discrimination of R/L
Assessment of Motor and Process Skills (AMPS)
- 3 yrs.+ regardless of diagnosis
- Examines person's func. competence in 2 or 3 familiar and chosen BADL or IADL tasks (indiv. chooses from list of over 60 standardized tasks)
- Th. observes/documents motor and process skills that interfere w/task perf.
- Skills scored from 1=deficit to 4=competent
Arnadottir Occupational Therapy Neurobehavioral Evaluation (A-ONE)
- Adult pop. presenting w/cog./perceptual (neurobx) deficits
- Structured obs. of BADL and mobility skills performed to detect underlying neurobx dysfunc.
Scoring:
- Functional Independence Scale: 0=unable to perform; 4=independent
- Neurobx Specific Impairment Scale: 0=no neurobx impairment observed; 4=unable to perform secondary to neurobx dysfunction
Allen Cognitive Level Test
- Pop. w/psych d/os, acquired BI, dementia
- SCREENING too to estimate indiv's cog. level
- Three leather lacing stitches
- Six level scale of cog. function (1=automatic actions; 6=planned actions)
Rivermead Perceptual Assessment Battery
- 16 yrs.+ w/VP deficits after BI or CVA
- 16 performance test that assess: form and color constancy, object completion, figure-ground, body image, inattention, spatial awareness
- Deficit-specific tasks in isolation from ADL tasks
- Scoring: accuracy of task completion and time taken to complete each task
Behavioral Inattention Test
- Adults presenting w/unilateral neglect
- Examines presence of neglect and impact on func. task perf.
- Nine activity-based subtests: picture scanning, menu reading, map navigation, address/sentence copying, card sorting, article reading, telephone dialing, coin sorting, telling/setting time)
- Six pen/paper subtests: line crossing, star cancellation, letter cancellation, figure and shape copying, line bisection
Lowenstein Occupational Therapy Cognitive Assessment (LOTCA)
- TBI, CVA, tumor
- Measure basic cog. functions that are prereq. for managing everyday tasks
- 20 subtests in 5 areas: orientation, visual, spatial perception, visualmotor org., thinking operations
- 1=low ability; 4=high ability
Rivermead Behavioral Memory Test
- Persons w/memory dys.
- Offers initial eval. of indiv.'s memory function
- Monitors skills t/o rehab program
- 11 categories w/9 subtests: each subtest presents series of items that the person is req. to recall in later assessment
- Scoring: 0-9=severe imp. memory, 10-16 mod. impair., 17-21= poor mem., 22-24=normal
Remedial/Restorative Approach to cognitive/perceptual intervention
Focuses on restoration of components to inc. skill
- Deficit specific
- Targets cause of symp.
- Emphasizes perf. components (result in inc. skill)
- Assumes cerebral cortex malleable/ can re-org.
- Tabletop activ. as tx modalities
Compensatory/Adaptive/Functional Approach to cognitive/perceptive intervention
- Repetitive practice of functional tasks
- Emphasizes modification/environ. adaptation/ compensatory strategies when task too diff.
- Emphasizes intact skill training
- Tx symptoms NOT cause
- Tx task specific, utilizes func. tasks (ADL, work, leisure, etc.) that indiv. desires or is req. to perform at d/c
Information Processing Approach to cognitive/perceptual intervention
- Provides info. on how indiv. approaches task
- Looks at how perf. changes w/cueing
- Standardized cues given to determine effect on perf.
- Cues/feedback to draw attn. to features of task
- Investigative ?'s used to provide insight to underlying deficits
Dynamic Interactional Approach (Multicontextual Approach) to cognitive/perceptual intervention
- Emphasizes transfer of info. from one situation to the next
- Utilizes varied tx environments
- Emphasizes metacognitive skills
- Transfer of learning occurs through graded series of tasks that dec. in similarity (scanning in fridge for milk->scanning to cross street)
- Th. utilizes awareness questioning ("how do you know this is right?") to help indiv. detect errors, estimate task diff. and predict outcomes; self-monitoring techniques
Quadraphonic Approach to cognitive/perceptual intervention
- Integrated model; makes use of several theories: info. processing, teaching/learning eval., neurodevl. eval, biomechanical eval.
- Micro-perspective: eval of perf. component subskills such at attn., memory, motor planning, postural ctrl, prob. solving
- Macro-perspective: eval includes use of narratives, interview, real-life occupations (shopping, cooking, etc.)
Neurofunctional Approach to cognitive/perceptual intervention
- Specifically used for indiv. w/acquired neuro impairments
- Based on learning theory
- Focuses on retraining real world skills rather than cog-percep processes
- Uses overall adaptive approach, some remediation
- Tx focus on training specific functional skills in true contexts
Allen Cognitive Disabilities Model
- Describes cog. function on continuum from level 1 (profoundly impaired) to level 6 (normal)
- Each level describes extent of person's disabil. and diff. in performing occupations
- After level estab., routine tasks presented that person can perform or that have been adapted so he/she can perform them
- Focus placed on adaptive approaches and strengthening residual abilities
Intervention strategies for aphasia
Dec. external aud. stimuli, give indiv. inc. response time, visual cues and gestures, concise sentences, investigate use of aug. communication devices