Cognitive Rehabilitation Therapy (CRT) is a specialized treatment designed to help individuals regain and improve cognitive functions that may have been affected by injury or illness. Whether caused by a traumatic brain injury, stroke, or degenerative conditions like Alzheimer’s or multiple sclerosis, cognitive impairments can have a profound impact on a person’s ability to manage daily tasks.
At Propel Physiotherapy, our occupational therapists work closely with clients to assess their cognitive challenges and design individualized and holistic rehabilitation programs aimed at retraining thinking, memory, and problem-solving skills, allowing clients to return to everyday activities with greater confidence and independence.
In this article, we take a closer look at how CRT can benefit people with injuries and conditions impacting cognitive function, and how an occupational therapist at Propel Physiotherapy will approach treatment.
Table of Contents:
- What is cognitive rehabilitation therapy?
- Who can benefit from cognitive rehabilitation therapy?
- The benefits of cognitive rehabilitation therapy
- The steps of cognitive rehabilitation therapy
- Other factors affecting cognitive function
- Cognitive rehabilitation therapy case study
- Conclusion
What is Cognitive Rehabilitation Therapy?
Cognitive rehabilitation therapy is a treatment approach that helps to improve a person’s ability to think and process information after an injury to the brain or illness that has affected the functioning of the brain. It aims to retrain cognitive functions that have been impaired and to assist clients to return to their daily activities.
Cognition plays an important role in our ability to learn, retain, and use new information which enhances our abilities to engage in daily occupations such as work, home management, educational studies, play, and leisure activities.
During cognitive rehabilitation therapy, a client practises skills to improve their cognitive impairments and learns techniques to assist them in managing deficits that are affecting their daily activities. This form of treatment can be provided by a number of different healthcare professionals, such as occupational therapists, who have had specialized training.
Who Can Benefit from Cognitive Rehabilitation Therapy?
Over the years, cognitive rehabilitation therapy has been studied extensively, and new research is continuously emerging. Studies have revealed positive impacts of cognitive rehabilitation therapy, particularly for clients who have sustained:
- brain injuries,
- stroke,
- or multiple sclerosis.
However, there is evidence that the various types of cognitive rehabilitation techniques can also benefit other illnesses affecting the brain such as:
- dementia,
- Alzheimer’s disease,
- Parkinson’s disease,
- long COVID,
- brain tumors,
- and other cognitive dysfunction as a result of brain surgeries or cancer treatment.
Through participation in a cognitive rehabilitation program with an occupational therapist, clients with these conditions focus on restoring, strengthening, and sharpening their cognitive functions such as their memory, attention and concentration, perception, problem solving, learning, planning, organization, judgement, and more.
Benefits of Cognitive Rehabilitation Therapy
Cognitive rehabilitation therapy (CRT) offers numerous benefits that enhance a client’s ability to function in daily life, including:
- Improved cognitive capability following an injury or illness to the brain
- Improved functional abilities
- Increased independence with daily activities at home, work, school, and within the community.
- Improved social relationships
- Improved communication skills
- Increased understanding and knowledge about your injury or illness to the brain.
What are the Steps of Cognitive Rehabilitation Therapy?
There are four steps to cognitive rehabilitation:
1. Initial Assessment – your therapist will conduct a comprehensive assessment of your condition to determine areas of cognitive impairments as well as education to the client and their family about their cognitive deficits and the impact it is having on their daily activities.
2. Process Training or Remedial Therapy – the therapist uses a variety of techniques and activities aimed towards restoring cognitive functioning through practice, exercise and cognitive stimulation. Remedial therapy uses the brain’s neuroplasticity to increase activation and connectivity patterns within and across several brain regions to increased cognitive functioning.
3. Strategy Training or Compensatory Therapy – this involves assisting the client to learn how to work around their injury to be able to function effectively despite their injury or impairments. This can involve making changes in their living environment, using assistive devices to compensate for deficits such as memory aids, or adapting their lifestyle to suit their current abilities during their recovery process.
4. Functional Activities Training – this involves assisting the client to be able to reintegrate learned strategies and knowledge about their cognitive impairments into daily activities. Clients are provided guidance and support with modifying their daily activities to increase their independence and functional abilities. There are many tasks at home, work, school, and in the community that require cognitive abilities such as making a meal, grocery shopping, planning a weekly schedule, etc.
