Problems with cognition – the ability to think, remember, and reason – are among the most frequently discovered long-term consequences of brain injury. As a person who has experience traumatic brain injury, I didn’t understand that poor quality of cognitive processing was at the root of my career, social and family problems until many years after my injury.
When our thought processes don’t cooperate with us, we become more susceptible to behavior and mental health problems down the road. The frustratingly poor quality of thought processes, along with chemical imbalances, frequently cause people with brain injury to battle depression and anxiety. Friends notice personality changes and the person with brain injury becomes more socially disconnected and isolated. Problems with reasonable thinking are behind acting out or becoming aggressive with others. Problems with thinking, remembering and reasoning cause inappropriate actions to spill out in social situations.
All of this happened to me and I’ve lived to tell the tale. Thinking problems contributed to my career implosion and to my living a life that has not been what I expected when I graduated from college. I look back on lots of moments that I could have handled better if I had known that my frustration was due to brain injury-induced slow-processing, an uncooperative working memory, and a tendency to jump to unreasonable conclusions.
Decades after my brain injury, when I learned that I had had a pretty bad brain injury, I wanted to learn more. In fact, I got so carried away with learning about brain injury that I went back to school to learn to be a speech-language pathologist. I wanted to be a speech-language pathologist so that I could work with people with brain injury and teach them to avoid the potholes I’ve managed to step into over and over again.
But it wasn’t until the last semester of my graduate program that I had an unfortunate experience working with people with brain injury – and the event caused me to realize that I was stepping into another pothole. I couldn’t do clinical speech-language pathology work because I couldn’t think on my feet, I had a hard time remembering to remember, and I didn’t always reason things out and acted hastily instead. On top of not being able to think, remember, and reason quickly, I got frustrated and acted out from time to time. There she goes again. Ugh.
The end of my graduate school career was not pretty. But since then I’ve learned something about the practice of speech therapy that makes me feel a little better. I’ve learned that we really don’t know the best way to treat persons with brain injury. Certain quick memory games and cued compensatory treatment strategies are widely used by speech-language pathologists, but we don’t have much scientific evidence to prove that these methods are efficacious – effect in the long run.
These days, as a brain-injured SLP, I still read papers and go to conferences on rehabilitation because I hope for change in the clinical practice of speech therapy. In my gut I knew that the speech therapy practices I observed as a graduate student wouldn’t really have helped me. I would not have seen the purpose in speech therapy worksheets. It is not treatment that causes the patient to see his shortcoming and accept the fact that he has to learn to adapt. It is not treatment for the long-term cognitive frustrations of brain injury.
At the 39th Annual Brain Injury Rehabilitation Conference in Williamsburg, Virginia. I listened to presenters talk about therapies that really solve problems and are relevant. In particular, I enjoyed two presentations by Rick Parente, author of Retraining Cognition: Techniques and Applications with Douglas Herrmann,
on cognitive rehabilitation treatment approaches. He presented research and concluded that attention training is among the best therapies. He called attention to several biofeedback programs online (www.wilddivine.com, www.playattention.com, www.thoughttechnology.com, www.mindmodulations.com, www.neurosky.com) that offer attention training. Therapists can use these games to teach persons with brain injury what it feels like to pay attention. Parente suggests getting the patient highly involved in an attention biofeedback program and then interrupting to ask him to think about how it feels to really pay attention. The individual is taught that this is a skill he has to develop to improve. Neurotherapy or biofeedback teaches people what it feels like to pay attention and “think the game.”
Parente also found that visual/spatial and language training are efficacious rehabilitation therapies. More on these in later posts.