Term
|
Definition
the ability to lvoe and to work
-self-awareness, self-identity and insight
-interperonal relationships
-symboic meanings, spirtituality |
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Term
|
Definition
-Oral
-anal
-phallic
-latency
-genital |
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Term
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Definition
-Reality testing (internal needs vs external demands)
-Judgment
-self-control
-sense of self control (self-concept,self-esteem, self-efficacy)
-object relationships
-thought processes (atention, memory, learning, problem solving)
-use of defense mechanisms
-mastery & competence (capacity to interact effectively w/ one's environment) |
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Term
|
Definition
NARCISSISTIC DEFENSES
-denial
-projection
-distortion
IMMATURE DEFENSES
-acting out
-regression
-passive -aggressive behavior
-fantasy
NEUROTIC DEFENSES
-controlling
-displacement
-intelectualization
-isolaiton
-repression
-rationalization
-identification
MATURE DEFENSES
-altruism
-anticipaiton
-humor
-sublimation |
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Term
|
Definition
-persona
-ego
-shadow
-essential self |
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Term
|
Definition
-outermost layer, the mask
-public face to appear in control, smart, witty, sensitive, and lovable
-act to achive this but we know its a mask
-beneath persona is layer of doubt and insecurity
-most peeps are dissatisfied with fronts and want to get real |
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Term
|
Definition
- center of the conscious mind
-gets the job of living done, decision maker, problem solving
-made of misinformation about ourselfe and world
-voice made of comments and influences
The ego tends to be very protective. It tends to move us toward safety, the familiar, the status quo. |
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Term
|
Definition
-unconscious self
Part of ourselves that tricks us into behaving in ways we never thought we would.
It is the internalized "dark side".
It tends to be destructive of the self, destructive in relationships and prone to impulsivity and risk-taking. |
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Term
|
Definition
Innermost protected layer
-unique essence of the person lies at the center beneath the persona, the ego and the shadow. The Essential Self incorporates both the conscious and unconscious elements.
-the center of consciousness which unites all of the opposing elements in human beings
-The self consists in the awareness on one hand of our uniqueness in all of Creation and of the intimate relationship and unity with all life.
-self once uncovered seems to hold the real truth about us as human beings. It is the self that is able to cross over in empathy and experience and feel what a moment in life must be like for another person. It is the self that we return to as we quiet our working minds in meditation. |
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Term
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Definition
EGO
Defensiveness
Self-preservation
Pity & sympathy
Requires patients to do as we say
Expects gratitude and thanks from patients for helping them
Needs to be puffed up in order to feel important, even at the expense of others’ feelings
Critical
Insecure
Controlling
ESSENTIAL SELF
Capacity to see clearly
Displays compassion in the face of threat or fatigue
Empathy
Sets appropriate boundaries
Unlimited patience and great understanding
Comprehends the need to be ethical and act with integrity
Has the desire and capability to feel unconditional positive regard
Has a oneness with all living beings that cancels out judgment and prejudice
Refuses to attempt to have personal needs fulfilled by patients |
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Term
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Definition
Taoist teaching
Knowing when and how to act and when not to act
Action that does not involve struggle or excessive effort
Wei Wu Wei: action without action, or effortless doing |
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Term
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Definition
Focus on enhancing adaptive functioning, develop ego skills
Opportunities for practice, support for mastery
Three phases: evaluation (to determine level of ego function), convalescence (to promote increased feelings of adequacy and independent function), rehabilitation (mastery)
Different activities used in each phase |
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Term
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Definition
Adaptive skills and developmental groups
6 adaptive skills learned in sequence: perceptual-motor skills, cognitive skills, dyadic interaction skills, group interaction skills, self-identity skills, sexual identity skills
Developmental groups: parallel, project, egocentric cooperative, cooperative, mature |
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Term
| Psychodynamic Group Process |
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Definition
Facilitative leadership
Basic belief in the group’s ability to be constructively self-determining
Goal: develop & practice ego skills
Task group phases: planning, doing, evaluating
Sharing, processing, generalizing and application are incorporated into the process of completing the task |
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Term
| Psychodynamic Task Group Phases |
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Definition
Planning: brainstorming, persuasion, decision-making, division of labor
Doing: working on the identified task
Evaluating: reflection on behavior and its consequences, feelings of members about the group, evaluation of task accomplishment |
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Term
| Psychodynamic Emotional Expression Groups |
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Definition
Self-expression through art, music, dance, poetry, drama, creative writing
Exploring the unconscious, symbolic meanings
Resolving painful memories
Examples: finger painting, drawing HTP, magazine picture collage, empty chair technique |
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Term
|
Definition
-EMOTIVE, the ability to imagine patients’ emotions and perspectives;
-MORAL, the professional’s internal motivation to empathize
-COGNITIVE, the intellectual ability to identify and understand patients’ emotions and perspectives
-BEHAVIORAL, the ability to convey understanding of those emotions and perspectives back to the patient |
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Term
|
Definition
Increases patient satisfaction
Enhances adherence to therapy recommendations
Improves clinical outcomes
Increases professional satisfaction
Decreases legal & liability risk |
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Term
Empathy
It is critical to understand the: |
|
Definition
Client’s thoughts
Client’s feelings
Client’s behaviors |
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Term
| Understanding the client’s thoughts or thinking |
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Definition
-Client is the expert on the meanings she attaches to her experiences.
-Each client’s manner of ascribing meaning to events is unique and idiosyncratic.
