Cognitive Rehabilitation After Head Trauma

How It Improves Brain Function

Cognitive rehabilitation has many unique aspects and is approached differently with each patient. Selecting the right approach relies on analyzing how well a wide range of abilities, which are made possible by one’s brain and nervous system, are functioning. Medical providers may refer to these as “neurofunctional abilities”.

An individual’s post-traumatic injury abilities are compared to what one would expect from someone whose nervous system and brain works the way it should.

A detailed history of the individual’s abilities before the accident is also collected.

Family, friends and co-workers may all be asked to help provide this background, so therapists have a complete picture of who the patient was before the injury.

Determining basic skill levels for a variety of cognitive and behavioral tasks serves as the starting point for any type of therapy. Strengthening these basic neurofunctional skills may be necessary before more complex tasks are introduced.

For example, being able to focus on a task, stay concentrated on that task for an extended period of time, and perceive changes associated with that task need to be mastered first.  Then, more complicated tasks that build on focus and concentration can be introduced.

This is important so that the right foundation is in place to relearn old skills, and develop new ones that may be needed to compensate for a loss of function in other areas.

How Is Cognitive Function Assessed?

It is standard for a neurologist to examine a patient soon after the initial head trauma. This specialist provides a baseline assessment of the patient’s ability to understand words and respond appropriately, ability to pay attention, and ability to communicate memories.

A speech-language pathologist then follows up to further determine speaking and communication skills. An occupational therapist assesses ability to perform basic day to day functions such as making meals and getting dressed.

A neuropsychologist may also be asked to consult. This specialist analyzes how cognition, communication and behavior inter-relate. For example, if emotional-behavioral reactions and verbal statements are appropriate to the situation.

It’s also important during baseline testing to determine if any other disabilities such as reduced hearing affect an individual’s ability to receive information and respond appropriately. Sometimes nerve cell injury in the brain, as well as damage to the face or neck structures, can lead to difficulty speaking.

All of these baseline tests are repeated several times during the rehabilitation process, and are used to determine areas of progress and areas where additional therapy may be required.

Starting Early

Cognitive rehabilitation begins as soon as a brain injured patient is clinically stable. This means they can breathe, their vital signs are within a normal range, and there are no life threatening complications interfering with progress.

For moderate to severe injuries, the initial focus is on improving attention span and remaining awake and alert. This can sometimes be complicated by ongoing medical treatments such as pain medications for associated traumatic injuries such as broken bones. However, early therapy is demonstrated to improve long term outcomes, so even though it may feel challenging it is essential.

What to Expect

Cognitive exercises work on a variety of skills. For example, in order to improve attention to detail, one exercise may be to read an article and highlight a specific word such as “that” every time it appears.

At first this will be attempted in an environment free from distractions. As it is mastered, various distractions may be added such as performing the exercise where people are walking by, or with the television playing.

Exercises to improve the brain’s ability to complete more than one task at once may also be attempted. Alternating between completing simple math problems, and drawing a picture exercises different parts of the brain.

A complete team of physicians, nurses and therapists work together to provide a comprehensive therapeutic program that is designed around each person’s unique recovery needs.


French, L. M., Lange, R. T., & Brickell, T. A. (2014). Subjective cognitive complaints and neuropsychological test performance following military-related traumatic brain injury. Journal Of Rehabilitation Research & Development, 51(6), 933-949 17p. doi:10.1682/JRRD.2013.10.0226

Watanabe, S. (2013). Vocational rehabilitation for clients with cognitive and behavioral disorders associated with traumatic brain injury. Work, 45(2), 273-277 5p. doi:10.3233/WOR-131594

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