COGNITIVE MODEL

                           COGNITIVE MODEL

1.      THEORY:

·          Defines cognition as a process of identifying, selecting, interpreting, storing, and using information to make sense of and interact with the physical and social world, to conduct one’s everyday activities, and to plan and enact occupational life

·         Cognition includes:

ü  Higher-level processes (metacognition) of awareness (ability to perceive oneself in relatively objective terms) and executive functions (e.g., identifying, initiating and pursuing goals, planning strategies and sequencing steps of action, solving problems, monitoring progress, and adjusting behavior to circumstances

ü  Specific or basic cognitive functions (e.g. attention, concentration, memory) 

·         Cognition is part of a mind-body system in which cognitive functions cannot be understood fully without reference to the motor system

·         Cognition involves a long developmental process influenced by social mediation

·         A central aspect of cognition is information processing through three distinct stages:

ü  Sensory-perceptual memory (the recall of sensory information [e.g., sight, sound, touch] just long enough for it to be analyzed and filtered)

ü  Short-term working memory (what one is thinking about at the moment)

ü   Long-term memory (information that is available for recall over an indefinite period)

·         Cognition is dynamic and results from multiple factors both inside and outside of the person interacting together

2.      PROBLEMS AND CHALLENGES:

·         Most cognitive approaches are concerned with difficulties relating to structuring, organizing, and using information for task performance (in a specific area such as visual processing or more generalized)

·          Cognitive problems may include difficulties with:

ü  Selecting and using efficient processing strategies to organize and structure incoming information

ü  Anticipating, monitoring, and verifying accuracy of performance

ü  Accessing previous knowledge when needed

ü  Flexibly applying knowledge and skills to different situations (Toglia, 2005) 

·         Cognitive problems:

ü  Are dependent on task and environmental context

ü  Routinely lead to problems in occupational performance

3.      RATIONALE FOR THERAPEUTIC INTERVENTION:

·         The explanation for cognitive interventions falls into two major categories:

ü  Remedial (sometimes referred to as restorative) Aims to retrain or restore specific cognitive skills  Used with persons with greater capacity for learning, with more intact higher-level cognitive processes and the ability to transfer learning

·          Compensatory (sometimes referred to as adaptive)

ü  Helps persons to capitalize on their existing potentials

ü  Applies to clients who have less capacity for learning

ü   Three types of compensatory interventions

Ø  Process-oriented and dynamic strategy learning (learning to compensate for their problems using their remaining abilities)

Ø   Specific skill training (teaching a very specific compensatory strategy or a specific functional task)

Ø  Task and environmental modification (identifying the extent of cognitive limitation and adapting tasks and environment accordingly)

4.      PRACTICE RESOURCES ASSESSMENT:

·         The main strategies of cognitive assessment are:

ü  Assessment of the occupational/functional consequences of impaired cognition

ü  Assessment of cognitive components to identify the extent and nature of underlying cognitive deficits to understand why performance is breaking down

ü  Dynamical assessment that reflects the principle that person, task, and environmental variables all contribute together to cognition

ü   Determination of level of cognitive impairment/function

·          Specific assessment methods include:

ü  Observation during task performance (to note processing strategies, functional impairment, and overall cognitive level)

ü   Interview (to gather information on the client’s awareness of cognitive impairments, lifestyle, and narrative)

ü  Standardized tests (verbal, paper and pencil, and tabletop) that range from screening for cognitive problems, determining cognitive level (extent of impairment), and assessing specific cognitive abilities, to examining multiple cognitive factors

5.      INTERVENTION:

·          Remedial treatment of awareness problems includes:

ü  Providing information to the client on impairment

ü  Helping the client experience the impairment in activities that highlight problems but do not overwhelm the client

ü   Using the therapeutic relationship to help the client to acknowledge and face emotionally difficult information about impairment  Remedial treatment of executive functions involves providing persons with opportunities to choose, select, plan, and self-correct 

·         Compensatory approach to awareness stresses environmental adaptations and using behavioral techniques to extinguish maladaptive behaviors stemming from unawareness  Compensatory approach involves providing external support or strategies to allow adequate performance

·          Dynamical strategy treatment is based on the principle that performance can be modified by changing:

ü  Activity demands

ü   Environment 

ü  Person’s use of strategies and self-awareness

ü   Task and environmental dimensions that create difficulty for the client as well as information-processing difficulties that create problems across different kinds of tasks 

·         Cognitive Retraining

ü  Mostly remedial approach designed for persons with stroke and traumatic brain injury

ü  Aims to improve: Capacity to process information Ability to transfer and generalize to functional areas  Awareness of abilities

ü   Uses the following methods: Enhancing remaining abilities through supports to maximize success and minimize frustration Individual or group training Using specific, structured teaching learning strategies  Training in procedural strategies

·         Neurofunctional Training

ü  For clients with severe cognitive impairments

ü   Uses two main compensatory strategies:

Ø  Training in highly specific (task and/or context) compensatory strategies

Ø   Specific task training to assist clients to perform a given functional behavior

·         Dynamic Cognitive Intervention

ü  Combines remedial and compensatory interventions that directly and simultaneously enhance participation while seeking to improve and expand learning ability and self-perception

ü  The mediator (therapist) aims to: Increase intentionality and raise awareness of the ways one acts Help go beyond immediate needs or concerns to make generalizations  Raise the awareness and understanding, making explicit the reasons and motivations for doing things  Support a sense of competence and ability in task performance 

·         Cognitive Orientation to daily Occupational Performance (CO-OP)

ü  A cognitive intervention for improving motor performance in children with developmental coordination disorder

ü   Uses a global strategic sequence of identifying a goal, planning, doing, and checking

