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Cognitive Approach

Part 1: Biological Perspective

The human brain is an incredibly complex set of connections that are constantly changing and unique to every individual. Mapping the connections throughout the brain into functional areas that provide the required information for the reconstruction of a human brain is currently unachievable. However, when we consider the functions, the brain provides these functional areas to become more comprehensible.

The function of a human is dependent on the conscious and subconscious processes spearheaded by the connections of the nervous system to the brain. Every task begins with a response from a functional component of the body. It is when these components are unable to function within the best interest of the individual, they encourage development of functional limitations identified throughout all disability. 

The actions completed daily consist of a distinctly unique process for every individual due to the neuroplasticity of the brain. Individuals formulate different neural patterns and networks which form the blueprint of how they initiate, process, and respond within cognitive processes.  

Part 2: Conceptual neuroplasticity perspective

Consider a human lifeform, born within a vacuum. This human lifeform has a neurotypical cognitive functioning represented as the anatomical equivalent of the brain. Additionally, this lifeform is self-sustaining and does not require passive or active cognitive input for ongoing functioning. The vacuum is absent from any source of stimulation internally and externally.

In this case neurons serve no purpose as there is no requirement for the function for the brain and therefore no need for neural connections. Therefore, the lifeform is unable of active and passive cognitive thought. The most basic form of cognitive thought is represented as sensory input and without a capacity to process this an individual is unable to generate cognitive thought. This is since the individual is unable to have any experience and awareness of any kind which is reflective an individual without consciousness.

Now when we consider the application of a singular sensory input for this individual it becomes their entire conscious. Examples of how this would be considered if inputted into the self-sustaining lifeform this singular thought would make up 100% of the cognitive function: 

  • Visual: A black vacuum (the only vision)
  • Auditory: A static hum (the only sound)
  • Olfactory: A smell of charcoal (the only smell)
  • Gustatory: A sweet taste from glucose extract (the only taste)
  • Tactile: A coldness against the skin (the only feeling)
  • Proprioceptive: 
  • Vestibular: Gravity (the only force)

This singular cognitive thought would be processed as a singular neural connection. 

When this concept is applied and scaled it can address all elements of human function which enables the quantification of cognitive thought. 

Part 3: Task application (Comprehensive Occupational Task Analysis Tool - COTAT)

COTAT was developed as a framework to interpret occupational component consistencies as a basis for adaptive task analysis. COTAT utilises the initiator, process, and response cognitive framework to break down combinations of thought into singular considerations. By doing this, patterns for how these thought combinations are processed will emerge. Thought combinations are categorized into the domains defined in the (framework) based on the cognitive domains of the DSM-V. 

This enables the identification and predictability of strengths and limitations for any occupation. 

The clinician must observe the individual completing these set of tasks and utilise the computational analysis described in part 2 to determine the effectiveness of the individual in each of the areas. This enables a universal assessment that can applied to every occupation which means assessment can have relevance to any individual at any time, anywhere without any cost. 

This type of assessment would typically be discussed to have a margin for error that would be too considerable between different therapists delivering the services. This is why the therapist has standardised collections of how the majority of people may complete a task within a contextual framework. As the database of assessments completed within the COTAT framework grows the reliability and validity increases as more unique individuals are sharing their process for completing different activities. The therapist must also complete a range of occupation assessments to categorize an individual to fit a profile to fulfil two functions:

  • Identify the limitations the individual experiences for diagnosis and assessment of function.
  • Determine the most suitable clinical intervention to provide the most benefit to the individual.

Both purposes fall outside of any bias the therapist may carry in their judgement of clinical intervention and is solely based on what the individual identifies to have the greatest impact within their life. 

1. Active cognitive thought (Occupational Thought Network)

The thoughts individuals have daily can be divided into similar chains of cognitive thought when considered more generally. 

Tasks can be broken down into fundamental types of different cognitive thought that contain combinations of cognitive components. Each of these different combinations reflect what are described as different task components.

