COGNITIVE REHABILITATION

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1 COGNITIVE REHABILITATION TREATMENT MODALITIES FUNCTIONAL APPLICATION ASSESSMENTS FOR MEDICAL REHABILITATION NEUROPSYCHOLOGICAL ASSESSMENT COGNITIVE SCREENING ASSESSMENT COGNITIVE PROBLEMS ASSOCIATED WITH ACQUIRED BRAIN INJURY EXECUTIVE FUNCTIONS MEMORY PROBLEMS SLOWED RATE OF INFORMATION PROCESSING ATTENTION AND CONCENTRATION COMMUNICATION READING RETENTION THOUGHT ORGANIZATION SKILLS 1

2 EXECUTIVE FUNCTIONS SELF-AWARENESS INITIATION PLANNING FOLLOW THROUGH PROBLEM SOLVING JUDGMENT ORGANIZATION GOAL SETTING MEMORY PROBLEMS AUDITORY VISUAL WORKING MEMORY PROSPECTIVE MEMORY IMMEDIATE MEMORY REMOTE MEMORY SLOWED INFORMATION PROCESSING AUDITORY- difficulty tracking details from conversations or information heard VISUAL- difficulty tracking details and making sense of information read 2

3 ATTENTION/CONCENTRATION SIMPLESUSTAINED ATTENTION COMPLEX SUSTAINED ATTENTION SELECTIVE ATTENTION ALTERNATING ATTENTION DIVIDED ATTENTION PROBLEMS ARE EXACERBATED BY LEVEL OF DISTRACTIBILITY EMOTIONAL PROBLEMS EMOTIONAL AND BEHAVIORAL CONTROL PROBLEMS SHORT FRUSTRATION TOLERANCE INCREASED IRRITABILITY ANGER MANAGEMENT DEPRESSION ANXIETY PTSD COMMUNICATION WRITTEN - thought organization, grammar, spelling, error detection VERBAL - word finding, dysarthria, dyspraxia, topic maintenance 3

4 COGNITIVE REHABILITATION/EXECUTIVE FUNCTION INTERVENTION SELF AWARENESS integrating feedback from client and others INITIATION, PLANNING, FOLLOW THROUGH coordinated use of daily memory systems (to-do lists), providing structure in the day with family reinforcement for task completion EXECUTIVE FUNCTION INTERVENTION JUDGMENT REASONING PROBLEM SOLVING evaluate consequences of actions on oneself and others, identify biases related to judgment and alternate solutions to problems, improve inductive and deductive reasoning with functional application to daily life EXECUTIVE FUNCTION INTERVENTION ORGANIZATIONAL PROBLEMS Strategies are provided for organizing and sorting mail, bills, etc. Carryover is provided in the work setting by establishing routines/structure, prioritizing tasks, assisting with the development of systems. GOAL SETTING Improvement of productivity in the work setting by implementing the strategies listed above. Clearly defining treatment and personal goals, progress and timelines for goal completion. 4

5 TREATMENT FOR MEMORY PROBLEMS Provide training in the coordinated use of functional compensatory memory aids for use in the home and work settings. (e.g. PDA s, recorders, day-planners and notebooks). Teaching of mnemonic strategies a. chunking or combining units of information b. association, visualization, categorization, etc. c. alarm systems Computer-generated programs ATTENTION/CONCENTRATION ATTENTION PROCESS TRAINING PROGRAM auditory attention COMPUTER PROGRAMS visual attention THERAPIST GENERATED MATERIALS number and word series presented in various sequences instruction in pacing techniques including taking regular breaks, alternating activities, etc. COMMUNICATION WORD RETRIEVAL TREATMENT USE OF POCKET THESAURUS/SPELLER THOUGHT ORGANIZATION PRAGMATICS 5

6 INFORMATION PROCESSING FOCUS ON IMPROVING SKILLS IDENTIFYING DETAILS FROM AUDITORY OR WRITTEN INFORMATION WORK ON CONTENT AND RETENTION INCREASING THE NUMBER OF DETAILS (using tapes, written and verbal instructions, et cetera) CAN BE EXACERBATED BY VISUAL PROCESSING PROBLEMS TRANSFER OF LEARNED SKILLS TO THE WORK ENVIRONMENT Coordination of planner and recorder Learning new procedures Creating structure and systems in the work and home environments Home-to-work transitions Communication with the employer and the client s family 6

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