(MRDC)
Octubre 2014
Autor:
Jorge Valverdi
Doctor en Salud Mental y Adicciones.
USA.
Magíster en Salud Mental
y Adicciones. USA.
Lic. en Terapia Ocupacional en la
Dirección General de Auditoría Médica del Ministerio de Salud. Santa
Fe – Republica Argentina.
Integrante del equipo terapéutico para la atención de personas con
adicciones de la Red de Clínicas Crecer. Santa Fe – Republica Argentina.
Director técnico
centro de rehabilitación psicosocial “UN PROYECTO DE VIDA”- Santa Fe – Republica Argentina.
Introducion:
Durante mas de 10 años me dedique a traducir e investigar al marco
de referencia de la discapacidad cognitiva de Claudia Allen, debido a que no podía
o no era fácil encontrar bibliografía de esta autora en castellano y al ver que
toda la literatura estaba en ingles, decidí traducir en algunos casos una parte
y en otros casi en su totalidad los capítulos de sus libros.
Quiero destacar que este marco de referencia, contempla en primera
instancia la evaluación de la discapacidad, el encuadre del nivel cognitivo
correspondiente en el cual se encuentra el paciente, las actividades que debe
realizar, los cuidados que el profesional debe tener antes y durante la
realización de estas actividades que se lleva a cabo, la cantidad de horas de
cuidado que requiere el paciente de acuerdo a cada nivel cognitivo, entre otras
virtudes.
A modo de aclaración y para no ser reiterativo de otras
publicaciones es que quiero hacer notar que para los niveles inferiores que
oscilan desde el nivel 0 al nivel 3, se debe aplicar lo que se denomina el kit
de estimulación sensorial, dado que por lo general el paciente no esta en
condiciones de hacer el proceso cognitivo correspondiente, no pudiendo
comprender las consignas que el terapeuta le proporciona, en tanto para los
niveles superiores que van desde el nivel 4 al 6, el ACLS o el RTI son una
buena herramienta para detectar la existencia de una discapacidad cognitiva,
fundamentalmente porque pueden responder a las demandas que una actividad
requiere.
Los niveles cognitivos que esta autora utiliza para determinar el
estadio de afectación en el que se encuentran los pacientes son seis, los que se
desarrollan más extensamente, en los siguientes párrafos.
Ø Test del nivel cognitivo / Allen Cognitive Level Test (ACL; Allen,
1985)[1]:
es una prueba estandarizada en trenzado de cuero que puede utilizarse para
examinar y evaluar los niveles cognitivos 4, 5 y 6.
Ø Inventario de tareas rutinarias / Routine Task Inventory (RTI;
Allen, 1985)[2]:
este inventario es una valoración complementaria del ACL, es una medida
práctica de observación de la ejecución, para describir las discapacidades
cognitivas.
Ø Test de ejecución cognitiva (CPT; Allen)[3]:
está compuesto por seis tareas, las cuales pueden observarse a través de ellas,
las capacidades funcionales para una amplia variedad de AVD.
Ø Modulo diagnóstico (ADM)[4]:
es una colección de proyectos de kits de estimulación sensorial y proyectos de
arte usados para verificar la valoración de la capacidad de funcionar, de
aquellos pacientes que se desempeñan en niveles altos (ACL 3.0 a 5.8). Mientras que para
los niveles más bajos se usa la estimulación sensorial (ACL 0.0 a 3.0).
En la actualidad, el modelo de discapacidad cognitiva y las
herramientas relacionadas son utilizadas por los terapeutas que ejercen en
áreas de salud mental, Psiquiatría Forense, rehabilitación física, y geriatría.
Para
poder entender su teoría, es que intente entrenarme de manera casi autodidacta,
dado que los espacios que existen son exclusivamente en los Estados Unidos, en
virtud de que esta autora junto a sus colaboradores anualmente realizan
simposios para poder actualizar conceptos y de esta manera realizar revisiones
de la teoría, por mencionar algunos destaco los siguientes:
Año
2004, días 22 y 23 de octubre en la ciudad de Chicago, symposium-highlights,
con el sponsor de Allen Cognitive Advisors, Ltd. And the Occupational Therapy
Department of Chicago State University[5].
