Cognitive Rehabilitation

Cognitive Rehabilitation

Many people benefit from cognitive rehabilitation after brain injury. Cognitive rehabilitation can help with many skills including:
Building mental stamina
Attention and processing speed
Working memory (what used to be called short-term memory)
Memory
Math and reading fluency
Communication skills
Executive functioning: planning, organization, sequencing, decision-making, judgment, doing, evaluating, and adjusting.

But where, oh, where can you get cognitive rehabilitation?

From Speech Therapists!

Now that you know that, you can educate your care coordinator and your health care providers. This is a little-known fact!

Speech therapists do help with swallowing and eating and forming words and sentences, but they do so much more. They address just about everything that goes into thinking and communicating.  So you may be able to talk and you may benefit from speech therapy. A speech therapist is also known as a “speech language pathologist.” These are two names for the same rehabilitation therapist.

So if you need help with any of these skills, ask your primary care provider to consider providing a referral to speech therapy. All insurance companies pay for speech therapy including Medicaid, Medicare, and private insurance.

Below are examples of skills you can find on the speech therapy checklist provided by the Brain Injury Alliance of New Mexico. Feel free to follow that link and print out the speech therapy checklist. Fill it out, or get someone to help you fill it out, and then show it to your primary care provider. Many primary care providers are unfamiliar with the benefits of  speech therapy after brain injury. If you have trouble getting a referral, consider reaching out to the NM Brain Injury Resource Center at 505-292-7414 for problem-solving help.

Non-Verbal Communication
 Not recognizing humor or sarcasm
 Believing all people are friends or a threat
 Feelings of not belonging
 Feeling that you don’t understand others or that they don’t understand you
 Getting fired for inappropriate behavior, but not knowing what that behavior was
 Misunderstanding the intentions of others
 Feeling socially disconnected

Conversation (speech therapists call this “communication discourse, but you can call it “talking to people”).
 Difficulty understanding what others are saying
 Not following abstract thought
 Concrete understanding
 Internal and external distractions
 Others complain that you are not paying attention
 It seems others don’t follow the rules of conversation
 Changing topics unexpectedly
 Not understanding information that before the injury was easily understood
 Afraid to participate in conversations

Appropriate Use of Language (speech therapists call this “social pragmatics”)
 Difficulty with interacting with other people
 Being socially unacceptable
 Overly trustful or paranoid
 Feeling out-of-step or being told by family that you are out-of-step with others
 Unable to control anger

Memory
 Not remembering family members
 Not remembering names as you could before the injury
 Not remembering phone calls or appointments
 Not recalling how to do all or part of your job
 Not completing or turning in assignments

Attention
 Not understanding a 30 min TV show
 Not finding common household items
 Unable to concentrate on reading
 Not finishing a work project

Problem-Solving
 Having a flat tire & you don’t know what to do
 Overwhelmed by too many choices
 Unable to explain a simple problem to a child
 Concrete thinking*
 Unable to follow a recipe if the directions don’t match what you are using

Difficulty with initiating activity or the opposite, hyperactivity
 Not being able to make a phone call or request help
 Making the call, finding the line busy and not following through to call again
 Not asking the questions you want to ask, or asking them and not listening to the answers
 No food in the house, but going to the store is too difficult, or going to the store with a grocery list but not getting anything on the list.
 Forgetting to bring the groceries home or leaving them on the counter at home and forgetting to put them away

Executive Dysfunction
 High-level sequencing (bring the coffee pot to the cups or the cups to the pot)
 Goal setting
 Recognizing success vs failure accurately
 Unable to start tasks
 Executing the task
 Monitor the passage of time (recognizing time restraints prior to running out of time)
 Self-monitoring
 Self-awareness*
 Inflexible thinking or behavior

Sequencing
 Unable to complete simple household chores
 Unable to balance a checkbook
 Unable to follow simple work procedures (ex: when to clock in or out)
 Unable to remember the order of numbers like in an address or phone number

Support to family and friends (not all speech therapists have experience with these needs)
 Caregiver training
 Return to work or school
 Understanding the survivor may be a different person in many ways
 Techniques to address the changes in everyone’s life without blame

It’s important to know that speech therapists work on short-term goals with you. They want to see you make progress on small goals in a short amount of time. If you want to make progress, it’s important to do your homework. If you make very good progress, your speech therapist and your doctor can request more sessions from the insurance company. Then if you get discharged, know that you can go back again. Wait a few months, and ask your primary care provider for another referral for speech therapy.

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