-Summary statements offer best means of understanding a client’s thoughts or thinking |
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Term
| Understanding the client’s emotional experience: |
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Definition
-Catching or seeing the client’s affect for what it appears to be (and asking if it is not clear)
-Naming how the client appears to be feeling
-Allowing yourself to feel that same feeling (emotional resonance) |
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Term
| Understanding the client’s behavior: |
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Definition
Noticing a significant behavior or a change in behavior
Describing what you see the client doing (without judging it or interpreting its meaning) |
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Term
To Which of the Three Do I Choose to Respond?
Client’s thoughts?
Client’s feelings?
Client’s behavior? |
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Definition
| Select the one that is most consistent with the client’s preferred means of communication. |
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Term
| Empathy is best used when: |
|
Definition
A therapist suspects that a client is struggling or upset
A client openly describes an upsetting circumstance or reveals that she is upset
A client happens upon an obstacle or challenge while participating in therapy
A client expresses or otherwise demonstrates concern about therapy or the therapist
Some other inevitable interpersonal event occurs (or is anticipated) in therapy |
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Term
|
Definition
Occurs when a therapist communicates or behaves in such a way that is perceived by the client as hurtful or insensitive
What we do and what we fail to do
Failure to notice, understand or validate
Results in discomfort, pain or embarrassment for the client |
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Term
| Resolving Empathic Breaks |
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Definition
Recognize that an empathic break has occurred
Avoid behaviors or comments that minimize the break
Avoid behaviors or comments that inflame the break
Raise the issue with the client
Repeat your understanding of the injury
Say something that soothes or reassures the client |
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Term
| Avoid Minimizing (examples of minimizing) |
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Definition
Using humor or joking about the situation
Apologizing prematurely or excessively
Changing the subject or trying to distract the client
Saying something dismissive (Its not that big of a deal, it happens all the time)
Using excessive self-effacement (typical me, I always seem to put my foot in my mouth) |
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Term
| Avoid Inflammatory Remarks/Behaviors |
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Definition
Denying what you said or did
Saying something that makes the client feel guilty or responsible for what happened (you really took it the wrong way)
Being sarcastic |
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Term
| Raising the Issue with a Client |
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Definition
Your face tells me I may have something wrong
I think I may have missed something important
I think I may have said something insensitive |
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Term
| Repeat your Understanding of the Injury |
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Definition
Validate the Client’s Reaction
When I did not show up on time you were wondering if I forgot about you
When I did not show up on time, you were wondering whether I really care about working with you
When I said that about your sister, it made you think I was judging her unfairly |
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Term
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Definition
Say something soothing or reassuring
I am sorry that what I said (or did) caused you to feel bad
I am sorry I am late, I left later than I should and I encountered traffic
I am sorry that I said that about your sister, I did not mean to offend you |
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Term
| Empathy: What It Is… What It Is Not (huge card) |
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Definition
What it is…
Ongoing striving for understanding
Achieving emotional resonance with a client
Drawing upon your own reactions and past experiences to better understand a client
Setting your own worldview and judgments aside in order to better understand the client
Noticing that an interpersonal event or communication has occurred
Describing problematic thoughts and behaviors from the client’s perspective
What it is not…
Questioning in an effort to gather information
Revealing your own emotional reactions to what a client says or does without gauging the client’s reactions first
Failing to recognize the many ways in which your reactions and past experiences differ from the client’s—no matter how similar they appear to be
Analyzing or interpreting what a client has revealed
Denying, ignoring, minimizing, or talking yourself out of the fact that an interpersonal event has occurred
Setting limits on what a client has revealed |
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Term
|
Definition
Manipulative behavior
Excessive dependence
Symptom focusing
Oppositional behavior
Emotional disengagement
Denial
Difficulty with rapport and trust
Hostility
Resistance to feedback or suggestions
Passivity
Unrealistic expectations of therapy
Critical of the therapist
Questions therapist’s knowledge & skills |
|
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Term
| Difficult behaviors according to Psychodynamic Approach |
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Definition
Difficult behavior is due to disrupted relationships early in life and internal conflicts
See person away from family, allow for re-enactment of early conflicts, facilitate insight (why the person is behaving this way) |
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Term
| Difficult behavior according to Behavioral Approach |
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Definition
Difficult behavior is learned and reinforced over time
Extinguish behavior through active ignoring, discontuing reinforcement, or replacing with a more adaptive behavior |
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Term
| Difficult behavior according to Cognitive Approach |
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Definition
Difficult behavior is due to distorted thinking and maladaptive ways of thinking about events
Change the way one thinks or interprets events and the behavior will change |
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Term
| Difficult behaivor according to Humanistic Approach |
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Definition
Difficult behavior is due to a lack of positive regard, affection and approval from key figures during childhood
Provide unconditional positive regard and the behavior changes on its own |
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Term
| Difficult behavior according to Systems Approach |
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Definition
Difficult behavior is due to a maladaptive dynamic within the larger social system of which the client is a part
