Brain Injury Caregiver: Cognitive Rehabilitation at Home/Language

The Resilient Caregiver Series- Tip Sheet #6

Brain injury can affect many areas of the brain involved in thinking, learning, remembering. and communicating. Cognitive rehabilitation aims to restore those abilities as much as possible, or teach the survivor strategies to compensate in new ways.

Cognitive rehab usually starts in the hospital or out-patient setting. But that’s just the beginning. Healing and recovering from a brain injury can take a long time.  Many people can continue to make progress in specific ways for months and years after a brain injury with ongoing treatment, motivation, and practice.

Once the survivor is home, most of the responsibility for continuing rehab belongs to the survivor and family caregiver. When my husband Alan suffered a severe anoxic brain injury he needed to learn to read, write, and think all over again. Alan’s therapists trained me to carry over some of his treatments, but as time went on we came up with ideas that kept him interested and moving forward.

Here are ten suggestions for reading, writing, and communication skills.

1.      Give your brain a break. The brain consumes an enormous amount of energy while concentrating and relearning material. Build frequent rest breaks into sessions. Take days off from intensive rehab work. We stopped our “rehab week” on Friday at 5 PM and just enjoyed the weekend. The brain also benefits from time to let new information settle in and integrate.

2.      Set a few realistic goals. Alan cared most about learning to read and write, so our goals reflected his priorities. Make your goal measurable. For example- “Alan will write three sentences in his log book five days a week.”

3.      Make your training materials match the task. We set up a table in Alan’s office as his new “learning center.” I put away his work as a physics professor. Then we added a children’s computer, children’s dictionary, and two reading books at a time. It can be humiliating to start learning basic skills as an adult, so we selected computers and puzzles that looked like they were made for adults. V-Tech makes such products. As long as the tool looked grown-up, Alan was willing to try it.

4.      Figure out what’s just enough. Alan had problems finding the words for common objects. So, we taped index cards with the words for the items we used most on the kitchen cabinets. I kept a deck of index cards with names of foods on the table, and pulled out a few at each meal for Alan to practice pronouncing and memorizing. We walked a fine line between enough labeling and information overload.

5.      Build cognitive rehab into your new daily routine. Doing cognitive and physical rehab became part of our “new normal” life. We scheduled time for certain practice sessions in a distraction-free room. Then we practiced spelling at the grocery store or reading comprehension while talking over a newspaper story. Sometimes I asked Alan to read me a poem before bed. We memorized poems together and enjoyed reciting them.

6.      Make music part of the act. The brain stores and accesses music in different ways than spoken words. Alan loved to sing, and sang long lyrics much easier than he spoke sentences. We sang TV commercials as cues to brush his teeth. Alan remembered the lyrics to camps songs and Broadway musicals, so I asked him to teach me. Playing an instrument and listening to music stimulate several parts of the brain and can be a lot of fun.

7.      Teach others the best way to communicate. Alan had a distinctive speech pattern from the brain injury. He started a sentence confidently, but always paused several seconds to recall the last few words. If anyone interrupted him, or jumped in with the word, his thought was short-circuited. That made him understandably angry. My job was to tell visitors to listen patiently and not interrupt. Alan could enjoy thoughtful conversations when we all used his strategy.

8.      Approach a skill from different angles. We built on Alan’s interests to work on concentration, comprehension, communication, and retention at the same time. For example, he decided to make a folder of articles about dogs. He clipped articles, read them, and wrote a few summary sentences in his log book. I asked him questions about the article as a lunch conversation.  We looked up pictures of dog breeds on the Internet and added them to his folder. When our young nieces visited, Alan taught them a lesson about shih-tzu dogs.

9.      Find the resources you need to keep learning. In an ideal world, survivors and caregivers would have access to therapists and coaches we could consult for years after the injury. Insurance coverage can be a problem, but ask your case manager, doctor, or local Brain Injury Association for referrals to cognitive rehab specialists. There are also great training materials and workbooks for a range of learning needs on the Lash and Associates Website. Browse the site for ideas and projects.

10.  Practice, Practice, Practice. Repetition is often the key to rebuilding language skills.

Tip Sheet #7 offers memory enhancement strategies to continue cognitive rehab at home.