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Allen Cognitive Levels: An Introduction to Theory & Assessment: Summary
Goals of Therapy Intervention Planning • The primary goal is to guide appropriate levels of assistance and activities based on cognitive functioning • Each therapy discipline shares common, functional goals for intervention planning:
ACL-5: Relevance to Speech-Language Pathology • SLPs are equipped to provide interventions to restore or maintain levels of cognitive domains (attention, executive function, memory, fluency, orientation, etc.) in how each domain impacts function, communication, and swallowing
○ Restore/establish ○ Maintain/prevent
○ Environmental modification ○ Caregiver/family education
CASE STUDY
Diana is a 78-year-old female with Lewy body dementia, which has made her develop symptoms of cognitive decline, rigidity, and tremor-like movements. Diana currently resides in a long-term memory care unit and has exhibited recent symptoms of depression and other mood changes. Before her stay in long-term care, Diana was living at home with her daughter and her three grandchildren, who still visit her regularly.
Diana is a retired nurse who loves scrap-booking, crossword puzzles, and hiking with her family. The patient was managing her own home independently prior to a series of falls, wandering from home, and urinary incontinence episodes outside her bathroom. From a physician referral, Diana is being assessed for PT, OT, and SLP services. All three disciplines agree to carry out the ACL-5 assessment and to create plans of care. • ACL 4: Familiar Activity: Global cognition is moderately impaired. The person is aware of tangible cues (see and touch) and understands visible cause-and-effect relationships. • There is no independent new learning and they cannot invent new motor actions. Diana scores a 4.0 on the ACL-5. So, what's next? • Validate results with another cognitive-based assessment: RTI? • Holistic evaluation of Diana’s functional performance factors: cognition, neurological, psychomotor, functional mobility, environmental/caregiver supports, etc. • Interdisciplinary consultations to discuss individual therapists’ approaches for Diana’s client-centered goals and therapeutic interventions. • Determine an approach based on meaningful, realistic, client-based goals for Diana: restoration, maintenance, or adaptation? • Sample Goals: ○ The patient will complete toileting tasks with up to supervision assistance with reduced risk for falls and urinary incontinence episodes. ○ The patient will ambulate up to 200 feet with a front wheeled walker (FFW) with reduced risk for falls. Tactile cues are used to utilize external supports for safety. INTERVENTION IDEAS BASED ON DISCIPLINE Occupational Therapy Physical Therapy Speech-Language Pathology
• Fall prevention • Transfer training • FM coordination • GM coordination • BUE strengthening • Sit/Stand balance • ADL participation • Cognitive-based therapeutic activity • Functional activity tolerance • Caregiver education
• Gait training • Ambulation • Endurance • Manual therapy techniques • Joint mobilization • Therapeutic exercise • Caregiver training • Therapeutic modalities
• Oral-motor therapy • Articulation therapy • Visual aids and other environmental adaptations/modifications • Swallowing therapy (if an issue is discovered) • Caregiver education
WORKS CITED https://qr2.mobi/allen-cognitive
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