What Is Cognitive Retraning?

August 31, 2007

In recent years, a variety of techniques have been developed to help people with neurological diseases or brain injuries function more effectively. While these efforts have generated considerable excitement in the scientific community, this field of study is still in its infancy. It is still unclear just how much difference these approaches make and for what kind of brain impairment. For those with a family member who suffers from Alzheimer’s disease, grief or desperation to help can tempt caregivers to do everything for their loved one. False hope should not be placed in some new development that has failed to stand the test of time and experience. Such an overreliance can be devastating to a family member who needs no additional undermining of morale.Cognitive retraining is an approach that has been used with other kinds of brain-injured individuals who have experienced a blow to the head (often called a closed head injury) or a stroke. Presumably with both head injuries and stroke some areas of the cortex remain intact. Alzheimer’s disease, however, is a degenerative disease that results in damage throughout the cortex of the brain, leaving no areas intact.

Many of the cognitive retraining approaches used with victims of stroke or head injuries involve working with some internal ability, that is, some aspect of brain functioning considered still to be intact. For example, a person with an injury to a language area of the brain may be trained to compensate for, or relearn, lost abilities by methods involving noninjured areas of the brain. Most techniques labeled cognitive retraining attempt to get the individual to use actively some ability to compensate or substitute for some deficit in reasoning, learning, or memory. We would caution against seeking help for an Alzheimer patient by enrolling in a program emphasizing retraining; this program ignores the fact that, at best, what one can hope to do is to delay an, as yet, unavoidable process of deterioration. Instead, external aids will be needed to compensate for the increasingly generalized deterioration.

In contrast, reality orientation approaches (which will be discussed in more detail later) emphasize use of external cues and structures to assist the Alzheimer patient in maintaining contact with the environment (e.g., calendars, written memory reminders). Behavior modification techniques, in turn, emphasize the selective use of rewarding out­comes for desired patient behaviors (e.g., dressing independently, going to the bathroom without protest). Typically the rewarding events. or reinforcers, are praise, physical or social contact, or something the patient values. With appropriate external cues (e.g., praise), the Alzheimer patient may be expected to continue to act in the desired fashion as long as rewards occur with some frequency. It is especially important to realize, however, that behavior modification approaches with the Alzheimer patient depend upon the caregivers providing consistent use of reinforcers (rewards) when the desired behaviors occur.

Posted in Alzhemier Disease