OTHY604 - Advanced Occupational Therapy Practice 3 Cognitive Rehabilitation for Everyday Living

Year

Credit points

Campus offering

Prerequisites

Completion of HLSC632 Holistic Rehabilitation and Restoration 2 AND OTHY613 Optimising Interprofessional Collaborative Practice for Occupational Therapists

Teaching organisation

Unit rationale, description and aim

OTHY604 offers post graduate students the opportunity to update and enhance theoretical knowledge and clinical skills with the aim of optimising functional assessment of cognition and application of compensatory strategies and rehabilitation techniques to manage or improve the effects of cognitive impairments on everyday activities. Guided practice supported by enhanced understanding of the neuroanatomy leading to cognitive impairment alongside rehabilitation and management techniques will be explored to facilitate occupational therapists in complex assessments and evidenced-based management of cognitive impairments in clients across the lifespan or those with neurological disorders. This unit aims to encourage students to further develop and apply their advanced knowledge and skills and demonstrate critical analysis of functional cognitive assessment, rehabilitation techniques and management; as well as enhance leadership and advocacy skills with professional colleagues and the broader community. 

Learning outcomes

To successfully complete this unit you will be able to demonstrate you have achieved the learning outcomes (LO) detailed in the below table.

Each outcome is informed by a number of graduate capabilities (GC) to ensure your work in this, and every unit, is part of a larger goal of graduating from ACU with the attributes of insight, empathy, imagination and impact.

Explore the graduate capabilities.

On successful completion of this unit, students should be able to:

LO1 - Integrate, apply and critically discuss enhanced knowledge of cognitive functions; and origins of dysfunction, that lead to functional changes in cognition requiring rehabilitation in order to implement optimal management plans (GA3, GA4, GA5). 

LO2 - Integrate, apply and discuss effective communication and application of evidence based knowledge and skills in functional cognitive assessment within the clinical context, when working with clients that address client-led needs and goals aimed at maximising outcomes and participation (GA3, GA4, GA5, GA7, GA8, GA9)

LO3 - Critically analyse cognitive impairments, and how these link to changes in participation and functional ability to apply evidenced based treatment strategies for the rehabilitation of these impairments (GA3, GA4, GA5, GA7, GA8, GA9)

LO4 - Select, apply and interpret outcomes achieved following intervention to improve cognitive performance using evidenced based outcome measures and functional assessments in people with disorders requiring rehabilitation (GA4, GA5, GA7, GA8)

LO5 - Reflect on application of knowledge, skills and experiential learning in the clinical setting to analyse the implications for holistic and functional rehabilitation management of people with cognitive impairments and as well as for personal and professional growth as an occupational therapist as an advocate for your clients and as a leader within your discipline. (GA1, GA3, GA4, GA5, GA8)

Graduate attributes

GA1 - demonstrate respect for the dignity of each individual and for human diversity 

GA3 - apply ethical perspectives in informed decision making

GA4 - think critically and reflectively 

GA5 - demonstrate values, knowledge, skills and attitudes appropriate to the discipline and/or profession 

GA7 - work both autonomously and collaboratively 

GA8 - locate, organise, analyse, synthesise and evaluate information 

GA9 - demonstrate effective communication in oral and written English language and visual media 

Content

Topics will include:

Structures and function

• Principles of neuropsychological rehabilitation in relation to brain anatomy.
• Neuroanatomy/ processes involved in cognitive functions; reading imaging scans and relating areas of damage to cognitive impairments
• Cognitive impairments and hierarchy of functions; Post traumatic amnesia (PTA), attention, memory, insight and awareness, executive functions; decision making, problem solving, planning.
• Frameworks of cognitive function – classification using the ICF
• Pathophysiology of conditions that result in cognitive impairment and their impact on occupational performance such as dementia, multi infarct, alcohol and drug related, TBI, hypoxia, encephalitis, stroke R versus. L, PD, Lewy Body, MS, Huntington’s.

