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Treating Executive Functioning Dysfunction with Occupational Therapy

Treating Executive Function Dysfunction with Occupational Therapy.

In early October 2012, a number of therapists from Galit Liffshiz & Associates attended a three-day workshop on cognitive perceptual deficits and cognitive rehabilitation. The course was presented by Dr. Joan Toglia, PhD, OTR, who is an Occupational Therapist and educator at Mercy College in New York. She has over 20 years of clinical experience in acquired brain injury awareness and specialization in issues related to cognitive rehabilitation.

The focus of the workshop was on assessment and treatment of Executive Functioning (EF) dysfunction.

Generally, EF is an umbrella term for cognitive/brain processes which regulate, control and manage other brain processes. The five domains of EF include:

  • Initiation and Inhibition
  • Cognitive Flexibility
  • Working Memory
  • Planning and Organization
  • Self-regulatory/Monitoring

EF symptoms can be seen in a number of populations, including stroke, head injury, Multiple Sclerosis, schizophrenia and peripheral vascular disease. These deficits can be either prominent or subtle and can influence balance, motor function and one’s ability to complete daily activities.

Of the five domains, one of the most commonly referenced is working memory (WM). WM allows us to hold and manipulate information in our mind and keep track of all aspects of an activity as it is being performed (for example, following a recipe while cooking). Symptoms of poor WM can include losing track of what was just done or said, difficulty remembering what the next step of an activity is or the inability to process a large amount of information simultaneously.

There are two main approaches to treating working memory deficits: compensatory strategies and remediation.

Remediation is based on neuroplasticity;  the brains ability to reorganize itself by forming new neural connections. It allows parts of the brain to compensate for the injured areas.

Cognitive remediation is becoming mainstream and is often referred to as “brain training”. Internet and computerized programs encouraging ‘healthy brains’ have quickly gained popularity. An example of this type of program is Luminosity. iPhone applications and other electronic devices allow you to access games that promote mental stimulation. Combining periods of mental exercise with regular physical activity is recommended for positive outcomes.

Compensatory strategies are required when recovery of lost brain function is unlikely. Individuals with poor WM can become easily overwhelmed when too many steps or instructions are provided simultaneously. Compensatory strategies for poor WM include grouping similar information together (e.g. grocery items by department), rehearsal/repetition (e.g. a phone number or address) and association (e.g. linking a name to a well known person).

Resources for online Brain Fitness Exercises: