Cognitive rehabilitation

Basic idea about cognitive rehabilitation

1. COGNITIVE REHABILITATION ) Diker Dev Joshi MPT(Neuro) CIMT, MIAP, IASTM

2. Introduction Epidemiology of cognitive Impairments Classification Aims Principle Uses Rehabilitation Strategies Review of Literature References Contents

3. Cognition The mental faculty of knowing, which includes perceiving, recognizing, conceiving, judging, reasoning, and imagining . Introduction

4. Cognitive impairment  is an inclusive term to describe any characteristic that acts as a barrier to the cognition process . The term may describe D eficits in overall  intelligence S pecific and restricted deficits in cognitive abilities N europsychological deficits

5. A cross-sectional study was carried out in 2010 found out prevalence of cognitive impairment as 3.5 %. The prevalence of cognitive impairment in the study population among elderly adults aged over 60 years, of both sexes was 8.8% . If one were able to successfully treat mild cognitive impairment such that the progression of these individuals to AD could be delayed by one year, there would be significant savings. Epidemiology of cognitive Impairment

6. The concept of cognitive disabilities is E xtremely broad Not always well-defined. Have greater difficulty with one or more types of mental tasks.

7. Clinical disability Functional disability. Clinical diagnoses of cognitive disabilities include Traumatic brain injury (TBI), and even dementia, Autism , Down Syndrome . Less severe cognitive conditions include attention deficit disorder (ADD), dyslexia (difficulty reading), dyscalculia (difficulty with math), and learning disabilities in general. Classification

8. Some of the main categories of functional cognitive disabilities include deficits or difficulties with : Executive Functions Memory Information processing Visual Processing Attention

9. Attention Memory Executive Function Selective attention, Sustained attention, Alternating attention, Divided attention Visual memory, Auditory memory, working memory, episodic memory, Semantic memory, Procedural memory Initiation, processing speed, problem solving, planning

10. Cognitive R ehabilitation is a complex collection of techniques designed to enhance perception, attention, comprehension, learning, remembering, problem solving, reasoning, and so forth in individuals who have impairments in these areas.

11. 1 . Reinforce, strengthen or re-establish previously learned patterns of behavior . 2. Establish new patterns of cognitive activity through internal compensatory cognitive mechanisms for impaired neurological systems . 3. Establish new patterns of activity through external compensatory mechanism such as external aids, or environmental structuring and support . 4. Enable persons to adapt to their cognitive disability. Aims

12. Cognitive rehabilitation operates on the principle that enriched and enhanced learning environments can promote gains via neuronal plasticity Principle

13. N eglect and apraxia R ehabilitation after stroke Attention training after TBI Memory rehabilitation with compensatory training in patients with mild amnesia Uses

14. A person may wish to address more general memory problems or person may specify area of concern s/he would like to work on. Hence the rehabilitation should depend on the focus of the individual. The person can be assisted in eliciting goals either informally through the discussion or by using structured goal setting approaches like Bangor goal setting Interview or Canadian Occupational Performance Measure Goal Identification

15. Sessions can be conducted in the person’s home or in a comfortable setting suited to practicing the identified goals. Family members should be debriefed on each sessions and provided with explanations of strategies so that they can be practiced outside of intervention sessions. Setting

16. There are four approaches to successful cognitive rehabilitation (Malia & Brannagan , 2000 ): Education Process Training Strategy development and implementation Functional Application

17. Education Individuals should receive education appropriate to their abilities and needs. In an inpatient center, done through a formal education group . At sufficient intensity and with adequate repetition to ensure learning.

18. At least once, so long as their language skills, attention skills and awareness levels permit. Understanding their own brain problems and what rehabilitation is all about . Cognitive and Emotional problems associated. Coping strategies.

19. Process Training To stimulate poorly functioning neurological pathways in the brain in order to maximize their efficiency and effectiveness . This will sometimes mean using new undamaged pathways (redundant representations ) and, sometimes, old partially damaged pathways . Process training therefore aims to overcome the damage.

