Cognitive rehabilitation

What is Cognitive Rehabilitation?

Cognitive rehabilitation is a structured set of therapeutic activities designed to retrain an individual's ability to think, use judgement and make decisions. The focus is on improving deficits in memory, attention, perception, learning, planning, and judgement. The term, cognitive rehabilitation, is applied to a variety of intervention strategies or techniques that attempt to help patients reduce, manage or cope with cognitive deficits caused by brain injury. The desired outcome of cognitive rehabilitation is an improved quality of life or an improved ability to function in home and community life.

Cognitive rehabilitation is a formal program of guided therapy to learn (or relearn) ways to concentrate, remember, and solve problems after an illness or injury affecting the brain. Also known as neuropsychological rehabilitation, it involves recovery of cognitive deficits through both restoration & compensation to improve memory, concentration and logic.


Who can benefit from cognitive rehabilitation?

Anyone who has experienced changes in their ability to concentrate, think, remember things, or carry out a job, school, or household duties, following an injury or disease, or who has non-progressive brain damage and is interested in reducing his or her limitations and increasing activities. Conditions may include:

* Traumatic brain injury
* Alzheimer's and similar neurological diseases

* Chronic physical pain
* Temporomandibular joint disorders (TMD)
* Anxiety and panic disorders
* Depression
* Attention deficit/hyperactivity disorder (ADD/ADHD)
* Learning disabilities and academic problems
* Chronic physical illness
* Emotional adjustment to medical problems
* Behaviour control problems
* Evaluations of people who don't speak English
* Forensic evaluations


Assessing your needs

First, a psychologist may use tests to evaluate strengths and weaknesses in your thinking and memory skills. You may be asked what problems in daily living you have noticed and what you would like to achieve through rehabilitation. Evaluations may involve neuropsychological, psychological, or chronic pain issues.

* Neuropsychological Evaluations
Questions frequently are asked about your attention, language functioning, mental flexibility, memory, problem solving and other thinking skills. A wide range of instruments is used to assess thinking problems in depth. Your personal history is also considered. Understanding the full range of your functioning is a key component in a thorough neuropsychological evaluation.

* Psychological Evaluations
The way in which you deal with a problem is frequently more important than the actual physical problem. The emotional reaction that you have to life stressors such as a significant loss or injury can result in the quality of their life decreasing even further. Likewise, living a whole life while having physical or emotional issues is achievable for most people with serious problems. Information obtained during the clinical interview provides the foundation for our understanding of your psychological state. We also utilize a wide range of psychological instruments to further assess emotional issues.

* Chronic Pain Evaluations
Chronic physical pain, including facial pain and TMJ pain, can be severely limiting for the person with the condition. Accurately assessing the pain condition leads to interventions that can make a significant difference in your ability to live a normal life. We integrate information from other health care professionals into our evaluations of people with chronic physical pain.



How long will cognitive rehabilitation take?

Length of treatment depends on how much progress you make and your ability to work toward your goals.


What to expect in the treatment program

Patients undergoing cognitive rehabilitation utilizing goal planning can expect a program that focuses on practical, everyday problems tailored to the needs of individuals, includes a measure of outcome; and avoids the artificial distinction between some outcome measures and real-life functioning.

Treatment may include both group and individual psychological support to deal with issues such as changes in family status and work relationships.

Goal-setting exercises may also take place, where the patient and doctor work together to set reasonable long-term and short-term goals, describe the patient's behaviour when the goal is reached, set a deadline and spell out the method so that other patients may benefit.

Your strengths and weaknesses may be evaluated at regular intervals while in the program. Your family may participate if desired. You will be expected to complete home exercises. A computer can be used for home exercises if available.


What can I expect after cognitive rehabilitation?

Since the goals of cognitive rehabilitation are targeted to the individual needs of each patient and their families, outcome measures such as return to work or independent living can cause problems when used to evaluate the effectiveness of the program. Employment of the patient is subject to economic factors beyond the control of the patient, and many independent living scales are not clear at distinguishing between those families who were only just coping with their brain-injured relatives before rehabilitation and those who were considering long-term care yet and, after rehabilitation, are coping more successfully.