Explain the role the behavior serves in the larger social system and have member share responsibility for changing the underlying dynamic |
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Term
| Difficult behavior according to Phenomenological Approach |
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Definition
Difficult behavior is due to whatever a person is thinking, feeling or experiencing in the moment
Inquire about their current experience, use reflective responses and summary statements to gain an understanding of the client’s behavior and then use an appropriate mode to respond |
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Term
|
Definition
Underhanded efforts to maintain control or have one’s own way when interacting with others
May manifest as fabrication of stories, inconsistent behavior, love/hate reaction to the therapist, dishonesty, attempting to make the therapist feel sympathy for something they did to themselves |
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Term
|
Definition
The need to rely on support and approval from others in order to feel comfortable with themselves
May manifest as clinging behavior, repeatedly asking for assistance, acting helpless or immobilized, refusing, either passively or actively to set their own therapy goals |
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Term
|
Definition
Spending a great deal of time and emotional energy focusing on what one cannot do, and the symptoms of their disorder
May manifest as constant complaining about symptoms, takes little initiative to manage symptoms, exaggeration, spends excessive amounts of time talking about their illness |
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Term
|
Definition
Lack of spontaneous and authentic emotional reactions
May manifest as restricted or flat affect, speaks in a monotone, emotionless facial expression, not fully engaged in therapy, lacks enjoyment |
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Term
|
Definition
A way of coping with a painful or uncomfortable event by denying the reality of their situation
May manifest as minimizing the seriousness of the situation, acknowledges the situation happens to other people but not to them |
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Term
| Difficulty with Rapport and Trust |
|
Definition
Client is unable to make a therapeutic connection with the therapist
May manifest as unresponsiveness, inability to initiate or maintain a conversation, skepticism regarding therapy, reluctance to engage in therapy |
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Term
|
Definition
Behavioral expression of rage, easily irritated or angered by seemingly insignificant events that do not warrant such a reaction
May manifest as threats to harm, attempts at intimidation, criticism, denigration, physical aggression toward objects or people, sexually inappropriate behavior |
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Term
| Prevention of Difficult Behaviors |
|
Definition
Make an effort to identify what interests a client
Make an effort to identify what a client values
Incorporate a client’s interests and values in therapy
Encourage and affirm the client’s sense of self-efficacy |
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Term
| Responding to Difficult Behaviors |
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Definition
Goals:
Understand what the client is thinking and feeling
Identify the purpose of the behavior
Identify the interpersonal need the behavior attempts to fill |
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Term
| Clinical Reasoning and Reflection of difficult behaviors |
|
Definition
What is the origin of this behavior? Is it an isolated reaction or a pattern of behavior?
What, if anything, about therapy might have triggered the behavior?
Does the client engage in this behavior in other settings and/or with other people?
What does the client hope to accomplish with this behavior?
What is the outcome when the client exhibits this behavior? |
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Term
| Emotions Underlying Difficult Behaviors |
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Definition
Anxiety
Fear
Anger
Frustration
Low self-worth |
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Term
|
Definition
Fear of abandonment, loss of love
Fear of failure
Fear of the future
Fear of death
Fear of loss
Fear of rejection or disapproval
Fear of losing control
Fear of responsibility |
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Term
| Strategies to Manage Difficult Behaviors |
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Definition
Avoid argumentation
Roll with resistance- work with the person not against them
Ask open questions
Affirm client’s strengths and assets- conveys respect for the person |
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Term
| Empathy and Reflective Response |
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Definition
The empathic mode has a disarming quality and can be used effectively with almost any difficult behavior
You are unlikely to hurt anyone by doing reflective listening and responding |
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Term
| "Managing difficult behavior requires not only understanding but also: |
|
Definition
self-confidence,
objectivity,
interpersonal self-discipline
and a thorough knowledge of interpersonal reasoning.” |
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Term
|
Definition
Mary Reilly (1962)- theory of occupational behavior
Kielhofner & Burke (1980)- students of Reilly, incorporated General Systems Theory
Oakley, Shepherd, Scheinholtz, Scaffa- students of Kielhofner |
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Term
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Definition
Input, throughput, output, feedback (p. 282 Cole)
System interacts with the environment
Hierarchical Subsystems: (p. 285 Cole)
Volition
Habituation
Performance Capacity |
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Term
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Definition
Guides occupational behavior through choices
Interests (enjoyable)
Values (meaningful)
Goals (purposeful)
Personal causation (sense of competence, locus of control) |
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Term
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Definition
Guides and organizes use of time
Habits: typical ways a person performs tasks, decreases effort required to perform task, sense of stability and predictability
Roles: position or status in a social group with expectations and obligations, balance of life roles (worker, parent, student, volunteer, etc)
Routines: organized patterns of behavior |
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Term
| Performance Capacity Subsystem |
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Definition
Ability to perform purposeful activities
Skills: perceptual-motor, process, communication/interaction
Client factors: musculoskeletal, neurological, sensory, etc. |
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Term
| Interaction with the Environment |
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Definition
Opportunities, resources, demands, constraints
Natural and fabricated: physical, social, temporal, cultural, etc.
Settings: school, work, community, home, etc.