Three fundamental groups for cognitive thought component categorisation:

  • Task component: Combination of multiple cognitive thoughts
  • Sequential Task: Combination of task components typically categorised together into a sequential step.
  • Activity: Combination of sequential tasks in a particular order categorised together

2. Task Components

Renewed understandings for cognitive ladder

Cognition: 

Sensory: Individuals have sensory sensitivity with a genetic component, capacity to filter different sensory stimuli and a threshold for further stimulation into cognitive thought chains. 

Conceptually this can be represented like a helmet where different individuals have different shapes and sizes each with a unique size for gaps. The shape and size reflect the total cognitive thought capacity dedicated to processing cognitive thought. The gap reflects the amount of sensory information within impact ratios for the seven senses (Visual, Auditory, Olfactory, Gustatory, Tactile, Proprioception and Vestibular)  that can pass through at one time. 

When a force exerts pressure from the outside / inside this is reflective of the sensory information passing through this gap with larger items taking up more of the total cognitive thought. This singular force is considered the relative sensory impact value, examples include; sound amplitude, touch pressure, colour contrast etc. that reflect the applicability of sensory assessments. 

When applied to language and communication this threshold remains dependent on neuroplastic developmental milestones however, the impact ratios can increase / reduce depending on the environmental exposure to the type of sensory stimuli. An outside force is considered receptive communication which reflects how much the individual can see / feel / hear etc. from their helmet and an inside force is considered expressive communication which reflects how much the individual can express through sensory information. 

Identification:

  • Static: Thought association to a particular object
  • Dynamic: Thought association to an object that is moving projecting a time component as relative position is changing

Movement:

  • Independent: Movement not influenced by any other apparent objects. E.g. Walking, scratching oneself
  • Dependent
    • Direct: Movement towards something in an endeavour to interact with it. E.g. Reaching for an item
    • Indirect: Movement impacted by an external factor without directly interacting with the external factor. E.g. Movement away from a loud noise, gestures within the communication. 
  • Manipulation: Movement that changes the object through altering it in some way. E.g. Writing with a pen, opening of pants holes
    • Self: Movement that changes an object relative to self. E.g. Completion of dressing activities
    • Relative to another object: Movement that changes respective to two objects.
2.1 Sequencing (Memory)

Sequencing is the combination of different memory components with differences in complexity related to the difficulty of the sequence.

  • Working Memory: Information is dynamic and random within the situation
    • Identification for short term storage: Thought process for a need to store the information.
    • Commit to short term storage: Thought repetition for the information stored in the identification process.
  • Implicit Memory: Process for steps follows a known static routine without adaptation (Any adaptation should be supplemented for episodic memory)
  • Episodic Memory: Process for steps follows a static sequential set however, there are relative fluctuations about what the familiarity with each of these steps.
2.2 Planning (Procedural Memory)

Planning is one’s capacity to utilise procedural memory for different outcomes. The initial instance and the desired instance then the relative time between the two instances. This process can be thought of as an individual’s capacity to predict future thought based on instances from their history. Therefore planning can be broken into three categories:

  • Definitive Procedural Planning: This is planning that relates to certain associations an individual may have that relate to an explicit understanding (e.g. knowing certain types of food need to be cooked before consumption) and implicit implementation as a process related to a definitive outcome (e.g. holding your breath before going underwater, preparing to catch a ball). 
  • Familiar Procedural Planning:  This is planning that relates experiences based on a combination of episodic memories that follow a similar workflow (e.g. knowing how long to put a timer on when cooking and choosing when to avoid different traffic times).
  • General Procedural Planning: This is planning related to unfamiliar items. These can be conceptualised as an individuals ‘goals’. These are items that correspond with a higher level of reasoning (e.g. planning to run a marathon or purchasing a new house). The events are based on experiences the individual has limited familiarity. 
2.3 Problem Solving

Problem Solving is the process of combining historical cognitive thoughts to create a new which is the desired solution. This can only come through a historical match where components of the cognitive thought are collected to apply to problem solving process. Problem solving processes are stored and can guide the process applied across a variety of different historical circumstances. 

