Cognitive Therapy

Our experience was that cognitive therapy options were pretty few and far between. In fact, the cognitive assessment post-stroke was pretty limited. And they only did something when I asked for it.

Later, it was only when we were claiming on a Total and Permanent Disablement insurance policy that the neurologist suggested any sort of neuropsychological testing. Basically, our experience was that the medicos were interested in physical therapies, but not cognitive therapies. So, we were on our own.

If you look at it from the perspective of cognitive domains, you can prepare a plan that consists of cognitive therapy that you can do yourself, and other areas where you need the assistance and guidance of a professional.

If you are doing any cognitive therapy yourself, the important things to remember are:

• Brain plasticity means that you can correct or recover from the brain injury resulting from stroke.
  
• Constraint induced therapy has principles of constraint, forced use and massed practice - you can leverage these with lots of repetitions in areas where there is a deficit.

Professional Help

The appropriate people to offer professional help are a neuropsychologist and occupational therapist. Your doctor, neurologist or rehab doctor should be able to provide referrals. Additionally, research institutes (such as universities) may offer programs that can be of assistance.

Generally, this will consist of a neuropsychological assessment and treatment. There are a variety of tests that can be performed.

If you want further information, PsycBITE might be of interest. This is a psychological database for brain impairment treatment efficacy, you can search the database filtering by Neurological Group = Stroke to see a list of reference articles about various stroke treatments

Self-Administered

Over recent years, a proliferation of brain training tools have become available. These typically focus on the cognitive domains of memory, attention, language and communication.

A useful starting point in doing some work on your own is The Mild Traumatic Brain Injury Workbook, by Douglas Mason, Psy.D.. This book is generic to brain injury, but has lots of information that is relevant to the stroke patient. The key topics are: Recognizing the symptoms of brain injury Assessing the damage Recovering brain function Improving memory and learning Increasing attention span. It provides information as well as a of simple tests that help you understand the impact of the brain injury. Exercises based on cognitive therapy techniques are then provided, as well as advice on dealing with depression and anxiety.

A range of books relating to brain fitness and brain recovery are in our bookstore.

Further to the cognitive therapy tips provided in these books, there are a number of software programs that can be used for basic cognitive therapy. These include:

• PositScience - Offers brain training software to improve attention and memory as well as the Insight program that is specifically aimed at visual acuity. Recent studies by the Mayo Clinic and USC report significant improvements. The software includes baseline testing of your abilities. You then complete exercises each day (these vary by the day) whilst the program monitors your progress. At various points, it suggests you re-test to see the performance improvement. Practice sessions are 40 minutes, which is better than the short training offered on the Nintendo DS.
  
  
  
  
  
  
• Nintendo DS Brain Training - The Nintendo DS is a handheld game system that can be puchased from any video gaming store. You can buy Brain Training modules that have been developed by Dr Ryuta Kawashima, a neuroscientist. Brain Training is designed to stimulate your brain and give it a workout by solving maths problems, doing memory exercises, drawing pictures and more. Each exercise takes only a few minutes. You can measure your "brain age" and watch how you improve after practice.
  
  
• Lumosity - Offers a range of brain games and brain training that is focused on improving memory, processing speed, attention and executive proccessing. There are a range of studies that have shown this software to improve these capabilities. The software has a free trial and can be purchased online (click on the link below).
  
  

Meditation

In addition to brain training, there is a growing amount of research suggesting that meditation can have a positive impact on concentration and other cognitive skills.

Most people think of it in terms of a stress relief, but the benefits of meditation include imrpovements in cognitive skills such as focus, concentration, memory and learning ability. Further, motivation and confidence is increased.

From a personal perspective, I believe that my meditation practice enabled me to capably manage the critical three month period after Peter's stroke. I was able to clearly define my purpose (to support him) and able to focus on whatever was important at the time (talking with doctors, organising his homecoming). I had been using Holosync meditation technology for about 18 months before Peter's stroke. I honestly believe that I was able to survive this incredibly stressful event without a meltdown as a result of my meditation.