Enhancing the therapist's role following TBI

Brain injuries result in a huge burden on society. Not just from the direct medical costs but also from lost productivity and a broader impact on the family. Cognitive issues are the major cause of long-lasting disability and impaired quality of life following brain injury but providing rehabilitation has been problematic. Something needs to be added into the care process that brings both effectiveness and efficiency into the mix.  This is where we see technology can play a role.  Let's start with the current situation and go on to point to a way that therapists and neuropsychologists can gain some "superpowers"

The challenges faced by many rehabilitation services are no surprise - they are typically due to

  • Financial pressures - budgets are tight (and not going to be eased anytime soon)
  • Growing demand - the number of incidents of acquired brain injury are increasing and it is necessary to somehow treat more patients than ever before`
  • Availability of staff - therapists and neuropsychologists are essential to the delivery of cognitive rehabilitation but numbers are not growing in step with the increasing demand for services.
  • Complexity - the spectrum of conditions that must be managed is often very wide and the severity of cognitive disorder is also highly varied. Consequently the therapist’s role is varied complex and demanding.
  • Location - treating patient's at home might be desirable but is it always effective? How can we deliver better rehabilitation irrespective of the location?

In general the intervention types we have available to bring about positive change in cognitive rehabilitation are as follows: (Cicerone 2000)

  • Restitution - to reinforce, strengthen or re-establish previously learned patterns of behaviour
  • Internal compensation - to establish new patterns of cognitive activity through compensatory cognitive mechanisms for impaired neurological systems
  • External compensation - establishing new patterns of of activity through the use of external aids
  • Adaptation - enabling patients to adapt to their disability in order to improve their overall level of functioning and quality of life.

The therapist's role of course is to deploy these various approaches to maximise the outcome for patients.  The therapist is the "conductor" and the various strategies are the "instruments" that have to be blended in the right way for a harmonious result.

In the UK I suspect that in the past Restitution Strategies have been not so favoured as Compensation Strategies. This has not been the case in other parts of the world.  In Germany for example, Restitution approaches have been applied clinically with effect since the early 1990's.

Once upon a time there was certainly less research evidence that Restitution Strategies could work.  Whilst that objection has now reduced, it is still the case that for Restitution approaches to work the intervention needs to be specifically targeted and fairly intensive - and this implies it might be challenge if Restitution training is carried out with paper-based, on-on-one therapist input.

We believe that a tool such as RehaCom has a great role to play in improving the efficiency and effectiveness of cognitive rehabilitation.  RehaCom is not magic - its not a substitute for a therapist - it IS potentially a great tool to be used BY the therapist in seeking the best outcome for a patient.

In Germany, 95% of relevant clinics already use RehaCom - lets look at how it is deployed.  As you realise, the rehabilitation of cognitive impairments ideally requires continuous treatment over time.  Training with RehaCom ideally begins early in the clinic and can then easily be continued at home under supervision of a therapist.  The software provides several solutions to enable continuous access to RehaCom training in clinics and at home utilising the principles of telemedicine.  

The duration of a therapy session with RehaCom depends on the client’s personal performance.  According to available evidence, clinical guidelines suggest that clients should train:

  • Several times a day for 10 to 15 minutes in the acute phase
  • In the following 6 to 8 weeks, training sessions of 45 to 60 minutes should take place at least 3 times per week
  • In the late phase of rehabilitation, and in the subsequent home training, clients should train 2 to 3 times a week for about 3 to 5 month

We know that training and therapy ideally needs to be specifically targeted, frequently applied and intensively deployed.  The technology and pedigree of RehaCom allows this to be more than a pipe dream.  Screening procedures within the system point to the patient's specific cognitive deficits and also point to which of the many RehaCom procedures to use.  You never need to worry about overwhelming a patient because the software automatically adjusts the difficulty of the tasks presented.  The therapist guides the patient using RehaCom as a precision tool and enjoys the possibility of very detailed analysis of how the patient has performed.

Does performance with the software transfer to real life?  Well we see this as the therapist's goal and RehaCom as just one of the tools to bring that about.  No product exists that will be suitable for all situations and all people but we encourage you to take a look at how RehaCom might work for you. You will be in good company.