COGNITIVE-COMMUNICATIVE DISORDERS: ACUTE
REHABILITATION
-
Stimulation Therapy - Also called coma stimulation therapy or coma
arousal therapy, stimulation therapy is the primary focus of
cognitive-communicative intervention in the acute stages of TBI. Types of
coma intervention are:
-
Multisensory stimulation, in which all senses are stimulated during each
session, and there are numerous sessions each day
-
Sensory regulation, in which the environment is controlled, rest periods
are provided, and optimal conditions are established before sensory information
is presented
-
Familiar routines, in which the patient is taken through the same sequence
they experienced in a routine 24 hour day prior to the injury
-
Structured sensory stimulation, in which stimulation begins with the parts
of the nervous system that usually remain intact, such as the brainstem,
midbrain, and limbic system, and the corresponding senses of movement, smell,
and touch, and then progresses from unisensory to multisensory stimulation.
Stimulation therapy is typically performed by the family, in coordination
with a speech pathologist, if it is indicated. Click on
Coma
Stimulation in TBI for additional information on the rationale for,
goals, principles, and techniques of stimulation therapy.
-
Augmentative Communication and Hearing - As patients emerge from coma,
nonverbal means of communication may be necessary, such as head nods and
gestures, eye blinks, and response buzzers, until the patient's cognitive,
communicative, and hearing potential can be assessed.
-
Structure and Routine Treatment - Following the resolution of
posttraumatic amnesia and a decrease in confusion and agitation, a more
structured treatment format can be introduced based on 7 cognitive dimensions
being in place: orientation to time and place, identification of staff and
peers, associative learning, attention to activities, episodic recall of
events of the previous day, and facilitation of orientation through environmental
cues. Structure and routine treatment focuses on improving attention,
orientation, and organization, and involves restructuring patients' rooms,
communication, staff and family interactions, and task demands. Structure
and routine treatment includes:
-
Introducing external orientation aids to the patient's environment, such
as watches and clocks, calendars, schedules, pictures, name tags, and logbooks
in which activities and events of the day are recorded at certain times of
the day, to provide cues needed by patients to improve orientation
-
Adjusting activities along a continuum, such as from multiple choices to
open ended choices, from simple to more complex, from unisensory to multisensory,
from one-to-one to small group, from no time to time requirements, from familiar,
repetitive stimuli to novel stimuli, from no demands on initiation to independent
initiation, etc. to improve organization
-
Modifying and initiating attention training for TBI patients:
-
Beginning with visual cancellation tasks and the use of words, as opposed
to letters or symbols
-
Stressing the importance of activities that promote reorganization of the
semantic knowledge base, e.g. the semantic feature analysis task
-
Utilizing other activities, such as:
-
Discriminating like features among objects or words
-
Sequencing common activities or procedures
-
Following simple written directions
-
Reading simple paragraphs to detect key points
-
Brief note taking
-
Discourse analysis, for patients on the high end of progress, to monitor
linguistic recovery
|
Based on information in Gillis, RJ. Traumatic
Brain Injury Rehabilitation for Speech-Language Pathologists. Boston:
Butterworth-Heinemann, 1996, except for information where other papers are
cited.
|