COGNITIVE REHABILITATION Information for Patients and Families

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1 COGNITIVE REHABILITATION Infrmatin fr Patients and Families What is cgnitive rehabilitatin? Cgnitive rehabilitatin is a gal-riented prgram that aims t imprve cgnitive functins (memry, attentin, and cncentratin) and daily living skills (i.e. using the telephne, managing medicatin, and handling mney) that may have been affected by yur strke. The rehabilitatin prgram is develped accrding t each clientʼs specific needs. The gal is t imprve perfrmance in tasks that are imprtant t yu. Tw appraches are usually adpted: the remedial (r restrative) apprach r the cmpensatry apprach Why use cgnitive rehabilitatin after a strke? Cgnitive impairment, a prblem invlving the mind, is very cmmn fllwing a strke. There are different kinds f cgnitive impairment such as frgetfulness, cnfusin and/r disrientatin. These impairments can interfere with safety, prductivity, independence and persnal relatinships. Cgnitive rehabilitatin has been develped by physicians, scientists, and health prfessinals t imprve cgnitive functin. This therapy als aims t help peple with cgnitive dysfunctin deal with the impact it has n their lives. With the help f cgnitive rehabilitatin, many peple can have a prductive and satisfying life fllwing a strke. Cgnitive Rehabilitatin 1

2 What can I expect befre I start therapy? Yur cgnitive rehabilitatin therapy treatment will be based n yur wn individual gals and will cnsider all f yur strengths and weaknesses in cgnitive functin. There are several techniques that can help yu t achieve the gals f yur treatment, such as auditry and/r visual attentin tasks and memry training. Yu may be asked t take a variety f neurpsychlgical tests in rder t determine yur current cgnitive functining. This will help yur therapists develp a suitable treatment plan. Sme f these tests may seem t ask silly questins r yu may feel nervus trying t answer crrectly. Remember that the mst imprtant thing befre starting therapy is fr yu and yur therapist t understand where yu need t fcus yur therapy effrts. S try t keep that in mind when ding the varius tests. Hw des the restrative (remedial) apprach wrk? The gal f this apprach is t restre the cgnitive functins that have been impaired by a strke. It invlves practicing the skills yu have difficulty with, until yu see imprvement. The gal is fr yu t eventually be able t apply the skills yu have learned in therapy t real life situatins. The restrative apprach invlves 3 frmats: Drill and practice This methd uses repetitive practice t develp yur cgnitive abilities. Yu can retrain yurself t perfrm tasks by practicing them ver and ver until yu have mastered them. Fr example, t relearn a task such as making cffee, yu wuld write dwn a series f steps (filling the cntainer with water, grinding the cffee, turning n the machine, etc) and then practice these steps until it becmes secnd nature nce again. Mnemnic Strategies These are tricks used t help remember specific infrmatin such as telephne numbers, vcabulary, appintments, etc. They can als help yu learn new infrmatin. Yur therapist will help yu develp these tricks and yu may already have sme f yur wn that yu have used in the past. Mnemnic strategies include: 2 Cgnitive Rehabilitatin

3 Verbal mnemnic strategies Wrds are used t aid memry. They might include: Acrnyms: These are abbreviatins in which each letter stands fr the first letter in a list f wrds. Fr example, the wrd 'HOMES' can help yu remember the names f the Great Lakes: Hurn, Ontari, Michigan, Erie, and Superir. Rhymes: Rhymes are useful in remembering facts. Fr example, Furteen hundred and ninety-tw, Clumbus sailed the cean blue Sngs: Sngs like the Alphabet Sng are great fr learning and memry a,b,c,d e,f,g, h,i, j, k, etc. Acrstics: These are similar t acrnyms, but instead f nly ne wrd per letter, there can be a sentence assigned t each letter. Verbal stries: Explaining smething ut lud as a stry is ften a useful memry tl. Cding methds: There are many ways f using cde, such as transfrming numbers int letters. Imagery mnemnic strategies In this frm f memry building, visual images are used t aid memry. The best-knwn techniques are list-learning strategies. They include 4 methds: The methd f lci r place methd: This is a mnemnic strategy that is very effective fr remembering lists. T use this methd yu chse a place that yu are very familiar with (yur huse fr example). Think f different landmarks in that place (the bathrm, the kitchen, the hall, etc) and train yurself t g arund the landmarks in a particular rder. Letʼs say yu are trying t remember a shpping list. Imagine each f the items n the list in ne f the landmarks yu have in mind. Fr example, yu may picture a giant cartn f milk n the cuch, r a huge banana in the bathtub. The numeric Pegwrd methd: This methd is useful fr remembering numbered r rdered infrmatin. It invlves rhyming wrds fr numbers, since the wrds may be easier t remember in assciatin with what yu are trying t learn. This way, instead f having t memrize numbers, yu picture the wrd assciated with them. Fr example: Cgnitive Rehabilitatin 3