Other Factors Affecting Cognitive Function
When addressing brain injuries or illness affecting the functioning of the brain, there are often other factors that can also affect cognitive functioning such as changes in speech and language abilities, vestibular/balance issues, and other neurological impairments.
Another area addressed during cognitive rehabilitation therapy involves visual motor skills. Often injury or illness to the brain can impact the way a client sees and processes visual information, thus affecting hand eye coordination, visual scanning abilities, and more. A variety of visual motor exercises are used to retrain the visual motor aspects of the brain.
Occupational therapists work in collaboration with other healthcare providers such as physiotherapists, speech language therapists, and neuropsychologists to address all areas of cognitive impairments.
Cognitive Rehabilitation Therapy Case Study
Stacey is a 35-year-old female who reached out for cognitive rehabilitation therapy services after a slip and fall that resulted in her hitting her head on the ground. She was diagnosed with a concussion and was experiencing post-concussion symptoms involving:
- Cognitive fatigue
- Decreased attention and concentration
- Poor memory
- Decreased motivation
- Poor follow through with activities
Stacey described herself as having a “foggy brain”. Getting through her daily activities was a challenge. She would often start an activity but only complete part of it. As she explained, she would become too tired to finish an activity such as making a meal or get distracted by something else and never get back to finishing what she started.
Other times she was struggling with remembering what was said during a conversation or what she just read in a book or watched on television. Stacey would also get headaches when she was concentrating on something for too long.
Her post concussion symptoms were affecting her ability to complete tasks at home such as keeping the house tidy and organized, doing laundry, making a grocery list, etc. She was struggling with keeping up with tasks at work and was often falling behind on deadlines. When she would run errands in the community, she would get distracted by other things in the stores and forget a few items on her list.
Stacey decided that she needed to get better from her concussion and started a cognitive rehabilitation therapy program with an occupational therapist. We developed a customized program to teach Stacey how to pace and balance her daily activities, so they were more manageable within a day.
We focused on teaching her how to manage her post-concussion symptoms and prevent them from escalating into a bigger problem, which would set her back and lead to her needing extra rest and time away from daily tasks at home.
We also had Stacey work on daily cognitive exercises using an online platform that I monitored. Once a week, she met with me for an in-person session. During the in-person sessions, Stacey participated in a variety of cognitive exercises using paper pencil format, games, graded activities of daily living (ADLs), and online programs.
She also learned various compensatory strategies to help her manage her symptoms while she was working on rewiring her brains cognitive functions. Some of the compensatory strategies consisted of:
- Using auditory reminders on her calendar in her phone
- Using Post-it notes at home to frequently forgotten items
- Keeping commonly used items in a designated place (ie. keys wallet, phone).
- Using a whiteboard calendar
Over time, Stacey’s abilities to recall important information, pay attention to details of tasks, plan and organize activities, etc., became easier. She followed her balanced schedule daily and made sure to pace her activities to avoid exacerbating her post concussion symptoms.
She reported improvements with her cognitive fatigue, decreased headaches, and better concentrate during tasks. She felt more productive and less restrained by her post concussion symptoms.
Conclusion
Cognitive impairments can affect people of all ages and with varying degrees of cognitive dysfunction as a result of their brain injury or medical condition that is affecting their abilities to engage in cognitive tasks on a daily basis. Occupational therapy treatment during the recovery journey has been shown to be essential to promote improved cognition functioning, thus leading to a better quality of life and engagement in daily occupations.
There is no one size fits all for cognitive rehabilitation therapy. Programs are tailored to meet the client’s needs and focuses on a number of cognitive impairments occurring simultaneously, while also aiming to improve their abilities to function and be successful with their daily activities and occupations.
References
Basford JR, et al. (2015). Brief overview and assessment of the role and benefits of cognitive rehabilitation. Archives of Physical Medicine and Rehabilitation. Vol 96, issues 6, page 977-980 June 2015
Beatriz Colon Abrea and Joan Pascale Toglia (July 1987): Cognitive Rehabilitation: A Model for Occupational Therapy, American Journal of Occupational Therapy Vol 41, Issue 7.
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