Environmental press: expectation of performance or behavior in a particular context
Occupational form: rule-bound sequences of behavior, recognizable and named, e.g. dinner, driving |
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Term
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Definition
Results from repeated interactions with the environment
Occupational identity: sense of who one is and wants to become as an occupational being
Occupational competence: ability to perform occupations in an effective and satisfying way, to meet one’s own needs and the demands of the environment |
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Term
| Levels of Occupational Functioning |
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Definition
Exploration: curious investigation of self and environment
Competence: striving to meet the demands of a task or situation
Achievement: striving for excellence and successful performance of roles |
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Term
|
Definition
Difficulty choosing, performing and/or organizing occupations
Components:
Inefficiency
Incompetence
Helplessness |
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Term
|
Definition
Leader is facilitator, advisor and collaborator
Goal: finding and engaging in meaningful occupations, occupational performance, occupational participation, occupational adaptation
Groups may be organized by subsystems, levels of occupational functioning, or roles (most common)
Therapeutic activities: everyday occupations
7 step group process: sharing is eliminated & processing is optional |
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Term
| Behavioral cognitive History/Framework Focus |
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Definition
The group of behavioral cognitive approaches were developed through application of the scientific method to human behavior
Derived from learning theories
Behavioral approach is best used when a client needs to learn or change their performance patterns
The context/environment is thought to serve as cues to trigger maladaptive behaviors or facilitate function
Cognitive behavioral approach is best used when self-control and self-management are main concerns |
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Term
| The Behavioral Cognitive Continuum |
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Definition
Consists of the following approaches:
Biomechanical, Rehabilitative
Cognitive-Perceptual Rehabilitation
Behavioral
Behavioral Cognitive, Dialectical Behavioral |
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Term
|
Definition
Biomechanical approach is primarily appropriate for clients who lack range of motion (ROM), strength, and endurance to perform daily tasks (Trombly & Radomski, 2002)
Included in Behavior Cognitive Continuum because it uses the behavioral principles of conditioning, habit formation, shaping and chaining, and rehearsal and practice with the goal of restoring function. |
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Term
| Biomechanical, Rehabilitative Approach |
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Definition
Theorists: Trombly, Denton, Mosey, Fidler
Client applications: Physically Disabled
Concepts and Techniques: Strength, ROM, endurance, positioning, prevention, restoration, compensation, adaptation, skill acquisition, lifestyle performance, biofeedback |
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Term
|
Definition
Trombly coined prevention, restoration, and compensation as simply the “rehabilitative approach”
This refers to the process of relearning lost skills in ADLs due to physical disability
Mosey and others: “acquisitional”
Denton: “functional performance”
Related approaches: Mosey’s “role acquisition and Fidler’s “lifestyle performance profile” |
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Term
| Behavioral-cognitive and Mosey |
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Definition
Mosey addresses the role acquisition approach to those individuals whose disability has stabilized and who continue to have difficulty in performance of tasks of their major social roles
Identified the basic skills common to all social roles as task skills and interpersonal skills
These basic skills are necessary building blocks for the performance of self-care (ADLs), family interaction, recreation, and work |
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Term
| Cognitive-perceptual Rehab chart |
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Definition
|
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Term
| Cognitive-Perceptual Rehabilitation Text |
|
Definition
Toglia’s Multicontext Treatment Approach
Self-awareness is key!
Learning theory- Foundation for cognitive rehabilitation/cognitive perceptual rehabilitation
Originally involved systematic procedures provided in each of the 6 discrete cognitive deficit areas to assist clients in the perception of stimuli & the effective solving of problems:
1)Orientation
2)Attention
3)Visual processing
4) Motor planning
5) Cognition
6) Occupational behavior |
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Term
| 6 Brain Functions for Cognitive Rehabilitation |
|
Definition
1) orientation
2) Attention
3) Visual Processing
4) Motor Planning
5) Cognition memory, organization problem solving
-->minimal effort alertness (concentration analysis) __>
6)Occupational behavior (adl, work, leisure, play) |
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Term
| The Multicontextual Approach |
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Definition
Cognitive rehabilitation with brain-injured adults involves the reorganization of functional systems
Retraining aims to maximize the efficiency of information processing & involves repetitive exercises (graded)
Toglia believed generalization of skills to life in the real world requires more than practicing each skill separately
Once cognitive strategies are relearned, they must be practiced & applied over a wide range of functional tasks, in a variety of social and situational context, in order to facilitate generalization of skills.
This approach promotes the understanding the significance of a strategy & recognizing properties of situations in which the strategy is applicable |
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Term
|
Definition
“ Insight, or the degree of awareness one has regarding one’s cognitive or physical capacities” (Toglia, 1991).
Due to profound effect on new learning, group’s ability should be addressed first
Skills Include the ability to:
Evaluate task difficulty
Predict consequences of action
Formulate goals
Monitor one’s own performance
Recognize errors
Demonstrate self-control |
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Term
|
Definition
Impairment results in misjudgment of attempted tasks
2 ways training increases self-awareness
Acquiring knowledge of one’s own processes & cognitive abilities
Developing self-monitoring strategies
Suggested Techniques Include:
Self-instruction
Self-estimation
Role reversal
Self-questioning
Self-evaluation |
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Term
| Generalization & Transfer of Learning |
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Definition
Toglia’s dynamic interactional model
Similarity of tasks depends on the following:
-Surface Characteristics - Type of stimuli; Presentation mode; Variable of size, color, shape, etc.; Stimuli arrangement; Movement requirements; Environmental context; Rules or directions, number of steps
Transfer of skills include:
Near transfers
Intermediate transfers
Far transfers
Very far transfers |
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Term
|
Definition
Include:
Behavioral goals and objectives
Conditioning and habits
Shaping and chaining
Reinforcement
Rehearsal and practice |
|
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Term
| Behavioral Goals & Objectives |
|
Definition
Initially, only behavioral goals were thought to be an appropriate focus for intervention.
They should always be observable and measurable
Goals are set collaboratively and progress is openly discussed within the group
LTGs are not always measurable, therefore they should be broken down into STG |
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Term
|
Definition
Pavlov identified classical conditioning, which is the process through which much of human behavior is learned.
Skinner identified operant conditioning, which states that behaviors that are reinforced tend to be repeated, whereas behaviors that are ignored tend to disappear.
Therefore, factors that reinforce behavior should be he identified and controlled for in the therapy environment. This enhances positive behavioral changes |
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Term
|
Definition
Skinner introduced the concept of shaping, which requires each step in a technique to be reinforced until the entire task is learned.
