Neurobehavioral Medicine Consultants
Neurocognitive Rehabilitation

Neurocognitive Rehabilitation Until relatively recently, most scientists and neurologists believed that brain development occurred primarily in childhood and adolescence and that functional areas of the brain, once developed, remained relatively stable for the rest of an individual's life. Functions lost as a result of an acquired brain injury could not be regained beyond any improvement which might occur during a relatively short recovery period. More recently, however, various lines of inquiry have led to the conclusion that the brain can often reorganize itself after an injury, a property referred to as plasticity. If an area associated with a specific function is damaged, the brain may be able to redevelop that function in a different, undamaged area.

Distribution of functions in the brain is not as simple as diagrams such as this one would indicate.

Many functions are actually distributed across multiple areas within the brain and are not conveniently confined to specific regions, and cognitive functions share pathways and brain structures, so that a cognitive deficit isolated to memory, for example, without accompanying deficits in other cognitive areas, is relatively uncommon. In some instances the injury to the brain may be biochemical rather than anatomic.

The discovery of plasticity has led to the concept that significant improvement in cognitive functioning can be achieved after an insult such as a stroke or traumatic brain injury by using various techniques to encourage the brain to restructure itself in ways that will support cognitive functions. These techniques are included in programs referred to by terms such as neurocognitive rehabilitation. They generally focus on processes such as attention, memory and executive functions, which include skills such as planning, decision making, time management, problem solving and mental flexibility. Cognitive exercises have been shown to be effective in improving these abilities. However, the focus of neurocognitive rehabilitation is somewhat broader than this description might suggest, and is directed towards the practical goal of helping the patient become as independent and functional as possible; in addition to cognitive exercises, the rehabilitation program will employ other techniques as appropriate, such as teaching the use of various aids to memory (notebooks or lists, for instance) to compensate for residual memory deficits. Both the rehabilitation exercises and the compensatory techniques may use computers or digital devices, so technological advances are making significant contributions to cognitive rehabilitation.

As implemented, a rehabilitation program has several components. Initially the patient will have a neuropsychological assessment to delineate the deficits. Then specific interventions are chosen to address the patient's problems, either by resolving them or, when necessary, by compensating for them. Periodic measurements of the patient's status are required to measure progress and to make any necessary changes. To be successful, the patient must be an active participant in the program, working to apply the techniques to his or her everyday life.

Physical and psychological factors can also play a significant role in the impact of a patient's cognitive deficit. Emotional problems such as anger, frustration, depression or anxiety may interfere with cognitive functioning and are common reactions of a patient to his or her circumstances following an acquired brain injury. Physical problems such as motor or sensory deficits may result in direct impediments to functioning, and headache or other sources of pain may provide severe distractions away from the rehabilitation. Consequently, a multidisciplinary approach is essential, and the treatment program may include, along with the rehabilitation, components such as psychotherapy, to help the patient deal with emotional issues, pain management and other disciplines such as physical, speech or occupational therapy. For the patient to be successful his or her family members or significant others must also be involved in the rehabilitation.

The frequency and duration of the treatment depend on the range and severity of the deficits and will be individually specified for each patient. Typically, the patient would have three or more cognitive rehabilitation sessions per week for several months, along with weekly psychotherapy and pain management sessions as well as physical, speech or occupational therapy as appropriate.

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