Cognitive Prosthetics and Telerehabilitation: Approaches for the Rehabilitation of Mild Brain Injuries

Introduction: The development of cognitive prosthetics closely follows that of treatment for traumatic brain injury. The field of traumatic brain injury originally focused on the needs of individuals who had an obvious serious medical crisis. Hospitalization was required, and frequently neurosurgery was required. Most of these individuals recovered and were able to resume their normal lives. Cognitive prosthetics was originally developed to address the needs of individuals who require a significant amount of caregiver support even after aggressive cognitive rehabilitation. In the mid-80s, these were individuals who, 2 years after their injury, still had moderate to severe cognitive deficits. Initially mild traumatic brain injury was not recognized as a significant medical and rehabilitation condition, and was considered outside the purview of traumatic brain injury. Only later was it recognized that individuals without a medical crisis could permanently loose a degree of cognitive functioning sufficient enough to cause cognitive disruption. These were individuals who didn't need caregiver assistance from the start, but were unable to return to their former level of functioning, particularly in some of the independent activities of daily living including their vocation. Fortunately, cognitive prosthetics has demonstrated its effectiveness in addressing functional cognitive needs of individuals with mild brain injuries. Cognitive prosthetics is also appropriate because it addresses significant social-psychological considerations as well: The use of computer technology is status-enhancing, and an obvious symbol of significant cognitive abilities. What Is a Cognitive Prosthesis Cognitive prosthetics is an assistive technology, and was developed by computer scientists working with rehabilitation professionals. Cognitive prosthetics combines complex technology and therapy; it is not sufficient to deliver the technology without the therapist. The first review article on cognitive prosthetics was just published this April (Cole, 1999), and developed a set of criteria for what constitutes a cognitive prosthesis. • A cognitive prosthesis is designed specifically for rehabilitation purposes. • A cognitive prosthesis uses computer technology. The hardware which is given to the patient may be changed during the course of treatment, i.e., a desktop computer initially and then a notebook computer. Other hardware may be added and integrated, such as a scanner, pager, or cell phone. • As such, it is a rehabilitation compensatory strategy, which the patient uses to compensate for acquired deficits. A cognitive prosthesis maximizes the individual's strengths and abilities. • It directly assists the individual in performing their daily activities, and is thus part of the community-based treatment model. …