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specific tests designed to measure component skills such as attention or constructional praxis |
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examine client’s performance in a particular occupational performance task as a means to understand possible underlying causes of poor performance |
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evaluations quantify the measured parameters through numbers |
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provides non-numerical data→ can highlight a problematic performance component and provide in-depth detailed information about that performance |
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-Clinical observation -Interviews -Visual data |
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Three main methods of qualitative evaluation: |
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Dynamic Interactional Approach |
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-The concept that cognition is an on going production or outcome of the interaction among the individual, task, and the environment. -assumes the clients social, physical and cultural environment can influence his or her adaptation to environmental demands. |
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-Focal control or attentive vision → provides attention to important features of an object for perception and discrimination -Ambient, peripheral, or preattentive vision → works in connection with proprioceptive, kinesthetic, tactile, and vestibular systems and acts as a feedforward system. |
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Visual processing through 2 modes: |
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-Top of pyramid = Visual cognition --Disorders of visual cognition = agnosia, alexia, decreased visual closure, disorders of spatial analysis, decreased figure-ground, and decreased position in space -Visual Memory -Pattern REcognition -Visual Attention -Visual Input through oculomotor control, acuity, and visual fields. |
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Warren's Hierarchical Model of VP |
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normal response- constriction rapidly in response to light and near vision; pre-dilation equally as fast to their offset abnormal pupillary response- results in anything from blurred vision to light sensitivity |
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Pupillary response (normal and abnormal response) |
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The product of integration of the optical systems of the eye and CNS processing |
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Contributes to CNS ability to detect and recognize objects → impairment can result in inability to recognize face and objects |
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area of the visual system that allows an individual to orient to specific spatial areas |
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Type of visual field thet is highly responsive to motion |
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Type of visual field thet is has low response to motion |
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narrowing of scope of scanning, slow scanning toward blind side, decreased visual monitoring of the hand, visual search into blind field is slow and delayed |
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Common problems in with visual field = |
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-If the visual field cut is homonymous or congruous in each eye -The contour of the boundary between the sound and scoptic field (if the boundary is abrupt, the client has more difficulty compensating) -The presence of a central field cut -Client’s awareness of the field cut |
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Warren identifies 4 factors that influence whether visual field loss will affect overall function |
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Crucial to coordinated function of both eyes and visual processing. Treatment - referral to optometrist, ophthalmologist, or vision specialist |
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Deficits can impair ability to effectively scan environment. During activities, client may squint, tilt head, sht one eye or complain of headaches, fatigue or become agitated. |
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sequenced rapid eye movements that change the line of sight; jump eye movements |
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Smooth pursuits eye movements |
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movements that keep an image steady on the retina; visual scanning |
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May have difficulty in spatial judgment, disorientation, impaired eye hand coordination, impaired mobility, postural control, may be mistaken for poor head or postural control. |
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increase in the angle of the visual axes; aligns the eyes to maintain binocular fixation and binocular vision |
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accommodation - dynamic and static |
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process by which the refractive power of the eye changes to ensure for a clear retinal image
-2 types |
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Visual inattention -preattentive and attentive processing |
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Decreased awareness of the body and spatial environment on contralateral side - 2 types: |
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Client’s with inattention can have... |
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Visual/vestibular processing |
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Vestibular, ocular, and postural responses and reflexes maintain a steady gaze on the fovea during head and body movements. A stable gaze depends on vestibular controlled eye movements, visually controlled eye movements and head movements. Accomplished by the VOR reflex. |
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Is a performance skill and forms the foundation for the development of performance patterns and occupations. |
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The inability to perform certain skilled purposeful movements in the absence of motor power, sensation or coordination. |
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-Inability to imitate gestures or perform a purposeful motor task on command even though the client fully understands the idea or concept of the task. |
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-Disability in carrying out complex sequential motor acts which is caused by a disruption of the conception rather than the execution of the motor act -Characterized by: --Loss of knowledge of tool function --Conceptual disturbance related to the sequential organization of actions involving objects |
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-Inability to select the actions associated with the use of a specific tool -Unable to recall which tool is associated with which object -Does not understand the mechanical advantage of certain tools |
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-Has difficulty or is incapable of making fine, precise movements with the limb contralateral to a central nervous system lesion -Spatial accuracy, timing and joint coordination can all be affected -Understands the action required and engages in appropriate motor programs; however, actions are performed in a clumsy manner because the muscle activity is incorrectly specified. |
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-Difficulty in forming and organizing intelligible words, Though the musculature required to do so remains intact. -May be able to use the tongue for automatic acts such as chewing and swallowing but may not be able to stick it out when asked. |
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-Impairment in producing designs in two or three dimensions (Copying, drawing, or constructing) whether upon command or spontaneously. -These clients have lost the ability to assemble and organize an object from disarticulated pieces |