2.4 Decision-Making

This is how the individual collects all the information throughout the cognitive process to formulate a cognitive response. These responses correspond with a start, maintain, or stop action.

2.5 Communication

This is considered a combination of the specifications within language as a part of the cognitive thought construction. 

Communication is sorted into relative levels of complexity:

  • No emotion: Communication dependent on singular sensory inputs such as an audio sound or visual input.  
  • Emotion: Communication that involves emotional components for singular items. This consists of multiple sensory input component integrations together. 
  • Emotion analysis: Communication that involves utilizing the environmental information available to the individual to express / understand the receptive communication – Historical Emotion

Receptive

Initiators

Responses

Non contextual responses 

Following instruction: This is an understanding of what is said to promote a unique cognitive thought stream. Integration of receptive language into another cognitive thought stream. 

Autism

  • Description: Rigid cognitive thought structure which reflects reduced cognitive flexibility to formulate creative thought. Either low sensory threshold, high impact ratios or both with varying intensity and impact. 
  • Types:
    • Level 1
    • Level 2
    • Level 3

Dementia

  • Description: Deterioration of supporting cells including astrocytes and oligodendrocytes responsible for neurotransmitter release informing function and history of cognitive thought for neuroplasticity and development. Variations of dementia are categorical of this process occurring in different functional regions throughout the brain. Causation is when the limit of telomers responsible for maintaining consistent DNA replication during mitosis causes mutation of the supporting cells and inevitably force neurons into a dormant state. 
  • Types:
    • Alzheimer’s
    • Early Onset Dementia 
    • Fronto-Temporal Dementia 
    • Mild / Moderate / Severe variations of Dementia

Intellectual Disability

  • Description: Reduced processing speed between neural connections through axon terminals required for all neural neural functions. Different intellectual disabilities are a result of the variations on this neural connection at micro and macro levels impacting specific neuron functions and functional areas. This applies to global developmental delays vs developmental delays and causation includes impaired function of oligodendrocytes storing cognitive thought history at axon terminals, neuron soma release from different excitatory and inhibitory neurotransmitters and action potential discharge across the synapse. 
  • Types:
    • Down syndrome: Micro  – A genetic mutation with the addition of an extra chromosome 21 within the DNA disrupting neurotypical developmental milestones. 
    • Fragile X Syndrome: Micro – Absence of Fragile X Messenger Ribonucleoprotein required which restricts the capacity to form appropriate connections between oligodendrocytes required for learning. 
    • Prader-Willi Syndrome: 
    • Rett Syndrome
    • Foetal alcohol Syndrome: Result of 
    • Mild / Moderate / Severe / Profound Variations of Intellectual disability

Oppositional Defiant Disorder (ODD)

  • Description: Environmentally developed disorder as a result of exposure to positive / negative experiences with collections of objects recognised as different individuals. This is a result of historical cognitive thought within neuroplasticity with an emotional release reflecting the benefit / detriment to the individual across different circumstances. Individuals with ODD have higher rates of neurotransmitters typically associated with anger, spite etc.

Dystonia

  • Description: Caused when cognitive thought chains (white matter) concerning movement fail to be processed as thought outcomes (gray matter) and signals travel directly to the limbs throughout the body. This can impact singular cognitive thought chains recognised in focal dystonia or have a wider global level with generalized dystonia. 
  • Types:
    • Generalized Dystonia
    • Focal Dystonia
    • Multifocal Dystonia
    • Segmental Dystonia
    • Hemidystonia
    • Huntington’s Disease: 
    • Stereotypic Movement Disorder

Tic Disorders

  • Description: Caused as a result of stimulation of cognitive thought patterns closely linked by similarity to thoughts containing specific repetitive associations. This can be stimulated by an impaired neurotransmitter release causing cognitive chains to automatically pass through the brain stem to other areas of spinal column and Peripheral Nervous System. 
  • Types:
    • Chronic Motor or Vocal Tic Disorder
    • Transient Tic Disorder
    • Tourette’s Syndrome

