Cognition and Perception

Question 1

Define orientation, attention, and memory and the each of the executive function skills.

Answer 1

Orientation:

• Alert & oriented x3
• Person
• Place
• Time

Assessment:- a lot of paper pencil testing. Do they attention deficits/ problems thinking

Intervention:

• Remedial- asking date/time/who are you? In groups maybe daily orientation
• Adaptive- cell phones/ clocks/ calendars/ notes/ get on routine/ sleep/wake routines

Attention:

• If don’t have on basic level, can’t learn
• Sustained: can they at least focus on task/ basic conversation/ might just be a conversation- how long can they sustain- ie 1 min, 2 hours; record as baseline. Environment also important ie quiet vs loud
• Selective: activating and inhibiting assessment; can they inhibit noise ie TV and have conversation at same time
• Alternating: you can go from one task to another/can they alternate ie cooking, meal prep, phone rings during a task. OBSERVE in different settings. Record where they are & how long can they sustain.
• Divided:

Assessment

Intervention

• Remedial- get them back to occupation/ meaningful/ something they want do. COPM find goals & interests. Grade the types the attention. Maybe start for just sustained attention for 5 min in quiet then up to 30min in same & then into loud environment. Do things done in the past. Have behavioral token system
• Adaptive-adapt environment or task. Maybe always quiet place maybe de-clutter environment. Teach others/family to shorter sentences, speak clearly. Use colors or signs- bright red letters.

Memory- short term to long term, depending on what you do with working memory. Longer you spend time doing something, better encoding.

How information is:

•Encoded, Stored, Retrieved

• Long-Term Memory
  
  • Implicit-
    
    • –Procedural- driving, riding bike, ADLs
  • Explicit
    
    • –Episodic- personal history/ life experiences/ helpful to have family there
    • –Semantic- learned about the world/ history class
  • Prospective

Assessment- River Test. Autobiographical Memory Test. Contextual Memory Test.(recommended)

▫Observe in environment. Ask about schedule

▫All sensory inputs help how memory is retrieved

Intervention

▫Remedial- must make sure attention in place first. Repetition. Concept maps. Verbal cues for memory. Give fewer and fewer cues. Retrieval cue ie do you remember that time, keep give more info. What did we do in our last session, remember we were…

▫Adaptive- writing down, keep lists, external aids, set reminders, phone. Calendar…medication organizers. Reminder lists. Post-its. Mnemonics. Audio taping. Pegging (take numbers and associate with the numbers)Chunking or grouping items ie grocery, all fruits, all veges…

Executive Function- more frontal lobe

• Initiation
• Problem Solving and Reasoning
• Decision Making
• Categorization
• Mental Flexibility
• Abstraction
• Generalization and Transfer

Self-Awareness

• Intellectual Awareness- need this first; have some idea of current strengths and weakness; cant be in denial
• Emergent Awareness- recognize problem when its occurring
• Anticipatory Awareness- they can anticipate it before it happens (good sign)

Assessment- ask what are deficits are. How will it affect how this will affect your task?

Intervention

▫Remedial- need insight for this. Start out with a lot of cues. Ask what problems do you anticipate? What do you think went well? If no improvements, maybe need a step by step checklist. Alert family about deficits. Initiation- starting a task, incentive training, sensory input, stand pt up, take hand to begin & verbal cues.

▫Adaptive- alarm, when goes off start task, calendar or audio recording.

Question 2

Executive Function- Initiation

Answer 2

• Assessment
• Intervention

▫Remedial- need insight for this. Start out with a lot of cues. Ask what problems do you anticipate? What do you think went well? If no improvements, maybe need a step by step checklist. Alert family about deficits. Initiation- starting a task, incentive training, sensory input, stand pt up, take hand to begin & verbal cues.

▫Adaptive- alarm, when goes off start task, calendar or audio recording.

Question 3

Executive Function- Problem Solving

Answer 3

• Assessment- attain goals through steps, assessing during all of it. Observe during & after task. Ask them while theyre doing “what are you doing? What went wrong?”
• Intervention
  
  • Remedial- create organizational steps, what to do, problems anticipate, have them rehearse it, find alternatives
  • Adaptive- write it all out step by step

Question 4

Executive function- Desision Making

Answer 4

• Assessment- yes or no. have classification of things pt needs to decide on, ie driving
• Intervention
  
  • weigh out pros and cons

Question 5

Executive function- Categorization

Answer 5

• Assessment- paper pencil tests,
• Intervention
  
  • Remedial- sorting clothes, putting away, gather ADL items. Order silverware.
  • Adaptive- have it organized for them & categorized

Question 6

Executive function- mental flexibility

Answer 6

• Assessment- start, stop & switch activity. Concrete vs abstract. If they can have more abstract thinking.
• Intervention
  
  • Remedial- functional activity, alarm set, bill pay, stop & go do something else and come back
  • Adaptive- Just do one activity, no interruptions. Only one task at a time.

Question 7

Executive function- Abstraction

Answer 7

• Assessment- paper pencil, lists of opposites, relating words, tell me what this phrase means
• Intervention
  
  • Remedial- work on understanding abstract concepts,
  • Adaptive- speak in concrete terms, teach family to talk concretely

Question 8

Executive Function –
Generalization and Transfer

Answer 8

• Assessment- can they take concept and apply in another context. If they can transfer can take skill in hospital and do at home — generalization novel idea
• Intervention

▫Remedial- near transfer- change 1-2 times, intermidiate- more items changed, change most of situation- generalization

▫Adaptive- never change anything