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Executive Function : Occupational Therapy

Low Level and High Level Cognition

The odds are very likely that if your client has a neurological condition, they will have low level cognitive and executive function deficits when they arrive to occupational therapy. In OT school we are taught the over-arching principles of working with cognitive deficits, but that’s where it stops. Remember that school teaches you the bare minimum and it’s your job to research and continue learning restorative and rehabilitative principles of these diagnoses! In outpatient rehab, you will work with many adults with progressive disorders and it will be your job as an OT to understand cognitive mechanisms and how to restore and maintain executive functioning superimposed on occupational performance! This is EVERYTHING! The occupational therapy practitioner is often times the first health care professional to spot these concerns as they become apparent during task/activity analysis when we look at  attention, executive function, memory, and behavioral components of tasks.

Difference between cognition [low-level] and executive function

Cognition versus Executive Function in Occupational Therapy

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Approaching Executive Function in Occupational Therapy

In Executive Function Deficits, Occupational therapy practitioners have the responsibility to be restorative first! This means that we need to know the research for how to always, at every stage, increase current level of function and maintain baseline. Working in the adaptation and compensatory framework (aka Rehabilitation Model) is not the primary role of the occupational therapist! Your continuum of care must include an action plan to delay loss of function as much as research supports.

Cognitive ReserveMemory is actually more complicated than you would think. There are several types of memory and each can be affected differently depending on many factors. Did you know that two people could have the exact same diagnosis, but their memory will be impacted differently and at different rates? This all stems from what we call cognitive reserve. Cognitive reserve suggests the brain has the ability to withstand a certain level of injury (we are speaking about any kind of injury, even changes from disease/trauma) before symptoms of dementia become visible. This idea of cognitive reserve explains the varying presentations of symptoms between those with the same diagnosis.

 

Motor Elements: Remember that the brain is all connected. If someone’s executive function is being impacted, their motor skills or various neuromuscular functions will also be implicated at some level! Especially during dual tasking. Alzheimer’s Disease specifically will impact mobility so it is important to look at the entire body during an Alzheimer’s and other related dementias or Mild Cognitive Impairment evaluation

DO NOT GIVE UP ON YOUR CLIENT BECAUSE THEY HAVE ALZHEIMERS OR OTHER RELATED DEMENTIAS

Life Space:

Life-Space Mobility (LSM) – the spatial environment a person moves through within a specific time period. It captures social interactions, higher levels of community engagement, and real-world applications of functional skills. [1]

 

Mild Cognitive Impairment does not NEED to become dementia or progressive decline. Preventative actions CAN impede cognitive degeneration in memory changes due to age. [1]

 

Longitudinal analysis found that individuals who are restricted to home versus those who are not have a higher risk of developing mild cognitive impairment, Alzheimer’s Disease, and accelerated decline in global cognitive function. [1]

 

Life Space PDF

 

Life Space Theory Explained: Executive Function Occupational Therapy

Symptoms and Clinical Presentation of Dementia

Main Types of Dementia treated in Occupational Therapy

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Symptoms and Clinical Presentation by Stage of Dementia

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Video on Dementia Progression impacting Executive Function

Basic Elements of Neuroanatomy for Occupational Therapy Executive Function

Cerebral Cortex, Lobes, and Corpus Collosum

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Cerebral Cortex : Executive Function Occupational Therapy

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Frontal Lobe: Executive Function Occupational Therapy

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Lobes and Hemispheres : Executive Function OT

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Executive Function Deficits and Clinical Presentations in Occupational Therapy

Attention and Memory Functions and Impairments

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Additional Impairments that are seen in Executive Function deficits

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Attention Levels and Memory Formation: Executive Function Occupational Therapy

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Types of Memories and Strategies: Executive Function Occupational Therapy

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Evaluations and Progress Notes for Dementia and Alzheimer’s Disease

(S) Subjective

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(A) Assessment

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(P) Plan

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General Treatment Ideas for Executive Function and Occupational Therapy

Person

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Environment

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Occupation

 

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Research Approach Ideas for Executive Function Occupational Therapy

Research Approach Ideas for Dementia Occupational Therapy

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A Note On Dual Tasking in Executive Function Occupational Therapy

References

References
  1. De Silva, N.A., et al., Examining the Association between Life-Space Mobility and Cognitive Function in Older Adults: A Systematic Review. Journal of aging research, 2019. 2019: p. 3923574-9.
  2. Mahle, A.J. and A.L. Ward, Adult Physical Conditions 2019, Philadelphia: F.A. Davis Company.
  3. James, B.D., et al., Life Space and Risk of Alzheimer Disease, Mild Cognitive Impairment, and Cognitive Decline in Old Age. American Journal of Geriatric Psychiatry, 2011. 19(11): p. 961-969.
  4. Crowe, M., et al., Life-Space and Cognitive Decline in a Community-Based Sample of African American and Caucasian Older Adults. Journal of Gerontology, 2010. 63(11): p. 1241.
  5. Woodbridge, R., et al., Use of the physical environment to support everyday activities for people with dementia: A systematic review. Dementia (London, England), 2018. 17(5): p. 533-572.
  6. van Uffelen, J.G.Z., et al., The effects of exercise on cognition in older adults with and without cognitive decline: a systematic review. Clinical journal of sport medicine, 2008. 18(6): p. 486-500.
  7. Smith, P.J., Pathways of Prevention: A Scoping Review of Dietary and Exercise Interventions for Neurocognition. Brain plasticity (Amsterdam, Netherlands), 2019. 5(1): p. 3-38.
  8. Gately, M. and S. Trudeau, Occupational therapy and advanced dementia: A practitioner survey. Journal of Geriatric Mental Health, 2017. 4(1): p. 48-53.
  9. Hunter, S.W., et al., A framework for secondary cognitive and motor tasks in dual-task gait testing in people with mild cognitive impairment. BMC geriatrics, 2018. 18(1): p. 202-202.
  10. Montero-Odasso, M., et al., Dual-tasking and gait in people with mild cognitive impairment. The effect of working memory. BMC geriatrics, 2009. 9(1): p. 41-41.
  11. Smith-Ray, R.L., et al., Impact of Cognitive Training on Balance and Gait in Older Adults. The journals of gerontology. Series B, Psychological sciences and social sciences, 2015. 70(3): p. 357-366.
  12. Doumas, M., M.A. Rapp, and R.T. Krampe, Working Memory and Postural Control: Adult Age Differences in Potential for Improvement, Task Priority, and Dual Tasking. The journals of gerontology. Series B, Psychological sciences and social sciences, 2009. 64B(2): p. 193-201.
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