Done in OT via task analysis
Sequence becomes a habit when it is done smoothly and without hesitation |
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Term
|
Definition
Early behaviorists identified reinforcement as external, whereas later behaviorists thought reinforcement might also be internal
Positive reinforcement is a reward; negative reinforcement is removal of a desired stimuli
Bandura identified 2 internal reinforcers: Vicarious and self-produced
Vicarious reinforces are symbolic
Self-produced reinforces come from the person’s sense of competence, efficacy, and control |
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Term
|
Definition
Involves the leader presenting the group members with hypothetical situations
The leader begins by using self-awareness exercises to help the member analyze their own habitual responses to difficult stimuli
Role play |
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Term
|
Definition
Evolved from the practice of psychodrama. The client directs his or her own real life situations with group members. Each role play has:
Definition of the problem
Assuming the roles
Enactment
Discussion
Helps clients practice and rehearse new behaviors in a safe and supportive therapeutic environment |
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Term
| Systematic Desensitization & Biofeedback |
|
Definition
Systematic desensitization is used for phobias
Used in OT via progressive muscle relaxation & guided imagery
Biofeedback is monitoring of body functions, such as pulse, respiration rate, heart rate, and body temperature |
|
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Term
| Systematic Desensitization & Biofeedback |
|
Definition
Systematic desensitization is used for phobias
Used in OT via progressive muscle relaxation & guided imagery
Biofeedback is monitoring of body functions, such as pulse, respiration rate, heart rate, and body temperature |
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Term
| Cognitive Behavioral Concepts |
|
Definition
Accepts behaviorism principles
Added thinking/cognition to behaviorism
Rejection of determinism
Use of behavior modification is considered outdated, but used with people with low levels of self control
Attempts to assist client in changing thinking patterns |
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Term
| Cognitive-Behavioral View of Human Nature |
|
Definition
We are born with a potential for both rational and irrational thinking
We have the biological and cultural tendency to think crookedly and to needlessly disturb ourselves
We learn and invent disturbing beliefs and keep our selves disturbed through our self-talk
We have the capacity to change our cognitive, emotive, and behavioral processes |
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Term
| Albert Bandura’s Social Learning Theory |
|
Definition
Internal and External reinforcers
Learning involves interaction between the person, behavior, and environment
Mediating Person and Environment Interactions
Attempts to discover beliefs, attitudes, interpretations, and logical conclusions
Modeling and Observation |
|
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Term
| Aaron Beck’s Cognitive Distortions |
|
Definition
Treatment is to correct maladaptive interpretations and conclusions
Automatic thoughts create habitual errors in thinking
Cognition is the problem
Involves feedback, setting goals, defining problems, problem solving, and homework |
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Term
| Albert Ellis’s Exposing Irrational Beliefs |
|
Definition
Rational Emotive Therapy (RET)
Attempts to replace irrational beliefs with rational alternatives through systematic approaches
Uncovers “unconditional shoulds,” “absolute musts,” and “simple preferences”
Encourages cognitive flexibility through confrontive methods (humor, absurdity) |
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Term
| Ellis’s Exposing Irrational Beliefs |
|
Definition
Cognitive Restructuring
Acknowledging responsibility for problems
Accepting ability to change
Understanding emotional problems stem from irrational beliefs
Disputing beliefs
Change beliefs
Continue cognitive monitoring over the lifetime
Psychoeducational approach in activities (pain management, time management, leisure planning, health, prevention, etc..) |
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Term
|
Definition
|
|
Term
| Linehan’s Dialectical Strategies |
|
Definition
Dialectical Behavior therapy (DBT)
Ongoing conversations to revealing problems and use logic to self regulate emotions
Designed to treat Borderline Personality Disorder
Pattern of behavioral, emotional, and cognitive instability
Symptoms of distorted reality, idolizing/condemning others, creating drama, relationship problems, continual redefining of identity, suicidal thoughts, substance abuse |
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Term
| Cog/Behavioral Function/Dysfunction |
|
Definition
Measured by adaptations to environments
Biomechanical and rehab frames- Function is when they have no restrictions in ROM, strength, and endurance and can perform tasks for work, leisure, self-care, and roles
Cognitive rehab- Function occurs when the brain is able to effectively process information. Dysfunction occurs when the brain is unable to process information efficiently
Cognitive behaviorism- Function occurs when the individual is able to think logically and form accurate perceptions of their self and environment. Dysfunction is faulty thinking, inaccurate self-perception, and inability to ones affairs |
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Term
| Cog/Behavior Group Interventions |
|
Definition
Groups are homogenous in needs and cognitive function
Intervention includes groups of up to 8 people
Intervention goals are specific, observable, and measurable
Skills are learned through rehearsal and practice
Leader takes a directive role
Provides cues, feedback, assistance, direction, limits choices
Change in thinking will produce a change in behavior
Special training is needed for flooding, paradoxical intention, and systematic desensitization |
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Term
| Cog-Behavioral Goals of the Group |
|
Definition
Behaviorally defined, specific, observable, and measurable
Focus is to increase functional performance
Meaningful task increase motivation and extract the client’s best effort
Include culture and the individual’s values when setting goals
LTG set collaboratively with group members |
|
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Term
| Cog-behavioral Role of the Leader |
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Definition
The occupational therapist’s role is more directive in this frame of reference than it is in most.
The therapist typically chooses the activity or task and structures the group for concentrated work toward a specific goal.
