Cognitive rehabilitation therapy aims to help those with cognitive impairments restore or compensate for deficits through direct retraining, compensatory strategies, and environmental modifications. It focuses on improving functions like attention, visual processing, information processing, memory, and executive functions. Treatment involves education, process training using conscious efforts and automatic processing, strategy training using internal and external aids, and functional activities training. The goal is to improve patients' ability to perform everyday tasks.
Cognitive rehabilitation therapy aims to help those with cognitive impairments restore or compensate for deficits through direct retraining, compensatory strategies, and environmental modifications. It focuses on improving functions like attention, visual processing, information processing, memory, and executive functions. Treatment involves education, process training using conscious efforts and automatic processing, strategy training using internal and external aids, and functional activities training. The goal is to improve patients' ability to perform everyday tasks.
Cognitive rehabilitation therapy aims to help those with cognitive impairments restore or compensate for deficits through direct retraining, compensatory strategies, and environmental modifications. It focuses on improving functions like attention, visual processing, information processing, memory, and executive functions. Treatment involves education, process training using conscious efforts and automatic processing, strategy training using internal and external aids, and functional activities training. The goal is to improve patients' ability to perform everyday tasks.
Cognitive rehabilitation therapy aims to help those with cognitive impairments restore or compensate for deficits through direct retraining, compensatory strategies, and environmental modifications. It focuses on improving functions like attention, visual processing, information processing, memory, and executive functions. Treatment involves education, process training using conscious efforts and automatic processing, strategy training using internal and external aids, and functional activities training. The goal is to improve patients' ability to perform everyday tasks.
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Cognitive
Rehabilitation Neurological Training • Meaning “To Know”: Learning & Thinking What is cognition? • Refers to the workings of the mind through which we are able to make sense of the world. • This includes speed of thought, memory, understanding, concentration, ability to solve problems and use of language. What is Cognitive Rehabilitation Therapy (CRT)?
• To help brain-injured or otherwise
cognitively impaired individuals restore normal functioning, or to compensate for cognitive deficits. • Aim of treatment: to improve the ability to carry out everyday tasks.
How to achieve that?
• Direct retraining • Use of compensatory strategies • Use of external aids Why is it important? • Review or change the way we deal with cognitive issues. • Focus our thoughts on clinical reasoning. How does the BRAIN WORKS? Example: Pouring a glass of milk • See the glass and the milk • Recognise that it is a glass and milk • Know what the items are used for • Pick up the milk Almost automatic actions require • Pour it into the glass using the millions of appropriate grip messages to be sent backwards and forward within the brain General Knowledges about the BRAIN • Brain weighs about 3 pounds • If not folded: 4 A4 sheets • Frontal: CONTROL & ORGANISATION (voluntary muscle movement) • Parietal: PERCEPTION/SENSATION • Occipital: VISION We learn new things • Temporal: LANGUAGE & MEMORY through our right • Cerebellum: BALANCE & COORDINATIONhemisphere and practice them with our • BRAIN STEM: CONSCIOUSNESS (LIMBIC left hemisphere. STRUCTURES: EMOTIONS) General Knowledges about the BRAIN (2) • Brain cell is called neuron, consists of: cell body, axon and dendrites. • Information is passed down the axon as an electrical charge, but when it reaches the synapse, it triggers the release of a chemical called neurotransmitter, which ferries the information across to another cell.
BUT WHAT IF THESE
NEURONS ARE DAMAGED? What if the neuronal pathway is damaged?
LOOK FOR A NEW
ROUTE!! HOW CAN WE IMPROVE?