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-The inability to dress oneself because of a disorder in body scheme and or spatial relations -More related to body scheme and spatial deficits than to a difficulty in motor performance. -Client makes mistakes of orientation in putting clothes on backwards, upside down, or inside-out. |
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-a representation of the spatial relations among the parts of the body and is different from the psychodynamic sense of identity |
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-A disturbance in the previously described body scheme, lack of awareness of body structure and the failure to recognize one’s body parts and their relationship to each other. -Client’s can recognize body parts individually → problem not wit knowledge of the parts themselves. |
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-Inability to integrate and use perceptions from one (usually left) side of the body. -May occur independently of visual field cuts or visual inattention or be compounded by these deficits |
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-Relatively transient, severe form of neglect to the extent that the client fails to recognize the presence or severity of his or her paralysis -May present as simply unconcern for the paralysis or, at the extreme, complete denial of paralysis. -Deficit often associated with mental confusion or intellectual impairments (but may occur alone) |
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Right-Left Discrimination |
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-A skill that develops relatively late. Not mastered until later than 7 years. -Requires many cognitive abilities including mental rotation, spatial ability, and a high level of conceptualization |
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-Consists of doubt and hesitation concerning the fingers. -Client has trouble naming his or her fingers on command or knowing which one was touched -Displays clumsiness in using fingers especially in tasks requiring imitation of meaningful gestures |
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The area of deficits that deals with a client's lack of recognition of familiar objects perceived by senses. Disturbance in sensory modes of visual, tactile, proprioceptive, and auditory. May involve additional problems in body scheme |
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“Perception without meaning” or inability to recognize visual stimuli despite adequate primary visual fx
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May be restricted to a specific category, such as objects, faces, or colors
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Inability to identify a known person by their face
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Inability to recognize a compound visual array
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Unable to perceive more than 1 thing at a time and the amount of tie necessary to distinguish between 2 perceptual acts is excessively long
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Unable to recognize abstract meaning of a whole stimulus array even though the details are correctly perceived
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Able to describe details of complex stimulus but cannot integrate them
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Disorder which involves impairment in interpreting a visual stimulus as a whole → seems to result from a reduction in visual span of apprehension
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-Plays an important role in visual recognition of objects, visually guided manipulations, and in navigation within an environment -Shape, color, orientation, edge, and motion cues are all utilized --Shape is the most common |
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Depth Perception (Stereopsis)- ability to judge depth/distances |
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-Crucial to the individual’s ability to locate objects in the visual environment, have accurate hand movement under visual guidance, and to function safely with tasks like navigating stairs or driving. |
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-Involves ability to distinguish the foreground from the background. -Separation of figures from the background is accomplished by the visual system based on differences in features such as color, luminance, depth, orientation, texture, motion, and temporal information |
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Spatial relations -categorical (above, below, left, right, etc.), coodinate (specify locations in a way that can be used to guide precise movements) |
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-ability to perceive the position of two or more objects in relation to self and each other -important to orienting the environment→ recognizing objects, scenes, and language; and for manipulation of objects within the hand. -two types |
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Topographical Orientation |
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-Ability to follow a familiar route or a new route once it has become familiar; clients generally have difficulty finding their way in space. |
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Deficit in perceiving spatial relationships between objects or between objects and self.
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Can include difficulties in: 1) spatial relations 2) in judging distances such that the client may go sit in a chair and misjudge so that they miss the chair 3) in depth perception, may continue pouring water into a glass after it is filled
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Impairment in the interpretation of maps, house plans, etc. can perform normally in real situations, but cannot find himself on a map
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Unable to draw a plan of their house or identify rooms on a pan that is drawn for them
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Inability to recognize objects tactually though tactile, thermal, and proprioceptive functions are in tact
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Often called astereognosis
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relates to learning and how we perceive our world. It involves how an individual encodes, stores and retrieves information. |
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has a recognition of one’s self with regard to time, place, and person within one’s personal environment. |
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a retrograde memory loss for autobiographical information |
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-An active process that helps to determine which sensations and experiences are alerting and relevant to the individual -ability to concentrate our perceptual experience on a selected portion of the available sensory information and, in doing so, achieve a clear and vivid impression of the environment |
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more related to the periphery, preparing the individual to mobilize to attention, and theoretically functions through different neurological systems from attention; a fluctuating condition of the CNS; phylogenetically the earliest of the attentional systems; associated with the frontal and parietal regions of the right hemisphere. |
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-the ability to respond to different kinds of stimulation; it involves direction and orientation, has both physical and mental components, and implies a body posture and orientation appropriate to receiving sensory information and taking motor action; the mind is free of extraneous thoughts, and an effort is made to keep sensory channels open. |
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vigilance; maintaining attention for a long time; the ability to self-sustain mindful conscious processing of stimuli whose repetitive, non-arousing qualities would otherwise cause habituation and distraction to other stimuli; ensures that goals are maintained over time; associated with right hemisphere specialization |
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activating and inhibiting responses selectively; involves discrimination of stimulus information and differentiating responses; helps goal directed behavior and is crucial for perception; ensures that an individual does not perceive a superposition of all stimuli present at a given time in our visual field by suppressing the non-attended stimuli such that only one stimulus is processed at a given time in higher cortical areas |