The therapist’s role is active during the group, giving assistance, providing cues, and asking questions that will guide group members to improve their performance. |
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Term
| Cog-behavioral Group Interventions |
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Definition
Toglia and Abreu’s cognitive rehabilitation uses the six cognitive areas to determine group selection
The same skill is practiced in multiple contexts
Benefits
Motivation and fun
Structured for safety
Feedback increases awareness
Observation increases generalization
Applications can be discussed |
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Term
| Behavioral versus Biomedical Rehabilitative (chart) |
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Definition
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Term
| Cognitive-Perceptual Rehabilitation versus Behavioral Cognitive, Dialectical Behavioral |
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Definition
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Term
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Definition
Began developing the theory in the early 1970’s
Developed and described 6 cognitive levels
Functional behavior is based on an individual’s cognition
Focuses on problem-solving, learning and safety |
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Term
| Allen's Cognitive Disabilities POPULATION |
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Definition
Stroke
Traumatic brain injury
Schizophrenia and other psychotic disorders
Anxiety disorders
Substance abuse disorders
Personality disorders
Alzheimer’s and other dementia disorder
Mental retardation
Autism
Learning disability
Post brain surgery |
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Term
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Definition
Working memory: used when we are actively processing information, necessary for orientation, new learning and problem-solving
Procedural memory: used for habitual actions that require little conscious effort |
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Term
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Definition
Allen’s Cognitive Levels Screen (ACLS)
Leather lacing task using 3 different stitches
Easy to use and score
Quick estimate of the client’s capacity to learn
Assesses cognitive levels 3.0 to 5.8
Routine Task Inventory (RTI)
Uses everyday activities to estimate cognitive levels
3 perspectives: self-report, therapist observation, and caregiver report
Cognitive Performance Test (CPT)
Uses everyday activities to determine and verify cognitive levels
Occupation-based
Allen Diagnostic Module (ADM)
Observe performance while completing craft activities
Craft kits and format for setting up the environment are standardized according to Allen’s specifications
Assesses and verifies Allen’s cognitive levels 3.0 to 5.8 |
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Term
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Definition
Level Actions
1 Automatic
2 Postural
3 Manual
4 Goal-directed
5 Exploratory
6 Planned |
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Term
| Cognitive levels should be used as guidelines for: |
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Definition
Planning intervention
Implementing appropriate activities
Making recommendations about assistance level
Adapting the environment
Providing adaptive equipment
Safety and precautions during daily activities
Making discharge plans |
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Term
| LEVEL 1- AUTOMATIC ACTIONS (TOTAL ASSISTANCE NEEDED) |
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Definition
Clients are bedridden
Responsive to internal cues (hunger, pain)
Behavior is habitual or reflexive
Arousal and response to others may be elicited for a few seconds
Provide appropriate sensory stimulation and attempt to elicit motor responses
Monitor aspirations, bed sores, and contractures |
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Term
| LEVEL 2 - POSTURAL ACTIONS (MAXIMUM ASSISTANCE NEEDED) |
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Definition
24 hour nursing care required
Stimulated to perform postural actions in response to proprioceptive cues
Imitates gross motor actions
Agitated and resistive behavior
Assists in bathing, dressing, and grooming
Self feeds, although it may be messy
Engage clients in self care tasks and movement or exercise groups using imitation |
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Term
| LEVEL 3 - MANUAL ACTIONS (MODERATE ASSISTANCE NEEDED) |
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Definition
Performs manual actions in response to tactile cues
Actions are based on an interest for objects located within arm’s reach
Repetitive work tasks
Attention can be maintained for 30 minutes
Basic grooming tasks completed with reminders
Walks to familiar places, can get easily lost in new surroundings
Require supervision with care of belongings and clothing, money management, meal preparation, following a schedule, and telephone and tool use
Cannot discriminate objects by their intended use
Dangerous items kept out of reach |
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Term
| LEVEL 4 - GOAL-DIRECTED ACTIONS (MINIMUM ASSISTANCE NEEDED) |
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Definition
Perform goal-directed actions in response to visual cues
Complete short tasks
Maintain attention for up to 1 hour
Steps toward a goal can be imitated in short sequences
Able to ask for assistance
Poor safety awareness
Complete basic self care tasks
Need assistance in coping with new events, anticipating needs, and managing money
Non-visible properties in the environment may cause danger (heat, electricity)
Cannot follow verbal and written directions
Unable to understand precautions, complications, or hazards |
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Term
| LEVEL 5 - EXPLORATORY ACTIONS (STANDBY ASSISTANCE NEEDED) |
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Definition
Can live alone
Use of trial and error
Capable of new learning
Use inductive reasoning
Imitate new procedures
Remember several steps at a time
Needs a schedule
Use interventions that increase social awareness, reciprocation in relationships, and accepting supervision of others
Future anticipation and planning deficits
Difficulty imagining long-term consequences of actions
Impulsive and has poor judgment
Lack abstract thinking
Repairs in the home may be neglected
Cooking is problematic when timing is required
Issues with money management
Neglect purchasing needed items for a meal, cleaning, laundry, and refilling prescriptions |
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Term
| LEVEL 6 - PLANNED ACTIONS (NO ASSISTANCE NEEDED) |
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Definition
Absence of disability
Use of deductive reasoning
Able to plan ahead
Future events are anticipated
Behavior is organized
Verbal and written directions followed without demonstration
Symbolic cue use |
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Term
| THE USABLE TASK ENVIRONMENT: |
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Definition
As cognition increases, awareness of the environment also increases.
1) Body
2) ROM
3) Arm's reach
4) Visual field
5) Task environment
6) Potential Task Environement |
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Term
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Definition
Activity Levels
Swallow 1.4
Moving in bed 1.6
Walking 2.4
Grasping objects 3.0
Cause and effect 3.6
Independent in self care 4.0
Home alone few hours 4.4
Drive 5.6 |
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Term
| Ways to Provide COGNITIVE ASSISTANCE |
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Definition
Facilitate – provide sensory cues
Probe – ask questions in order to encourage problem solving
Observe – allow time to process cues and try out new behaviors
Rescue – correct an error or complete a step if frustration arises |
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Term
| THE PRINCIPLE OF BRAIN CONSERVATION |
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Definition
The brain has the ability and tendency to conserve energy when engaging in tasks that do not require a higher level.