BY PRACTICING!! 4 APPROACHES TO CRT • Education: Develop AWARENESS • Process Training: OVERCOME the problem i) Conscious training: learn new skills slowly and effortfully. ii) Automatic processing: become more familiar, faster and less effortful. • Strategy Training: to compensate for the problem i) External Strategies: relies on things outside of them (e.g. phone, alarm) ii) Internal Strategies: relies on mental processes (e.g. following) iii) Environment strategies: for person who does not have enough awareness to utilize strategies independently. Minimise the functional impact of their problems by controlling the environment (e.g. minimizing extraneous noise) • Functional Activities Training: encourage application of skills in real life situation 5 KEY COGNITIVE MODULES
Visual processing Model 1: Attention • Ability to focus • Foundation of thinking and problem-solving skills • Alertness and arousal • Attention can affect the following functions: i. Social judgement ii. Self-awareness iii. Thought processes iv. Communication • 5 aspects to attention 1. Focused: an individual is out of coma 2. Sustained: concentrate, to maintain focus over a period of time 3. Selective: to ignore irrelevant distractions 4. Alternating: to switch the focus of attention between different stimuli 5. Divided: to split sustained attention between two or more stimuli simultaneously Model 2: Visual Processing • The most important sensory system to obtain Visual information about the surrounding environment Processing Skills • Oculomotor skills: ability to move eyes • Visual fields: area that the eye can see at one time (approx. 160-180 degrees) • Visual Acuity: sharpness of eyesight • Visual attention: ability to attend and shift between visual stimuli • Scanning: ability to record all details of a scene in a systematic organised way. • Pattern recognition: ability to identify e.g. colour, shape, texture… • Visual memory: ability to visually process information, store it and recall it later. • Visual cognition: the ability to mentally manipulate visual information and integrate with other sensory information. • The way to make sense of the world • Involves the processes of taking in information and of creating meaning from the information
Model 3: • also includes the selection and activation
of a response to that information Information • This requires capacity of thinking, speed of thinking and control of thinking. Processing • Reduced speed, capacity and control of information processing commonly occur after brain injuries • ALLOW TIME FOR RESPONSE • DON’T OVERLOAD PEOPLE Model 4: Memory
• Ability to keep things in the mind and to
recall them at some point in the future. • Pre-requisites to Memory are attention and the ability to process information • TBI and stroke: difficulties with attention • Encephalitis and anoxic damage: difficulties at the storage stage • Example: Post-traumatic amnesia and Retrograde amnesia • No amount of training or practice will improve or reduce memory failure. • Only way is to aim at teaching and practising strategies. Model 5: Executive Processes • Cognitive skills that allow for self-regulated Planning and behaviour and thinking to accomplish goal directly organisation Self-initiation activity. • Co-ordinating and Controlling our thinking and Self- Goal setting inhabitation behaviour so that we can accomplish purposeful Self- monitoring activity and behave appropriately and evaluating • Individuals with executive problems are often Flexible Self awareness wrongly thought to be lazy or unmotivated. problem solving Examples of Therapeutic Strategy to treat cognitive problems Attention Visual Processing Information Memory Executive Processes Processing • Minimise • Stimulus • Learn to ask to • External strategy STRUCTURE Distractions reduction repeat things and e.g alarm, diary, • Set goals • Time • Conscious slow when they notes • Checklists management compensation are given • Internal Strategy • Plan • Repeat • Focusing and instructions or e.g. Rehearsal, • Self-questioning • Eye contact sustaining during method of study, • Self-awareness • Language attention conversation association, • Cue & Prompts • Simplifying the • Develop and use stories task organisational strategies “SMART” GOAL Goals should be SMART - specific, measurable, agreed upon, realistic and time-based. 1) Specific • Well defined • Clear to anyone that has a basic knowledge of the project 2) Measurable • Know if the goal is obtainable and how far away completion is • Find out when you have achieved your goal 3) Agreed Upon • Agreement with all the stakeholders what the goals should be 4) Realistic • Within the availability of resources, knowledge and time 5) Time-Based • Enough time to achieve the goal • Not too much time, which can affect project performance Reference • Brain Tree Training: https://www.braintreetraining.co.uk/ • E.T. van Schouwen-van Kranen. (2014) Clinical reasoning in cognitive rehabilitation therapy. NeuroRehabilitation 34: 15-21.
McKay Moore Sohlberg Justine Hamilton Lyn S. Turkstra Transforming Cognitive Rehabilitation - Effective Instructional Methods The Guilford Press 2022 X3qkyy
McKay Moore Sohlberg Justine Hamilton Lyn S. Turkstra Transforming Cognitive Rehabilitation - Effective Instructional Methods The Guilford Press 2022 X3qkyy
