Setting Up a Cognitive Rehabilitation Program
Introduction
Setting up a cognitive rehabilitation program offers many benefits. It builds cognitive skills needed to accomplish tasks, has patients engaging in a stimulating environment incorporating individual and group work, and facilitates transfer of skills to aspects of everyday life. This in turn can reduce the risk of re-hospitalization related to injury/disorder and will help foster independence.
Needs for a Successful Cognitive Rehabilitation Program
To have a successful cognitive rehabilitation program, you will need:
1. Trained and licensed therapists
2. Clients/patients
3. Office space
4. Technology and internet access
5. Support of the program and administration
Kinds of Therapists Who Do Cognitive Rehabilitation
Many therapists can do cognitive rehabilitation. Examples of therapists that do cognitive rehabilitation include psychologists, social workers, licensed professional counselors, and medical doctors. Therapists doing cognitive rehabilitation may work in a private practice setting, a small therapeutic practice, or a large medical facility.
Medical Conditions That Benefit from Cognitive Rehabilitation
Aging, neurological, and psychiatric populations can all benefit from cognitive rehabilitation. Cognition is impacted by a variety of factors and medical conditions, which is why cognitive rehabilitation is important for so many populations.
As people age, natural processes cause the brain tissue to atrophy and cognitive processes begin to slow. With conditions such as Alzheimer’s disease or dementia, cognitive functions decline at a more rapid rate and patient’s begin to gradually lose their independence.
Stroke and brain-injury cause cognitive decline as brain tissue is damaged by oxygen starvation, hemorrhaging, penetration of an object into the brain tissue, or by blunt force causing the brain tissue to strike the skull. Neural connections needed for optimal function are lost and cellular metabolic processes are altered in injured tissue. Without stimulation, cognitive processes in these patient groups decline and patients are at risk for re-injury or re-hospitalization.
Lastly, psychiatric conditions can cause cognitive problems. Bipolar disorder and schizophrenia may present with cognitive deficits, while patients receiving proper treatment may live relatively normal lives and present cognitively intact. Cognitive rehabilitation with these patients can not only benefit their cognitive functioning, but emotional and social well-being.
Space Requirements for a Cognitive Rehabilitation Program
For a successful cognitive rehabilitation program, therapists and clients need the proper amount of space for computer work-stations, therapist desks, and space for group therapy. Typically, cognitive rehabilitation can occur with 6-8 clients in addition to 1-2 therapists. A single-room with enough space or a multi-room setting can be used if the space is available.
Technology and Internet Access
Cognitive rehabilitation programs often use digital software programs with exercises designed to target various domains of cognition. Many platforms exist, but it is up to the therapist to determine which program or programs may be the best for their needs. If the budget allows, you can select multiple programs. Often times, budgets are limited. You will want to select a platform with at least 25 or more exercises so that there is a variety of content available so your clients do not get bored.
Support and Administration Needs
Billing, supply collection and maintenance, recruitment, and retention of patients requires administrative support. So as not to take away focus of the therapists, it is important that there are staff to support the needs of the program. Assistants and junior level staff serve a great role in the success of a cognitive rehabilitation program, as they help the therapists stay focused on therapy and prevent unnecessary distraction away from therapeutic activities.
Supervision and Training
There are conferences and sessions that do training on cognitive rehabilitation, in addition to plenty of literature on instruction. Two recommended written manuals are Cognitive Remediation To Improve Functional Outcomes by Dr. Alice Medalia and Dr. Christopher Bowie and Cognitive Remediation for Psychological Disorders, Second Edition by Dr.’s Alice Medalia, Tiffany Herlands, Alice Saperstein, and Nadine Revheim.
It is important that providers of cognitive rehabilitation programs understand cognitive deficits patients experience, how people learn, and understand impacts of cognitive impairment in life. Therapists providing cognitive rehabilitation need several weeks to practice and get familiar with tools they plan to use as well as get familiar with bridging discussions and activities they plan to implement as part of the program.
Running a cognitive rehabilitation program is possible as a private practice therapist. While private practice therapists may not have supervision and support of other therapy staff, doing training and reading literature to become knowledgeable on how to carry-out a cognitive remediation program is effective. Practice does make perfect as the more familiar a therapist becomes with a technique, the more smoothly and consistently they can standardize their intervention.
In a larger therapeutic setting, a senior therapist should provide training and guidance to junior staff who will be working with patients. Weekly meetings should be had to ensure that therapists know how to troubleshoot any issues that may occur during therapy sessions. As junior therapists become more comfortable, the senior therapist can pull-back and allow their junior practitioners to function more independently.
It is highly suggested that any therapist goes for a live training session. You can find programs by searching online.
Client Characteristics
Many patients can benefit from cognitive rehabilitation. Aging, neurologically compromised, and psychiatric populations can benefit from cognitive rehabilitation, even healthy people!
Certain characteristics are common of people who would benefit from cognitive rehabilitation. Some of these characteristics include:
1. Being between 13-65 years of age
2. Having an IQ of 7o or higher prior to injury, onset of psychosis, or aging complication
3. Being able to read at least at a 4th grade level
4. Being substance free
5. Being stable enough to handle sitting and participating in therapy sessions
These standards are set from clinical practice experience as well as research. As life goes on, patients may experience difficulties that interfere with some of the criteria. They may not have to stop cognitive rehabilitation, but may continue on a more individual basis or with modifications to their participation at the therapist’s discretion.
Naming Your Program
Creating a name for your program can be challenging. It is important that your name is empowering while also informing members of what the service is. Examples of names used for cognitive rehabilitation programs include The Learning Center or The Thinking Gym. With these names, there is an emphasis on cognition with a more positive and active connotation attached to the following words of gym and center. The name does not give away that it is therapeutic, and therefore people will feel less shy about going or discussing their participating with family members or friends should they feel like they want to. The name of your program should advertise the emphasis of cognition while respecting the discretion of the clients you aim to serve.
In Sum
For your cognitive rehabilitation program to succeed, you will need the following five ingredients:
1. The right office space/therapeutic environment
2. Trained and licensed therapists
3. Computers, internet, and a digital therapy tool
4. The right kinds of clients
5. Proper program and administrative support
Curious about starting a cognitive rehabilitation program in your practice? Check out the suggested books and purchase them online. You can also search for training sessions in cognitive rehabilitation as there are workshops you can attend throughout the year. To check out a tool used in many cognitive rehabilitation programs, visit www.happyneuronpro.com.
