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Monday October 15, 2012


World-renowned for her expertise in rehabilitating people with cognitive perceptual deficits, Joan Toglia, OTR, PhD, professor and director of the graduate occupational therapy program at Mercy College in Dobbs Ferry, N.Y., continues to write the book on treating individuals with neurological dysfunction. For more than 25 years, Toglia has been researching, publishing and reporting her findings to international audiences, providing a glimpse into the world of neurological impairments through lectures and workshops. In the past year alone, Toglia has presented in Buenos Aires, Argentina; Tel Aviv, Israel; Hong Kong; and Saskatchewan, Canada.

How did you get into the area of cognitive perceptual dysfunction?

When I graduated in the early ’80s, I began working at Helen Hayes Hospital [West Haverstraw, N.Y.], a rehab facility with a traumatic brain unit. The focus was on physical rehabilitation, but often when you have a traumatic brain injury, cognitive difficulties are contributing to the dysfunction. In many cases, these difficulties were not known. I did a master’s degree in cognitive educational psychology because I wanted to learn more to help the patients I had at the time.

My work has been around a while — I started publishing in the late ’80s and [my research] has been in the literature and gradually continued to expand through the years. In the early ’90s, I proposed a theoretical framework [the dynamic interactional model of cognition] that’s been popular and integrated into different texts by many different authors.

Joan Toglia, OT
What are some components of a dynamic assessment and a multicontext approach?

We’re looking at performance, which is an integration of several skills, and trying to look at the impact of those skills on that performance. For instance, in a task that involves multiple errands: Are they completing them, following the list and obeying the rules? It’s more of a real-life performance where you’re not giving cues or helping. I’m investigating the strategies the client is using.

Is there growing interest in this topic?

Yes, there is, across disciplines because the research coming out has consistently identified that even mild problems with cognition can impact someone’s quality of life, even six months after an injury. There’s lots of evidence that cognitive difficulties relate to participation, functional outcomes, quality of life — to many important indicators in rehabilitation.

Initially, most work done was surrounding traumatic brain injury. We’re now seeing research across diagnostic categories, such as in young adults with developmental disabilities, in autism, in people with schizophrenia, and across the lifespan as well.

Describe your recent international presentations.

In Buenos Aires, I went to the FLENI Institute and commented on a case before an interdisciplinary audience. In addition, I did a workshop for occupational therapists on the topic of perceptual difficulties in a person who’d had a stroke. In Hong Kong, at an interdisciplinary conference I was part of a panel discussion on clinical cases and did a two-day workshop on executive function, an area of cognition that has to do with the ability to organize, plan, coordinate, think flexibly and use strategies. Also in Hong Kong, I went to the Polytechnic [University] and spoke with students about subtle cognitive difficulties. As part of an interdisciplinary conference in Israel, I presented with two Israeli therapists on an assessment tool where they were collecting data, and I was collecting data and we did a comparison of the Israeli versus the U.S. performance on the tool.

What are the latest approaches?

The intervention and assessment approaches are the same, but there’s more understanding about cognitive difficulties and the ability to recognize them early. Traditionally, most of the focus on cognitive impairments was geared toward people with more significant difficulties, but during the past decade there’s been more recognition of the impact that even mild deficits can have on function and participation, so it’s more of an expansion across the different diagnoses, and having high enough levels of assessment to be able to address those people with mild deficits.

How do OTs work with other disciplines in this area?

Cognition is something that goes across all disciplines — it’s important for any diagnostician to understand cognitive symptoms. Our different specialties have different goals, so I believe that working as a team, we should understand cognitive symptoms and work on strategies in our specialty areas to help the patient cope.

Where should OT students go for the best education in this area?

If a student is interested in post-professional degrees he or she has to look at a school’s faculty and who’s publishing and presenting in these areas. All facilities with a traumatic brain injury unit will have a special cognitive rehabilitation program. There are institutes in many different countries — Canada, Israel, Sweden, Hong Kong — that have done a lot of work in these areas.

Some basic master’s degree programs, such as Mercy College, have a separate course that focuses specifically on cognition, while other programs address it throughout the curriculum. Program areas of study at a doctoral level in OT typically have a broad focus such as neurorehabilitation, mental health, or rehabilitation science ... while others include it as a separate course.

What about working OTs?

I think there are some key books in the field now on cognition as well as journal articles. There are a lot of resources out there by the American Occupational Therapy Association, and there’s a text called "Cognition, Occupation and Participation Across the Lifespan" that’s a key foundation for anyone interested in this area. There are many different types of continuing education workshops and courses. •

Robin Huiras is a freelance writer.

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Monday October 15, 2012
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