Monday, April 18, 2005

Home-based rehabilitation for patients with cognitive disorders

As part of my cognitive disorders course, we have to create an "on call notebook" which contains rehabilitation activities that can be used for a variety of patient encounters. These activities are often subjective, as therapies that address "real world" activities such as going to the grocery store aren't often studied for efficacy in a systematic manner. In addition, rehabilitation is often most effective when the therapy activities can be continued at home (in small, focused sessions spread out throughout the day.) But, caregivers don't necessarily have access to advanced therapy materials that work on specific cognitive skills such as attention or memory.

The University of Alabama at Birmigham has developed a great set of exercises that can be done both in a rehabilitation setting, and at home with primary caregivers. The Home-Based Cognitive Stimulation Program contains a list of 48 exercises that address many every day skills such as working with money and improving motor control. Each exercise has variations for different skill levels, and involves single or multiple cognitive domains. Everything can be done at home, with minimal or no rehabilitation training, and everyday materials. It's a great starting point for involving caregivers in treatment, and empowering both the patient and their caregivers (a very important consideration in rehabilitation.) For patients not in a structured rehabilitation program, this home-based program can be recommended by the treating physician.

In this era of reduced inpatient and outpatient coverage and services, home-based rehabilitation programs will be a valuable resource for patients with stroke, TBI or other neurological impairments. While the most significant gains in cognitive function occur in the "spontaneous recovery period," which is generally within 6 months post insult, improvements can occur any time. I hope that more of these home-based programs are created (and studied for efficacy), because home-based rehabilitation may be the only type of rehabilitation available to some patients.