Brain Injury Rehab

How do you start on brain injury rehabilitation?

Stroke is a brain injury. However, most of the focus for both the health care system and the patient is around the physical recovery and (is required) speech recovery. However, both of these disabilities exist because of the brain injury, not because of issues with the affected arm, leg or vocal chords.

It's also difficult, because often the stroke patient is resistant to accepting that there have been changes beyond those apparent. This can make life difficult for carers, family and friends. This is where a neuropsychologist can help by making a neuropsychological assessment.

To determine the most appropriate brain injury rehab, assessment needs to be made on:

• Cognitive function
• Executive function
• Communication function.

Further, the objective of brain injury rehab is to firstly to restore functions that can be restored, and secondly, to learn workarounds when functions cannot be restored.

This page provides an overview of the key areas affected by brain injury with links to more information and options for brain injury rehab in those areas.

Cognitive Function

Cognitive function is the ability to think. This involves perception (perceiving and understanding things), thinking (mental processing of ideas), reasoning (logical thought) and memory.

The testing of cognitive function often involves batteries of tests that are somewhat akin to IQ testing. These tests look at things like mathematical ability, logical ability, temporal capabilities, short term memory, etc. From one perspective, cognitive function is more easily assessed than executive function because tests are either right or wrong, whereas of executive function is about comparing the response to that of a standard group of people.

Cognitive therapy aims to improve cognitive function and this can be a contributor to brain injury rehab.

Executive Function

Executive functioning is the ability to control and purposefully apply a person's intellect and cognitive skills. Without executive functioning, the cognitive skills are of little use as they cannot be effectively applied. Indeed, someone can have significant damage to their cognitive function, but still be able to operate effectively so long as they have their executive function working.

An analogy is that cognitive function is the knowledge of how to do each discrete step of an overall task, and executive function is the ability to manage the steps in the right order, at the right time to complete the task and identify and respond to any issues that arise. A stroke patient may get hung up on the discrete steps in great and intimate details, whilst missing how that fits into the bigger picture, and even that a bigger picture actually exists.

The types of capability that are affected by executive function include:

• The ability for self-care (many stroke patients suffer from "neglect" of the affected side of the body - which is different to not being able to do what is required, or even know what is required)
• Self-direction and motivation
• Flexibility of response to external changes
• Understanding the impact of behaviour on social relationships (emotional intelligence).

When executive function is missing, it generally impacts all aspects of behaviour. Research indicates that the part of the brain responsible for executive function are the prefrontal lobes of the cerebral cortex.

There isn't a lot of information available on brain injury rehab for executive function. The application of research into neuroplasticity has largely focused on the areas that are more visible and measurable, such as physical therapies (e.g. constraint induced therapy) and cognitive therapies.

Communication Function

Communication function covers a number of areas. There are two different types of communication function - those related to language and those related to speech. Speech therapy can offer options for brain injury rehab where communication functions have been affected.

Communication problems can have a significant impact on a stroke patient because the inability to communicate with others can impose an isolation on the stroke patient that can lead to inward focus and depression.

Language-Related

Language-related problems occur when the stroke patient finds it difficulty in finding the right word, constructing sentences and clearly explaining things. This generally is a result of damage to the speech areas of the brain, and occurs most commonly in those who have had the stroke in the left side of the brain.

The stroke patient with aphasia may often feel that the right word is just outside of their grasp (perhaps on the tip of their tongue). They may be able to communicate their meaning by "working around" the missing word, e.g. instead of referring to "dinner", they may talk about "the time we eat at night at the table".

Language-related problems may also occur in the stroke patient's interpretation of what someone else is saying. They may miss the subtle nuances of language. This can result in them not "getting" the joke, not understanding a pun or witticism, or taking things literally. Particularly in the latter circumstance, those around the stroke patient need to be careful what they say - "hit me with it" might actually result in a physical punch in the extreme situation.

Language-related problems are termed as aphasia. Aphasia impacts both the spoken and the written word. Research shows that aphasia typically arises from damage to Wernicke's area of the brain.

Speech-Related

In addition to language-related problems, a stroke patient may experience speech-related problems. These are problems relating to the physical act of speaking. Research shows that such difficulties typically arise from damage to Broca's area of the brain.

Dysarthria is when the stroke patient speaks slowly, slurs their words and/or is difficult or impossible to understand. This occurs when the part of the brain controlling the muscles that facilitate speech is affected by the stroke. The inability to communicate can be a particularly frustrating experience for a person. Patience and a willingness to listen can be the greatest gift that someone can offer people affected with this.

Often coupled with dysarthria is dysphagia. This is when a person experiences difficulty in swallowing. In the early days following a stroke, most hospitals have a speech therapist monitoring the patient to ensure that they are able to swallow and will not suffocate on their food and drink.

Another speech-related problem is apraxia. This is when the person cannot pronounce a word in a consistent way. The person may be able to say the word in a sentence, but not repeat it (or vice versa).

A speech therapist can assist with brain injury rehab exercises associated with both language- and speech -elated comunication problems.