COMMUNITY COGNITIVE REHABILITATION

The science bit.........!

Impairments of cognitive function are among the most common and important problems that lead to disability after acquired brain injury. Due to the widespread impact of cognitive deficits on functional independence, social interaction and safety to name but a few, our use of community cognitive rehabilitation approach is central to the treatment and recovery of individuals.

The goal of cognitive rehabilitation is to achieve the most independent or highest level of functioning. The centre for cognitive rehabilitation cites treatment goals as including: relearning of targeted mental abilities, strengthening of intact functioning, relearning of social interaction skills and substitution of new skills for lost functions, all of which we include in our services at The BIS. For some of our clients the ability to express needs verbally in simple terms may be a goal. For others the goal may be to express needs by pointing at pictures. Most individuals respond best to programs tailored to their background and interests, in most cases we look to the family and friends for guidance. The overall goal for some clients may be attempting to restore function in a cognitive domain or set of domains or teaching compensatory strategies to overcome domain specific problems- i.e. implementing the use of devices such as diaries, alarms, PDAs for memory difficulties.

Strategy training is an important part of the rehabilitation and makes use of both external and internal strategies. External are those where the client uses and relies on their support or physical objects or devices such as those above. We can provide suggestions for such

strategies, as well as serving as the external ‘device’ by providing various forms of prompting. Internal strategies means the person must rely on his or herself and usually can only occur after external strategies have been mastered, and confidence and insight has increased. Throughout our work with clients we provide positive reinforcement and feedback as much as possible in order to improve outcomes. We have found that this enables us to build strong and trusting relationships with our clients which ensure we are able to continue our support in the long term.

Early in recovery, arousal, attention and memory encoding difficulties may be the most prominent. Over time, difficulties in divided attention, memory retrieval and executive functioning may be at the forefront. We aim to provide a flexible service in order to support our clients with their evolving deficits and our training packages are designed to ensure that the clients and those around them are aware of the changes that can occur, and how best to approach them.

CCR is best delivered in a individually targeted and practical manner, aimed at developing a greater independence, improving of everyday functioning and attainment of personal goals identified in our early dealings with clients. Coordination and collaboration with other service providers is an important element in the cognitive rehabilitation process and is incorporated into our work as far as is possible. Research has shown that the rehabilitation should be integrated into and co-ordinated with vocational services, special education and community based programming such as supported living, support networks, and recreational groups in order to increase the efficacy of the rehabilitation. The BIS Services has positive links with such services and we strive to include them within our work should our clients require.

The greatest visible progress occurs in the first 6 months, after which improvement is often more subtle and less obvious. But it is important to bear in mind that progress does not stop after 2 years, as has been suggested in the past. Rather people continue to improve even 5, 10 or more years after a head injury.

Of course, cognitive rehabilitation has its limitations and is by no means a ‘cure’, success is very dependent on the quality of service provided and upon the clients willingness to accept the support and work with us.