Cognitive Rehabilitation in an InpatientResidential Setting Karin Curtiss, Ph'D' Mike Cecil, M'A' Th

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Cognitive Rehabilitation in an Inpatient/Residenti
al SettingKarin Curtiss, Ph.D.Mike Cecil,
M.A.The University of Texas Medical Branch at
Galveston
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Introduction

• Cognitive Rehabilitation services
• Inpatient and Residential Settings
• Importance of orientation and cognitive
  retraining activities
• Integration of services with other medical
  personnel
• Team management

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UTMB Galveston

• Transitional Learning Community (TLC)
• John Sealy Adult Orthopedic Unit

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Transitional Learning Community

• Residential treatment facility for adults with
  traumatic brain injuries
• Cognitive retraining sessions
• Orientation, brain injury awareness groups
• Trial runs in real-life, safe setting
• Compensatory strategies
• Alternative communication strategies

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Cognitive Retraining

• Targeting specific cognitive functions
• Practice skills in session using exercises
• Repeat tasks, monitor progress over time
• Process comments/feedback with client
• Increase personal awareness

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Orientation Groups

• Orientation groups of different functional levels
• Daily Worksheets
• Cognitive games
• Compensatory strategies
• Monitor progress over time

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Awareness Groups

• Education
• Sharing Experiences
• Group Support
• Importance of Insight

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Trial Runs

• On-campus dorms
• Off-campus apartments
• Community outings
• Weekend evening passes

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Alternative Communication Strategies

• Speech Devices
• Communication Notebooks
• Voice Inflection
• Facial Expressions
• Gestures
• Drawings

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Compensatory Strategies

• Getting around deficits that are
  longer-lasting, permanent
• Examples datebooks, watches, alarms, memory
  notebooks
• Training to use
• Monitoring progress

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John Sealy TowersAdult Rehab Center
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Adult Rehabilitation Unit

• Acute hospital setting for adults
• Initial ongoing assessments
• Orientation
• Behavioral management
• Compensatory strategies
• Family involvement
• Cotreatment
• Safety recommendations

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Assessment

• Initial assessment to evaluate status upon
  admission, continue during stay to monitor
  progress and changes
• GOAT
• MMSE
• Cognistat

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Behavioral Management

• Assess behavioral problems and how they impact
  treatment and therapies
• Behavioral strategy feasible for the patient,
  staff, and rehab setting
• Staff awareness, incorporation with behavioral
  strategy
• Maximizing patient involvement

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Compensatory Strategies

• Schedules posted for patient
• Calendars clocks
• Important phone numbers posted
• Reminders of when visitors are coming
• Memory notebooks
• Medication checklists, nurse supervision of
  medication competency

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Family Involvement

• Sessions during family visiting hours
• Family education of current deficits,
  compensatory strategies
• Participation in patient/family conferences,
  weekly rounds
• Family suggestions of what could be helpful for
  patient

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Cotreatment

• Typically with PT, Speech, OT
• Behavioral management issues in therapies
• Anxiety management
• Incorporation of PTs OTs in overall
  behavioral management strategies

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Safety Recommendations

• Discuss concerns with patient, treatment team,
  and family
• Consider discharge safety concerns in light of
  patients current cognitive status.

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Behavioral Medicine in Rehabilitation

• Jeff Baker, Ph.D.
• Clinical Associate Professor, Orthopaedics
  Rehabilitation
• Chief Psychologist, Anaesthesiology,
  Orthopaedics, Surgery
• University of Texas Medical Branch
• Galveston, Texas

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UTMB Galveston

• Psychology Services

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Behavioral Medicine Treatment Options

• Assessment Evaluation
• Consultation
• Individual Treatment
• Group Treatments
• After Care

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Assessment Evaluation In Rehabilitation at UTMB

• Clinical Interview
• FMMSE
• GOAT
• HADS
• Cognistat
• Neuropsychological Screen

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Adult Rehabilitation Unit
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Clinical Interview

• History Background
• Presenting Concern
• Behavioral Observations
• Psychological Affect
• Strengths Weaknesses
• Family Social Support

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FMMSE

• Total Score of 30
• Measures
• Orientation
• Immediate Recall
• Attention
• Calculation
• Recall
• Language

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Galveston Orientation Amnesia Test (GOAT)

• Measures patients orientation and gives an
  indication of PTA.
• Can be measured daily.
• Score of 78/100 on three consecutive occasions
  indicates patient is out of PTA.

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Cognistat

• Neurobehavioral Cognitive Status Examination
• Five Major Ability Areas Assessed
• Language
• Constructions
• Memory
• Calculations
• Reasoning

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Cognistat

• Attention, Level of Consciousness, and
  Orientation are assessed independently.
• Reading and Writing are not assessed
• Reasoning has two subsections
• Similarities and Judgment
• Language has four subsections
• Spontaneous Speech
• Comprehension
• Repetition
• Naming

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Consultation in Behavioral Medicine

• Psychologist Serves as Consultant to
• PMR Specialists
• Primary Provider
• Nursing Services
• Physical/Occupational Therapy
• Social Work (Case/Program Managers)
• Recreational Therapy
• Psychiatry
• Family Members

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Individual Treatment in Behavioral Medicine

• Individual Psychotherapy
• Relaxation Training
• Biofeedback Training
• Hypnosis
• Supportive Therapy
• Cognitive Retraining Therapy

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Group Treatments

• Patient Support Groups
• Pain Management Groups
• Family Therapy Groups
• Spiritual Groups
• Professional Staff Support Groups
• Orientation Groups

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Follow Up Care
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After Care in Rehabilitation

• Patients are usually transferred to another
  facility or back into the home environment.
• Usually a community group (Stroke Support, etc.)
• SNF Units, Retirement Centers, Transitional
  Centers, etc.

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UTMB Psychology Internship Program
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