4 ne is bun tw is she three is tree fur is dr five is hive etc. The link methd: This is when yu make simple assciatins between items in a list, linking them with an image cntaining all f the items. Fr example, if the first item n the list was a dg and the secnd was a mtrcycle, then yu may try t visualize a dg riding a mtrcycle. The fact that this image is bizarre and impssible will help yu t remember it. The visual stry methd: This invlves linking items tgether in a memrable stry. Fr example, yu may try t remember the planets in rder f distance frm the sun: As the heat cmes ff the SUN, the MERCURY in the thermmeter rises. Then the thermmeter expldes and the mercury drplets fall nt a beautiful gddess named VENUS. T hide frm the mercury drplets, Venus digs a big hle in the EARTH.. Cmputer-based tls Virtual reality Virtual reality is a technlgy that allws yu t interact with a cmputersimulated envirnment. Virtual reality can help t imprve: Shrt-term memry (the capacity t remember infrmatin fr a shrt perid f time) Selective attentin (the ability t cncentrate n and perfrm activities while filtering ut ther distractins) Sustained memry (the ability t remain fcused fr a length f time) Divided attentin (the capacity t attend t tw r mre stimuli at the same time). Other cmputerized tls Cmputer sftware exists t wrk n different cgnitive abilities such as visual memry, verbal memry, attentin t visual bjects, etc. Activities t wrk n these functins include the use f numbers, letters, wrds, and shape sequences. NOTE: Dnʼt be cncerned if yu are nt familiar with cmputers these prgrams wrk quite simply and yur therapist can shw yu hw t use them easily. 4 Cgnitive Rehabilitatin

5 Is restrative therapy effective? There has nt been a lt f research n cgnitive retraining fr memry and attentin. We need mre studies befre we can say hw effective this treatment is fr retraining cgnitive skills after a strke. Hw des the cmpensatry apprach wrk? The cmpensatry apprach is anther type f cgnitive rehabilitatin used with peple wh have had a strke. Yu r yur therapist may turn t the cmpensatry apprach when effrts t restre cgnitive functin are nt wrking well. Cmpensatry strategies can be taught by an ccupatinal therapist, a physitherapist, r a speech-language pathlgist. Family members can als help yu find ways t d daily activities. It is imprtant t be creative when cming up with cmpensatry techniques. Let peple knw yur preferences in terms f strategies when planning cmpensatry techniques. Cmpensatry strategies include making changes in yur envirnment (hme, schl, wrkplace, etc) r adpting different methds f perfrming activities. As well, cmpensatry strategies invlve making use f devices that help with remembering tasks. Fr example there are many ptins fr wristwatches and ther innvative gadgets that can remind yu abut a scheduled activity (e.g. a dctrʼs appintment r visiting a lved ne). Other examples f cmpensatry strategies fr memry might be t use an agenda bk, a diary r a tape recrder t help t remember things yu need t d. Is cmpensatry therapy effective? Cmpensatry strategies can pssibly wrk fr anyne wh has experienced a strke but they may be mre effective if the persn is yung and nly has ne r tw cgnitive issues (i.e. cmpensatin strategies will wrk better fr smene with nly a memry prblem than fr smene with a memry and a cncentratin prblem). Cgnitive Rehabilitatin 5

6 One gd quality research study lked at cmpensatry strategies and their effect n perfrmance f everyday activities in peple with strke. The results shwed imprvement in the time and quality f perfrmance f every day activities. External links t helpful sites n cgnitive rehabilitatin Fr further details n the different mnemnic strategies, please visit: Fr the link and stry methd, please visit: Fr mre infrmatin n cgnitive rehabilitatin, please visit: Infrmatin n this web site is prvided fr infrmatinal purpses nly and is nt a substitute fr prfessinal medical advice. If yu have r suspect yu have a medical prblem, prmptly cntact yur prfessinal healthcare prvider. 6 Cgnitive Rehabilitatin

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