Care for People with Acquired Brain Injury

Essential Questions
What is cognition?
What can impact healthy cognition?
What is Cognitive Rehabilitation Therapy (CRT)?
Who can benefit from Cognitive Rehabilitation Therapy (CRT)?
How do I know whether services provided by ‘Mind your Brain’ would be beneficial to me?
Is Cognitive Rehabilitation Therapy (CRT) effective?
Do you do counselling?
How many sessions would I need?  

Essential Answers

What is Cognition?

In simplified terms, Cognition means nothing else but the processes that enable us to integrate knowledge and think about it.  Thinking thus is a complex activity that allows us to get to know, understand, and respond to the world around us and understand our inner world (i.e., mental well-being).  Thinking is made up of a number of areas including attention, memory, information processing (e.g. thinking speed), and other more complex functions such as decision-making, problem solving, multitasking, and orientation, all of which are required for successful daily functioning at home and at work.   Thus, these abilities, which are collectively referred to as cognition, enable a person to think, understand one’s external and internal world, and in turn, empowers a person to behave in a goal-oriented manner. Consequently, cognitive difficulties can have far-reaching real-life consequences such as difficulties completing tasks efficiently and accurately as well as experiencing difficulties with emotional regulation or other emotional difficulties such as irritability or impulsivity, and feelings of vulnerability, all of which can lead to social isolation, and the accompanying stress, frustration, and emotional suffering.

What can impact cognition?

Cognitive functioning can be impacted by many factors such as the amount of sleep we get per night, level of fatigue, pain, caffeine, medical and recreational drugs, emotional processing, as well as healthy aging.  Conditions such as dementia and mild cognitive decline (i.e.  pathological aging) neurodegenerative diseases (e.g. Parkinson’s disease), other neurological disorders (e.g. stroke), acquired brain injury including mild traumatic brain injury and chemotherapy, as well as psychological conditions such as depression, schizophrenia, and attention deficit disorder can also affect a person’s cognitive functioning.

What is Cognitive Rehabilitation Therapy (CRT)?

“Cognitive Rehabilitation refers to the therapeutic process of increasing or improving an individual’s capacity to process and use information so as to allow increased functioning in everyday life.  This includes a) methods to restore cognitive functions and b) compensatory techniques.” (Sohlberg,1989).   The American Congress of Rehabilitation medicine (ACRM) describes cognitive rehabilitation as “a systematic, functionally oriented service of therapeutic cognitive activities, based on an assessment and understanding of the person’s brain-behavior deficits.”   Thus, cognitive rehabilitation intends to alleviate cognitive difficulties so as to promote better everyday life functioning. Its goal is to maximize safety, independence, and quality of life through improving daily functioning.  (Please, see “Services- Brain Injury Rehabilitation” page on this site for more detailed information).

Who can benefit from Cognitive Rehabilitation Therapy (CRT)?

A person can benefit from cognitive rehabilitation services if his/her thinking (e.g. memory, attention, executive functioning such ability to organize and plan strategically) has been compromised, and/ or if a person requires assistance with cognitive strategies to support successful everyday life functioning.  A strategy is an approach or method we use to support successful task completion.  In this definition, using a cane can be considered a strategy to support successful walking.  In the same manner, we can support our cognitive functions by using cognitive strategies to support functionality.  In fact, the world uses computers, which can be considered a compensatory memory strategy when used to store information for later retrieval.  Similarly, cognitive strategies can be internal, using our mind. For example, repeating information several times in one’s mind enables remembering of the information.

Conditions in which cognitive rehabilitation principles can be and have been successfully utilized include for example:

• Acquired Brain injury (including mild traumatic brain injury, encephalitis, meningitis, brain tumor, brain surgery)
• Psychological Conditions (e.g. depression, schizophrenia)
• Chemotherapy
• Pathological Aging (e.g. mild cognitive impairment, dementia, stroke)
• Healthy Cognitive Aging 

How do I know whether Services provided by ‘Mind your Brain’ would be beneficial to me? 

