What is cognitive rehabilitation?
As many of you probably know, and according to the definition most commonly used by the World Health Organization (WHO), the term rehabilitation implies the recovery of the patient’s functional status to the highest possible level from a physical, cognitive, psychological and social adaptability perspective. On the other hand, Dr. Barbara Wilson defined cognitive rehabilitation as “a process in which individuals with a brain injury work together with healthcare professionals to remedy or alleviate the cognitive impairrments that occur after a neurological injury.” In this way, one could say that -through the use of cognitive rehabilitation- healthcare professionals work together with their patients to restore the highest possible functional level from a cognitive perspective, with the goal that this will also be useful to attain the highest possible functional level on a daily basis. As you can see in the last two definitions, a special emphasis is placed in the collaboration between healthcare professionals in charge of designing the cognitive treatment plan and their patients. Cognitive rehabilitation should not be passive. On the contrary, it is important for patients to get involved and participate actively in their treatment.
Cognitive Rehabilitation Exercises
But, how do we get patients to participate more and, on top of that, ensure that this participation is active? Numerous studies have shown that patients that participate more actively in their rehabilitation process are the ones that obtain better results when that process is completed. In other words, those patients are the ones that achieve a higher functional level from a cognitive perspective after completing their treatment.
And, what can we do to ensure that the exercises we use for cognitive rehabilitation promote an active participation? The main way to do this (but not the only one) is through motivation. The use of cognitive rehabilitation exercises that are not motivating for patients can even have negative effects on their recovery, independently of how good those exercises are or how well designed they are. Although there are several way to increase patient motivation, some of the best known methods are:
- Use therapeutic activities that are more fun.
- Provide relevant information to patients on how they are completing the prescribed exercises.
- Adjust exercise difficulty in a personalized manner.
- Promote the variability of the exercises used by the patient during the rehabilitation process.
Therapeutic Activities for Cognitive Rehabilitation
Not only is the activity itself important but also the way in which the different therapeutic activities that will be completed by patients are presented to them. In order to make therapeutic activities more fun, we should use gamification. Gamification is a technique that allows for the application of game strategies and methods to contexts that normally do not use them, with the objective of making individuals adopt a certain behavior. Cognitive rehabilitation can benefit greatly from the use of gamification in the therapeutic activities used by patients. On the other hand, the combination of gamification techniques and relevant feedback during the cognitive rehabilitation exercise will also result in an increase in patient motivation. Finally, it is also important that the activities adjust their difficulty to make the task easier or more difficult according to what the patient does during the rehabilitation session. And, of course, it is also important that the cognitive rehabilitation activities prescribed to patients are frequently changed. This therapeutic variability will achieve a higher level of generalization of the new skills learned by the patient during cognitive rehabilitation sessions.
Cognitive Rehabilitation Examples
Although there are many examples of cognitive rehabilitation, digital health technologies are specially useful to implement cognitive therapeutic activities based on the elements mentioned in previous paragraphs. The video below shows a selective attention task that uses digital technologies to ask patients to search for the image (or images) that are not repeated among several that do repeat themselves. This task has been “gamified” because:
- It has an attractive design.
- Keeps an agile “tempo” during the session.
- Includes “levels of difficulty” as a way to give feedback.
- Gives visual and auditive feedback while patients complete the prescribed exercise.
Moreover, software will continuously monitor patient performance to adjust session difficulty, increasing it (if patients make few mistakes) or decreasing it (if they make many). Exercise difficulty is adjusted by modifying the number of simultaneous stimuli that appear on screen, increasing similarities between them and changing the maximum time patients have to find the correct answer. Finally, each one of the more than 110 cognitive rehabilitation exercises available in Rehametrics has several personalization options that enable them to adapt perfectly to the clinical goals of each patient.