ü   Emphasizes talking and uses a process of guided discovery that seeks to scaffold learning

6.      TYPES OF COGNITIVE MODEL :

	APPROACH/INTER-VIEW OF AUTHOR(S)	[INTENDED DISCIPLINARY	VIEW OF COGNITION	VIEW OF IMPAIRMENT/PROBLEMS	ASSESSMENT STRATEGY	INTERVENTION APPROACH
1	cognitive Rehabilitation (Averbach & Katz) [stroke and TBI]	Incorporates ideas of neuro-plasticity	Through learning and experience one can: (1) improve ability to evaluate and be aware of abilities and avoid entering situations beyond one’s capacities, (2) create alternative cognitive strategies		Assess cognitive abilities/disabilities, level of awareness and executive functioning abilities, occupational information, and preferred learning patterns	Broaden capacity to process information, transfer, and generalize to functional areas
2	Neurofunctional Approach (Giles) [clients with several cognitive deficits]	Behavioral and cognitive theories of learning, movement science, and OT, dynamical systems perspective		In clients with severe cognitive impairment, learning potential is very constrained by inability to generalize and use higher-order compensatory skills. Learning must be specific, clearly guided, and practiced until highly habituated to result	Determine current level of functioning under conditions similar to expected living situation. Standardized testing can be used to identify specific reasons why performance may break down	Training in highly specific compensatory strategies. Assist performance of a specific functional behavior through specific task training
3	Cognitive Orientation to daily Occupational Performance (Polatajko & Mandich [children with developmental coordination disorder]		Thinking patterns drive behavior and new thinking patterns can result in behavior change. New skills emerge from the interaction of the child, the task, and the environment	Does not describe cognitive impairments, as cognition is used as a strategy for addressing performance difficulties due to motor coordination problems	Daily activity log. Activity card sort (things done and not done). COPM. Performance Quality Rating scale: observation scale for repeatedly measuring performance and change (research tool). Dynamic performance analysis (observation-based process of identify performance problems or performance breakdown)	CO-OP is a client-centered, performance-based, problem-solving approach that enables skill acquisition. It uses: (1) a strategic sequence of identifying a goal, planning, doing, and checking, and (2) a process of guided discovery in which the child is supported to find out how to do the task at hand
4	Dynamic Cognitive Intervention (Hadas-Lidor & Weiss) [all populations]	Luria’s and Feuresten’s notion that cognition is influenced by social mediation	Cognition is shaped and mediated by learning experiences (i.e., how stimuli emitted by the environment are transformed by a mediating agent [e.g., parent] who selects, frames, filters, and schedules stimuli)	Low performance is linked to learned cognitive structures that can be more important than cognitive impairment due to etiological factors	Focuses on modifiability of cognition and attempts to understand cognitive functions responsible for deficiencies in cognition (which may be motivational, emotional, as well as cognitive)	Change cognitive structures that determine low performance through mediated learning experience. Seeks to transform client into an autonomous independent thinker capable of initiating and elaborating actions
	Cognitive Disabilities (Allen, Levy, & Burns) [severe psychiatric illness, dementia]	Originally based on Piaget’s concepts of cognition. Reformulated emerging theory and concepts from cognitive neuroscience	Based on a conceptualization of information processing, offers a hierarchical description of different levels of functional performance capabilities and limitations	Neurological injury or disease impairs cognition, imposing restrictions on performance and learning potential	Identify/monitor level of cognitive function based on an ordinal classification scheme that identifies six levels of cognitive functioning	Centers on current capabilities, providing the just-right challenge, and adapting the task and environment to the individual
5	Dynamic Interactional Approach (Toglia	Dynamical systems theory	Cognition is a product of the dynamic interaction among the person, activity, and environment	Examines abilities and problems in terms of underlying strategies, ability to monitor performance, and potential for learning	Use cues and task alterations to identify a person’s potential for change. Alter task and environmental variables to enhance ability to process, monitor, and use information	Remedial: change the person’s strategies and self-awareness. Compensatory: modify external factors such as activity demands and environment or simultaneously focus on person, task, and environment systematically
6	Higher-Level Cognition ( Katz & Hartman Maeir	Interdisciplinary literature of higher-level cognitive functions	Focus on higher-level cognition: awareness and executive functions	Unawareness of limitations. Difficulties with executive functions (planning, problemsolving, monitoring, and adjusting performance	Awareness. Compare client’s estimation of ability, prediction of performance with actual abilities/ performance; examine on-line awareness to choose appropriate tasks and detect/ correct errors. Executive functions. Use a battery that combines tabletop, functional, and observational measures	Awareness. Remedial (for mild-to-moderate unawareness): educate client or allow client to experience impairment in task performance, provide support to face emotionally difficult information. Compensatory: environmental adaptations and behavior approaches. Executive functions. Remedial: provide persons with opportunities to choose, select, plan, and self-correct. Compensatory: provide external support or strategies
7	Quadraphonic Approach (Abreu)	Information processing, teaching-learning, neurodevelopment and biomechanics, and narrative concepts	Stresses the mindbody connection (i.e., the relationship of cognition and the motor system) and the life history context in which cognition occurs	Disruption of cognitive and motor systems with impact on client’s life story	Micro evaluation: cognitive and motor control strategies, assessment of cognitive processes (e.g., attention, memory, problem-solving, motor planning). Macro evaluation: the client’s subjective sense of satisfaction and adaptation. Identifies client’s level of functional performance (seven levels)	Focus on the client-learner, therapist-teacher, and training-compensatory environment. Emphasis of intervention is based on client’s functional performance level and integrates cognition, movement, and client’s personal narrative. Approach depends on client’s functional level