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Dynamic Interactional Model

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Cognitive intervention approaches
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Strategy and Learning a. A Dynamic Interactional Approach (DIM) b. Cognitive Orientation to Daily Occupational Performance (CO-OP) c. Awareness Model Adaptive and Functional Skill Training a. A Neurofunctional Approach b. The Cognitive Disabilities Model for Rehabilitation in Dementia
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How intervention approaches relate to awareness level
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Intellectual Awareness= Adaptive and Functional skills training (NFA and Cognitive Disabilities Model) Emergent/Anticipatory Awareness= Strategy and learning Models (DIM, CO-PM, Awareness Model)
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In DIM Cognition is…
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The product of the dynamic interaction between the person, the activity, and the environment BUT NOT divided into seperate sub-skills
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DIM person factors
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-Structural capacity (physical limits in person’s cognitive abilities) -Personal context (unique lifestyle/personality or emotions) – Self Awareness (must have some potential for awareness) -Processing strategies (methods and behaviors that we use to enhance behavior and cognitive skills)
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DIM Activity factors
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-Demands of the activity -Familiarity of the activity -Emphasizes importance of activity analysis and grading of tasks
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DIM environmental factors
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-Social -Physical -Cultural
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DIM Assessment overview
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-Assessment is viewed as dynamic -Self awareness and processing strategies are core aspects of cognition -These core aspects are modifiable -The person, activity, and environment influence the expression of the cognitive abilities
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Review of dynamic assessments
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-Qualitative (observation and modification of performance) -Focuses on the process of change -May see different abilities in different situations -Helpful for providing a more comprehensive range of capabilities and determining intervention approaches. -Answers questions: can performance be facilitated/changed? What cues or alterations increase/decrease symptoms
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DIM Assessment goals
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-To provide an estimate of learning potential -To see if the client will be able to change or increase their capabilities if different opportunities are provided (cues, modifications) -To discover the client’s best performance or maximum level of function (rather than severity of dysfunction)
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DIM Assessment and intervention for self-perception
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-Examine client’s self perception throughout tasks -Ask open ended questions -Perform Strategy investigation -Probe the client’s response without suggesting answers
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Examples of DIM Assessments
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Contextual Memory Test Toglia Category Assessment Dynamic Object Search Test (derived from Dynamic Visual Processing Test)
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DIM answers these questions
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To what extent is change expected from this person? Does the person recognize difficulties during or after an activity when feedback is given? Is performance helped or changed with cues? How does changing the task and environment affect performance?
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Treatment begins at a level ______________, then ___________
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they will be successful at slightly grade it up and change it to see if they can handle slightly more difficult
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DIM focus of change is the ____
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a. Learning: The person needs to learn a technique or strategy b. Generalization: Be able to apply it across situations b. Awareness: To recognize need for therapy and use of strategies
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Components of the DIM multicontext Approach
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-Personal Context -Awareness training -Process Strategies -Activity Analysis -Establishment of criteria for transfer -Practice in multiple environments
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Personal Context
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The activities depend on the client’s personality, interests, goals, and occupational activities.
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Awareness training intervention
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-Focus is transferring the cueing from the therapist to the client -Create an atmosphere that is non-threatening -Self-ratings (compared to therapist or family) -Structured logs to allow comparison over time of abilities -Self evaluation/observation – videotaping -Self predicting, Self questioning, Client-therapist role reversal
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Processing Strategy
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Treatment provides opportunities to practice strategies in a variety of situations that are within a similar level of difficulty `
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Criteria for transfer
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-Treatment activities are not increased in difficulty unless the client has successfully used the strategy in different, similar contexts -Gradually changing the difficulty, may enhance strategy transfer -It is not necessarily being able to do the activity that is important – but being able to use the same strategy successfully (across activities) in the activity that is important.
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DIM Pros
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-Very useful in treatment planning -Address transferring of skills -Some assessments have reliability/validity -Client centered -Very functional -Incorporates person, activity, and environment
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DIM Cons
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-Not heavily researched -Difficult to measure change with assessments -Treatment is time consuming -Clinicians have to be very skilled in working with cognition