The main difference between a person with normal cognition and a person with cognitive deficits is that no amount of effort can induce a higher level of functioning. |
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Term
| PRINCIPLE OF TASK EQUIVALENCE |
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Definition
“The cognitive processing necessary in doing a craft activity is presumed to be equivalent to a variety of everyday tasks that a client will choose to participate in after discharge from an acute setting” (pg. 185).
Many areas required for ADLs, such as attention, can be observed during activities.
Recommendations can be made by a skilled therapist for levels of assistance needed, supervision, or adaptations because of the principle of task equivalence. |
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Term
| Allen's cognitive disabilities GROUP INTERVENTION |
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Definition
Role of the leader
Directive
Controlling/Adapting the environment
Instructing
Activity analysis
Structure and goals
Groups are homogeneous and based on cognitive level
Maximum number of participants is 8, smaller numbers depending on level of assistance needed
Goals and interventions are different for each level
Level 2 is the lowest level that can be effectively treated in groups
Level 3 is the lowest level at which group interaction can be expected
Specific goals might be set to encourage a client to progress to a higher level or to provide the ideal environmental support and assistance so that a client can maximize function within a given cognitive level. |
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Term
| Allen's STRUCTURE AND GOALS |
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Definition
Level 1 sensory stimulation
Level 2
Movement activities
Activities that target gross motor movements
Ex. Nerf basketball, bean bag toss
Level 3
Repetition and manipulation
Not goal directed
30 minutes maximum
ex.. Tile trivets or ribbon mugs, stuffing envelopes
Level 4
Goal directed, sequencing is now possible
Attention is still limited, one hour maximum
Ex. Woodworking kit with three pieces that is structured into a simple sequence
Level 5
Focus is on safety
Intervention entails addressing
Impulsivity
Lack of planning
Lack of anticipation
E.g. mosaics or cooking |
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Term
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Definition
Introduction
Therapist(s) introduces self, member names are acknowledged, purpose of group is explained at cognitive level of group members, emphasis that assistance is available from therapist(s)
Activity
Demonstration according to cognitive level, interaction primarily between group members and therapist(s), provide a sample, clean up last 5-10 minutes
Sharing
No formal sharing takes place
Processing
End product is the focus, leaders should limit praise to reality-based feedback
Generalization
Not possible until level 5
Lower levels- therapist comments about the purpose of group and goals when appropriate
Application
Apply learned techniques to everyday life
Therapist should not provide feedback during group |
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Term
| RESEARCH on Allen's cognitive disabilities |
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Definition
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.
Investigated the effectiveness of treatment based on Allen’s Cognitive Disabilities Model
Sample included schizophrenic patients in the post-acute stage of illness
Study group (n=11)
Control group (n=8)
Treatment
The study group participated in treatment activities outlined in ADM. They were given the choice of 6 tasks- 3 low level, 3 high level
The control group engaged in industrial-type tasks at the local community center.
Results
Improvements in ACL scores for the study group
No change or slight decline in ACL scores for the control group
Study group showed greater improvements in cognitive functional ability than control group |
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Term
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Definition
Nuclear family
Single-parent family
Remarried, blended family
Multigenerational family
Military family
Grandparent- headed family
Gay/lesbian family |
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Term
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Definition
Single young adults leaving home- develop personal autonomy, establish a career
The new couple- adjust and adapt to new status
Families with young children- adjust time & energy to take care of children
Families with adolescents- increased family tension, possibly caring for aging parents
Families launching children- rediscover being a couple, midlife issues
Families in later life- adjust to aging, possibly loss of spouse |
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Term
| Characteristics of Healthy Families |
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Definition
Commitment to the family and its individuals
Appreciation for each other
Willingness to spend time together
Effective communication patterns
High degree of religious/spiritual orientation
Ability to deal with crises in a productive manner
Clear roles |
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Term
| Hierarchy & Subsystems of the family |
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Definition
Marital subsystem
Parental subsystem
Sibling subsystem
Grandparent subsystem |
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Term
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Definition
Family cohesion: emotional bonding among family members
Family adaptability: the ability to be flexible and change
Homeostasis: tendency of families to resist change in order to maintain a steady state
Boundaries: emotional and physical barriers that protect and enhance the integrity of individuals, subsystems and families |
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Term
| Boundaries (in regards to families) |
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Definition
Disengaged: rigid boundaries, isolation, constricted communication, low cohesion, focused on the individual, high independence
Connected: permeable boundaries, balance of I-We, moderately high cohesion, interdependency
Enmeshed: unclear, diffuse boundaries, emotions are shared, no room for individual differences, unity is stressed, high dependence |
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Term
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Definition
Alcoholism, drug addiction, gambling addiction, domestic violence, mental illness, chronic illness, child abuse & neglect, eating disorders, suicide
Characteristics: denial, chaotic, unpredictable, family secrets, broken promises, limited emotional expression, lack of empathy, boundary violations, conflict, unequal treatment, lack of trust |
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Term
| Maladaptive Family Dynamics |
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Definition
Codependency: over involved, attempts to control behavior of others, enables addiction to continue
Enabling: any behavior done to protect the addict from the consequences of their behavior
Chief Enabler: a spouse or other family member on whom the substance abuser is most dependent, through enabling behavior allows the addiction to worsen |
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Term
| Children of Dysfunctional Families |
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Definition
Hero: usually oldest child, high achiever, used to gain recognition and provide self-worth for the family, often feel inadequate, super responsible & perfectionistic
Scapegoat: takes the focus off the addict by acting out, problem child, truancy, unwanted pregnancy, disruptive, made to feel they are responsible for the family’s problems, trouble with authority, angry, high risk for substance abuse
Lost child: never needs attention, the “perfect child”, has few friends, lonely, feels rejected, tends to cope using fantasy & escapism, poor self worth, have problems developing relationships in adulthood, emotionally distant
