Cognitive Rehabilitation Therapy - How It Is Done?

Introduction

Brain injuries caused by falls, accidents, being struck or colliding with an object, stroke, dementia, and cancer affect the person’s cognitive, behavioral, psychosocial, and physical abilities. Healthcare professionals use cognitive rehabilitation therapy to restore cognitive functions in people who experience brain injuries. Cognitive rehabilitation therapy is not a specific treatment but includes various modalities to improve a patient’s quality of life. Not all people with brain injuries require cognitive rehabilitation therapy. Some may recover independently. The effectiveness of cognitive rehabilitation therapy is measured using neurocognitive tests during the person’s treatment.

What Is Cognitive Rehabilitation Therapy?

Cognitive rehabilitation therapy (CRT) refers to treatments that aim to restore cognitive functions, such as memory, attention, reasoning, organization, planning, self-awareness, language skills, and executive functions. In addition, it uses different technologies and tools to improve the patient’s ability to think after brain illness or injury. The cognitive rehabilitation team includes the following professionals:

• Physiatrists.

• Neuropsychologists.

• Physical therapists.

• Occupational therapists.

• Vocational rehabilitation counselors.

• Speech-language pathologists.

• Nurses.

Cognitive rehabilitation therapy services are provided in the following settings:

• Hospitals.

• Outpatient departments.

• Inpatient rehabilitation.

• Community brain injury rehabilitation centers.

What Are the Types of Cognitive Rehabilitation Therapy?

The two types of cognitive rehabilitation therapy include the following:

1. Restorative Cognitive Rehabilitation - Helps to improve skills. For example, memory exercises, mental exercises, and problem-solving games to improve attention.

2. Compensatory Cognitive Rehabilitation - Helps to work with underlying injuries and deficits. For example, memory tools, calendars, and smartphones compensate for cognitive function reduction.

Who Requires Cognitive Rehabilitation Therapy?

Cognitive rehabilitation therapy is appropriate for individuals with impaired cognitive functions due to injury, illness, or other factors. For example, the following individuals require cognitive rehabilitation.

• Traumatic Brain Injury Survivors - People who experience traumatic brain injury have cognitive deficits such as memory, attention, and executive functional impairments. Some common cognitive impairments following traumatic brain injury include impaired visual-spatial conceptualization, communication disorder, and poor judgment. Cognitive rehabilitation therapy helps these people improve these deficits and support recovery.

• Neurodegenerative Diseases - People with neurodegenerative diseases, such as Parkinson's disease and Alzheimer's disease, have cognitive impairments, such as attention deficits and memory loss. Cognitive rehabilitation therapy helps to improve deficits and quality of life.

• Stroke Survivors - People who have experienced a stroke may experience cognitive deficits such as motor and language impairments, memory loss, and attention deficit. Cognitive rehabilitation therapy helps stroke survivors to improve their cognitive impairments.

• Multiple Sclerosis - Cognitive rehabilitation therapy helps patients with multiple sclerosis with attention and memory impairments.

• Attention Deficit Hyperactivity Disorder (ADHD) - Individuals with ADHD experience cognitive defects. Cognitive rehabilitation therapy improves these deficits and supports occupational and academic success.

• Learning Disabilities - People with disabilities such as dyslexia or dyscalculia have cognitive impairments that impact academic success. Cognitive rehabilitation therapy supports and improves their academic success.

Cognitive rehabilitation therapy is also used to treat people with the following conditions:

• Dementia.

• Aneurysms.

• Bipolar disorders.

• Epilepsy.

• Schizophrenia.

• Obsessive-compulsive disorder (OCD).

• Executive dysfunction.

• Anxiety.

• Depression.

• Autism.

• Aphasia.

• Long COVID.

• Brain surgeries, cancer, or cancer treatment cause cognitive dysfunctions.

What Is the Treatment Plan for Cognitive Rehabilitation Therapy?

The cognitive rehabilitation treatment plan includes the development of an individualized treatment plan depending on the cognitive abilities and deficits of the individuals. The major steps in cognitive rehabilitation include the following:

• Cognitive training involves structured exercises to improve memory, attention, and problem-solving skills.

• Environmental modifications to support their cognitive functioning.

• Strategy training includes teaching new strategies for performing tasks.

• Psychoeducation informs individuals and their families about their deficits and strategies for coping.

• Behavioral interventions modify the behavior of individuals to improve their cognitive functioning.

The following include the exercises, strategies, and techniques of cognitive rehabilitation therapy:

Concentration Exercises for Patients With Traumatic Brain Injury:

• Repeat numbers and matching.

• Rhythm matching.

• Addition and subtraction.

• Fine motor exercises include stacking pennies, jigsaw puzzles, therapy putty exercises, and stretching rubber bands.

• Using the non-dominant hand to strengthen cognitive functions.

• Sitting out and writing down everything the patients see, smell, and hear.

Rehabilitative Exercises for Memory Skills:

• Picture recall.

• Naming therapy.

• Card recall.

• Mnemonic strategies.

• Paragraph listening.

• Word lists.

Other exercises include making changes, color sudoku, tower of Hanoi, chess, crossword puzzles, and cognitive therapy games to improve the problem-solving skills of the patients.

Attention Process Training (APT):

• Attention process training restores and improves the visual and auditory attention of the patients after acquired brain injury.

• The five target components of attention include sustained, focused, alternating, selective, and divided attention.

• APT improves the complex attention of the patients significantly as it helps to focus and ignore distractions.

Neurofeedback:

• It is also called an electroencephalogram (EEG) biofeedback.

• It allows the patients to see their brain waves on a computer monitor while performing tasks.

• It helps the patients to recognize and regulate their brain functions.

Computer-Assisted Learning:

• It helps the patients to recover many different lost abilities.

• For example, computer memory and attention games help them regain their attention and memory.

Assistive Devices:

• Many assistive devices compensate for the patient’s lost skills.

• For example, a person who suffers from a stroke has speech loss (aphasia) and can use communication boards to share their needs.

• Smartphones and GPS (global positioning devices) devices help in daily living.

Non-invasive Brain Stimulation:

• Various types of non-invasive brain stimulation, such as transcranial magnetic stimulation, provide functional restoration for patients after traumatic brain injuries.

• Non-invasive brain stimulation improves the patient’s mood, memory, language, visuospatial and executive functions.

Speech Therapies:

• Speech or language therapies include computer-assisted speech therapy, constraint-induced aphasia therapy, and melodic intonation therapy to improve communication and language in brain injuries.

• Lee Silverman's voice treatment improves the patient’s loudness, phonation, and connected speech.

What Are the Benefits of Cognitive Rehabilitation Therapy?

The benefits of cognitive rehabilitation therapy include the following:

• Helps the patients to perform everyday activities independently.

• Improve social relationships.

• Enhance communication.

• Make decisions.

• Perform better in education and the workplace.

Conclusion

Cognitive rehabilitation therapy has limitations, such as the severity of cognitive defects, underlying medical conditions, limited generalizability, and lack of evidence. Several strategies, such as telehealth, multimodal approach, and individualized treatment plans, help to overcome the limitations. More research is necessary to identify new strategies and techniques to improve the generalizability and effectiveness of cognitive rehabilitation therapy.