Our cognitive program has been treating patients for over 28 years. The program is designed to target the full spectrum of thinking problems associated with brain injuries.

Led by director and board certified neuropsychologist Dr. Robert B. Sica, NRS is a comprehensive practice that provides answers and solutions to problems ranging from acute head injuries to chronic conditions such as Alzheimer’s and learning disabilities like ADHD.

Objective data obtained from a comprehensive neuropsychological examination (NPE) serves as the foundation for our treatment program. Using this blueprint allows us to target both general deficits (abstraction & reasoning) as well as specific deficits (e.g. language).

 Our program is tailored to the individual. We are able to offer the full range of services, from consult to treatment completion.

What is “Cognitive Rehabilitation”?

Cognitive Rehabilitation is a therapeutic intervention aimed at retraining thinking skills disrupted as a result of neurological illness.

Our program also addresses and provides risk assessment for our patients.

Generally, patients work with a trained cognitive therapist 3 times a week, for 2 hours per session. Computer exercises and paper and pencil tasks target specific deficits in a patients thinking profile.

What Cognitive Rehabilitation is NOT

Remember, cognitive rehabilitation is not done by computers. Computers are only one of the aids utilized by trained rehabilitation specialists who supervise and teach the patient throughout the length of their treatment. Cognitive therapy is not a replacement for Occupational Therapy and its ADL’s, for e.g. shopping lists, etc.

What thinking abilities does the program assess?

1. Reasoning/Abstraction
2. Flexibility of Thinking
3. Processing Speed
4. Language
5. Memory
6. Visual Spatial
7. Insight/Judgment
8. Attention/Concentration

What populations do we treat ?

Many approaches have been employed in the attempt to rehabilitate brain injured patients.  These cognitive rehabilitation programs are not organized around a meaningful conceptualization of human brain-behavior relationships. The Halstead Reitan Neuropsychological Battery provides the basis and the solution to this problem by identifying the patients impaired or deficient neuropsychological functions and the frame work of a model of brain behavior relationships.  Thus, the Halstead Reitan Neuropsychological Battery provides diagnoses on which to prescribe a cognitive remediation program.  This procedure makes it possible to offer the specific type of training needed by the patient.

Verbal and language functions are customarily related to the integrity of the left cerebral hemisphere; visual-spatial and manipulatory skills are dependant upon the status of the right cerebral hemisphere.  However, non-specialized types of abilities, which are dependant upon the brain generally, have been relatively neglected.  Because they involve all cerebral tissue rather than representing specialized abilities, it is precisely these abilities that characterize brain functions that generally are more important than the abilities that are represented by only one half or even a lesser proportion of the brain.

Rather than using a “shotgun” approach to cognitive rehabilitation, this approach is specifically organized to remediate the patient’s neuropsychological deficits as determined by the Halstead Reitan Neuropsychological Battery.

This approach to cognitive remediation involves 5 tracks:

• Track A - Exercises specifically designed for developing expressive and receptive language and verbal skills and related academic ability.

 

• Track B - Also specializes in language and verbal materials, but includes an element of abstraction, reasoning, logical analysis, and organization.

 

• Track C - Involves tasks that do not depend upon particular content as much as reasoning, organization, planning, and abstraction skills.

 

• Track D - Also emphasizes abstraction, but its content focuses on material that requires the patient to use visual-spatial, sequential, and manipulatory skills.

 

• Track E - Specializes in tasks that require the patient to exercise fundamental aspects of visual-spatial and manipulatory abilities. 
  
  

Regardless of the content of the training, every effort is made to emphasize the basic neuropsychological functions of attention/concentration and memory.

In some instances, one area will be emphasized more than the other areas.  The decision for prescribing the cognitive remediation package is based upon the results of testing with the Halstead Reitan Neuropsychological Battery.

Until recently, rehabilitation following moderate to severe brain injury focused exclusively on remediation of medical and physical problems: patients received intensive physical, occupational and speech language therapy in addition to careful medical management while in the acute rehabilitation setting and were then discharged to long term care facilities or home. Mild brain injuries were (and still are) overlooked in diagnostic work-ups and detected only when a seizure disorder developed, the individual could not maintain employment, or family and other social relationships deteriorated secondary to personality changes. Professional literature suggested that “spontaneous” recovery of function would occur for 12-18 months but further improvement rarely occurred and formal intervention strategies did not exist.

The true costs of treatment programs which ignore cognitive-behavioral deficits are frequently not readily apparent to the injured individual, the family, referral agencies, or society at large. Several important financial factors deserve mention:

1.    Unremediated cognitive-behavioral deficits increase the cost of health care throughout the client’s life and usually also increase those same costs in other family members. Clients who are impulsive, have poor judgment and limited awareness of deficits coupled with poor memory, repeatedly place themselves in dangerous situations which result in injury to themselves and others and increased medical costs. Furthermore, the stress of providing care frequently results in escalating medical problems in the spouse or other family members.
   
   
2.    Unremediated cognitive-behavioral deficits preclude successful employment and require financial subsidy from federal, state or local programs or from insurance programs, particularly long disability carriers. Reserves exceeding $1,000,000 are common following such injuries.
   
   
3.    Clients whose cognitive-behavioral deficits are not remediated frequently require 24 hour a day care for life, either from family members or other community resources.
   
   
4.    Since the majority of clients who sustain brain injuries are young, otherwise healthy males, they can be expected to live nearly normal life spans and thus be dependent upon community resources for many years.

In addition, the social and psychological cost of unremediated cognitive-behavioral deficits is immense. Families are literally torn apart and overwhelmed by the unrelenting care demands. Brain injuries are unusual in that the individual may be unchanged physically but in every other critical aspect be a totally different person. Families frequently find that they must actually go through a mourning process wherein they bury the person they previously knew and develop a relationship with a totally new and frequently much less likable stranger.

Over the past 10+ years, programs which focus directly on remediation of cognitive-behavioral deficits following brain injury have emerged. Such programs are usually community based, encouraging full utilization of the client’s support system, local resources and pre-injury knowledge of the community. Since one of the major problems following brain injury is failure to generalize learning and behavior from one situation to another, maintaining community ties during rehabilitation maximizes learning and ultimately decreases the cost of care. Most programs require comprehensive neuropsychological examination prior to initiating treatment so that the client’s deficits are clearly delineated and specific cognitive and behavioral objectives can be formulated.

Following a successful cognitive-behavioral rehabilitation program referral agencies should expect changes in the following areas:

Improved behavioral control as measured by:

1. Decreased supervision needs.
2. Independence in ADL’s within limits of physical deficits.
3. Increased ability to be productive in a group setting.
4. Increased attention and concentration.
5. Decreased impulsivity and distractibility.
6. Sexual appropriateness.
7. Increased initiative.

Improved cognitive skills as measured by:

1. Improved ability to recall pre-jury information and to learn new information.
2. Improved basic academic skills, particularly mathematics and reading.
3. Improved insight into remaining deficits.
4. Improved judgment in social situations.
5. Improved reasoning and planning ability.
6. Improved performance on repeat neuropsychological assessment.

Improved community living skills and social skills as measured by:

 

1. Increased independence in transportation and community mobility.
2. Increased independence in basic home living skills.
3. Decreased social isolation.
4. Increased endurance.