Mental Health Disability

  • Description: Deterioration of supporting cells including astrocytes and oligodendrocytes responsible for neurotransmitter release informing function and history of cognitive thought for neuroplasticity and development. Variations of dementia are categorical of this process occurring in different functional regions throughout the brain. Causation is when the limit of telomers responsible for maintaining consistent DNA replication during mitosis causes mutation of the supporting cells and inevitably force neurons into a dormant state. 
  • Types:
    • Alzheimer’s
    • Early Onset Dementia 
    • Fronto-Temporal Dementia 
    • Mild / Moderate / Severe variations of Dementia

Intellectual Disability

  • Anxiety Disorders
    • Description: Caused by a genetic predisposition to neurotransmitter release through an alteration of ratios in supporting cells (Global reflection). Variations in neurotransmitter release through correspondence with specific cognitive thought chains. 
  • Types:
      • Generalised Anxiety Disorder:
      • Panic Disorders: Caused as a result of neurotransmitter overstimulation of multiple cognitive thought chains containing similar emotional responses. The individual must force its brain to engage in cognitive thought without the neurotransmitter combination present. 
      • Specific Phobias: Caused as a result of amygdala fight and flight accelerated neurotransmitter release connected to an association with a specific cognitive chain. This connection can be through objects, sensory stimuli, movement etc. 
      • Obsessive Compulsive Disorder: Caused through a negative environmental association with unpredictability in historical thought where the individual has attached negative outcomes with certain preventative measures. These preventative measures are alternative cognitive thought streams that take the form of compulsive behaviours to reduce neurotransmitters causing anxiety. 

Bipolar Disorder

  • Description: Result of abnormal functioning of the emotional network in the distribution of different neurotransmitters. This is coupled with the astrocyte-oligodendrocyte connection storing the history of cognitive thought within respective emotions. Within bipolar disorder the oligodendrocytes responsible for development are more frequent in changing cognitive thought selection in different periods (this accounts for fluctuations between manic and depressive systems). The neuron function additionally has causal effects on the neural network in function which can account for positive symptoms (hallucinations – sensory impact, delusional thought – semantic impairment etc.). Oligodendrocytes have an important role in life transitions for inhibitory (depressive) and excitatory (manic / hypomanic) periods regulating the neurotransmitters at each cognitive thought connection. However, when this is not controlled fluctuations are not contained in a neurotypical development model and result in major depressive and manic episodes. 
  • Types:
    • Bipolar type 1: 
    • Bipolar type 2
    • Cyclothymia

Dissociative Disorders

  • Description: Impaired connection of historical thought that inform a consistent 
  • Types:
    • Dissociative Amnesia 
    • Dissociative Fugue 
    • Depersonalisation Disorder 
    • Dissociative Identity Disorder

Paranoia

  • Description: The result of a person associating cognitive thought chains with anxiety causing neurotransmitter release. 
  • Types:
    • Paranoid Personality Disorder 
    • Delusion (paranoid) disorder 
    • Paranoid Schizophreniaa

Psychosis

  • Description: Result of cognitive thought chains that are sent from white matter to gray matter that are not processed as external stimulated thought as opposed to internal stimulated thought to the cognitive thought channels. This causes a discrepancy between what the brain considers as conceptual (internal) and factual (external) which makes it difficult for individuals to differentiate. 
  • Hallucinations: Result of impairment of cognitive thought chains that are involved in sending sensory information to the receptors at sensory terminals (eyes, ears etc.). This function is important for triangulating distance from objects, filtering out different stimuli etc. In psychosis a cognitive thought chain sends the reverse of what is typically received from the sensory receptors to the gray matter where the information can be filtered. These thought chains are then processed normally and the individual forms typical associations with these objects. The major difference between people who experience psychosis and others is cognitive thought associated with the hallucination triggers a sensory response that consumes the active cognitive thought. For others this would be typically recognised as visualising an object or describing a person’s voice etc. 
  • Types:
    • Brief Psychotic Disorder 
    • Delusion Disorder 
    • Schizoaffective Disorder 
    • Schizophreniform Disorder 
    • Schizotypal Personality Disorder 
    • Shared Psychotic Disorder 
    • Paraphrenia 

