Progressing from the Clinic to the Community

Typical therapy approaches used for rehabilitation of adults with cognitive deficits due to brain injury or stroke target primary cognitive sub-skills (memory, orientation, attention, etc.) in isolation. Therapy methods normally include tabletop activities, computer training, and pencil/paper tasks to improve underlying cognitive impairment. However, the learning associated with these methods does not always translate to the world outside the clinic. Patients may become frustrated with their lack of progress or find themselves unable to perform necessary tasks once they return to their home environment.

This recording introduces an innovative, alternative, and effective approach to TBI and stroke rehabilitation. It proposes that therapists dealing with cognitive deficits conduct therapy sessions that steer away from work on primary cognitive skills in isolation and switch to having the patient perform comprehensive activities in “real-life” environments. This is accomplished by utilization of a graded sequence of functional therapy activities. The main concept behind this approach is that three global factors influence the patient’s “real-life” functioning. These factors include the awareness and management of interpersonal relationships, the environment, and time constraints.

Therefore, therapy activities in this sequence have been structured to interweave the three global factors so that the patient interacts dynamically with other people, physical space, and time parameters during sessions. As the patient improves, expectations for sessions change as environmental demands increase and tasks become more complex. The levels of the sequence pertain to patients ranging from inpatient rehabilitation to those in community reintegration.Gain a better understanding of how patients’ successes in cognitive rehabilitation require a multidisciplinary effort, as well as an emphasis on “real-life” activities, to achieve maximum independence.