Rehabilitation strategies for people with cognitive impairments

In this chapter, rehabilitation strategies to promote independence in daily living tasks for people with cognitive impairments will be outlined. The clienteles described in this chapter include people after a stroke or brain injury, people with Parkinson's disease and mild cognitive impartment or dementia. Two case reports using self-regulation and mental imagery respectively and two randomized clinical trials on testing the efficacy of the three-week self-regulation and mental imagery interventions on post-stroke patients will be summarized in this paper. Mental imagery has been extended to be used by people with mild cognitive impairments. The strategy helps the people to maintain a perceptual map within which the daily tasks are structured. A clinical trial using rehabilitation strategies including mental imagery to promote cognitive function necessary for daily living task performance will be summarized in this chapter. The use of external aids is common for people with Parkinson's disease to help them in initiating motor performance. This treatment strategy is believed to arouse attention of the people in starting off the motor tasks. The use of external aids and how it is internalized using the treatment technique of mental imagery will be described. With the use of various rehabilitation strategies in the occupational therapy programs, people with cognitive impairment showed better performance of daily living tasks.People with a neurological condition such as stroke, brain injury Parkinson's disease (PD) or dementia might suffer from cognitive impairments which impact on their independence in activities of daily living (ADLs). For example, a study on 149 people after stroke found that 72% of the sample suffered from cognitive impairments of various kinds (Claesson, Lindén, Skoog, and Blomstrand, 2005). Their dependence in ADLs was significantly correlated with the presence of cognitive impairments. Cognitive impairments in attention, memory, visual perception and construction were reported to be found in people after stroke (Hochstenbach and Mulder, 2003; Nys et al., 2006). For people with traumatic brain injuries, cognitive deficits are common and could include memory disturbance, reduced attention, orientation problems, word-finding difficulties (Christensen et al., 2008; Wilson, Pettigrew, and Teasdale, 2000). Cognitive impairments are being more recognized for people with PD (Bruck, Kurki, Kaasinen, Vahlberg, and Rinne, 2004; Mitchell, Kemp, Benito-León, and Reuber, 2010). Their memory and visuospatial function are affected. Among all, executive performance is more seriously affected. For people with dementia, there are numerous reports on the cognitive profile and the impairments in memory, orientation, constructional ability (Liu et al., 2011; Morris, Mohs, Rogers, Fillenbaum, and Heyman, 1988). Rehabilitation strategies for remediating the effects of cognitive impairments on independence in ADL's include, memory training and cognitive stimulation for people with dementia (Liberati, Raffone, and Olivetti Belardinelli, 2012); memory and ADL training using external cues and internal strategies to facilitate memory performance (Ávila et al., 2004), attention process training (Barker-Collo et al., 2009) and cognitive skills remediation training (Carter, Howard, and O'Neil, 1983) for people with stroke (Hoffmann, Bennett, Koh, and McKenna, 2010); self awareness training for people with brain injuries (Goverover, Johnston, Toglia, and Deluca, 2007) and self-regulation for people with stroke (Liu, Chan, Lee, Li, and Hui-Chan, 2002), mental imagery for people with stroke (Liu, 2009; Liu, Chan, Lee, and Hui-Chan, 2004a, 2004b; Liu et al., 2009); functional training using imagery (Tamir, Dickstein, and Huberman, 2007) and external cues for people with Parkinson's disease (Akamatsu, Fukuyama, and Kawamata, 2008; Baker, Rochester, and Nieuwboer, 2007; Mak and Hui-Chan, 2008). In the following section, two case reports using self-regulation and mental imagery and two randomized clinical trials on testing the efficacy of the self-regulation and mental imagery interventions on post-stroke patients are summarized. They are followed by reporting on a pilot study investigating the effectiveness of a cognitive training program that involved the use of mental imagery for people with mild cognitive impairments. The uses of external cues and in combination with imagery are also described.