26

Introduction

—The goal of cognitive adaptation training is to adapt the environment to compensate for cognitive impairment.This type of treatment strategy is useful for persons with severe and persistent mental illness. The main idea behind this type of intervention or treatment strategy is that environmental adaptations need to be done in order to make up for individual’s  poor executive function. These specific individuals would benefit from higher levels of structure and more obvious environmental cues. CAT involves evaluating the current cognition function of the client, performance of —ADLs and IADLS, as well as the clients envronment. Plan treatment where you —Identify which area of function to work on first,  prioritizing safety and client’s priorities. Then implement the plan according to the plan set out. The last step in accordance to CAT —is to evluate the treatments, then reprioritize problem list and address emerging concerns (Draper et al, 2009).

Theory

The person, environment, occupation model focuses on altering one of these components for an individual to maximize their fit therefore, maximizing occupational performance. Once this is accomplished an individual will be able to succeed in achieving desired occupations. In interacting in all 3 contexts cohesively, the client can overcome their anxiety to perform at their optimal level of performance.   (Brown, 2011).

Evidence

A small pilot study by Raweh, D. V, & Katz, N. (1999) found that persons in a group using the cognitive disabilities model improved on the Allen Cognitive Levels but did not improve on other measures when compared to a control group. Cognitive adaptation training (CAT) is a home-based, manual-driven treatment that utilizes environmental supports and compensatory strategies to bypass cognitive deficits and improve target behaviors and functional outcomes in individuals evidenced by the research of Draper et al, 2009.

Case Study

Clint is a 25 year old male who goaltends for the Florida Panthers hockey team.He finally went back to work and during his first week back from time off he was involved in an accident where he collided with another player during practice and fell and hit his head. As a result of the fall he sustained a traumatic brain injury. He was admitted into the hospital and once the swelling went down he was administered the ACLS and scored a 3.8 according to the claudia allen cognitive disability model. The wife has taken off time from work in order to be present for Clint’s occupational therapy sessions. In order for Clint to be safe at home the therapists will implement cognitive adaptation training in order to make adaptations for the home environment.

Intervention Plan

Problem statement

• Clint is unable to participate in grooming tasks due to deficits in sequencing skills.

2 long term goals

• Client will improve sequencing skills by completing a 5-step task with supervision for grooming in 4 weeks.
• Client will complete 5/5 steps of a visual aid checklist with min verbal cues for brushing teeth in 4 weeks.

3 short term goals

• Client will open and apply toothpaste using an adaptive device for brushing teeth in 2 weeks.
• Client will complete 4/5 steps of a visual aid checklist with mod verbal cues for brushing teeth in 2 weeks.
• Client will improve sequencing skills by completing a 4-step task with mod assistance for grooming in 2 weeks.

Intervention format: Individual environmental adaptations

Description of setting: Home environment

Supplies:

• Brushing teeth Checklist
• Toothbrush
• Toothpaste
• Sink
• Cup
• Towel

Agenda

• Build rapport with client (3 min)
• Educate client on the use of environmental adaptation (visual aid checklist) (10 minutes)
• Practice brushing his teeth and wiping his face by using his checklist (25 minutes)
• Overview of session (2 minutes)

Documentation

S: Client expressed wanting to complete grooming tasks on his own.

O: Client engaged in a 40 min OT session to improve grooming and sequencing skills. Client worked on brushing his teeth. Client was educated on the visual aid checklist he will use to brush his teeth. Client retrieved his supplies with min verbal cues from labeled cabinets with close supervision. Client grabbed his toothbrush but had difficulty grasping it and dropped it 3 out of 5 attempts. He then wet the brush under the sink faucet. Client required mod assist to open the toothpaste and to squeeze it onto the toothbrush. Client brushed his teeth for 1 minute and independently wiped his mouth with a washcloth.

A: Client had difficulty finding the toothbrush due to his cognitive deficits, as client is at a ACL 3.8. Client exhibited deficits in fine motor skills as evidenced by his difficulty holding the toothbrush, opening the toothpaste, and squeezing the tube. Client would benefit from environmental adaptations including a built-up toothbrush handle and flip top toothpaste.

P: Client will benefit from continuing OT once a week for 40 minutes to work on fine motor skills and further adaptations to his environment. Client requires further practice of ADLs and continued evaluation of the level of supervision needed as he navigates and adjusts to his home environment.

References

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

Brown, C. (2011). Cognitive Skills, in Occupational Therapy in Mental Health: A Vision for Participation. Brown, Stoffel, Editors. FA Davis: Philadelphia.

Draper, M. L., Stutes, D. S., Maples, N. J., & Velligan, D. I. (2009). Cognitive adaptation training for outpatients with schizophrenia. Journal of Clinical Psychology, 65(8), 842-853. 10.1002/jclp.20612 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19521972

Raweh, D. V, & Katz, N. (1999). Treatment Effectiveness of Allen’s Cognitive Disabilities Model with Adult Schizophrenic Outpatients. Occupational Therapy in Mental Health, 14(4), 65–77. http://doi.org/10.1300/J004v14n04