Cognitive Disability Frame of Reference Evaluation and Intervention OT 452

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

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

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

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

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

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”.

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

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)

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

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)

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