What to know about cognitive rehabilitation therapy

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Any therapy aimed at rehabilitating cognitive function is a type of CRT. In this regard, CRT is not a singular, one-size-fits-all approach.

Many different healthcare professionals may use this type of therapy, including psychotherapists, speech-language pathologists (SLPs), physical therapists, neurofeedback practitioners, and occupational therapists.

There are two different approaches to CRT: restorative and compensatory.

Restorative CRT

Healthcare professionals use restorative CRT to improve cognitive function by reinstating or strengthening the functions a person has either lost or continues to find challenging.

For example, a person might perform increasingly difficult memory tests to improve their memory or undergo training to improve their attention span.

Restorative CRT helps a person practice skills so that they can improve. It builds on the idea of neuroplasticity, which suggests that the brain can change with practice.

A person’s brain might establish new connections to work around an injury or strengthen existing connections due to repeated use.

Compensatory CRT

Compensatory CRT helps a person work around their injury.

Sometimes, this is a temporary strategy, such as when a person uses assistive devices as they build up new skills.

Compensatory CRT can also be a long-term strategy when it is not possible to restore a person’s functioning fully.

Some examples of compensatory CRT include using:

• assistive speech devices for a person with a speech impairment
• calendars and memory tools for people who struggle with executive functioning
• alarms to regain a person’s attention in certain contexts

CRT is any therapy that healthcare professionals have designed to help improve quality of life following a brain injury.

There is no single approach to CRT. Instead, it usually involves several experts working together to develop a comprehensive plan to restore as much function as possible.

In some cases, the goal is to restore brain function or rewire the brain, helping this organ work around the injury.

For example, an SLP might help a person practice saying previously familiar words, or a physical therapist might help a person practice challenging movements so that their brain can learn to coordinate these movements more effectively.

As it is not always possible to restore brain function, CRT also involves helping a person learn coping tools, such as using assistive devices to help them communicate or move more easily.

Any therapy that aims to improve cognitive function following an injury to the brain is a type of CRT, so this therapy comes in many different forms.

Some examples of CRT include:

Neurofeedback

This intervention uses scans of brain waves to offer real-time brain feedback. Healthcare professionals often recommend specific activities based on these scans.

The authors of a 2017 systematic review highlighted neurofeedback as a potential CRT tool following a stroke.

Attention processing training (APT)

This treatment aims to improve five different domains of attention: focused, selective, sustained, alternating, and divided.

APT uses progressively more challenging tasks to help a person improve their attentiveness.

Computer assisted learning

Computer assisted learning is not a specific type of CRT, but it can target many different abilities.

For example, computer memory and attention games may help a person regain attention and memory.

Assistive devices

Various assistive devices can compensate for lost skills.

For instance, a person with aphasia (lost speech) following a stroke might use a communication board to share their thoughts and needs.

Doctors most frequently recommend CRT following a brain injury, such as a TBI or stroke.

In recent years, though, researchers have begun testing CRT as a treatment for chronic or progressive illnesses.

A 2013 review suggests that CRT may be effective for mild cognitive impairment, an age-related cognitive issue that often precedes dementia. However, the authors emphasize that more research is necessary to establish its effectiveness in this use.

There is no evidence that CRT is harmful, so people with any cognitive issues may have an interest in trying it.

However, it can be an exhausting and time-consuming process. Due to this, people with diseases for which there is no known cure, such as dementia, may prefer to focus on improving their quality of life if they do not enjoy CRT.

Also, not all people with brain injuries need CRT. Most people with TBI, for example, recover on their own. A doctor will only recommend CRT when a person has clear symptoms of a cognitive issue.

Diagnosing brain injuries can be difficult when the cause of the injury is not immediately clear.

A doctor may recommend cognitive testing, brain imaging scans, or even bloodwork to rule out other causes.

In many cases, though, the cause of the problem is obvious, such as when a person develops cognitive issues following a fall or stroke.

To assess the effectiveness of CRT, the person’s treatment team may carry out ongoing evaluations, such as neurocognitive tests.

A person can also measure their own progress by assessing how well they are functioning. They can consider various factors, including whether they have been able to return to work and whether they can now communicate more effectively with loved ones.

Several factors make it difficult to give an outlook for all people undergoing CRT. They include the following:

• There are many different types of CRT, some of which may be more effective than others.
• The condition that a person has may affect their outlook. For example, dementia has no cure, but people often recover from strokes.
• Effectiveness can be subjective. A person recovering from a stroke might see measurable improvements in attention or memory but not improve as much as they would wish to in speech.
• It can be difficult to determine the effectiveness of CRT because it is not possible to compare a person’s recovery with and without CRT.

However, most studies of individual types of CRT show that it is effective.

In one example — a 2017 meta-synthesis of perspectives on CRT among people with multiple sclerosis — the participants reported improvements in quality of life and social and emotional functioning.

Brain injuries and illnesses can affect virtually every aspect of a person’s daily functioning, from their speech to their ability to work.

CRT offers a comprehensive approach, targeting treatment to a person’s specific needs and goals.

Anyone interested in trying CRT should speak with a healthcare professional about the most suitable options for them and ask for evidence showing that these interventions work.