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FAQs for Case managers - Neurological rehabilitation

What is meant by cognition?

The word cognition broadly refers to the different processes the brain uses to concentrate, remember, learn, perceive, organise and use information, so that we can think, plan and make decisions and judgements.

Why is it relevant to Occupational Therapy?

Someone who has an impairment or difficulty in any of these processes is said to be cognitively impaired. Occupational Therapists are uniquely placed to understand that, not only do cognitive impairments impact a person’s ability to participate in day to day activities, but more importantly, how the person will be impacted.

Occupational Therapists analyse tasks and activities in order to identify the demand and level of cognition required to complete the activity, once they have done this, Occupational Therapists will use this knowledge to identify potential problems and the best treatment approach, all the while working with the client to set goals that are specific to them.

How do you assess for cognitive impairments?

There are generally two methods of assessing for cognitive impairment, both are valuable and valid methods and are often used jointly.

1. Informal/ functional or non-standardised assessments

You are likely to hear Occupational Therapists use all three terms and they all mean the same thing.

Occupational Therapists like to watch a person perform their regular roles and routines; however, there is more to it than simply watching. The Occupational Therapist is in reality assessing how well that person performed their task and what issues surfaced during the performance. An example could be the activity of preparing a meal, Occupational Therapists know this activity often requires a person to be able to divide their attention; they may have to cook more than one item at the same time or prep some vegetables whilst cooking. An impairment in attention may mean that the OT will observe the person only focus on one task to the exclusion of the other, leading to a less than desirable result.

This type of assessment is called functional because the person was actually observed completing it; it is non-standardised because the method in which the assessment was carried out will vary according to the Occupational Therapist.

2. Standardised assessments

These are formal, often pen and paper based assessments but can incorporate functional elements into the assessment as well.

The term “standardised” is used to denote the fact that the assessment has been designed to measure a person’s abilities compared to other people. It will have been validated by testing it out on hundreds or thousands of people with differing abilities, so that an average level of ability can be determined.

It becomes standardised because it has to be administered in a standard way, as stated in the test instructions. This means that regardless of which therapist administers the test, the results should be the same.

What is challenging behaviour?

Challenging behaviour describes behaviour outside the accepted social “norms”, the intensity, frequency and duration of the behaviour often means that there is a physical risk to the individual or others around them; it also means that this behaviour limits or stops the person from accessing the community and its facilities.

Types of challenging behaviour include:

  • Physical and verbal aggression
  • Sexual disinhibition
  • Withdrawal /avoidance
  • Substance abuse
  • Impulsivity
  • Restlessness
  • Paranoia
  • Self-harm.

Why do client‘s with brain injuries, often display challenging behaviour?

It is very difficult to understand the specific causes of why a person behaves in a certain way, but generally a person’s behaviour can be considered in 3 categories;

  • The behaviour is a direct result of damage to a specific area of the brain.
  • It is a learned or adopted reaction to the environment and its demands, it is the only way they know how to cope with it.
  • The behaviour was present before the brain injury and is not as a direct result.

How can an Occupational Therapist help?

Some of the ways in which an Occupational Therapist can help are;

  • Providing advice on managing behaviours.
  • Environmental assessment to look at the physical and social demands it places on the individual.
  • Sensory assessment
  • Goal setting, introduce meaningful activities and structure.
  • Anxiety management and relaxation techniques
  • Anger management

This list is not exhaustive and will largely be dictated by the person’s needs.

What is Vocational rehabilitation?

In Scotland, vocational rehab has been defined as

“A process that enables people with functional, psychological, developmental, cognitive and emotional impairments or health conditions to overcome barriers to accessing, maintaining or returning to employment or other useful occupation”
A delivery Framework for Adult rehabilitation in Scotland, Scottish Executive, 2007

What is the value of engaging an Occupational Therapist for vocational rehabilitation?

Occupation is the core element of occupational therapy practice; they are experts in understanding the importance of occupation and purposeful activity. They use this knowledge of how occupation contributes to participation, social inclusion, health and wellbeing and gives meaning to many people’s lives, during vocational rehab.

Some of the tools an Occupational Therapist may use in vocational rehab are:

  • Functional assessments
  • Task analysis
  • Workplace / environmental assessments
  • Absence management
  • Motivation building
  • Return to work planning
  • Fatigue management

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