What is Cognitive Rehabilitation?

  • Introduction
  • Self-Help and Coastline Education
  • How Does Cognitive Training Help?
  • Understanding Cognitive Rehabilitation
  • Where Should the Focus Be?
  • Another Way to Get Help with Cognitive Rehabilitation
  • References

Introduction – what is cognitive rehabilitation?

Based on the science of neuroplasticity. cognitive rehabilitation is a tool used by brain injury experts such as:

  • neuropsychologists
  • neuropsychiatrists
  • occupational therapists 
  • speech and language therapists

Cognitive rehabilitation is used as a tool as part of the therapeutic process to help enhance interaction and engagement and to supplement therapy.

Because so many people struggle to get access to professional help, more is being done to support existing services and patients. 

The need for self-help tools

Science is catching up very quickly with improving understanding about the effects and outcomes of brain injury. 

Research has documented the benefits of cognitive rehabilitation and its’ use for improving executive dysfunction and treatments, which help to improve an individual’s ability to function after a brain injury.

Only available in a clinical setting, and therefore usually only accessible to patients with the most severe brain injuries or where there is loss of motor function, many people go without medical support or only receive a set number of therapy sessions.

Despite these circumstances, the idea of cognitive rehabilitation goes back a long way and has been used successfully in clinical practice and educational settings.

Poor social and economical outcomes coupled with patient feedback drive science to provide the evidence for change. For example, a study measuring inflammatory biomarkers in people diagnosed with mTBI where there was minimal or no loss of consciousness found a potential relationship between inflammation and neuropsychological outcomes.

Studies like this demonstrate a very real need for change and for additional services. Until this happens, there is a need to provide self-help strategies and tools to support individuals and their families.

Another way to get help with Cognitive Rehabilitation

Coastline College (US) offers a comprehensive cognitive retraining program that addresses executive dysfunction and psychosocial issues often experienced post injury.

The Acquired Brain Injury Program, established in 1978, was the first community college in the US to offer specialized classes to adults with brain injury. It is an online educational program that meets 4 hour/day, 4 day/week via Zoom. 

Check out Coastline Education to find out everything you know about the application form, curriculum, costs and everything else you need to know.

GBIA will be raising money to help those of you who need it with financing this training course. Please get in touch for further information. 

How does cognitive rehabilitation help?

Cognitive rehabilitation focuses on two major therapeutic approaches.

One is to teach compensatory or coping mechanisms, and the other is based on meta-cognitive coaching strategies. While it is felt expert guidance is needed, and therapies should only be used in a clinical setting, this leaves many people struggling alone. 

Rehabilitation is focused on helping individuals to improve everyday life, and is therefore usually focused on what is meaningful to that person. 

Everyone needs help to regain their optimum psychological and functional well-being, and where there has been no referral to specialist services, this responsibility falls to the individual and their family.  

There are limits to what can be done outside of a clinical setting, however, this should never create barriers to self-improvement. The more you understand about what has happened to you, the more your intellect has the chance to work things out.

Although you may struggle with reading, processing and remembering, your intellect is working and is taking in all of the information you address. As time passes, you will notice that you know a lot more about your brain injury than you thought. 

Keep at it – brain injury doesn’t affect your intelligence.

Cognitive rehabilitation supports the process of learning about how executive dysfunction can interfere with your cognition or thinking and understanding.

Understanding cognitive rehabilitation

There has been an explosion of brain training programs on the internet. Many of these are directed at people living with neurological disorders and yet, rather than enhancing cognitive and executive skills, they teach you how to fill, move, identify shapes and so on. 

Many neurological experts feel that these programs teach you to ‘fill, move, identify shapes and so on,’ and don’t have real benefits for people living with brain injury despite claims. These programs are usually costly and ineffective.

Likewise, playing computer games teaches you to be good at playing computer games. They don’t help you transpose intellectual strategy into everyday living, and neither do they help you overcome issues with insight.

Focusing on something that is pleasurable to do isn’t the same as maintaining your attention long enough to achieve a goal.

While keeping the brain active is good for all of us, playing games can be a distraction from doing what is going to help you rebuild your brain and life.

Cognitive training should be focused on improving deficits in areas like:

  • attention
  • insight
  • memory
  • speed of processing
  • problem solving
  • planning and organisation
  • working memory
  • control of impulses
  • staying on track
  • idea generation

Where should we focus?

While everything people try to do after a brain injury can be problematic, there are key skills that can drive the repair or improvement of other losses.

Whatever we do, there will always be some disruption to our executive skills, however, if we can minimise these effects or can be aware of when they are happening, how we manage our everyday life improves.

Metacognition

Metacognition is essentially the ability to monitor your own thinking or cognitive processes. We can think of this as being able to ‘hear’ the ‘self’ think or to follow what the ‘inner narrator’ is doing and saying as we go about our business. 

Also referred to as the ‘thinking voice,’ this ability to follow or ‘hear’ what our brain is up to can be absent after a brain injury. Devoid of any ability to keep an eye on what is happening and why, it can feel as though Scottie beamed the real you up when you weren’t looking.

You feel as though the autopilot has taken over and as if you, as the captain of your ship, and commander of the control tower, has been tied up, blindfolded and dumped in the back seat. 

If you can’t observe what your brain is doing, you can’t work out why you feel this way, have so many problems, or what has happened than you. 

Because metacognition is the single, most powerful tool for effective reasoning, learning and problem-solving, and is also an essential aspect of learning, it has to be at the top of the list of things to focus on. 

Metacognition allows us to reflect upon the demand of any task, and to select and use the best strategy to complete it.

By focusing on learning to self-observe by using reflective techniques, we can learn to slow things down, improve our memory, and ‘hear’ what we are thinking again.

Insight

Working our way through our challenges by trial and error may seem like an inefficient way to make ground after a brain injury, but it works at many levels and encourages insight. 

When we can work out what works and what doesn’t for ourselves, we can start to integrate feedback from our observations and environment that help us to adjust both our behaviour and actions. 

Cognitive rehabilitation should focus on creating opportunities for us to regain these two primary skills.

Further resources available to you:

Cognitive rehabilitation is often unavailable to brain injury survivors as they continue their ongoing journey.

It is important to find reliable cognitive resources that can provide insight and practice in the cognitive strategies necessary for continued growth.

Brain Education Strategies & Technology (BEST) is a non-profit that recognizes the personal and financial challenges experienced by many living with brain injury.

BEST strives to provide affordable materials to help fill the gap often left after one completes their medical therapies.

BEST offers the following resources:

  • BEST Suite app
  • self-paced 
  • online cognitive training
  • webinars
  • special projects
  • and more

These resources help manage executive function and self-regulation challenges. Their goal is to teach individuals to use smart devices as cognitive prosthetics. They emphasize the benefits of applying cognitive skills to the use of technology and everyday life. They call this the ‘Making Cognitive Connections‘ approach.

References:

Pub Med – Early versus late profiles of inflammatory cytokines after mild TBI and their association with neuropsychological outcomes 

Cambridge University Press – Executive function and metacognitive self-awareness after Severe Traumatic Brain Injury