02 shears cognitive functions rehabilitation

8/12/2019 02 Shears Cognitive Functions Rehabilitation

1/19

Cognitive Rehabilitation in

practice

Steve Shears [email protected]


2/19

Headway UK the brain injury associationWWW.HEADWAY.ORG.UK

Headway UKa registered charitable organisation in the UKsupporting and providing information to people living with acquired

brain injury and their relatives.

We also provide information and training about acquired brain injury

to health and social care professionals.

We deliver this service through a network of 117 local support

groups in all four countries of the UK.

We are involved in bridging the gap between the excellent work

done by acute medicine to save people following brain injury and

cognitive rehabilitation services.
http://www.headway.org.uk/http://www.headway.org.uk/


3/19

Aims for today

To consider aspects of assessment andtreatment of cognitive problems and how theclients emotional needs should be part of aholistic assessment and treatment programme.


4/19

My role in Headway

I head the training services but also see people for psychotherapywho are having problems with the psychological adjustment to their

brain injury.

I also see partners and relatives of people living with brain injury.

I have a specialised interest and training in psychosexual therapy

and I am interested in sexuality and relationships as a rehabilitation

concern following acquired brain injury (Baker, M and Shears, S 2010)

I need to modify my therapeutic approach in order to engage clients

with cognitive deficits.


5/19

Key brain sites and implications for

injury.


6/19

Key issues in neurorehab

Restoration versus Compensation.

The brain does not regenerate after damage due

to stroke or head injury.

But long term functional improvements do occurover months or years.

Lost skills can sometimes be re-taught or

compensatory strategies can be taught to help

get round the deficit.


7/19

Cognitive problems like those in our

everyday lives but more frequent?


8/19

Had any of these in the past week?

In the past week have you had an experience of:-Getting to the top of the stairs (or anywhere) and have forgotten whyyou went there?

Knowing that you knew the same of someone or something andcouldnt quite retrieve it (tip of the tongue)?

Losing the thread of what you were saying when you becamedistracted?

Forgetting an appointment or something else you should havedone?

Finding it hard to divide your attention between two tasks?

Following a brain injury these difficulties become more pronounced.


9/19

A quote

We do not lack cognitive rehabilitative strategies following braininjury. In the last few decades we have developed a lot of them. It is

getting patients/clients to do them that is the challenge Rick

Parente PhD

His talk at a cognitive rehabilitation conference in Denver was

subtitled stuff we tried in brain injury rehab over the past 25 yearsand it worked!

A key factor was a person-centred approach of the client seeing it as

something that solved a problem for themtherefore they might be

more motivated towards achieving their goals.

Clear goals are an important part of treatment.


10/19

Holistic Assessment and Treatment

It is helpful to have a through assessment, clear goals andmultidisciplinary input but the cognitive rehabilitation might not be

successful if the clients emotional needs are not addressed

(Prigatano 2002).

This is particularly salient when some researchers have said that a

significant proportion of people living with brain injury are sufferingfrom depression and anxiety (Wilson et al 2009)

As cognition improves due to rehabilitation people may also become

more aware of their deficits and changes to their lives thus

increasing anxiety and depression.


11/19

Cognitive Rehabilitation Therapy

CRT is made up of:1. Education about cognitive weaknesses and strengths. Educationin groupsless threatening.

2. Setting of clear goals and development of goal managementplans. (Wilson et al 2009)

3. The development of skills through direct retraining or practicingthe underlying cognitive skillsoften referred to as process training

4. The use of external and internal compensatory strategiesdiaries, electronic aids and mental strategies to remember things.

5. Application of these in everyday life, and using functional tasks toimprove cognitive skillsfunctional activities training.

6. Input about the emotional aspects of adjustment.


12/19

Case 1 Ian Hidden Disability

Synopsis

28 year old man knocked down by a car when crossing the road.

Unconscious for three days.

Treated in hospital in an acute medical ward and required surgery

for broken bones.

Released home and treated for Post Trauma Stress by

psychological therapist.

Brain Injury element not followed up on.

Referred to me for seven week anxiety management course for

residual effects of post trauma stress.


13/19

Ian (Continued)

Treatment (7 Sessions)Education and information about causes and effects of acquired brain injury.

Videoing of sessions to reinforce points discussed in sessions - due to his

attention and memory problems Ian had a copy of the sessions to review at

home.

Development of cognitive strategies to help Ian compensate for his memoryproblems at work.

Anxiety management strategies to use at work.

Self monitoring sheets for Ian to use regarding his anger management.

Counselling for the emotional adjustment issues related to his awareness

that he had a brain injury.Referral to neuropsychology and neurology.


14/19

Case 2 - Heather

Synopsis

Sub-arachnoid haemorrhage

Damage to frontal lobe and hypothalamus areas.

Alteration in executive function and hypersexuality with

behavioural problems and risk-taking behaviours due to

poor insight and impulse control.


15/19

Heather (Continued)

Treatment (Over a five year period)Medication to lower libido and hormone replacement.

Education for Heather about her brain injury.

Behavioural therapy aimed at reducing incidences of inappropriate behaviour.

Supervision

Whole family/friendship networks educated to give consistent response to Heathers

behaviour. Husband was very involved in co-ordinating this.

Counselling for Heather to deal with her emotional adjustment to the loss of her pre-

injury self and status.

Social Services have now involved Heather in a volunteer training programme and

this is meeting her vocational needs.

Her insight and behaviour are such improved now.


16/19

Conclusion

Holistic assessment and treatment incorporatingcognitive rehabilitation therapy and counselling

support can lead to better outcomes for clients

following acquired brain injuries.


17/19

References

Baker, M and Shears, S (2010) Sexuality training for health and social careprofessionals working with people with an acquired brain injury. Social Care

and Neurodisability Volume 1 Issue 3 November 2010 Pier

Professional Ltd

Parente, R (2007) Society of Cognitive Rehabilitation Conference,

Westminster, Denver, Colorado

Powell, T (2004) Head InjuryA Practical Guide, Speechmark.

What Do Patients Need Several Years After Brain Injury?(2002) Prigatano,

G.P. Barrow Quarterly. Vol18 No2

Wilson, BA, Gracey, Evans, J, Bateman, A. (2009). Neuropsychological

Rehabilitation: Theory, Therapy and Outcome. Cambridge University Press.


18/19

Web references

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D

H_4105361 (2005(NSF Long Term Conditions-

UK Department of Health Website)
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4105361%20(2005http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4105361%20(2005http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4105361%20(2005http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4105361%20(2005http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4105361%20(2005http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4105361%20(2005


19/19

Your views or questions to :

[email protected]

(+44)115 9240800
mailto:[email protected]:[email protected]

02 shears cognitive functions rehabilitation

Documents