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Corinne Jenkins, Cati Rodriguez, Angeli Serna, Karen Lopez
Introduction
Cognitive Adaptation Training (CAT) is an intervention approach used by occupational therapists to provide environmental supports and modification to the home of the client while taking into consideration their current cognitive deficits to optimize participation in ADL’s and IADL’s (Draper, Stutes, Maples,& Velligan, 2009). When occupational therapist implement CAT it is essential to incorporate the caregivers and provide them with training in adapting the environment to increase participation in activities at home. Occupational therapists can also work to increase problem-solving skills and assist clients in recognizing safety hazards.
Theory
The Person-Environment-and-Occupation model (PEO) is a client-centered theory which focus on the person’s experience, satisfaction, and functioning in their environment. It mainly targets the environment and the barriers individuals might face due to changes in their lifestyle and medical conditions in their lifetime (Strong, Rigby, Stewart, Law, Letts,& Cooper, 1999). There are internal and external factors that need to be modified either at the home or their physical environment to increase the PEO fit for optimal performance (Strong, Rigby, Stewart, Law, Letts,& Cooper, 1999).
Evidence
An statistical report showed that traumatic brain injury (TBI) from domestic violence can affect up to 20 million women per year (Shifflett, 2017). Severe head trauma can affect memory, cognition, and decrease clients’ participation in daily living activities. Once they suffered the head trauma they faced deficits with problem-solving, planning, and safety awareness (Shifflett,2017). For this reason, cognitive adaptation training (CAT) would be beneficial for female survivors of domestic violence who have suffered head trauma.
Case Study
Leslie is suffering from a cognitive impairment due to head trauma sustained in an abusive relationship. Leslie has left the women’s shelter and is currently living with her mother. After evaluating Leslie using Allen’s Cognitive Levels, she is determined to be at level 4.2. Leslie requires 24-hour supervision, does not have insight of dangerous situations or changes in terrain, and demonstrates difficulties with problem solving. The occupational therapist plans to complete a home visit to assess the patient’s environment and assist with caregiver training.
Intervention Plan
Problem Statement
Client has difficulty with community mobility due to deficits in problem solving and impaired insight.
■ Outcomes – What is the desired outcome of intervention?
Long term goals
- With supervision, client will be able to locate and utilize public transportation (bus transit) in order to improve community mobility by discharge.
- With supervision, client will locate and walk to the bus station while noticing changes in terrain (sidewalk or road) to improve community mobility in 2 months.
Short term goals
- Client will be able to navigate the home safely with 3 or less verbal cues in order to improve mobility in 1 week.
- Client will be able to locate 2 landmarks on her way to the bus stop in order to improve community mobility in 2 weeks.
- With verbal cues, client will demonstrate ability to use the bus schedule by correctly identifying the next available bus departure time to improve community mobility in 1 month.
Intervention format: Individual with the caregiver
Description of the setting: Today’s session took place in the morning at the patient’s home with her caregiver.
Supplies (if any): None
Agenda & description
Evaluate client’s ability to navigate the home environment safely and efficiently (15 min)
Caregiver training (20 min)
- Strategies to create a safe environment by decluttering home and maintaining clear walkways
- Instruct in communication strategies (verbal and tactile cues) to better equip the caregiver to improve the client’s mobility
Debriefing with the client and caregiver (10 min)
Documentation
SOAP Note
S: Caregiver expresses concern with the client’s ability to be safe when moving around the home.
O: Client and caregiver participated in a 45 minute occupational therapy session in the home. The session began with an evaluation of the client’s ability to navigate the home environment safely and efficiently. Based on this evaluation, the clinician was able to train the caregiver in environmental modifications to improve the client’s quality of life and safety. Initially, the clinician provided caregiver education regarding the cognitive level of the client. In addition, safety of the environment was discussed. Environmental modifications were suggested, including decluttering the home, and maintaining clear walkways to improve safety. The caregiver was also instructed in communication strategies, including verbal and tactile cues, to facilitate client’s safe mobility around the home.
A: Client’s ability to safely move around the home environment was hindered by clutter and disorganization. She was unable to problem solve and recognize barriers, making her at risk for falls. Caregiver was receptive to suggestions, and was motivated to make improvements in the home.
P: Client and caregiver will continue therapy in the home environment. Next session will include recognition of difficulties that may arise in the community, such as varying terrains and becoming familiar with specific routes.
References
Draper, M. L., Stutes, D. S., Maples, N. J., & Velligan, D. I. (2009). Cognitive adaptation training for outpatients with schizophrenia. Journal of clinical psychology, 65(8), 842-853.
Shifflett, C. M. (2017). Domestic Abuse and Brain Injury in Women. Women’s Health Activist, 42(2), 6-7.
Strong, S., Rigby, P., Stewart, D., Law, M., Letts, L., & Cooper, B. (1999). Application of the person-environment-occupation model: A practical tool. Canadian Journal of Occupational Therapy, 66(3), 122-133.