Assessment

• Framework for assessment and clinical reasoning
• Initial assessment of cognition; bedside assessment, PTA, interviews with patient and significant others, data gathering tools; logs, diaries
• Functional / Occupation focussed assessment / analysis of cognitive function within activity, standardised versus non standardised assessments methods; PPRP, AMPS. Selection and interpretation of results
• Impairment based assessments - Evidence based review (validity, reliability, utility) of standardised cognitive assessments used by Occupational Therapists; MMSE, Montreal Cognitive Assessment, LOTCA, MEAMS, Rivermead, COTNAB, Cognistat, Multiple Errands Test, Westmead PTA scale. Selection and interpretation of results.
• Cognitive requirements for return to work, driving and more complex tasks and decision making capacity. 

Intervention

• Goals for cognitive rehabilitation; 
• Critical review of evidenced based interventions for cognition
• Implementing interventions for cognitive rehabilitation and occupational performance; attention training, internal and external memory strategies –evidence based selection of memory aids for/ with your patient in relation to their cognitive impairments; educative cognitive groups, developing memory and planning systems, use of technology, errorless learning implementation, strategies to build awareness/ insight, limb activation training for inattention, and goal management training. 
• Consistent and effective implementation of cognitive strategies in practice - short term/ long term rehabilitation 
• Measuring change and goal achievement 

Behaviour

• Occupational therapy involvement in assessment of behaviours of concern; physical and verbal, socially inappropriate behaviours related to cognitive impairment.
• Evidence based practice principles guiding neurobehavioral strategies for managing and changing behaviours of concern and socially inappropriate behaviours, including setting goals and risk assessments.
• Understanding restrictive practice principles in relation to behaviours of concern and development of behaviour support plans for aids or equipment considered restrictive.

Learning and teaching strategy and rationale

This unit is offered through multi-mode and online delivery for specific on and offshore cohorts. Both modes aim to facilitate learner centred activities. Learning and teaching strategies within this Masters level unit are based on a blend of constructivism, social constructivism, and experiential learning. These strategies focus on active participation and developing a community of inquiry. Purposefully designed content and activities that are the same or similar for all participants regardless of the mode of delivery have been identified. This has led to the development of purposefully designed learning activities that are transferable and work well across both delivery mediums whilst maintaining the flexibility to create and deliver mode specific activities focusing on inquiry based learning principles aimed at encouraging critical thinking, application of knowledge and skills, evidence for practice, collaborative peer learning, and critical self-reflection.  

In addition, students participate in individual and small group activities based on analysis of current practice, to assimilate application of enhanced knowledge and facilitate translation of learning into practice. Engagement in extended dialogue is encouraged to guide change to a more interprofessional, person-centred practice. Unit activities include, but are not limited to: guided readings, synchronous on-line tutorials, work-based activities with reflection, use of a reflective journal during experiential learning, skill development, and mentoring to enhance practice. To facilitate practical application of knowledge and skills, multi-mode delivery requires participation in online tutorials and discussion of clinical cases on contemporary practice issues. Learning and teaching strategies for online delivery to specific cohorts will be adapted to accommodate different time zones for example as required. Activities are aimed to facilitate acquisition of advanced knowledge and skills in collaborative and assessment and intervention planning strategies. Workplace activities are included to support leaning and application of knowledge gained through the unit. 

Assessment strategy and rationale

OTHY604 assessments have been purposefully designed to replicate authentic clinical practice. Significantly, the unit’s assessments have also been designed from an “Assessment for Learning” approach in order to not only provide evidence for judgement of learning, but also to reinforce, facilitate and support learning and application of learning. The assessment tools have been designed to provide for a broad range of tasks aligned to andragogic principles of adult learning, facilitating choice and self-direction for the post graduate student. The design enables timely judgement to ensure students have appropriate knowledge and skills prior to the workplace application segment of the unit. In addition, the range of assessment activities at the end of the unit encourage application of evidence to practice and embed clinical reasoning, problem solving and implementation of advanced knowledge and skills.   

