I have worked as an Occupational Therapist with acquired brain injury clients for the last 20 years. And that’s why I get really discouraged when the doctors in the acute, and even rehabilitation hospitals, call cognitive rehabilitation mental stimulation and tell the clients to do random quizzes and Sudoku etc. to help in their cognitive recovery following a brain injury.Cognitive rehabilitation as we have seen in the recent literature is a science, just like physical rehabilitation. It takes a detailed assessment by a neuropsychologist and an occupational therapist to identify the impairment areas, followed by developing and implementing a well-defined plan of action to obtain the optimal results.
It uses some of the same principles as physical rehabilitation; namely, the use of the right challenge to progress the clients. For example, you would not expect a client who is disoriented to his/her surroundings and has a very limited attention span, and who just came out of a coma two days ago in an ICU, to do Sudoku or cross word puzzles. It would only lead to frustration and failed outcome for the therapist and the client.
Cognitive intervention has to be tailored to the specific client, their educational background, their cultural and social beliefs and their level of functioning. It’s not one-size-fits-all.
Another issue is the assessment tools being used for screening and assessing cognition. The MOCA and the MMSE for the acquired brain injury clients is being used as the first line of action by the occupational therapists in acute care hospitals. However, these are very simplistic ways of looking at and assessing a very complicated area i.e. cognitive functioning. I would suggest that clinicians execute caution in using and reporting the results from these screening tools.
Occupational Therapists have to be careful about the assessments/screening tools they use and the interventions they employ to obtain the optimal results for their acquired brain injury clients. The biggest piece of the puzzle is to educate the team members on the very complicated nature of brain injury and recovery and veer them away from oversimplification of assessment and intervention techniques!!
Submitted by: Meeta Gugnani, BSc. OT, MSOT, OT Reg. (Ont.)