Dr. James Malec Talks About Cognitive Rehabilitation

Cognitive rehab for people with TBI includes any intervention that addresses cognitive problems — from using a smartphone to help with memory to developing particular visual-spatial skills.

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Cognitive rehabilitation is a set of procedures that addresses a number of different cognitive issues. In some ways, it's like saying 'medicine'--you know, that covers a lot of territory. So, cognitive rehabilitation could be an intervention to train people to attend better. It could be an intervention to give them a notebook or an electronic device to assist their memory if they have memory problems. It could be training in problem-solving and reasoning. It could be language therapy. It could be training in visual-spatial skills. It's really any intervention that addresses a cognitive problem. In my mind, cognitive rehabilitation is not controversial. There's good evidence that many forms of cognitive rehabilitation are effective. Have we answered all of the questions about how to do cognitive rehabilitation? What is best for whom under what circumstances? No, but we've only been at this about 20 years which is a blink of the eye in terms of most clinical science. But on the other hand, I think we have enough information to say that this intervention works when appropriately applied. I think if we've made any mistake on the provider-side in cognitive rehabilitation, is at times, adopting kind of a one-size-fits-all approach-- if you had a brain injury, of course you need cognitive rehab. That's not always the case. Maybe you don't need a broad-spectrum approach from cognitive rehab. You may need a more selective intervention. I think that on the provider's side, too, we need to be more judicious in applying these procedures and be good stewards of the healthcare dollar. But on the other hand, we've got some good tools, and I feel that, to some degree, the controversy in cognitive rehabilitation has been driven by reimbursement issues-- that there's a desire on the part of some insurance companies to say that it's not effective so that they don't have to reimburse for it. It's just that simple.
Posted on BrainLine November 1, 2012.

Produced by Victoria Tilney McDonough and Erica Queen, BrainLine, and Dan Edblom.