1. Cognitive Disability Frame of Reference
Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Cognitive Disability Frame of Reference
OT 460A
OT 460A

2. Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Objectives or what Robin wants you to know to be a great OT (and for the mid-term)
An understanding of the basic assumptions and principles of this theory so that you can compare and contrast it to other theories, especially ones that are logical to do so, like the DIA FOR. This means that you need to be able to:
Contrast the assumptions in this model to other models
Describe the purpose and use of the Allen Cognitive Levels and apply these levels based upon task performance
Determine when Allen assessment tools are appropriate
Utilize Allen’s information processing system for task analysis
Describe appropriate intervention strategies that can be used to assist clients
9/21/09
OT 460A
OT 460A

3. Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Allen’s Principles
Based on Piaget’s stages of cognitive development and neurobiological science
Cognitive behavior is based on biological factors and potential for improvement is dictated by these factors
Once the maximum cognitive level has been achieved, compensations must be made biologically, psychologically, or environmentally
9/21/09
OT 460A
OT 460A

4. Week 5 Lecture #1: Cogintive Disabilities
Allen’s Definitions
9/21/09
Cognitive disability: a limitation in sensorimotor actions originating in the physical or chemical structures of the brain and producing observable and assessable limitation in routine task behavior.
Maximizing engagement and participation is done by assessing the cognitive impairment; using assistance and environmental adaptations to compensate for activity limitations; and promoting routines that allow for continued participation in daily occupations (Does this sound similar to DIA?)
9/21/09
OT 460A
OT 460A

5. Uses of Cognitive Disabilities Theory
Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Uses of Cognitive Disabilities Theory
When there is a need to measure and monitor a client’s problem-solving ability and safety while performing daily activities.
For grouping together clients who function at similar levels of cognitive disabilities
For training caregivers in providing assistance while facilitating best ability to function
For providing a pragmatic approach to living with the consequences of illness or injury
9/21/09
OT 460A
OT 460A

6. Criticisms and Cautions of ACLS
Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Criticisms and Cautions of ACLS
Focus is on disability
Emphasizes weaknesses versus strengths
ACLS has many variables and individual differences
OTs need to be cautious when making judgments about cognitive levels
The levels should never be used as labels, but as guidelines
9/21/09
OT 460A
OT 460A

7. Assessment of the Person
Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Assessment of the Person
Allen Cognitive Levels Screen (ACLS)
Defines a cognitive level from 3.0 to 5.8
Purpose: Gives a quick estimate of the client’s current capacity to learn (Pay attention to this– a lot of students think that it is to assess problem-solving abilities.Look at the first use listed in Slide #5 to see why this may be confusing)
Routine Task Inventory (RTI) and Cognitive Performance Test (CPT):
Determine cognitive level based on everyday activities
9/21/09
OT 460A
OT 460A

8. Assessment of the Person
Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Assessment of the Person
Allen Diagnostic Module (ADM):
Uses a dynamic approach to assess cognitive level while taking motivation and socialization into account
Performance is observed during a group centered around a variety of standardized craft activities
Crafts are viewed as being motivating
Observation of response to instructions and sensory cues from materials and tools provide the basis for prediction about function in other occupations
9/21/09
OT 460A
OT 460A

9. Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Task Analysis
Task Analysis: a method of determining the functional complexity of an activity into steps and determining the physical and cognitive functional abilities required to do each step (Like your analysis of a game!)
Allen has modified approach to include factors like culture, motivation, situational context, and basic ability to process information (I wonder if she did this based on Toglia’s work or if they are in competition with each other)
9/21/09
OT 460A
OT 460A

10. Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Task Analysis
Allen’s information processing system (Cole, p. 181)
Serves as basis for planning and interpreting craft activities like those used in ADM
There is a distinction between working memory and procedural memory
Working memory: Used during active processing of information
Procedural memory: Used to perform habitual actions without conscious awareness
9/21/09
OT 460A
OT 460A

11. Task Analysis (Refer to Cole , p. 181)
Week 5 Lecture #1: Cogintive Disabilities
Task Analysis (Refer to Cole , p. 181)
9/21/09
Allen’s functional information processing system approach includes the following factors:
Cues
Environment, materials needed for task, and all forms of verbal, written, or demonstrated instruction
Attention
When using cues, plan the environment, selection and placement of supplies and equipment
Vary amount and type of assistance given based on the cognitive level
Action
The thinking processes that produced them
Speed of processing
Dependent on biological factors
9/21/09
OT 460A
OT 460A

