Neurology

Cognitive dysfunction refers to deficits in attention, verbal and nonverbal learning, short-term and working memory, visual and auditory processing, problem solving, processing speed, and motor functioning.

Cognitive impairment is not caused by any one disease or condition, nor is it limited to a specific age group. Alzheimer’s disease and other dementias in addition to conditions such as stroke, traumatic brain injury, and developmental disabilities, can cause cognitive impairment.

Occupational therapist provides Cognitive rehabilitation through:

• Intervention should be implemented through functional ADLs and IADLs.

  • EX: engaging those patients with cognitive problems in activities they need to participate in everyday life.

• Providing assistive technologies 

Example of interventions used for memory:

1. Memory strategies:

• External Memory Strategies: Tools which help compensate for memory impairment. When effectively used they can reduce day-today memory problems, including: 

  • Daily Planner/ Notepad: Used to record/check information across several categories such as appointments, “things to do”, contact details, personal information and general note taking

  • Calendars: Used to record and check events across time (e.g. birthdays, future activities)

  • Laptops, smart phones, tablets and other electronic devices: using various Apps or software programs which can be used to record or check information, appointments and events; link information across devices and set alarms to help recall important events. Trials for functionality of devices , apps and software prior to purchase are recommended.

  • Whiteboards: Used to provide a larger and more visual representation of a daily planner/ notepad but over a much shorter period of time.

  • Lists / Checklists: Lists are used to record steps for specific routines (e.g. bedtime routine) or lists of items (e.g.shopping list)

  • Medication blister packets from a Pharmacist: The most common pre- packaged version of medication blister packs brands available is a “Webster Pack”. These are available from a Pharmacy and must be organized by your GP

  • Medication dosette boxes: Dosette boxes can also be used to organise medications. These are used to sort your own medication yourself, however some Pharmacists will pre-pack medication into suitable dosette boxes.

2. Environmental memory strategies: involve modifying the environment or the way you interact with the environment. They can be used in conjunction with external memory strategies to help remind you to use specific external strategies, including:

• Having a Routine: Can help with memory as tasks can become a habit after some time (e.g. writing your daily list of things to do with your morning coffee first thing in the morning)

• Everything having a place: Effective use of this strategy will reduce need to “go looking for” or misplacing items (e.g. hook at front door for keys)

• Keeping things in sight: By placing external memory strategies or various items in certain places that are used as visual cues to complete a task (e.g. placing pegs on the counter to remind you that the clothes are on the line) Labelling drawers and cupboards with contents can help to prevent clutter while reminding of the existence of some items. This can help to prevent over purchasing

• Designating a point of organization: Using a desk and/or computer/filing cabinet to organise various affairs (e.g. bills)

• Avoiding a cluttered environment: A cluttered or untidy environment may cause things to be lost more easily

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3. Internal memory strategies: they can be described as focusing your attention in a particular way and being mindful of certain information.

• Mental Imagery/ Visualization:

  • Forming an internal ‘visual image’ to assist with learning and recall “visualising,” “seeing in the mind's eye,” “hearing in the head,” “imagining the feel/smell/taste of”

  • Remembering an experience without an external prompt

  • Copying or reconstructing past experiences or imagining / anticipating possible future experiences

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Examples for Visualization: 

Example/Exercise 1: Try to visualise where you have breakfast; the table, the plate, the cutlery, the food, what it smells like, moving your arms to put the food in your mouth, what it taste like, what you usually hear i.e. kids, TV, birds etc.

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Example/Exercise 2: Rehearse in your mind or visualise your morning routine and all the tasks involved. Break each task down as much as you require to be able to complete the task yourself in your mind, that is, if you experience difficulty putting your top on, break that task down to every step that you would need to do in real life.

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• Association:

  • This involves relating what you want to learn with something you already know

  • It’s the process of forming a link between visual information and verbal information, new information and prior knowledge and environmental cues and intended actions

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Examples for Association: 

Example/ Exercise 1: Associate in your mind the person you have just been introduced to with another person you already know with the same name, whether it be a friend, family member or famous person,

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Example / Exercise 2: If you are having trouble remembering something, it can be helpful to think of as much related information to the situation as possible. This increases the chance that you will trigger an association and remember what you were trying to remember.

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• Categorization/chunking: Refers to organizing or grouping separate pieces of information together.

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Examples for Categorization: 

Example:/ Exercise: Breaking your lengthy shopping list up into smaller categories “fruit and vegetables”, “dairy”, “cleaning products”, “meats” etc. 

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• Repetition/Rote learning: Trying to learn something that isn't meaningful by repeating it over and over

• 4 pillars of a healthy lifestyle: A balanced and healthy lifestyle is important for maintaining mental performance including memory. This can be accomplished through consistent exercise, good diet, adequate sleep and maintaining stress. It is important to understand that this balanced lifestyle is specific to a person’s standards and capacities, as each person is an individual and every brain injury is unique. The 4 pillars are: 

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1. Exercise helps by improving blood circulation, thus supplying extra oxygen to the brain and promoting growth of new brain cells.

2. By maintaining a good diet you can enhance your concentration and memory

3. Quality sleep helps you think more clearly, be more alert and function at your best in all areas; physical, mental and emotional.

4. Chronically high levels of stress are not only bad for blood pressure, cholesterol and other physical problems, but also wears away at brain fitness and overall memory performance.

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For more detailed activities for each cognitive skills, check this file: 

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More about occupational therapy role with Alzheimer’s disease, check this file: 

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Apraxia:

It is a neuropsychological deficit that can affect stroke patients. It refers to ’disorders of the execution of learned movement which cannot be accounted for by either weakness, incoordination, or sensory loss, or by incomprehension of or inattention to command.

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There are several kinds of apraxia, which may occur alone or together. The most common is buccofacial or orofacial apraxia, which causes the inability to carry out facial movements on command such as licking lips, whistling, coughing, or winking. Other types of apraxia include limb-kinetic apraxia (the inability to make fine, precise movements with an arm or leg), ideomotor apraxia (the inability to make the proper movement in response to a verbal command), ideational apraxia (the inability to coordinate activities with multiple, sequential movements, such as dressing, eating, and bathing), verbal apraxia (difficulty coordinating mouth and speech movements), constructional apraxia (the inability to copy, draw, or construct simple figures), and oculomotor apraxia (difficulty moving the eyes on command).

Apraxia intervention techniques:

• Strategy training in daily living activities: this technique teaches internal (for example, the patient is taught to verbalise and implement the task steps at the same time) or external (for example, when aids are used to overcome a functional barrier) compensatory strategies that enable a functional task to be completed. These strategies will not have been used prior to the stroke.

• Sensory stimulation: stimulations including deep pressure, sharp and soft touch are applied to the patients' limbs.

• Proprioceptive stimulation: the patient leans on and puts weight through their upper and lower limbs;

• Cueing, verbal or physical prompts: given to enable each stage of the task to be completed;

• Chaining (forward or backward): the task is broken down into its component parts. Using backward chaining the task is completed with facilitation from the therapist apart from the final component, which the patient carries out unaided. If successful next time further steps are introduced. Forward chaining is the reverse of backward chaining.

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For more information, check this article:

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