Cognitive rehabilitation therapy

Cognitive Rehabilitation Training - ACRM

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Cognitive rehabilitation is a program to help people with brain disorders or cognitive impairment to restore normal function, or to compensate for cognitive deficits. This requires an individualized program of specialized skills training and exercises plus metacognitive strategies. Metacognitive strategies include helping patients raise self-awareness of problem-solving skills by learning how to monitor the effectiveness of these skills and self-correct when necessary.

Cognitive rehabilitation therapy (offered by trained therapists) is part of Cognitive Rehabilitation (community-based rehabilitation, often in traumatic brain injury, provided by rehabilitation professionals) and has been shown to be effective for individuals suffering from strokes on the left or right hemisphere. or brain trauma. A type of computer-assisted cognitive rehabilitation therapy called cognitive remediation therapy has been used to treat schizophrenia, ADHD, and major depressive disorders.

Cognitive rehabilitation is built on a strategy of brain injury involving memory, executive function, activity planning and "follow-up" (eg, memory, task sequencing, lists).

It can also be recommended for traumatic brain injury, a major population developed in the medical community and university rehabilitation, as experienced by US Representative Gabrielle Giffords, according to Dr. Gregory J. O'Shanick of the Brain Injury Association of America. His new doctor has confirmed that it will be part of his rehabilitation. Cognitive rehabilitation can be part of a comprehensive community service program integrated into residential services, such as supportive living, employment supported, family support, professional education, home health (as personal assistance), recreation, or educational programs in the community.

Video Cognitive rehabilitation therapy

Assessment

According to standard texts by Sohlberg and Mateer:

Individuals and families respond differently to different interventions, in different ways, at different times after injury. Premorbid function, personality, social support, and environmental demands are just a few factors that can severely affect results. In response to treatment variables, cognitive rehabilitation is no different from treatment for cancer, diabetes, heart disease, Parkinson's disease, spinal cord injury, psychiatric disorders, or other injury or disease processes where variable responses to different treatments are the norm.

However, many different statistical analyzes of the benefits of this therapy have been performed. One study conducted in 2002 analyzed 47 treatment comparisons and reported "differential benefits that support cognitive rehabilitation in 37 out of 47 (78.7%) comparisons, with no comparison demonstrating benefits supporting alternative treatment conditions."

An internal study conducted by the Tricare Management Agency in 2009 was cited by the US Department of Defense as an excuse to refuse to pay this therapy to veterans who suffer from traumatic brain injury. According to Tricare, "There is not enough evidence, evidence-based research is available to conclude that cognitive rehabilitation therapy is beneficial in treating traumatic brain injury." The ECRI Institute, whose report serves as the basis for this decision by the Department of Defense, has concluded their own findings in this way:

In our report, we conducted several meta-analyzes using data from 18 randomized controlled trials. Based on data from this study, we can conclude the following:

Adults with severe to severe traumatic brain injury who receive social skills training work significantly better on measuring social communication than patients who are not receiving treatment.

Adults with traumatic brain injury who receive comprehensive cognitive rehabilitation therapy report a significant improvement in the quality of life measures compared with patients receiving less intense forms of therapy.

The strength of the evidence supporting our conclusions is low because of the small number of studies that discuss interesting results. Furthermore, the evidence is too weak to draw definitive conclusions about the effectiveness of cognitive rehabilitation therapy to treat the following cognitive-related deficits: attention, memory, visuospacial skills, and executive function. The following factors contribute to the weakness of the evidence: differences in outcomes assessed in the study, different types of methods/strategies of cognitive rehabilitation therapy used throughout the study, differences in control conditions, and/or insufficient number of studies.

Citing this 2009 assessment, the US Department of Defense, one of the federal agencies that is not responsible for health care decisions in the US, has stated that scientific cognitive rehabilitation therapy has not been proven and should refer their concerns to the US Department of Health and Human Services. Budget and Management, and/or Government Accountability Office (GAO). As a result, he refused to cover the cost of cognitive rehabilitation for a brainwashed veteran. Cost-benefit and cost-effectiveness studies, along with service analysis of personnel and veterans for new groups emerging in head and brain injury, are recommended.