20. Components : - Good comprehensive assessment - Analysis of the results according to a practical cognitive model The analysis should always ask, “Why is that problem occurring?” until an impaired component skill or cluster of skills is revealed. T o develop and improve the impaired skills. Generation of a hypothesis, which is then tested with appropriate training materials. Formal reassessment to determine the accuracy of the hypothesis.

21. The development of awareness through the exercises. The structured programmed approach to the materials. Daily concrete feedback and concrete goals. The relatively short time frames to complete blocks of work. The development of patient self-confidence. The development of patients’ feelings of being in control .

22. The massed practice available via homework exercises. improves performance. enables them to accept constructive feedback more readily. The activities are easily quantifiable and scoreable. Results can be easily graphed to demonstrate improvement and this , in turn, leads to improved motivation and self-esteem.

23. Strategy deelopment and implementation External strategies consist of those things that are external to the person , such as alarms, notebooks, notes, and calendars. Internal strategies are those mnemonics that cannot be observed by anyone else, such as visualizations and word associations ( Malia & Brannagan, 1997)

24. Functional Activities Training Should focus on improving real life functioning. Functional activities should be used in two distinct ways: -As a vehicle within which to treat the cognitive skill deficits -To train the person to complete the particular functional task Goals should be written for each of these approaches.

25. Awareness Awareness should be considered to be the key to successful rehabilitation .

26. R ole of healthcare professional to help the individual understand how to use these strategies individual is responsible for practice and implementation between sessions . The requirement of commitment and effort on the part of the patient need to be explained. Typically , therapist identifies target areas or goals to work on, practise a number of different strategies, and then decide which strategies the person prefers and can use most efficiently.

27. Rehabilitation strategies

28. Effortful Processing Dual Cognitive Support Errorless Learning Guiding Principles

29. Mnemonics Cueing Chunking Method of Loci Spaced Retrieval Recall strategies

30. Face-name Recall Number Recall Specific Interventions

31. Story Recall List/Object Recall

32. Fluency Training Semantic Impairments

33. Procedural Memory

34. A quasi-experimental study was done among of 40 patients with mild cognitive impairment in 2012 to evaluate the effectiveness of cognitive rehabilitation on improving selective attention in patients with mild cognitive showed an increase in selective attention scores in the experimental group compared with the control group leading to the conclusion that cognitive rehabilitation leads to improvement in the performance of selective attention. Review of Literature

35. A literature review conducted in 2015 to identify and summarize interdisciplinary evidence-based practice targeting cognitive rehabilitation for civilian adults with TBI highlighted that more empirical, interdisciplinary research is needed in the field of cognitive rehabilitation.

36. There are problems with studying efficacy that include the following : Partitioning out the effects of spontaneous recovery from the treatment effect. The effects of concurrent treatments, i.e., language therapy and physiotherapy , which may assist with emotional adjustment, which then can interact with the cognitive gains. The standardized treatment usually required for experimental research reduces the opportunity to tailor the treatment to the needs of the individual . Problems

37. CRT is rarely offered in isolation. CRT cannot be easily studied in a ‘blind’ or ‘double blind’ experimental design. It is difficult to maintain experimental control for the length of time one would expect to be required for meaningful change of brain function.

38. CRT is not just about restoration; rehabilitation includes compensation and environmental re-design—which are patently helpful, e.g., giving a patient a talking watch (modified to prevent resetting), which keeps a cortically blind stroke survivor from waking his wife all night to find out if it is time to get up.

39. Kelly ME, Sullivan MO. Strategies and Techniques for Cognitive Rehabilitation. TASI. 2012 . Sengupta P, Benjamin AI, Singh Y, Grover A. Prevalence and correlates of cognitive impairment in a north Indian elderly population . Cognitive Rehabilitation : Information for Patients and Families. Stroke Engine Tomás P, Fuentes I, Roder V, Ruiz JC. Cognitive rehabilitation programs in schizophrenia: current status and perspectives. International Journal of Psychology and Psychological Therapy. 2010;10(2 ). Petersen RC, Stevens JC, Ganguli M, Tangalos EG. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review). References

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