You will hear the term ‘functional cognition’ thrown around in the occupational therapy profession as if practitioners are nervous to claim their place in the cognitive realm of rehabilitation. In school, we are introduced to this area of practice by performing the ‘SLUMS’ or ‘MMSE’ assessment on one another and then maybe learning how to apply and teach internal and external compensatory memory strategies to maximize the occupational performance of our client who is living with cognitive, executive, memory function deficits. Unfortunately, because we know that occupational therapy is just as much holistic restoration and remediation of function as it is working within the rehabilitation frame of reference, many of us feel lost when we are working with clients who have Alzheimer’s and other related dementias (ADRD), early memory loss, age-related cognitive decline, or cognitive and executive dysfunction resulting from a Progressive Neurological Disorder (PND).
Do not be scared to claim your seat at the cognitive and executive function table. An occupational therapy is in their complete scope of practice by treating these types of symptoms! If you have identified a cognitive or executive dysfunction as being a barrier to your client’s maximum functional potential, then the restoration/remediation and maintenance of that function should be a part of your occupational therapy continuum of care.
Some Causes of Cognitive Decline:
- Traumatic Brain Injury
- Acquired Brain Injury
- Cerebrovascular accident
- Aneurysm rupture
- Arteriovenous malformation (AVM) Bleed
- Multiple Sclerosis
- Dementia (ADRD)
- Huntington’s disease
- Brain Tumors
- Specific genetic and chromosomal abnormalities
- Developmental impairments
- Temporary conditions [delirium]
- Medication Management
- insomnia/sleep issues
- NEW Environment [hospital delirium]
Attention and Concentration Impairments
(increasing from easiest to hardest skills)
- Phasic Alertness – an individual’s momentary, rapidly occurring (within milliseconds) readiness to respond (reaction time test)
- Response Inhibition – the ability to inhibit the inclination to direct attention toward something distracting.
- Focused Attention – thought to be the most basic level of attention.
- Sustained Attention – the ability to remain focused and on task for an extended period of time.
- Selective Attention– enables a person to focus on one item while mentally identifying and distinguishing the non-relevant information (filter out non-necessary information)
- Alternating Attention – allows for shifting focus between two tasks or activities
- Divided Attention- allows for simultaneously attending to multiple stimuli
Showcase : Dual Tasking (Cognition + Mobility)
Assessments to use in Evaluation and Progress Notes:
- Executive Function Performance Test
- Dual Tasking
Models and Frame of References (not an all-inclusive list):
Helpful Printables in the Occupational Therapy Store
How should you approach cognition and executive function deficits in Occupational Therapy?
Explanation: An occupational therapy plan of care and treatment approach should always be a continuum. Secondly, the rehabilitation frame of reference (compensations and adaptations should be considered for immediate independence while you are restoring/remediating cognitive deficits OR at the end of your restorative plan of care when you know your client is on a maintenance track and requires an added assist to maximize independence.
Special note: If your client has a progressive neurological condition when you know at some point your they will require the procedural memory to use durable medical equipment, adaptive equipment, or assistive technology, it is appropriate to begin training during a restorative plan of care continuum. Your client will benefit from treatment sessions based in repetition even when it feels ‘silly’ because they are functioning well above level necessitating the equipment. In this case, take time educate your client and tell them why you are incorporating the training into their usual restorative sessions.
What is an example of the ‘OT therapeutic flow’?
- Comprehensive Evaluation including executive function AND physical performance.
- Include caregiver (if present) by giving them caregiver-based assessments while you perform the evaluation of your primary client.
- Establish baselines according to the reason you are seeing them
- Establish patient ‘buy-in’ and make sure you are on the same page
- Discuss plan of care and the path you believe will allow maximum return on time spent in occupational therapy
- Be sure to incorporate mobility AND cognition-based activities into each treatment session. Multi-modal is key!
- Monitor progress using objective measures, caregiver check-in
- Upon discharge, establish ‘next steps’ and ‘warning signs’ to ensure your clients know when to call occupational therapy for a screen, new evaluation, or consult for additional resources
Occupational Therapy Treatment and Documentation Examples
Traumatic Brain Injury Rehabilitation Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.What is a Traumatic Brain Injury (TBI)A traumatic brain injury (TBI) can occur after a fall, sport injury, motor vehicle accident, blunt force trauma, accident at work, or any...
Lewy Body Dementia and Rehabilitation Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.What is Lewy Body Dementia?Lewy Body Dementia (LBD) is the second most prevalent progressive neurodegenerative diagnosis causing dementia. It is second to Alzheimer's disease...
Multiple Sclerosis and Rehabilitation Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.Common Symptoms of Multiple SclerosisMultiple sclerosis (MS) is a neurodegenerative disease affecting the central nervous system (brain and spinal cord). During the progression...
Parkinson's Disease and Rehabilitation Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.Common Symptoms of Parkinson's DiseaseParkinson's disease is the second most common neurodegenerative disease affecting the amount of dopamine your brain produces and stores....
Early Memory Loss and Confusion Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.Symptoms of Early Memory Loss and Confusion You Should Take SeriouslyIf you are experiencing signs and symptoms of early memory loss, it is important to take them seriously. Although...
Dementia Diagnosis Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.What do I do if I just received a dementia diagnosis?'Dementia' is a general term for memory deficits or memory changes. It is important to note that 'dementia' is not a synonym for any other...
Joint Replacement Rehabilitation Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.What is the role of outpatient occupational therapy for a joint replacement?Outpatient occupational therapy, like every other outpatient rehabilitation, is a specialized area of...
Buffalo Rehab in West Seneca, NY Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.Buffalo Rehab Option : Buffalo Occupational TherapyBuffalo Occupational Therapy is a specialized buffalo rehab option and was founded in October of 2018 through the Aging with...
Outpatient Occupational Therapy Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.What is the role of outpatient occupational therapy? Outpatient occupational therapy, like every other outpatient rehabilitation, is a specialized area of rehab that makes the ability...
Stroke Rehabilitation Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.In search of an outpatient neurological stroke rehab program in Buffalo, NY?When should you have stroke rehabilitation?Depending on how big your stroke was and the area of the brain your stroke...