Finding the Sweet Spot in Functional Cognitive Intervention: Grading Tasks to Maximize Outcomes

Editor’s note: This text-based course is a transcript of the webinar, Finding the Sweet Spot in Functional Cognitive Intervention: Grading Tasks to Maximize Outcomes, presented by Angela Reimer, OTD, MOT, OTR, CBIST.Learning Outcomes Hi, how are you guys? We're gonna talk a little bit today about functional cognition and acquired brain injury. So really quick here, we're gonna go over the Learning Outcomes. At the end of this course, I would like you guys to be able to identify key components of functional cognition and their impact on IADL performance, develop appropriately occupation-based interventions to address cognitive dysfunction, and to demonstrate the ability to appropriately grade functional cognition interventions to the patient's appropriate skill level and maximize functional outcomes. Before we talk about this, I think we need to talk a little bit about the prevalence of traumatic and acquired brain injury in the United States. So annually in the United States alone, 2.4 million people sustain a traumatic brain injury. Additionally, about 795,000 individuals also sustain some other type of an acquired brain injury from a non-traumatic cause. So when we're talking about that acquired brain injury, that could be stroke, that could be, like, a glioblastoma, any type of a brain tumor. It could be some type of viral encephalitis, anything like that that would affect the brain in a different way. Interestingly, in the United States alone, somebody has a stroke about every 40 seconds, so when you think about it in those terms, it really quantifies how much or how many people annually in the United States have some type of a brain injury because it would be about every 15 seconds that someone has a traumatic brain injury with the United States. So with these types of brain injuries, more than about 30% of these survivors actually experience cognitive impairment, and we're looking at the literature, some studies are saying it's up to 70 and 80% of the survivors who are having some type of a slight cognitive impairment, depending on the cross-sections that they're using in the literature and the sample sizes, the sample types. It's changing that a little bit, so we're having some difficulty getting some really accurate data. So we talk about functional cognition, what is this, and how is it different than the cognition we've kind of traditionally talked about in occupational therapy, because this is something that's newer to the forefront of occupational therapy and really taking over our place at the table when it comes to cognition and its effect on ADL and IADL function. So when we talk about functional cognition, we're looking at how an individual utilizes and integrates his or her thinking and processing skills into accomplishing everyday activities in the clinical and community living environments. So pretty much, it's not looking at the cognition itself or the cognitive skill itself. We're looking at how is that cognitive skill integrated into functional activity or into IADL/ADL activity? So this really does hit home as far as what we do as occupational therapists. And why does it matter, why do we even care about cognition? Isn't that speech's job? When we look at cognition, it's associated with a threefold increase for mortality. So these patients with cognitive dysfunction are three times more likely to die than patients without cognitive dysfunction. So when we think about that, we think about patients with poor safety awareness, poor memory, they're forgetting, leaving the stove on. Driving is a huge deal in occupational therapy right now. So we look at these patients who have some type of cognitive deficit in their getting behind the wheel and driving. And honestly, I've had a patient that burnt their house down because he put a bunch of dog blankets beside a space heater, and these are things that happen on a pretty regular basis, whether or not they're coming back to us and letting us know about these is another thing. Cognitive dysfunction's also associated with decreased ADL and IADL function. These patients can require longer term, ongoing rehab. You know, these aren't patients that we're gonna do something once and they're gonna catch on to it right away. They're gonna need longer term rehab. These are patients that may have trouble counting their exercises. How many of you guys have had that patient where you're like, okay, go ahead and do 10 of these, and you look away, and all the sudden, you're like, what number was that? And they have no idea. That's not necessarily because they're not counting. A lot of times, it's because they have decreased divided attention, so they're not able to attend to more than one thing at a time. So when we're talking about this I can't count and do something at the same time, therefore, I'm gonna need a longer term rehab in order to be able to function at the level to be safe to return to home or return to that next level of care. And cognition's also associated with major depression, negative affect, and anxiety, which is huge because a lot of these patients with acquired brain injury are already in that place of having depression, negative affect, and anxiety because of kind of everything that's happened to them recently. When you add on a cognitive deficit, especially when it's someone who maybe ran a bank or was a physician or a nurse, you know, if it's a high-level cognitive deficit, everybody's walking up to these patients and saying, you're doing so great, you look awesome, but they know in their head that they're a hot mess. And that's really upsetting for patients. And we kind of talk about these patients in our clinics sometimes as being called, you know, the kinda, quote, walking wounded because they look great, but everything's kinda falling apart internally, and maybe not even to the point where other people can see it from a conversational standpoint. But when you start to talk to these people more or you get them into...