Mascot/Family Clown: usually the youngest child in the family, the cute one, brings humor to the family, acts like a clown, needs to be the center of attention, tends to remain immature, unable to express their true feelings |
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Term
| Psychoanalytic Group Formats |
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Definition
Loosely structured
Task oriented
Goals: ego skill development, insight
Leadership: facilitator
Activity guidelines: members project self through activities (projective techniques). Creative & expressive media |
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Term
| Behavioral-Cognitive Group Formats |
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Definition
Highly structured, focused on cognitive deficits or coping skills
Goals: specific, observable, measurable, focused on learning skills, changing thoughts & behaviors
Leadership: directive/educator, therapist instructs
Activity guidelines: focus on alteration of thought process, attention, problem-solving, judgment and metacognition, educational worksheets, practice of new skills |
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Term
| Cognitive Disabilities (Allen) Group Formats |
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Definition
Highly structured, homogeneous groups based on cognitive level
Minimal interaction, parallel group
Leadership: highly directive
Activities: crafts, daily life tasks
Goals: specific, measurable, observable, improved functional performance |
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Term
| Developmental Group Formats |
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Definition
Homogeneous groups based on developmental level
Work on age appropriate skills in a growth-facilitating environment
Activity: 30-90 minutes (increases with maturity)
Goals: Master skills needed to progress to next higher level of development
Leadership: directive or facilitative depending on developmental level, therapist sets up environment and plans activity
Activity guidelines: based on life tasks appropriate for person’s age and stage of development |
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Term
| Sensory-Motor Group Formats |
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Definition
Highly structured sequence of sensory motor activities
30-60 minutes
Goals: stimulate development of central nervous system, adaptive functioning, normalize movement patterns, sensory integration
Leadership: directive, role-modeling and imitation used to guide client
Activity guidelines: movement oriented, sensory stimulation, limited cognitive demands |
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Term
| Model of Human Occupation Group Formats |
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Definition
Members grouped by common/expected roles
Activity may last 1 hour to several days
Goals: restore order to daily occupation, re-establish occupational roles, develop healthy routines
Leadership: facilitator/advisor, consultant
Activity guidelines: normal daily activities, work, play/leisure, self-care at levels of exploration, competence and achievement |
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Term
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Definition
Occurs when a person’s psychological strategies and defenses for coping are overwhelmed and inadequate, leaving them traumatized by chronic emotional pain, loss and/or fear.
Also known as secondary traumatic stress disorder
Symptoms are similar to PTSD
A natural consequence of caring for persons who are traumatized
Affects police, firefighters, EMTs, health care workers, mental health professionals, child welfare workers, ministers, etc. |
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Term
| C.F. Emotional Indicators |
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Definition
Anger
Sadness
Anxiety
Depression
Mood swings
Irritability
Cynicism
Guilt
Powerlessness
Numbness
Increased emotional sensitivity
Depleted emotional energy
Helplessness
Fear |
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Term
| C.F. Social/Interpersonal Indicators |
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Definition
Self-isolation
Mistrust
Intolerance
Loneliness
Increase in interpersonal conflicts
Decreased interest in sex/intimacy |
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Term
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Definition
Headaches
Stomach aches
Lethargy
Sleep problems
Loss of appetite or overeating
Dizziness & disorientation |
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Term
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Definition
Absences
Lateness
Loss of motivation
Avoidance
Low morale
Obsession about details
Negativity
Detachment
Apathy |
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Term
| C.F. Cognitive Indicators |
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Definition
Loss of concentration
Rigidity in thinking
Perfectionism
Distractibility
Thoughts of self harm
Preoccupation with trauma
Decrease in self esteem |
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Term
| C.F. Behavioral Indicators |
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Definition
Impatient
Withdrawn
Nightmares
Hypervigilance
Accident prone
Easily loses things
Regression |
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Term
| C.F. Spiritual Indicators |
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Definition
Loss of purpose
Question the meaning of life
Anger at God
Loss of faith in a higher power
Question religious beliefs |
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Term
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Definition
A state of physical, emotional and mental exhaustion brought about by devotion to a cause, profession/job, way of life, or relationship that failed to produce the expected reward or results.
CF can lead to burnout
CF is preoccupation with trauma and the emotional stresses of others
BO is a persistent, chronic condition of physical and emotional exhaustion due to a mismatch between the person |
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Term
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Definition
Emotional numbing- protective mechanism- decreased capacity for feeling all kinds of emotions
Compassion fatigue
Burnout |
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Term
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Definition
Spend plenty of quiet time alone
Recharge your batteries daily by doing something you enjoy
Hold at least one focused, connected and meaningful conversation each day
Exercise and eat properly
Understand that the pain you feel is normal
Get enough sleep
Take some time off
Develop interests outside of work
Identify what is important to you
Tend to your spirituality, meditate/pray
Read literature unrelated to work
Improve ability to say “NO”
Spend quality time with friends and family
Spend time in nature |
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Term
| Burn out Don’ts of Recovery |
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Definition
Blame others
Work harder and longer
Self-medicate
Neglect your own needs
Waste energy complaining
Make any big decisions (divorce, buy a new car, have an affair, quit your job) |
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Term
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Definition
People, places, activities and things that stimulate, invigorate, inspire or motivate you
People, places, activities and things that give you power, strength, enthusiasm, pep, vitality or exuberance for life |
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Term
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Definition
| People, places, activities and things that drain your energy, deplete your emotional and physical resources, wear you out, and cause you to feel tired, weak or empty |
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