Tag Archives: cognitive rehabilitation

09.22.13 — Talking about cognitive rehabilitation with problem solving strategies

The following was my attempt to organize thoughts/strategies/approaches about cognitive rehabilitation strategies for working with an adolescent.
“Just in quick follow-up to our conversation earlier today, I wanted to send some examples of problem-solving strategies for your consideration. As we discussed, using a strategy-based approach has advantages for the learner, and can potentially support how we define the goals in structured/measurable ways.

I do place a high personal value on applying/modeling these kinds of strategies regardless of whether or not they are targeted/explicitly taught goals, particularly for any (a) young child, (b) individual with language difficulties, and (c) individual with social-pragmatic issues. To these groups, the problem-solving that the rest of do may well appear magical (or that we don’t have problems). Because often adults just manage difficulties discretely or out of sight, or because these populations already have difficulty interpreting language or social cues involved, the actual steps that are happening to cope with a problem are not identified and learned unless explicitly taught. So I did a lot of think-alouds for both actual and manufactured problems. Even for simple stuff — “Oh man! My pen ran out of ink. I wanted to use this pen. That’s frustrating. Okay, I’m flexible. What else do I have? I can use a pencil instead.”

Anyway, the following are some published ideas. I think you will notice similarities among different approaches overall, even with the different acronyms.

A problem-solving approach Dr. Janice Light and Dr. David McNaughton used with the AAC Mentor Project was summarized by the acronym, “Do It!”

Describe the specific problem or goal and explain why this is a problem or a goal
Outline lots of different ways to solve the problem or meet the goal
Identify the consequences of each plan and choose the best plan
Take action
! Celebrate success when the problem is solved or the goal achieved

Phelps-Teraski & Phelps-Gunn (2007) developed their FOCUS strategy based on Norris & Hoffman’s language model (situation-discourse-semantics, or SDS); this was primarily around helping individuals negotiate pragmatics (social dynamics), but certainly could be shaped more broadly around problem solving/emotional regulation:
F: Figure out what you want to say
O: Observe the partner and situation
C: Communicate message
U: Use your eyes, ears and brain to decide if message got expressed appropriately
S: Self-correct, if needed.

If you search using FOCUS under the Resources (password: “m4ter14ls”), the one with “Literacy Modifications” is based off of an actual activity I used years ago (which is why the icons are owls — that was the mascot of the school I worked at then), modified to sort of work as a shared reading piece: some decodable and sight words have been highlighted, although Client may be able to read substantially more than just those. I tried to use both sides of the conversation — one could be used as an example/model, the other for more of a guided practice.

The SPACE Storytelling Outline is from Social Problem Solving: Making Best Plans by K. Noel, 2013, The Chippewa Falls, WI: The Cognitive Press. (c) 2013. In this case, it is structured around story comprehension, but could also be used for problem solving/coping/communication in other ways.
S: Setting = Who is involved? When does it happen? Where does it happen? What’s going on?
P: Problem = What is the problem? How do the characters feel? What do the characters need or want?
A: Action = What did the character do?
C: Consequence = What was the result of the character’s action?
E: End / Evaluation = How did the story end? What was the lesson learned? How do you feel in response to the story?

Also under the Resources is a set of bookmarks (slightly blurry) using this acronymn — search under SPACE bookmark for comprehension.

Singer (2013) summarized a problem-solving approach with EMPOWER:
Evaluate
make a
Plan
Organize
Work
Evaluate
Re-work

This one feels the most contrived to me since the “M” is “Make a” and does not stand on its own.

Finally, Larson (2013) recommends the following for adolescents who may respond to problems/frustration with an emotional reaction (such as anger or abandonment/giving up), or be impulsive and guess; summarized by Stop-Plot-Go-So:

Stop: I can stay calm by [insert personal strategy].

Plot: My problem is: [identify and label], My options are: [identify and list], Consequences of each are: [identify and evaluate], My choice is: [select one]; social-emotional skills I need are: [identify and label; e.g., to be calm and think things through, to find help, to draw, etc.]

Go: What can I say or do so I actually use my plan?

So: How did my plan work?

Certainly there are others and these all take a broad view of problem solving; that is, the idea that knowing a generic strategy can support/structure across a wide range of concerns. There may be reasonable arguments in favor of a more narrow view: spending time assessing with observations, interview, review of work portfolios, etc. for trends which identify specific concerns. These might include (but are not limited to): (1) paying attention, (2) remembering what he is supposed to do specifically, (3) applying what he is supposed to do with purpose (e.g., not guessing), (4) comprehending the sequence of a situation (social or academic), (5) making plans to set goals or solve problems, (6) making appropriate choices, & (7) self-monitoring/awareness.  There may be much more effective interventions directed towards the unique demands of these needs/concerns.”

End blip.