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April 22, 2016 OT’s Role in Functional Cognition Rehabilitation By: Julie Thornton, OTD, ORT/L Marisa Velez-Spina, OTR/L Clinical Mentors A cornerstone of Occupational Therapy is the belief that cognition plays an inextricable part in daily occupations and life roles. Our clients require cognitive abilities and skills in order to successfully engage in simple to complex daily tasks such as: bathing, dressing, managing medications, budgeting funds, time management, organization, engaging in leisure pursuits, shopping, and driving ; to name but a few. Occupational therapy practitioners address cognition in a functional context as it pertains to initiation, sequencing, planning, processing, problem-solving, and safety awareness. Occupational Therapy plays an important role as a member of the interdisciplinary team by performing comprehensive assessments and data collection, determining how cognitive deficits impact function and safety, assessing the patient’s preserved strengths, and designing a customized plan of care driven by standardized assessments and evidenced based practice. Examples of OT Cognitive Based Assessments Mild Dementia Moderate Dementia Severe Dementia Allen Diagnostic Module Canvas Placemat Allen Diagnostic Module Canvas Placemat Allen Diagnostic Module Canvas Placemat Routine Task Inventory Routine Task Inventory Routine Task Inventory Montreal Cognitive Assessment Montreal Cognitive Assessment Edinburgh Feeding Evaluation in Dementia Brief Cognitive Assessment Tool (BCAT) Brief Cognitive Assessment Tool (BCAT) Brief Cognitive Impairment Scale Trail Making Test Trail Making Test Non Verbal Pain Scale Clock Drawing Test Clock Drawing Test Global deterioration Scale Spaced Retrieval Trial Spaced Retrieval Trial Spaced Retrieval Trial Vision Screen Assess remaining Abilities Vision Screen Assess remaining Abilities Vision Screen Assess remaining Abilities 1 | Page Examples of OT Cognitive Based Interventions Mild Dementia • Assist with establishment of external memory aids such as calendars/notebooks to track medications, activities, appointments, new routines, time, family visits, etc. • Topographical orientation training of new environment(s) to safely navigate and successfully locate personal items ( labeling drawers /doors, etc.) • Compensatory training in technology use (cell phone, Ipads, desktop computers, talking watches, programmable phones) • Environmental modification for visual spatial organization and simplification, grouping of like items to improve visual attention, spacing (efficiency) • Use of spaced retrieval / errorless learning for new learning using procedural memory training • Simplification of tasks/task segmentation to facilitate functional sequencing Moderate Dementia • Use of spaced retrieval / errorless learning for new learning using procedural memory training • Development of memory aids to increase recall, simple and direct communication prompts • Provide orientation to environment : navigation, positioning of ADL items • Provide sequencing with visual aids using color contrasts, enlarged items Severe Dementia • Maximize participation in preferred daily tasks: self feeding, mobility, leisure pursuits. • Provide staff education on maintenance of ADLs, psychosocial engagement and functional mobility • Maximize positioning for proper respiration, digestion, environmental interaction, skin integrity • Provide caregiver education/strategies for client engagement in daily tasks utilizing preserved areas of strength. • Provide caregiver education/strategies for communication/comprehension to promote engagement and minimize maladaptive behaviors. Occupational Therapy’s expertise in understanding human performance and its inherent need for successful interaction with the environment helps to capitalize on the client’s preserved cognitive, physical, and psychosocial skills. This abilities focused model affords our clients the opportunities for meaningful and purposeful engagement in activities of daily living. OT’s Role – Functional Cognitive Rehab | 04.22.16 2 | Page