Depression

  • Description: Result of repetitive cognitive thought chains that have high correspondence with negative excitatory neurotransmitters (neurotransmitters that send signals that result in the release of inhibitory neurotransmitters) and inhibitory neurotransmitters. Due to the component of neural decay, cognitive thought is consumed by “depressive thoughts” and individuals have variations in length and impact of depressive episodes. Episodes can be triggered by a drastic fluctuation as the neurotransmitter release ratio dynamically changes based. 
  • Types:
    • Clinical Depression / Major Depressive Disorder
    • Dysthymia / Persistent Depressive Disorder: Oversupply of neurotransmitters within ratios that release the depressive associated neurotransmitters. 
    • Seasonal Affective Disorder: Cognitive thought association to similarities between sensory stimuli that relate to historical thoughts that correspond with a depressive neurotransmitter release. 
    • Postpartum Depression: Result of increased neurotransmitter release from the excitement of creating life for preparation to a sudden fluctuation to inhibitory neurotransmitters causing depressive symptoms. 

Schizophrenia

  • Description: Result of an alternative reality being created through a failure to differentiate between conscious thought and subconscious thought. This can be imagined as an individual planning their communication, visualisation of a person or place or the correct ways to behave in different environments. For an individual with schizophrenia the same cognitive thought patterns individuals use to visualise, plan communication etc. are undirected by active cognitive thought which causes the individual to perceive these cognitive thoughts as a secondary reality added on top of their current reality. Schizophrenia has a global impact specific and unique to individuals dependent on their cognitive thoughts. 

Motor Neuron Disability

  • Description: Motor neuron disease is caused from the results of impaired connection between the cerebrum, brainstem and cerebellum required for sending communications to the associated organs. This is reflected through a loss of neural feedback between the original cognitive thought signal (sending) and the cognitive thought response (receiving). Upon the receival of the response the brain believes the function has been achieved therefore, the only treatment is brain retraining through insight. Insight enables some control over cognitive thought patterns as a process of learning and remodelling existing cognitive thought chains to have new flexibility. 

Cerebral Palsy

  • Description: Static reduction in sending and receiving responses from the cerebrum to the spinal cord which has multiple implications for neurological development. With a variety of different signals and a unique static reduction in sending and receiving responses for each of these signals there results in a range of variations of cerebral palsy. Issues in the generation of cognitive thought outcomes reflects more global impacts in muscle spacity whereas impact on specific limbs is the result of the capacity to send / receive the unique signal to an area. 

Multiple Sclerosis

  • Description: In MS, the immune system attacks the protective sheath (myelin) required to accelerate and modulate neural connections in cognitive thought. This typically results in cognitive thought to travel in paths of greatest ease for similar cognitive thoughts which reflects the gradual decline in function and loss of coordination. Continual destruction of the disease can cause permanent damage or deterioration of the nerve fibers.

Parkinson’s disease

  • Description: Result of motor impairment of passive cognitive thoughts related to movement (facial expressions, body posture, repetitive movements etc.). 

Pain / Chronic Pain:

  • Description: Opioids typically used for the treatment of pain cause a global inhibitory effect directly interacting with astrocytes connected to the cerebrospinal fluid for nutrient acquisition. This overrides the emotional network informing neurotransmitter release and forces inhibitory release. This same collection of neurotransmitters is fired concurrently until the effects wear off and are stored as unknowingly as historical cognitive thought with a relative ease of access. The brain seeks any stimulant / narcotic as it assists in the neural connections which causes addiction.