Becoming Well Again Through Cognitive Retraining

When we use the word "cognitive" we mean our thinking, reasoning, and perceptual abilites. Cognitive rehabilitation has two parts:restoring the actual cognitive skill, and learning to use strategies to compensate for the impaired ability.

The first part of cognitive retraining - restoring skills - is sometimes compared to rebuilding a weakened muscle. Exercises used in retraining programs may actually rebuild cognitive skills such as attention, concentration, memory organization, perception, judgment and/or problem solving. These exercises can include computer programs designed to improve visual-perceptual skills (our ability to correctly interpret what we see), reaction time, memory and attention. A large chalk board or a practice grocery store shelf can be used to practice visual scanning and visual attention skills. Workbooks and puzzle books can help with reasoning, mathematical skills, memory and visual-perceptual skills. These items can be found at teachers' stores or large discount stores. It is important that the materials selected are neither too difficult or too easy.

Strategic games, such as "Uno" are also an excellent way to work on a variety of cognitive skills while interacting with others.

The therapy setting itself offers many opportunities to practice cognitive skills. Therapists can develop personalized tasks that requre "thinking on your feet" and more closely simulate your real life situations. For example, for those who prepare meals, therapy may include using the program facility's kitchen to practice following a simple recipe or to plan, in sequence, a more complex meal.

For those whose jobs require organizational skills, the therapist may suggest using a checklist format to complete complex tasks or using the copy machine to practice planning skills and problem solving skills. One of our favorite activities involves patients organizing and ordering-out lunch from a local restaurant. This works on the skills required to make and follow a plan of action, the ability to keep track of details, and staying focused on a cognitive task. Another good way to work on memory is to ask the patient to relay a message, later in the day, to another therapist.

These are just a small sample of the activities and exercises available to rebuild cognitive skills. Working with a therapist allows selected tasks to be supervised and tailored to each persons needs, strengths, and fuctional levels.

Using memory strategies can also be an important part of cognitive retraining. Using "tools" to cope with weaker areas not only compensates for impaired ability, but may help to rebuild the skill itself. For example, using a checklist may actually improve attention skills. The following srategies are some of the other tools we find helpful.

Take written notes and make sure your notes contain complete and accurate information: Include who, what, where , and why. Refer to your notes regularly. Use association, visualization, repetition, rehearsal, and categorization to help with recall. Use a daily planner system to keep track of all information. It is too complicated to try and locate information that is recorded in several different places. Use a daily or weekly pill box to keep track of medication. Arrange items in an organized fashion and place them in strategic, easy to see locations. You may wish to consider using a tape recorder to record lengthy or important conversations.

Attention Strateties:

Organize your environment. Use a self talking technique to stay on track. For example, ask yourself "Am I wandering?" or "What should I be doing right now?" To improve your attention while listening to someone, make constant eye contact with the speaker, ask the speaker to slow down, request clarification or repetition, take notes, and/or ask the speaker to provide the information in an alternate way - such as in writing or with pictures.

Avoid Fatigue:

When activities start to become overwhelming or frustrating, stop and take a mental break. Reduce distractions as much as possible - turn off the radio or television, or close the door.

An important part of therapy is training and education of caregivers. It is important that those who spend the most time with the patient understand these cognitive strategies and encourage their use. Consistent practice of learned strategies is critical to proficiency. Patience is the key word. It takes time for the brain to learn new ways to do familiar things. The results are worth the effort.

Source: ABTA Quality of Life Articles.

For more information on the care and services provided by Elderwood Senior Care, please contact us at (716) 633-3900