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Alternating attention→ AKA attentional flexibility. |
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Alternating back and forth between mental tasks (i.e. chopping vegetables while periodically checking food on the stove) |
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ability to do several things at once; requires the ability to allocate attentional resources, switch between tasks that cannot be done simultaneously, and time-sharing of processing resources. |
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the ability to do mental work while attending, the process of active encoding in working memory. |
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the ability to sustain attention over a period of time. Thirty seconds is considered a vigilant period in a mental status examination; a control process that coordinates functional components of attention (alertness, arousal, selectivity) to direct attention to a significant feature of the environment. Note: vulnerable to brain damage. |
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What type of memory: An individual attends to sensory input in the environment depending on his or her interests this is called |
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-May not engage in conversation without it being started for them -May lack spontaneity, be slow to respond and generally show little to no initiative -May be able to plan, organize, and carry out complex tasks, but only when instructed to do so -Often misinterpreted as lack of motivation or drive |
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Temporary storage and manipulation of information
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includes the ability to organize steps to complete an action, prepare for setbacks in carrying out the plan, assemble needed materials, and the skills to carry out the plan. |
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Maintenance rehearsal
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Elaborative rehearsal
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consists of information which can be consciously declared to have been learned or experienced |
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involves information whose learning is only reflected by changes in future behavior as a result of the prior experience without the client consciously remembering the experience itself. |
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memory of nonpersonal events and sometimes episodic (events) and semantic (facts) |
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memory of personal events |
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Nondeclarative (Procedural) Memory |
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Involves unconscious memory ability
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Information that is learned or acquired during the development of skill learning (motor skills, perceptual skills and cognitive skills
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Involves a mixed group of abilities whereby experience alters behavior unconsciously without providing access to any memory context
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Can be motor skills or mental procedures such as performing complex math problems
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Remembering to complete an activity or carry out a task at a time in the future
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Remembering what one intends to do as well as remembering the context of a given task
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Allows individual to carry out an intended action in the future without performing continuous rehearsal of the intention until the appropriate time has occured.
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Two types:
- What type of memory is this and what are the 2 types?
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Time-based prospective memory |
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-Requires attention, ability to devise and initiate a plan, information access, and a feedback system -Requires good impulse control, ability to organize and categorize, mental flexibility, and reasoning skills -Active process, breakdown can occur at any time -Need to understand the problem → the initial representation of problem will determine how quickly an accurate solution can be found -Motivation is key -Must be able to screen out and discard irrelevant info |
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-Viewed as a form of problem solving for which the problem is to choose from several options -More general activity to rectify an unacceptable situation -Factors that influence this are both conscious and unconscious |
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-finding commonalities and assigning objects or events into groups -An individual needs to be able to perceive and utilize perceptual features in order to be successful |
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-Ability to carry out a given plan requires the ability to initiate, stop, and switch actions depending on feedback from the environment related to these actions. |
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Abstraction AKA concept formation; |
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-fundamental to thinking and communication -is the ability to conceptualize and make inferences from information. |
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Clients with poor ______________: have limited imagination, stick to people, objects, and events that catch their eyes at once (concrete or factual fashion), fail to form concepts/generalize, fail to plan ahead, unable to go beyond the immediate situation, have difficulty explaining their ideas, and are unable to analyze relationship between objects and their properties |
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-Client with poor ______________: will have difficulty with mental shifts and will exhibit rigid, inflexible, or perseverative behavior |
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-Client with poor ______________: may lack foresight and sustained attention necessary for achieving goal; can describe in detail the elements but shows poor, unrealistic or illogical plans for himself |
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-Client with poor ______________: may exhibit concrete thinking, impulsivity, confusion as to where to start to solve a problem, difficulty sequencing info, and trouble learning from mistakes and successes. |
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-Client with poor ______________: struggle with identifying various options and determining which options are best |
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-Client with poor ______________: May be unable to use attributes to describe objects; may be unable to use symbolic features |
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-Near transfer→ only one or two task characteristics have changed. -Intermediate transfer→ 3-6 task characteristics are changed; new task shares some physical characteristics of -the original task but are less readily identified -Far transfer→ conceptually similar to the original task but completely different or only shares one surface characteristic -Very far transfer→ generalization or the spontaneous application of what has been learned in treatment to everyday functioning |
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Transfer of learning continuum |
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involves training skills applicable to specific situations. Relates the effect of training specific skills and the extent to which these abilities facilitate or limit new learning. |
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involves the ability to use a newly learned strategy in a novel situation. Therapist can increase this by varying the task elements while simultaneously keeping the organization relatively constant. |
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