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Introduction

Allen’s cognitive disability model uses a dynamic approach to assess cognitive level while taking motivation and socialization into account. Performance is observed during completion of a variety of standardized craft activities and observation of response to instructions and sensory cues from materials and tools provide the basis for prediction about function in other occupations. Assessment and intervention are based on how the client learns and performs tasks.

Cognitive performance is placed on a continuum divided into 6 levels that are further divided into modes. These modes outline 3 dimensions of task performance at each level and include attention, motor actions, and conscious awareness (Allen, Earhart, & Blue, 1995).

The occupational therapists can use cognitive disability model to measure and monitor a client’s problem-solving ability and safety while performing daily activities to enable client’s best ability to function considering assistance needed from caregivers, adaptations of the environment, expected behaviors in ADLs, quality and quantity of cognitive and physical assistance needed at each level (Allen, Earhart, & Blue, 1992).

Theory

The Person-Environment-Occupation Model of Occupational Performance describes the theory and clinical application of the interaction between the person, the environment, and the occupation. The model is a framework that guides clinical reasoning in analysis and understanding of the interdependent interaction between these dynamic elements. This model provides a framework for a systematic interactional analysis of: P-E; P-O; E-O. Optimal function or occupational performance results from a good fit between the three components (P-E-O). Maximum fit relates to optimal occupational performance, whereas minimum fit relates to minimum occupational performance, hence dysfunction. Disability can be associated with a minimum or poor person-environment fit rather than the impairment itself (Law et al., 1996).

Evidence

The relationship between assistive technology and cognitive function was examined using a systematic review. Ninety-one studies looking at interventions using assistive technology in populations with cognitive deficits were used for the review. Results show that assistive technology has been proven to effectively support cognitive functions relating to attention, calculation, emotion, experience of self, executive functioning, and memory. (Gillespie, Best, & O’Neill, 2011)

Case Study

Anne is a 43 years old housewife and mother of four children who was diagnosed with major depressive disorder 10 years ago. She complains about pain in her shoulders and at the back of her head most of time, weakness, lack of concentration in her daily work, disturbance with loud voices of anyone, and shivering of body without any reason. She has poor memory, negative dreaming which disturbs her sleep, fidgety and restless most of the time, aggressive behavior and sometimes weeping and shouting without any reason. She visited a psychiatrist for treatment because she had become very aggressive and started to throw things. She underwent ECT for treatment as per her psychiatrist’s recommendation but ECT only affected her memory badly. She was referred to occupational therapy for evaluation and intervention directed at improving her functional performance in the activities of daily living. The ACL assessment was administered and the results indicated her current level of function at 4.4 level.

Intervention Plan

Problem Statement

Client has difficulty maintaining personal hygiene on a daily basis due to impaired cognition secondary to catatonic depressive episode.

Long Term Goals

1. Anne will successfully brush her teeth using a 3-step illustration to improve her ability to complete hygiene tasks within 4 weeks.
2. Anne will independently

Short Term Goals

1. Client will identify one environmental safety hazard from picture cards to improve her ability to safely complete bathing tasks within 2 weeks.
2. Client will maintain grasp of a make-up brush with an built-up handle for 30 seconds to improve her ability to complete grooming tasks within 2 weeks.
3. Client will accurately identify the sequence of brushing teeth by organizing picture cards in the proper order 2 out of 3 times within 2 weeks.

Intervention Format

Individual

Setting

Outpatient

Supplies

None

Agenda

• Greet Anne (3 min)
• Review and discuss goals (7 min)
• Discuss environmental safety hazards using picture cards (10 min)
• Practice identifying the sequence of brushing teeth using picture cards (5 min)
• Session reflection and feedback (5 min)

Documentation

S: Client reported feeling sad about not being able to brush her teeth in the morning.

O: Client participated in a 30 minutes treatment session to address difficulty in maintaining personal hygiene on a daily basis due to impaired cognition.  Client was educated on the importance of hygiene and on environmental safety hazards using picture cards as well as the sequence of brushing teeth using picture cards. Client required visual motor cues in carrying out the instructed tasks and demonstrated minimal insight into mistakes that occurred during the goal-oriented activity and was unable to correct errors. Client looked restless and fidgety during the duration of the treatment session and presented with inattention when instructed to pay attention toward one cue at a time.

A: Client demonstrated increased awareness on the importance of hygiene and safety hazards. However, due to her inability to maintain attention during activity it hindered her ability to correct her errors without verbal cueing. Client would benefit from additional skilled OT services to improve her ability to maintain proper hygiene.

P:  Client will continue to see OT 2x/week for 45 minutes. Clint will continue to be monitored for progress in the completion of goals and on maintaining personal hygiene on a daily basis.

References

Allen, C. K., Earhart, C. A., & Blue, T. (1992). Occupational therapy treatment goals for the physically and cognitively disabled. Bethesda, MD: American Occupational Therapy Association

Allen, C.K., Earhart, C.A., & Blue, T. (1995) Understanding Cognitive Performance Modes Ormond Beach FL: Allen Conferences

Gillespie, A., Best, C., & O’Neill, B. (2011). Cognitive function and assistive technology for cogitation: A systematic review. Journal of the International Neuropsychological Society, 18(1), 1-19. doi: 10.1017/S1355617711001548

Law, M., Cooper, B,. Strong, S., Stewart, D., Rigby, P. & Letts, L. (1996). The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy. 63(1):9-23.