Functional Model of Cognitive Rehabilitation (FMCR)
The Functional Model of Cognitive Rehabilitation (FMCR) applies general concepts from the Canadian Model of Occupational Performance (CMOP). It aims to complement to the CMOP for choosing, organizing, and performing useful and perceived meaningful occupations in order to addresses the cognitive performance component. In the CMOP, the cognitive performance components include perception, concentration, memory, comprehension, and judgement. The FMCR recognizes the dynamic interaction between clients and their environments (physical, cultural, and social). For example, it considers the progression of various rehabilitation settings (coma care, intensive care/medical care, inpatient rehabilitation, outpatient community clinic, in-home/vocational rehabilitation, independence in community settings with occasional support). Treatment shifts from remedial approach to functional approach along the recovery, and metacognitive intervention is included along with traditional remedial and functional treatment after intensive care stage. Cognitive rehabilitation begins at coma care, by using coma stimulation. At the acute/intensive care stage, therapists prescribe activities with appropriate stimuli to facilitate orientation. The inpatient rehabilitation program includes activities initially in a simulated environment, and later transit to natural environment such as at home and in the community. Cognitive rehabilitation in outpatient clinic mainly focuses on functional area in ADL, work/education, and leisure. At the last stage, therapists support and assist clients in learning and using problem solving skills in novel and overwhelming situations, and responding to crisis. The FMCR also considers the external environmental factors (physical, institutional, social environments) and client related factors (personality, values, cultural background, previous experiences, and motivation). It uses client-centered approach to facilitate clients in regaining or achieving their meaning occupational goals.
Domain of occupation
Except being a facilitator who provides guidelines, cues, advice, and feedback, therapist also has a role in providing emotional support to clients during the process.
Lee, S. S., Powell, N. J., & Esdaile, S. (2001). A functional model of cognitive rehabilitation in occupational therapy. Canadian Journal of Occupational Therapy, 68, 41-50.
The Allen’s Cognitive Disabilities Model (CDM) emphases on the integration of the cognitive functional ability and the level of activities that clients are able and willing to perform. Interventions using this model can take place individually or in group. When implementing the intervention, therapists consider each client’s needs and implement changes in task accordingly. In group sessions, each client’s cognitive mode of performance is considered individually and adapted to the modified task with appropriate level of required cognitive functional ability.
The dynamic interactional model of cognitive rehabilitation emphasizes that cognition is a continuous product of the dynamic interaction between the individual, task, and environment. Individual factor includes structural capacity (including physical limitation), strategies (including organized approach/routine/tactics), metacognitive processes (knowledge and regulation of own cognitive processes and capacities) and learner characteristics such as motivation and knowledge. These individual factors interact with other factors during information processing and learning.
The Canadian Model of Occupational Performance and Engagement (CMOP-E) is an occupational performance model, which is evolved from the Canadian Model of Occupational Performance (CMOP). The CMOP-E includes three main components: person, environment, and occupation. In this model, the inner part represents “Person”, and its center is the spirituality of a person. The other components surrounding a person’s spirituality are affective, physical, and cognitive abilities.
Rehabilitative frame of reference (FOR) considers rehabilitation as the process of facilitating patients in fulfilling daily activities and social roles with competence. This FOR is used with clients whose underlying impairments are unlikely to remediate and be considerable permanent, or the clients who lack motivation to participate in remediation. The theoretical basis of this FOR is that the client must focus on the remaining abilities, despite of any disabilities, to attain his/her highest level of functioning in the desired occupational performance.
This model aims to facilitate occupational therapists in accessing clients’ mind as an instrumental tool for occupational functioning and adaptation to the environment. It consists of three phases across 10 steps.