1. Cognitive Disability Frame of Reference
Evaluation and Intervention
OT 452

2. Cognitive Disability Level 1- Automatic Actions (bed bound)
Protective Reflexes
Stimulus response, goal is survival
Intervention- Sensory Stimulation

3. Cognitive Disability Frame of Reference
Level 2- Postural Actions
Can overcome the effects of gravity
Gross motor
Attention to body position, movement, large external objects
Infer that client is thinking about safety, comfort, balance

4. Cognitive Disability Frame of Reference
Level 3-Manual actions
Follow cues to do next step, needs a model
Attention span influenced by the materials we give them
Attention to gross motor coordination, can start to do fine motor activities, to most striking visual cues (size, shape, color, placing things in a row, names of things,)
Emergence of Cause and Effect, but actions are disorganized

5. Cognitive Disability Frame of Reference
Level 4- Goal Directed Activities
Attends to samples, possessions, understand errors (beginning), from their questions we can infer what they are thinking about
Differentiate b/t parts of an activity, can generally copy a model
Can carry through with a task…will follow a routine
Match for two features at a time when completing a task
Try hard to complete a goal
Begin to look around and attend to the environment, will go an get tools
4.4 lowest mode to live alone

6. Cognitive Disability Frame of Reference
Level 5-Independent learning through new activities
Will explore their actions
Attention to surface properties of objects
Attention to discovery of new effects and remembers where they are
Hard time inhibiting their actions, lack good judgment
Externalizes blame, miss social cues
Learning to improve the effects of their actions to considering social skills (empathy)
A lot of social disability in this level

7. Cognitive Disability Frame of Reference
Level 6- Planned activities
Attention to symbolic, hypothetic, social rules and obligations, what would happen if?,
Assumed to be the “normal”.

8. Function and Abilities
What people can do (what the ACLS screens for) Biological
What people want/don’t want to do (motivational and psychological)
What people may do (potential)- sociologically determined… more dependent on the environment

9. Cognitive Disability Frame of Reference
Cognitive level is based on motor and verbal performance- The link between these is attention
The scale of cognitive performance is a continuum
You might need to give two cognitive scores when a person has a big discrepancy b/t verbal and motor performance (particularly impt. w/CVA’s)

10. Cognitive Disability Frame of Reference
Modes
Even numbers-
Odd numbers- for when they pay attention to a cue, but cannot act based on the cue

11. Cognitive Disability Frame of Reference
Memory
Attention
Speed
Visual spatial
Verbal propositional
Procedural Memory
Habits (ADL’s)
We don’t think about them (automatic)
Relearning is much harder when there is a physical disability (people have to learn a whole new procedure)

12. Model for memory Cues Attention Action Speed Visual Spatial Memory
Verbal propositional
Procedural Memory