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Cognitive Rehabilitation After TBI by Charles Watson


Posted on July 8, 2020

If you're a victim of TBI or related to someone who suffers from TBI, the first changes you might have noticed are the impaired cognitive skills. These are skills that we unknowingly practice in our everyday lives and are incredibly vital. So, what do cognitive skills include?

  • Your ability to stay focused;
  • Processing and comprehending information;
  • Retainable memory;
  • Communication;
  • Decision-making, judgment, reasoning;
  • Planning and organization;
  • Controlling desires and practicing patience

Cognitive impairment plays a significant role in the difficulties and hindrances that a TBI patient faces and is a key reason for the frequent disorientation, frustration, and short-term memory. 

Considering that cognition is required everywhere, TBI victims must be effectively rehabilitated. Even though TBI victims are advised to let their cognitive skills develop naturally, there have been two successful approaches to speed up this process. They are remediation and compensation.

Remediation

The treatment that focuses upon restoring, strengthening, and improving the affected functions is called remediation. During this treatment, the patients are encouraged to undergo activities that help normalize specific impaired cognitive skills affected by TBI. For example, the patient is asked to detect targets on computer screens to improve concentration. To monitor performance, the tasks are strategized with increasing difficulty along different dimensions like task duration, higher speed, pacing, etc. Such treatment is important to bring life back to normal.

Compensation

Doctors often recommend compensation rehabilitation, which teaches the victim to minimize the effects of cognitive impairment. It seeks to provide alternative strategies to work around the hindrances that cognitive impairment offers. Such treatment can be either internal or external. Internal compensation is the ability of a TBI victim to consciously practice concentrating or retaining information like breaking down steps into uncomplicated steps or keeping the conversation short and precise. External compensation is when you take support from other people or technologies like alarms, reminders, or labeling your stuff.

Comparing Remediation and Compensation

It is often difficult for doctors to determine which treatment approach is more effective. There have been many doubts about whether remediation actually helps restore cognitive impairments or if it's just the improvements that somehow let us believe that the impairment has been completely restored. Whereas, compensation is a more practical and implementable approach which greatly depends on the condition of the TBI victim.

However, the lure that remediation provides is the holistic and broad range of rehabilitation. This means that if the treatment is done on impaired memory, then all fields or areas that were affected by weak memory will improve. On the other hand, compensation is a more specific treatment approach. It tends to revolve around a particular activity rather than the affected cognition and hence deemed a more local solution.

Despite their contrasting approaches to treat a certain cognitive skill, remediation and compensation are not included in either/or case. They work hand in hand to assist the TBI victim in coping up with their deteriorating cognition. The overall neurological rehabilitation aims to maximize these skills while simultaneously learning to minimize the problem (Society for Cognitive Rehabilitation, 2004).