Año
2005, días 07 y 08 de octubre en la ciudad de San Louis, bajo el lema “Cognition
and Occupation-Based Practice - Advances in Theory, Assessment & Clinical
Applications of the Allen Cognitive Levels in Occupation-based Practice”, con
el sponsor de la Allen Cognitive Advisors, Ltd., y los aportes de la Saint
Louis University. Doisey School of Allied Health,
Dept of Occupational Science & Occupational Therapy.
Año 2006, dias 20 y 21 del mes de octubre en la
ciudad de Indianapolis, bajo el lema “A Kinder Way of Caring”, con los aportes
de la School of Occupational Therapy University of Indianapolis Indianapolis,
In;
Año
2007, dias 9 y 10 de noviembre en la ciudad de Akron, Ohio, bajo el lema “Functional Cognition: Supporting and Expanding Clinical Application”,
con los aportes de la University of Akorn, Ohio.
Año 2008, no se cuenta con la información pero si con el resumen
de lo que se llevo a cabo en esa oportunidad:
Año 2012,
dias 01
y 02 del mes de noviembre en la ciudad de San Diego, bajo el lema “Practical Approaches to Promoting Best Abilities to Function”, con los aportes de la School
of Occupational Therapy University of Indianapolis Indianapolis, In.
Año 2012, días 6 y 8 de noviembre en la ciudad
de Redondo Beach – California, bajo el lema “Global Strategies for Integrating
& Interpreting Cognition” con los aportes de la the Allen Cognitive Network
and Advisors.
Por este motivo es que en la actualidad hay innumerables
publicaciones que hacen que este marco sea un poco más descifrable, no porque
sea difícil de entender sino porque luego de haber traducido casi en su
totalidad diversos capítulos de la literatura relacionada con este teoría, se
pudo lograr que otros profesionales también puedan acceder a ella, y de este
modo trasladar este conocimiento a la población que presenta una discapacidad
cognitiva.
Creo que no hay mucho que desarrollar o decir en cuanto a la
bibliografía relacionada con este marco de referencia, porque seria un sin fin
de explicaciones que nunca podría terminarse, es por eso que invito a todo
aquel que quiera explorar este marco e incursionar en lo que se refiere a la
discapacidad cognitiva, para que indague y analice no solo lo que hasta acá ha
escrito Claudia Allen y sus colaboradores, sino a todos los autores que de
alguna manera aportan información para sostener sus concepciones.
Las citas bibliográficas son un compendio de autores que han hecho
aportes a esta teoría, mas allá de que hayan tenido o no relación alguna con
este marco de referencia, en todo caso se han consignado porque de alguna
manera se tomaron opiniones o se han hecho analogías para poder construir
conceptos nuevos, partiendo de teorías o constructos para sentar bases de
conocimiento.
Considero
que para un mejor entendimiento de este marco de referencia, es necesario leer
la literatura publicada por esta autora como por ejemplo: How to
Use the Allen's Cognitive Levels in Daily Practice (1999), Occupational therapy
for psychiatric diseases: measurement and
management of cognitive disabilities (1985), A Study
Guide for Occupational Therapy Treatment Goals for the Physically and
Cognitively Disabled (1993), Occupational therapy treatment goals for the
physically and cognitively disabled (1992); estos
brindan aportes y argumentaciones acerca de porque esta teoría debe ser
utilizada y como es que a lo largo de tanto tiempo sigue vigente, si se tiene
en cuenta de que han pasado mas de 40 años y aún continua actualizándose, dado
que del mismo modo que tanto la ciencia como la tecnología avanza, debe
avanzarse en la evaluación, el tratamiento y en la comprensión de la
discapacidad.
Lo invito entonces a analizar la propuesta bibliográfica que a
continuación se consignan.
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