Specific Rehabilitation Therapy Interventions and Goals	<<< about CNS

Specific goals of different therapeutic interventions at the Center for Neurorehabilitation Services can be summarized as follows. (Reimbursement for individual therapies will vary according to specific insurance policies.)

Cognitive Rehabilitation
Cognitive rehabilitation is designed to remediate and provide compensatory strategies for acquired cognitive difficulties. In the past several years, it has become increasingly difficult to obtain insurance reimbursement for cognitive rehabilitation as a separate therapeutic intervention because insurance companies have failed to acknowledge efficacy studies that demonstrate the value of this intervention. Certainly, there is little evidence that brain drills and exercises will reduce cognitive impairments, but cognitive rehabilitation that focuses on reducing disability caused by the impairments has been very effective. Cognitive rehabilitation is most effective if practiced within a holistic approach which addresses emotional, motivational, and other noncognitive aspects of functioning, in addition to cognitive aspects. In our program, cognitive rehabilitation goals are now typically incorporated across speech-language therapy, occupational therapy, and psychological services treatment plans.

Our approach to cognitive rehabilitation involves a combination of process-specific rehabilitation (e.g., Attention process training), skills-based training (e.g., prospective memory strategies training (e.g., compensatory memory strategies), and metacognitive training (e.g., memory training), compensatory awareness and strategy training). Once a client’s strengths and weaknesses have been determined through formal neuropsychological assessment, an individualized treatment plan can begin to address the following:

• attention/concentration
• perception
• memory
• flexibility of thinking
• speed of information processing
• problem solving/reasoning
• awareness of one’s own particular brain injury
• increasing frustration tolerance to brain injury related problems
• learning compensatory strategies
• real-life applications are emphasized to improve generalization

Speech - Language Therapy
Many people with brain injury or neurological disease experience difficulties in the area of speech and language. This involves many aspects of communication which affect the person’s ability to effectively and efficiently interact with others in their lives. Speech and language therapy will address the following:

• following auditory directions/conversations
• reading
• word finding
• pronouncing words clearly
• stuttering and fluency
• organizing written/spoken sentences
• abstract reasoning/problem solving
• swallowing/oral motor problems
• social interactive language
• returning to school/academic accommodations

Occupational Therapy
Occupational therapy will help the individual develop new skills to compensate for cognitive and physical deficits. Therapy may occur in the clinic, home, work, or community settings. Goal areas may include the following:

• activities of daily living
• community re-entry including driving or community mobility
• psychosocial skills
• sensory systems, including vision and balance
• movement and motor skills
• work and work-site analysis
• return to work

Physical Therapy
Physical therapy addresses chronic pain and mobility issues with our clients. The primary goal is to help clients work toward the highest level of motor function possible. Areas addressed in physical treatment plans include:

• muscle tone, strength, and range of motion
• general mobility, including walking
• balance
• coordination
• endurance
• special equipment needs
• individualized exercise programs for home and community
  

Music Therapy
Music therapy addresses cognitive, physical, and communication deficits. All treatment is aimed at addressing functional goals. Areas addressed in music therapy include:

• gait training
• endurance
• range of motion/strength
• neglect training
• coordination
• attention/concentration
• executive functioning
• memory training
• initiation and rate of speech
• vocal control

Psychological Services
Psychological services can occur in both individual and group settings, with clients, clients and significant others, or just significant others. Goals of psychological services can include:

• increasing awareness/understanding about the client’s neurological condition or brain injury-related difficulties
• increasing the ability to cope with brain injury related difficulties
• relieving symptoms of anxiety and depression related to the brain injury
• promoting acceptance of and accommodation to altered capabilities
• stress management and relaxation training
• pain management
• EMDR training to address trauma issues