Traumatic brain injury (TBI) is a serious public health concern associated with extensive residual impairments, including cognitive difficulties, such as memory and executive dysfunction, which can result in lifelong disability. Recent studies estimate that more than 3 million people in the United States live with severe disability due to TBI.
A growing body of research suggests that cognitive rehabilitation is an effective intervention to help improve functioning and diminish disability in TBI. Various interventions have been shown to be effective in clinical settings to improve attention, memory, executive functioning and other major cognitive domains that are affected after brain injury.
Many of the treatments studied use a compensatory approach that teaches patients techniques and strategies to help them compensate for impaired functioning in one or more cognitive domains. One strategy that improves patients' functioning in daily life is the three-stage calendar acquisition approach. This approach, combined with other interventions, has been the basis of Mayo Clinic's outpatient brain rehabilitation program for many years.
For successful results, this approach requires numerous face-to-face therapy sessions necessary to learn and apply the strategies that allow people with a brain injury to compensate for areas of impaired functioning. Unfortunately, individuals with a brain injury in need of this important therapy often have to travel some distance to find a therapist who is skilled in delivering this kind of specialized treatment.
"Distance from specialized services particularly affects patients in rural regions," explains Thomas Bergquist, Ph.D., L.P., a neuropsychologist at Mayo Clinic in Rochester, Minn. "While some therapy services are available in many small communities, they are often provided by therapists with limited expertise in addressing the unique needs presented by TBI." As a result, people with TBI from rural areas often relocate to be closer to specialized services, typically at their own expense, or they simply do not receive the best level of service.
Advances in communications and computer technology have helped overcome some of these logistical barriers and made telehealth services a viable means of providing a variety of services for TBI. Through telehealth, specialized clinical services may be delivered to those in need who live considerable distances from specialized service providers.
Mayo Clinic researchers recently tested the efficacy of using telehealth to deliver specialized post-acute rehabilitation services to individuals with TBI. The goal of this research was to assess the feasibility of providing cognitive rehabilitation using an instant messaging (IM) system for individuals with TBI and associated memory impairment.
Specific study aims were to identify factors that predicted who could participate in and potentially benefit from telehealth-based cognitive rehabilitation and to evaluate the effects of this care on emotional and cognitive functioning.
"The first phase of our research was meant to determine types of disability, such as severity of brain injury, cognitive impairment, level of emotional distress, personal preference or participant preferences that precluded participation in telerehabilitation," says Dr. Bergquist. "We assessed attitudes toward receiving rehabilitation in this manner and attempted to determine which factors differentiated those who responded to telehealth from those who did not."
Subsequent studies measured the impact of telerehabilitation on emotional and cognitive functioning. Participants were individuals with a history of moderate to severe TBI with documented memory impairment. Participants received training in how to use a secure IM system and then logged in to the system weekly to participate in online cognitive rehabilitation therapy sessions over the Internet with a cognitive rehabilitation therapist at Mayo.
Treatment focused on training participants to use a calendar system aimed at improving accuracy and efficiency in home and work tasks. Participants underwent assessment of cognitive function, psychological status, level of functioning, and use of compensation techniques both before and after treatment.
"Our findings indicate that the Internet may be an effective delivery mechanism for compensatory cognitive rehabilitation, particularly among individuals who are already utilizing some basic compensatory strategies," explains Dr. Bergquist.
Building on these initial findings, research is under way to assess whether participation in this Internet-based cognitive rehabilitation program results in improved daily functioning.