Cognitive strategies and metacognition in occupational therapy for a long COVID-19 patient: a single case report

Andrade, Sancler

doi:10.1590/2526-8910.ctoRE265434642

Brasil

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Experience Report • Cad. Bras. Ter. Ocup. 31 • 2023 • https://doi.org/10.1590/2526-8910.ctoRE265434642 linkcopy

Cognitive strategies and metacognition in occupational therapy for a long COVID-19 patient: a single case report

Estratégias cognitivas e metacognição em terapia ocupacional para um paciente com COVID-19 longa: estudo de caso

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction The impact of COVID-19 on occupational and cognitive functioning deserves further exploration since clinicians have observed long COVID and neurological manifestations of COVID-19 long after the remission of respiratory symptoms. Patients with long COVID represent an underexplored population in need of quality occupational therapy interventions.

Objectives (a) present an experience report on occupational therapy for assessment and intervention with this population in a hospital setting; (b) demonstrate how perceived occupational performance and health behavior can be improved by the adoption of cognitive strategies and strategies for changing habits.

Method This was a single-case study of a long COVID patient in a hospital setting. A description of the framework for assessment and treatment is provided. The patient received a total of nine sessions focused on the use of cognitive strategies and metacognition. The data were analyzed descriptively.

Results After exploring guided interventions, the client could create new habits and routines and have perceived occupational performance.

Conclusion This experience report presents a framework for assessing and intervening in long COVID that highlights neurocognition. Prospective studies should evaluate if the effects of the proposed awareness assessment and treatment guidelines are reproducible in other settings and if this approach could be helpful for other COVID-19 survivors.

Keywords: COVID-19; Occupational Therapy; Cognitive Function; Metacognition; Case Report

Tool#1: Activity Measure for Post-Acute Care (AM-PAC)^* * AM-PAC is the Activity Measure for Post-Acute Care (Haley et al., 2004). **The Raw Score for AM-PAC Activities of Daily Living (ADLs) is a scale from (6-24), the higher is the AM-PA (ADLs) the less assistance is needed by the participant to perform the task.	Level of Assistance Needed by J.R.	Raw Score (6-24)**
Bathing (including washing, rinsing, and drying the body)	A little	3
Putting on and taking off regular lower body clothing	A lot	2
Putting on and taking off regular upper body clothing	A little	3
Toileting	A little	3
Personal grooming, such as brushing teeth	A little	3
Eating meals	No assistance	4 Total =18/24

J.R.’s goals	Occupational Therapy goal	Interventions used
“I want to be less clumsy.”	The client will improve perceived occupational performance, evidenced by anticipating errors in the performance and using strategies for successful performance 100% of the time.	Verbal rehearsal of tasks, mental imagery, and verbal feedback on performance to identify strategies, barriers, and facilitators of implementation.
“I want to lose weight and be healthy.”	The client will be able to record most of his current health habits, identify strategies for creating new habits in anticipation of discharge from the hospital, and track small attainable health habits daily.	Use a diary, develop new habits, re-think the home environment, and rely on small and attainable goals to form health habits.

Strategy: verbal mediation	Number of times used in sessions
Day 1	0
Day 3	1
Day 5	5
Day 9	6
Strategy: mental rehearsal	Number of times used in sessions
Day 1	0
Day 3	1
Day 5	1
Day 9	1

Tool#1: Activity Measure for Post-Acute Care (AM-PAC)^* * AM-PAC is the Activity Measure for Post-Acute Care (Haley et al., 2004). **The Raw Score for AM-PAC Activities of Daily Living (ADLs) is a scale from (6-24), the higher is the AM-PA (ADLs) the less assistance is needed by the participant to perform the task.	Level of Assistance Needed by J.R.	Raw Score (6-24)**
Bathing (including washing, rinsing, and drying the body)	No assistance	4
Putting on and taking off regular lower body clothing	No assistance	4
Putting on and taking off regular upper body clothing	No assistance	4
Toileting	No assistance	4
Personal grooming, such as brushing teeth	No assistance	4
Eating meals	No assistance	4 Total =24/24

Habit	Mon	Tue	Wed	Thu	Fr	Sat
Eat fruit	Yes	Yes	No	Yes		Yes
Drink more water	No	Yes		Yes
Do physical therapy	Yes	Yes	Yes	Yes	Yes

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Universidade Federal de São Carlos, Departamento de Terapia Ocupacional Rodovia Washington Luis, Km 235, Caixa Postal 676, CEP: , 13565-905, São Carlos, SP - Brasil, Tel.: 55-16-3361-8749 - São Carlos - SP - Brazil
E-mail: cadto@ufscar.br

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[TFN1] ^*
AM-PAC is the Activity Measure for Post-Acute Care (Haley et al., 2004). **The Raw Score for AM-PAC Activities of Daily Living (ADLs) is a scale from (6-24), the higher is the AM-PA (ADLs) the less assistance is needed by the participant to perform the task.