The MultiContext Approach - Press Here for MC Book
Listen to the AOTA PodCast on Everyday Evidence: The Multicontext Approach (11/22)
The MultiContext (MC) Approach provides a framework for promoting strategy use and online awareness of performance (eg. self-monitoring) across everyday activities. It was developed to provide occupational therapists with guidelines to help people who experience cognitive lapses or symptoms that interfere with daily life.
The MC approach helps people generate and use cognitive strategies to manage, regulate, or control cognitive performance errors and cope with cognitive challenges within functional activities, using guided learning methods. The initial focus of treatment often involves enhancing online awareness of performance. This includes helping a person recognize and fully understand when and why performance errors tend to emerge so that they can then use effective cognitive strategies to prevent, monitor, and adjust to performance challenges. Methods (strategies) that promote success and empower a person to stay a “step ahead” or solve problems that occur during performance, foster and build cognitive self-efficacy.
The MC approach integrates metacognitive and cognitive strategy intervention methods and draws upon literature on learning, transfer, and generalization (see selected publications). Guided questions to promote self-monitoring and efficient strategy application are used across different functional activities and situations. Explicit methods to help a person recognize connections between treatment sessions and everyday life activities are also utilized.
The MC approach can be classified as a metacognitive strategy intervention due to its focus on self-awareness, self-monitoring, and self-regulatory skills. Metacognitive strategy training is recommended as a Practice Standard for deficits in executive functioning following traumatic brain injury and stroke. (Cicerone et al., 2019).
Below is an outline of the Key Aspects of the MC approach. Activities within each session are embedded within a metacognitive framework; at the same time, the treatment program is structured horizontally to enhance the transfer of learning. Mediation or guided questions are used to empower a person to generate their own strategies or solutions for challenges (see VIDEO of a simulated treatment session (video is also at bottom of page). See slides of sample MC treatment modules
Strategy Training beyond a specific task: Focus on Metacognitive Skills
•Anticipation
•Error Detection
•Error Correction
•Strategy Generation
•Self-Evaluation
Key aspects of the MC Approach include:
Focus on developing, generating, selecting, or using strategies to cope with and manage cognitive performance challenges.
Functionally relevant or meaningful activities
Horizontal Continuum — Wide range of activities with similar characteristics and demands to promote repeated practice of strategy. There is a focus on transfer/generalization or explicitly helping clients make connections across activity experiences
Metacognitive Framework and use of mediation or guided questions to promote executive function.
Focus on increasing cognitive self-efficacy
Goals of the MC Approach include:
Enhancing understanding of cognitive strengths and weaknesses
Increasing ability to anticipate, detect or correct errors and spontaneously self-check or monitor cognitive performance
Helping people effectively use cognitive strategies to:
- Encode, process and integrate information needed for learning, remembering and successful task completion
- Self-manage cognitive lapses, performance errors or cognitively challenging activities
- Transfer strategy use across activities
- Generalize strategies to everyday life or novel situations
Who is the MC Approach used with?
The MC approach was initially developed for adults with cognitive impairments as a result of neurological disorders such as stroke, traumatic brain injury, brain tumor, Multiple Sclerosis, Parkinson's Disease and Mild Cognitive Impairment (MCI).
The principles of the MC approach are general and have also been applied to populations with executive function deficits including Long COVID, schizophrenia, ADHD and learning disability as well as clients with spatial neglect.
See selected publications
PRESS ON ARROW BELOW for VIDEO
VIDEO: A Simulation of 2 MC Treatment Sessions
Examples of Recent Articles describing use of the Multicontext Approach
Andrade, S. (2023). Cognitive strategies and metacognition in occupational therapy for a long COVID-19 patient: a single case report. Cadernos Brasileiros de Terapia Ocupacional, 31, e3464.
Foster, E., & Toglia, J. (2024). Effect of the Multicontext Approach on Functional Cognition in Parkinson Disease: Pilot Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 105(4), e15.
Nagelkop, N. D., Rosselló, M., Aranguren, I., Lado, V., Ron, M., & Toglia, J. (2021). Using multicontext approach to improve instrumental activities of daily living performance after a stroke: a case report. Occupational Therapy In Health Care, 35(3), 249-267.
Jaywant, A., Steinberg, C., Lee, A., & Toglia, J. (2022). Feasibility and acceptability of the multicontext approach for individuals with acquired brain injury in acute inpatient rehabilitation: A single case series. Neuropsychological Rehabilitation, 32(2), 211-230.
Jaywant, A., Mautner, L., Waldman, R., O’Dell, M. W., Gunning, F. M., & Toglia, J. (2023). Feasibility and acceptability of a remotely delivered executive function intervention that combines computerized cognitive training and metacognitive strategy training in chronic stroke. International Journal of Environmental Research and Public Health, 20(9), 5714.
Toglia, J., Lee, A., Steinberg, C., & Waldman-Levi, A. (2020). Establishing and measuring treatment fidelity of a complex cognitive rehabilitation intervention: The multicontext approach. British Journal of Occupational Therapy, 83(6), 363-374.
Wilcox, J., & Frank, E. (2021). Occupational therapy for the long haul of post-COVID syndrome: a case report. The American Journal of Occupational Therapy, 75(Supplement_1).