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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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