For people, whose quality of life and emotional well being has been compromised through any of the above or similar conditions, life can become a daily struggle.  Tasks like being at an important appointment at the right time can be daunting for a variety of reasons. These reason can range from simply forgetting the appointment to getting confused with directions or which way to turn when leaving the appointment to go home.   Cognitive difficulties might show up in daily life as feeling overwhelmed by too much information.  Examples include feeling overwhelmed by the number of items in the grocery store aisle when you want to find a specific product; difficulties planning and organizing a task or errands because it involves too many things to consider, or just simply filling out a form; making errors; or just not being able to stay on a task because you either cannot concentrate for as long as the task requires or because of distractibility.  These are just a few examples of the myriad of daily difficulties that people experience when brain function has been compromised by disease or injury.  These difficulties can affect a person’s relationship and translate into decreased emotional well-being and quality of life.

In addition, people and/ or their loved ones often do not know what specific causal factors underlie these everyday difficulties, potentially resulting in inappropriate strategy utilization.  The consequence is confusion, an increased level of stress, less motivation to go out in public or to meet friends because of the worries and fear that come with not knowing how to solve the problem effectively and successfully.

It is for these reasons that cognitive difficulties are often cited as the “greatest barrier” for people to return to work, school, home, and normal life.

At the same time, feelings of vulnerability, difficulties relating to people, and the social isolation are often the behavioural consequences that are difficult to address and create everyday struggles that can result in the downward spiral or a vicious cycle that is difficult to escape without outside help!

At Mind your Brain, I can help you and your loved ones understand why these everyday difficulties are happening and why, despite so much energy invested in staying ahead of the difficulties, the problems remain to keep your life a daily struggle.   And, of course, I will show you how to address these difficulties.  Depending on your specific needs, this can be accomplished via teaching you how to utilize cognitive exercises as well as strategies efficiently, effectively, and successfully, and/ or providing you with the emotional support throughout your journey towards reaching your optimal level of functioning and leading a productive life.

Is Cognitive Rehabilitation Therapy (CRT) effective?

CRT is evidence-based.  That means that a large body of scientific research has been accumulated over time that shows that cognitive rehabilitation therapy leads to significant improvements (i.e. beyond chance improvements that might have occurred without CRT interventions) in individuals who require such interventions (e.g. people with traumatic brain injury).  In addition, the National Institute of Aging (NIA) ACTICE Study has produced positive results for cognitive training in older adults:  Cognitive training shows staying power as well as in older adults with pre-existing memory impairments: Older adults with mild memory impairment still benefit from cognitive training.

You can also watch the short video by Brainline.org below on effectiveness of CRT for people with brain injury:

Do you do counselling?

• Yes.  Within the context of cognitive rehabilitation, I provide counselling to a client who is seeking support for dealing with the emotional difficulties that arise from the struggles of living with acquired brain injury or cognitive decline due to healthy or pathological aging (e.g. Parkinson’s Disease, Mild Cognitive Impairment, Dementia).  This type of counselling can include but is not limited to support for emotional consequences after acquired brain injury including difficulties with emotional regulation and symptom management following concussion.
• Outside of the above context (acquired brain injury; healthy/ pathological aging), I also provide counselling if feelings of anxiety and/ or depression interfere with your relationships, and/ or keep you from successfully functioning in your everyday life (e.g. work/ home/ school).
• The counselling approaches that I utilize include (but are not limited to)  Rogerian (client-centered), Cognitive Behavioural Therapy (CBT), Motivational Interviewing, and Existential.

I do not provide counselling for specific conditions or situations arising outside of the above described contexts (e.g. trauma counselling, family/ marriage counselling).

How many sessions would I need or how long would I have to see you? 

The number of sessions that you will need depends on the complexity of the difficulties you are experiencing.  If you are not sure whether counselling/ cognitive rehab therapy is a good idea for you, I usually suggest to try out this approach by utilizing four (4) sessions to help you make an informed decision as to whether this counselling approach is right for you (i.e. whether you see improvements).

However, to re-assure you, we will come to the decision of how long you need to see me together. And, ultimately, it will be your decision to make, a decision I will be happy to assist you with.