Academic journal article Indian Journal of Psychiatry

Cognitive Rehabilitation for Reversible and Progressive Brain Injury

Academic journal article Indian Journal of Psychiatry

Cognitive Rehabilitation for Reversible and Progressive Brain Injury

Article excerpt

Byline: Ravi. Samuel

Cognitive rehabilitation (CR) is a specialized treatment procedure to develop the cognition affected by internal or external injury to the brain. The process of cognitive rehabilitation involves assessment of cognitive functions, goal setting, and applying appropriate cognitive exercises to improve the cognitive function. There are two types of CR: Restorative rehabilitation and Compensatory rehabilitation. The CR therapist will make a comprehensive assessment of the impairment and design appropriate cognitive exercises. Studies on the efficacy of CR for brain damage have shown two extremes; one opinion was CR has a positive effect on the patients cognitive functioning and the other opinion was that CR has no effect on the cognitive functioning. This case study examines the dynamics and relevance of CR in reversible and progressive brain injury. It was observed that in reversible condition CR improves cognition and thereby functional ability. In progressive conditions like Alzheimer's disease (AD), CR improves the cognition marginally and thereby improves functional ability and also reduces Behavioral and Psychological Symptoms in Dementia (BPSD).

Introduction

Cognitive rehabilitation (CR) is a specialized treatment procedure to develop the cognition affected by internal or external injury to the brain. This is based on the theory proposed by Luria that the recovery of function can occur through new learned connections established through cognitive retraining exercises.[sup] [1] The process of cognitive rehabilitation involves assessment of cognitive functions, goal setting, and applying appropriate cognitive exercise to improve the cognitive function.[sup] [2]

There are two types of CR: Restorative rehabilitation and Compensatory rehabilitation.[sup] [3] Restorative rehabilitation is to enable the person to develop the lost function through specialized computerized and manual cognitive exercises. Compensatory rehabilitation helps the patient to develop use of aids and tools to overcome the impairment. For example, people with poor memory can have a small slip to write down what they need to remember.

The brain needs specific exercises to enable it to regain the lost function after injury; in case of internal event like stroke or external accident like head Injury. CR is normally done after the patient medically stabilizes.[sup] [3] CR is also beneficial for people who have developed their brain functioning in a faulty manner due to poor supervision in learning during childhood.

CR therapist will make a comprehensive assessment of the impairment and select appropriate cognitive exercises. For example if a person suffers from severe memory difficulties, the exercises will start with simple exercises like learning five randomly selected words and then recalling as many times during the day. And with the development of the brain; the difficulty and complexity of the exercises will be increased like asking the patient to learn three new words. Initially CR is done through manual exercises and computerized programme with assistance of the therapist. The therapist will enable the patient to perform exercises in areas in which they have difficulty. After the patient develops confidence over their performance in doing the exercises, they will be encouraged to do cognitive exercises at home.

Studies on the efficacy of CR for brain injury have shown two extremes; one opinion was CR has a positive effect on the patients cognitive functioning[sup] [4],[5] and the other opinion was that CR has no effect on the Cognitive Functioning.[sup] [6],[7] This case study examines the dynamics and relevance of CR in reversible and progressive brain injury.

Case 1 Mr. S aged 39 years, working as manager of a multi national company was referred by a Psychiatrist for CR. He was a heavy smoker and also had the habit of drinking alcohol occasionally. One and half years ago, he had severe myocardial infarction and consequent hypoxia, resulting in severe brain injury, leading to severe cognitive impairment. …

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