Ask Kathy M. Archives
A Collection of Questions and Answers from TBI Advice Expert - Kathy Moeller

Topic: Therapy - Cognitive Therapy


Dear Kathy M.,

My brain injury was a year ago and I was told to wait a few months before starting cognitive therapy, which I want to do. The problem is, I'm confused. We don't have a lot of resources where I live. The resources we have here seem to be limited to doing things like mental exercises to improve attention and memory. There is one program I can attend that will teach me to use a "memory book" but it's only one day a week for an hour with a speech therapist, and it's a one hour drive each way! I'm afraid I'll be so tired by the time I get there I won't be able to learn anything (I get tired very easily now). Then, there's software I can buy for doing some of the exercises at home on my computer. Is this the kind of thing that will help me learn the compensatory skills you talk about?


Kathy's Response:

Dear Sabrina,

Gosh, I wish there was an easy answer to this, but there isn't.

First, you need to know that there seem to be basically two basic approaches to "cognitive therapy." One school of thought focuses on the exercises you refer to. The assumption is that cognitive function can be regained (or improved) by doing various exercises. The other school of thought focuses on compensatory skills training. Some rehab. centers and therapists offer a combination (which is what I received when I was in residential rehab.)

Cognitive Exercises
In my experience, the first approach is more common. And yes, there is software you can buy and use on your home computer. The exercises are designed to improve what I call "organic brain power," meaning brain function. One example I remember from rehab. is what was called "attention training." We were given tasks to do while we listened to a news report that was pre-recorded on a tape. Our assignment might be something like "Circle all the "A's" and every other "O" after being given a piece of paper with a bunch of letters on it. The idea was that repeated exposure to this kind of exercise would help improve our ability to ferret out the newsreel and concentrate ("attend") to the task at hand, namely circling the numbers correctly.

Personally, I found these kinds of exercises to be painful and not very helpful. In all candor, some people with brain injury report that they feel these kinds of exercises helped them. I don't think they helped me. In fact, I recall becoming so frustrated that I lost hope for a while that I would ever "get better." Since my rehab. facility also offered compensatory skills training too, and I could see how that helped me day-to-day, I chose to focus on that aspect of my cognitive rehabilitation program.

Compensatory Skills Training
I think this approach is more effective long-term. It also seems to be less common. Learning to use a "memory book" would be in this category. The biggest problem I see with the option you describe is the amount of time you are being coached. One hour a week is not enough TIME!

The second problem is that most of the memory books I have seen are not designed specifically for persons with brain injury. That means you will most likely have to adapt whatever book you are given to meet your needs, as someone with memory impairment, organizational difficulties, and other things.

The approach we choose depends on whether we think a brain injury is more like weak muscles that need strengthening exercises, a sprained ankle (which does not), or permanent hearing impairment. Clearly, we would not ask a profoundly hearing impaired person to practice "hearing exercises." But we would suggest physical therapy for some kinds of weakened muscle conditions. We would not suggest strengthening exercises for a sprained ankle, right? So you see, it's complicated.

Of all these analogies, my experience tells me that brain injury is most like permanent hearing impairment, where the use of compensatory skills and tools is the most effective long-term. A person with hearing impairment uses compensatory tools and skills in the form of amplification equipment, TTY machines and probably learning to sign or read lips. Compensation for persons with brain injury include use of memory books, learning skills to write memory notes, and using visually-based tools to help them stay organized and on task.

How to decide
Ironically, "decision making" is a skill that many people with brain injury struggle with -- that is, until they learn compensatory skills for making decisions on paper! It sounds like you need some help with getting the information you need, and perhaps also with looking at all the pro's and con's of each of your options. You could get this kind of help from a good therapist. And you could see out your peers.

Are you part of a local brain injury support group? That might be a good place to start. Do you have a therapist who could help you gather information, analyze it, and map out your options (ie. help you learn about the decision-making process, not make the decision for you). Do you participate in any of the Internet-based discussion groups for persons with brain injury?

If you want to network with others with brain injury who might be able to offer their experiences with both decision-making and cognitive rehabilitation, please see the Internet-based support group list on this website.

In the last few weeks, we have had several discussions on this very topic (on the TBI-WORKING list). I'm sure the other lists have participants who talk about cognitive rehab. too!

Your confusion is well-founded, Sabrina. The rest of the world is probably just as confused as you are about how to deal with cognitive rehabilitation following a brain injury. Hope this helps to give you some resources for exploring further.

Kathy M.

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