Brain damage, whether caused by stroke, traumatic brain injury (TBI), tumours, or multiple sclerosis, damages both physical and mental wellbeing. The level of impairment varies widely from person to person and depends on many factors, including an individual‘s personality and the severity and area of the brain damage.
In terms of the recovery of physical function, modern rehabilitation techniques recognise that recovery can often be secured to some degree by employing the right techniques that exploit the ability of the brain and nervous system to "rewire itself" given the right stimulus. The question of what constitutes the right stimulus is still being explored; this idea of neuroplasticity is exciting but not fully understood and the "wrong kind" of stimulus may not produce the outcomes we hope for.
In recovering arm function after a stroke, for example, we know that specific, guided exercises performed frequently and intensively can help in many cases. This is typically not easy for the client - many will find it the hardest thing they have ever done. Some individuals will relish the challenge and others will find the challenge to exercise and strive for recovery just too much.
Research methodology can have problems with this highly individualised approach too. Health services demand evidence that interventions are effective which means having confidence that there is a clear "cause" and "effect" relationship at work. For example, patient takes a pill - patient gets better because they took the pill, with other influences either eliminated or controlled.
Physical and cognitive rehabilitation are challenging interventions to study because they often need to be highly individualised forms of treatment. The conditions are highly variable in how they impact on a person. In addition we would know for sure that nature of the intervention matters and the dose matters (frequency and intensity of rehabiliation) but dont have a clue about what the right dose might be.
In the days before science had identified that the brain could recover from brain injury, the belief was that the body-brain would recover to some extent in the first six months post injury and then further recovery would be unlikely. This belief naturally shaped the rehabilitation that was offered and the approaches for physical and cognitive rehabilitation would naturally be constrained by this. The rehabilitation goal was often to compensate for what was lacking and it seemed pointless to aim for any great degree of functional recovery.
Clients following a brain injury often experience difficulty with concentration and sometimes develop speech disorders. They may also experience difficulty recognising or naming objects or persons. Frequently, spatial orientation and memory are also affected.
Different diagnostic measures are used depending on the severity and the type of brain damage. Clients may undergo physical, occupational and speech therapy as well as neuropsychological therapy, which includes cognitive therapy.
The aim of cognitive rehabilitation is now to minimise the damage, to regain lost skills, to develop compensation strategies, and to help the client to progress to the highest possible level of independence. Intact cognitive functions should be trained first because success leads to better self-confidence. After that, affected functions can be trained specifically by using clear and explicit instructions.
Evidence for the effectiveness of computer aided cognitive rehabilitation has grown along with the belief - and fact - of the potential for recovery.
RehaCom is like a multigym for the brain. It provides the means for clients to carry out quite specific exercises designed to support the recovery of cognitive function wherever and whenever this is possible. The aim is to recover what can be recovered and compensate for what cannot.
RehaCom is not a "pill" though - it's not something that is "done to" the client. The client has to be a willing participant and RehaCom is a tool to used intelligently by a therapist.
As in the gym metaphor, we believe that training needs to be directed by a competent person who can guide the client based on their individual needs. This training needs to be frequent and intensive to achieve anything and it also needs to be the right level of intensity. Where RehaCom is excellent is that it automatically adjusts the level of cognitive challenge so that it is not too hard nor too easy - it supports and motivates without frustrating the client.
An often quoted belief was that performance gains in the use of rehaCom would not convert into real-world gains in function. The fact is if you were to use RehaCom like a pill that would be true. It would be like you and going to the gym frequently - this may not mean we do more with our lives but it would give us the potential to do more. RehaCom may gave someone the capacity to do more but it's the therapists job to exploit that potential and find strategies that deploy that potential to good effect in that persons life.
I suppose many persons would like to just take a pill but sadly no so thing exists. There is also the challenge of how to provide this type of intensive therapy for those who need it. RehaCom has developed over many years to be a flexible tool that can be used in the community and this allows both efficiency and effectiveness