12. Task Analysis Continued (Refer to Cole , p. 181)
Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Task Analysis Continued (Refer to Cole , p. 181)
Information Processing:
Involves the underlying mental processes:
Visual spatial components
Short and long-term memory
Prior knowledge, experiences, and preferences
Sensorimotor abilities
Verbal abilities
9/21/09
OT 460A
OT 460A

13. Week 5 Lecture #1: Cogintive Disabilities
Cognitive Levels
9/21/09
Assessment and intervention are based on how the client learns and performs tasks
Cognitive performance is placed on a continuum divided into 6 levels that are further divided into modes
Outlines 3 dimensions of task performance at each level:
Attention: What sensory stimulation capture interest
Motor actions: Observed during task performance to make assumptions about perception, understanding, and intention
Conscious awareness: awareness to determine appropriate actions
9/21/09
OT 460A
OT 460A

14. Allen Cognitive Levels
Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Allen Cognitive Levels
Level 1- Automatic Actions (bed bound)
Behavior is mostly reflexive
Responds to internal or subliminal cues
Arousal and response elicited for only a few seconds at a time
Self-care performed by caregivers
Intervention- Sensory Stimulation
9/21/09
OT 460A
OT 460A

15. Allen Cognitive Levels
Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Allen Cognitive Levels
Level 2- Postural Actions
Can be stimulated to perform postural actions in response to proproceptive cues
Can overcome the effects of gravity
Can imitate gross motor actions
Can assist with hygiene and dressing
Can feed self
Interventions: Movement or exercise groups based on imitation
9/21/09
OT 460A
OT 460A

16. Allen’s Cognitive Levels
Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Allen’s Cognitive Levels
Level 3-Manual actions
Respond to tactile cues to perform manual actions
Actions based on interest in objects at arm’s reach
Attention span can be maintained up to 30 minutes and is influenced by the materials we give them
Can perform basic grooming independently with some reminders and can walk to familiar places, but gets lost
Intervention: Repetitive tasks including IADLs
Emergence of Cause and Effect, but actions are disorganized
Potentially dangerous items must be placed out of reach
9/21/09
OT 460A
OT 460A

17. Allen’s Cognitive Levels
Week 5 Lecture #1: Cogintive Disabilities
Allen’s Cognitive Levels
9/21/09
Level 4- Goal Directed Activities: Big step for independence
Activities are purposeful and able to perform short tasks
Basic ADLs are intact and may ask for assistance
Needs assistance with new tasks, and for anticipating needs and managing money
Attends up to one hour and attends to samples, possessions, understands errors (beginning), from their questions we can infer what they are thinking about
Requires visual demonstrations for tasks because doesn’t follow verbal and written directions
Interventions: Reinforce familiar routines and perform repetitive drilling
4.4 lowest mode to live alone
9/21/09
OT 460A
OT 460A

18. Allen’s Cognitive Levels
Week 5 Lecture #1: Cogintive Disabilities
Allen’s Cognitive Levels
9/21/09
Level 5-Exploratory Actions/Independent Learning through new activities
Uses trial and error, use inductive reasoning, and are capable of new learning
Novelty and variation are sought
Concrete thinkers, so have difficulties with imagining long-terms consequences of actions or inactions
Timing for cooking, money management, purchasing needed items, cleaning clothing, and getting prescriptions refilled are problems
Attention to discovery of new effects and remembers where they are
Has poor social awareness
Interventions: Learning to improve the effects of their actions to considering social skills (empathy)
9/21/09
OT 460A
OT 460A

19. Allen’s Cognitive Levels
Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Allen’s Cognitive Levels
Level 6- Planned activities
Absence of disability
Attention to symbolic, hypothetic, social rules and obligations, what would happen if…?
Assumed to be the “normal”.
9/21/09
OT 460A
OT 460A

20. Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Role of OT
Enabler of client’s best ability to function by taking into account:
Assistance needed from caregivers
Adaptations of the environment
Expected behaviors in ADLs
Quality and quantity of cognitive and physical assistance needed at each level (find this in the Gray Book!)
9/21/09
OT 460A
OT 460A

21. Methods for Giving Cognitive Assistance
Week 5 Lecture #1: Cogintive Disabilities
9/21/09
Methods for Giving Cognitive Assistance
Facilitating: Giving appropriate sensory cues
Probing: Asking focused questions to encourage problem solving (similar to Toglia’s DIA!)
Observing: How client processes cues and questions and try new behaviors
Rescuing: Stepping in when client becomes frustrated or is unable to perform
9/21/09
OT 460A
OT 460A