RehaCom software can play a role in dealing with some of the cognitive problems that result from a Traumatic Brain Injury (TBI). A TBI is an acquired brain injury caused by some kind of trauma to the head. The most common causes are:
- Road traffic accidents, accounting for 40-50%.
- Domestic and industrial accidents account for 20-30%,
- Sports and recreational injuries for 10-15% and
- Assaults 10%.
Brain injury can have a very wide range of effects and will vary from one person to another depending on the exact nature of the brain injury and its severity. In many cases - the majority that lead to a need for cognitive therapy - there is a period of unconsciousness. This period allows natural healing processes to occur. However, as the person emerges from unconsciousness gentle stimulation and familiar voices become important.
As the person emerges from this period the longer term effects become obvious. It is difficult to predict how quickly or how much recovery can take place. Longer term effects can be physical, cognitive, emotional and behavioural.
The most common cognitive problems following a brain injury are certain types of memory impairments, concentration difficulties and issues with processing "incoming" information. Memory of events from the past may be preserved but the memory for recent events compromised.
Executive problems may be an issue. Parts of the brain have the function of planning, integrating an organising the day to day tasks of life. Damage to these parts of the brain can result in these so-called executive issues.
RehaCom and Traumatic Brain Injury
RehaCom has a number of procedures relevant to the cognitive rehabilitation of persons following such brain injuries. In Germany, computer-aided methods of supporting the therapist have been applied since the 1980's although it has not been adopted to the same extent in the UK. Part of the reason for this is that UK clinicians doubted that training with the software may not transfer into real world benefits fro the user. In Germany no one really questions now whether training with RehaCom carries over into functional recovery.
In common with many rehabilitation areas it is difficult to get clinical evidence in the manner that would be used with drug trials for instance. The brain injured group are not an homogeneous group so it is difficult to know who is going to do well with therapy and who will do less well. When large scale studies are difficult or impossible, researchers turn to a meta-analysis where, in simple terms, the aggregate effects of many smaller studies are considered.
in Germany a meta-analysis of the literature did provide good evidence and therefore support for computer based cognitive rehabilitation.
" " See articles in: Neurologie und Rehabilitation 2010 (Issue 2)
" " and earlier by Cicerone et al, Arch Phys Med Rehabil Vol 86, 2005 and Vol 81, Dec 2000
In terms of when to use RehaCom the belief is that the sooner cognitive rehabilitation begins the better. Whilst there is not strong evidence that this is necessary, it is backed by clinical consensus and there appears to be no “down-side” to early intervention.
An assessment process is very important to determine what cognitive deficits and other issues there might be. Typically there may be a range of deficits and other issues such as behavioural problems or depression to deal with. The therapist must look at the broad issues faced by the patient and decide if and when rehacom would be useful. For example, depression might be a reason to delay using RehaCom - dealing with depression might be a priority compared with cognitive deficits.
In practice, the prevailing view is that training needs to be SPECIFIC, FREQUENT and INTENSIVE. Of course, training depends on what patients are capable of doing; but 3 times per week would not be considered enough.