Cognitive Rehabilitation

Cognitive rehabilitation, cognitive retraining, or neuropsychological rehabilitation, is a process in which a patient who is disabled by brain injury or disease works with health service professionals to alleviate cognitive insufficiencies. The primary objective of this cognitive rehabilitation program is the establishment of an appropriate life objective or social role within the family and community and a level of meaningful, productive activity. The second objective of the program is to achieve a level of awareness of limitations, strengths and needs so that the person is destination ready, having acquired the self knowledge and awareness of functional compensations for deficits that will enable them to function successfully within an appropriate community setting. Cognitive rehabilitation may involve:

• Relearning of targeted mental abilities
• Strengthening of intact functions to compensate for lost abilities
• Relearning of social interaction skills
• Substitution of new skills for lost functions
• Optimizing control over the emotional aspects of an individual's functioning, including management of impulsivity and anger

Who benefits from cognitive rehabilitation?

Cognitive rehabilitation may benefit anyone who:

• Is disabled by injury or disease who
• Has non-progressive brain damage
• Has some awareness of his/her cognitive deficits
• Is interested in reducing his/her limitations
• Is interested in increasing activities

How do I prepare for cognitive rehabilitation?

To prepare for cognitive rehabilitation, the psychologist may do a one-day, neuropsychological assessment to determine the range of cognitive difficulties.

Following the neuropsychological assessment, the rehabilitation team and patient will formulate long-term goals the patient would like to achieve during the program. These may include returning to work, relearning how to drive, improving speech, etc.

The professionals involved in your care have to work towards long-term goals that are realistic for you. If they feel the goals that you have in mind are over ambitious, they might encourage you to set your sights a little lower or look at other ways to achieve what you want to do.

Who will I work with during my cognitive rehabilitation?

Rehabilitation after a stroke is best achieved by a team approach made up of the different professionals who will assist you with your recovery. This is often called the multi- disciplinary team or MDT. The team will work closely with you and your family and involve you in any decisions that are made about your rehabilitation. MDTs are made up of various professionals including medical staff, nursing staff, physiotherapists, occupational therapists, speech and language therapists, dieticians, social workers, and clinical psychologists.

A clinical psychologist plays a key role in cognitive rehabilitation. Clinical psychologists are often involved in helping and assessing people whose stroke has caused cognitive problems, or problems with thinking, learning, concentrating, remembering, making decisions, reasoning and planning. Psychological problems such as depression or anxiety, or difficulties relating to other people may also be referred to a psychologist.

How is cognitive rehabilitation performed?

Cognitive rehabilitation may take place while the individual is an impatient or outpatient, and would address the cognitive, emotional, social, and behavioral aspects of brain injury. 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 therapist work together to set reasonable long-term and short-term goals, describe the patient’s behavior when the goal is reached, set a deadline and spell out the method so that other patients may benefit.

Patients undergoing cognitive rehabilitation utilizing goal planning can expect a program that focuses on practical, everyday problems tailored to the needs of individual. This includes a measure of outcome that aims to avoid the artificial distinction between some outcome measures and real-life functioning. Assessment is an ongoing process that continues throughout your rehabilitation. Your progress will be monitored and, if necessary, the therapy you are receiving can be adjusted so that together you and your therapist can work towards short term goals.

What can I expect after my 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.

While neuropsychological tests are important in identifying cognitive strengths and weaknesses (and should be taken into account when planning rehabilitation programs), the goal of cognitive rehabilitation is not to improve standardized cognitive test scores.

The time will come when your “formal” rehabilitation ends and you will no longer have therapy session with professionals. This does not mean the professionals concerned do not expect you to make any further recovery. Progress does not necessarily stop just because therapy sessions have finished. Continue to set realistic goals for yourself and work towards them by continuing to use the knowledge and skills which you have learned during your rehabilitation. There is no fixed ration of rehabilitation that is right for everyone – how long your rehabilitation continues will depend on the problems you have and the progress you are making as well as the resources available in your area. As time goes by after your stroke your situation may change. New problems may arise or old ones resurface. If this happens to you, you may ask your family doctor to refer you back to the appropriate therapist for a reassessment of your problem and for further treatment or advice.