In assessment task 1 students will provide a critical analysis of a client with cognitive impairment, demonstrating advanced knowledge of neuroanatomy and neuropathology underpinning cognitive impairment and application to the individual client. The focus of the final two assessment items, is to reflect on personal and collaborative practice, and communicate reflections, evidence based reasoning and decision making, to management and peers. Assessment task 2 enables students to demonstrate the application of advanced skills in the delivery on an evidence based intervention with a client, their clinical reasoning and clinical decision making. In the educational seminar students will analyse the evidence-base for managing a specific cognitive impairment. Students will outline the evidence, appraise the relevant evidence and communicate an implementation plan for this evidence practice gap within their work setting. 

In addition to assessing enhanced clinical skills, a major focus of the final two assessment items, is the ability to reflect on personal and collaborative practice, and communicate reflections, evidence based reasoning and decision making, to management and peers. These assessments incorporate the advanced level of professional knowledge and skills, enhanced critical analysis and professional presentation modes developed throughout the post graduate program. Assessment tasks 2 and 3 may be presented via remote methods, be delivered and assessed locally and, moderated according to University Policies and Procedures. All assessments will be submitted electronically. 

Overview of assessments

Representative texts and references

Bayley, M. T., Tate, R., Douglas, J. M., Turkstra, L. S., Ponsford, J., Stergiou-Kita, M., ... & Bragge, P. (2014). INCOG guidelines for cognitive rehabilitation following traumatic brain injury: methods and overview. The Journal of Head Trauma Rehabilitation, 29(4), 290-306. 

Cicerone, K. D., Goldin, Y., Ganci, K., Rosenbaum, A., Wethe, J. V., Langenbahn, D. M., Malec, J. G., Bergquist, T. F., Kingsley, K., Nagele, D., Trexler, L., Fraas, F., Bogdanova, Y., & Harley, P. (2019). Evidence-based cognitive rehabilitation: Systematic review of the literature from 2009 through 2014. Archives of Physical Medicine and Rehabilitation, 100, 1515-1533. 

Gillen, G., & Brockmann Rubio, K. (2016). Treatment of cognitive-perceptual deficits: A function-based approach. Ch 27 in Gillen, G. Stroke rehabilitation: A function-based approach, 4th Ed. St Louis: Elsevier. 

Haskins, E.C., Cicerone, K., Dams-O’Connor, K., Eberle, R., Langenbahn, D., Shapiro-Rosenbaum, A. (2012). Cognitive Rehabilitation Manual. Translating evidence-based recommendations into practice. (1sted.). American Congress of Rehabilitation Medicine. 

 Katz, N (2011) Cognition, occupation, and participation across the life span: neuroscience, neurorehabilitation, and models of intervention in occupational therapy 3rd Ed. Bethesda, MD: AOTA Press. 615.8515 COG 

Langenbahn, D (2013) An evidence based review of cognitive rehabilitation in medical conditions affecting cognitive function. Archives of Physical Medicine and Rehabilitation. 94 (2) 271-286.  

Rogers, J.M., Foord., R., Stolwyk, R. J., Wong. D., & Wilson, P.H. (2018). General and domain-specific effectiveness of cognitive remediation after stroke: Systematic literature review and meta-analysis. Neuropsychology Review, https://doi.org/10.1007/s11065-018-9378-4. 

Teasell, R and Hussein N (2016). The Cognitive Impairment Post Stroke. Chapter 5 in Stroke Rehabilitation Clinician Handbook. Evidence based Review of Stroke Rehabilitation (EBRSR)   

Sohlberg, MM & Turska, LS (2011) Optimizing Cognitive Rehabilitation: Effective Instructional Methods. New York: Guilford Publications, Inc.  

Unsworth, C.A. (2017). Cognitive and perceptual strategies. Ch 41. In M. Curtin, M. Egan & J. Adams (eds.). Occupational therapy for people experiencing illness, injury or impairment: promoting occupation and participation (7thEd), Elsevier.