.jpg)
Public Policy of the Brain Injury Network
Policy approved by the Board 3-11-10
Cognitive Retraining (Also Called Cognitive Therapy or Cognitive Training):
Cognitive Retraining is a method by which people after brain injury are taught to restore skills (in such areas as attention, concentration, memory, organization, perception, judgment, and/or problem solving) and also to develop compensatory strategies to cope with or even overcome deficit areas that have arisen due to brain injury. Cognitive retraining is also one aspect of the broader concept, cognitive rehabilitation. Cognitive retraining is the term used by therapists, especially psychologists and neuropsychologists who offer cognitive retraining services. The purpose of cognitive training is to help the patient with a brain injury to restore cognitive or sensory function or at least compensate for loss of function by training or retraining neural pathways in the brain. Cognitive retraining sometimes is also sometimes referred to as cognitive therapy or merely cognitive training.
Recent studies suggest that cognitive therapy helps improve outcome for persons who have sustained acquired brain injury (from tbi, stroke, brain illness, brain tumor, hypoxic injury, etc.) It is claimed that cognitive retraining will help people with brain injuries regain independence and improve their quality of life as well. There is even research suggesting that the outcome will be better if the therapy is started sooner rather than later.
We acknowledge that insurance companies should cover cognitive retraining as a part of a complete program of treatment modalities for persons recovering from acquired brain injury. However, it must also be noted that it has not been proven that cognitive retraining always can restore competency and/or “normal function” to people with brain injury, but improvements to function, however large or small, are welcomed by survivors, especially those with few prospects for a recovery.
Cognitive retraining, as conducted, for example, by neuropsychologists, is very similar in many respects to programs or service delivery offered by speech pathologists and even severely disabled and/or learning disabled special education teachers. We think that limiting reimbursable cognitive retraining to hospital systems and/or psychologists would be a mistake, as many professionals have specialized training in “cognitive retraining”, although it might be called something else such as speech therapy or special education services. So we think these therapies or educational interventions should also be encouraged and adequately covered by insurance.
There is also the cost factor for education or rehabilitation depending on the setting. “Therapies” in medical venues such as hospitals or medical provider offices tend to be far more expensive than those in community settings. How could any medical providers expect that cognitive “treatment” be offered to individual patients in a hospital or other medical setting perhaps for a life time? Yes, they would like the business and certainly have high level training to accomplish their medical programs, but, some individuals with brain injuries will require many years of and perhaps even life-long “cognitive retraining”.
It would be more cost effective for this kind of ongoing, long-term “treatment” or “training” to be delivered initially in a hospital or other medical setting, but with an eventual shift to outpatient settings with a community reintegrative aspect. This would also be more palatable to people with brain injuries who want to leave the hospital environment, normalize their lives as much as possible, and not be permanently under the control and direction of medical or other “institutional” personnel. With generalized social system supports within the community, in addition to medical “cognitive retraining”, this is possible in most cases.
People with brain injuries usually want and need as much retraining as they can afford, so we encourage the inclusion of “cognitive retraining” in services that are covered by insurance. However, since one of the main goals of survivors is return to the community as soon as possible we also encourage the development and support of additional community venues for “cognitive retraining”. Some services similar to “cognitive retraining” are available and performed by schools, individual providers, non-profit entities serving the disability community, state and county departments of health and human services, etc. More could certainly be done by state departments of rehabilitation, county day programs, post-secondary colleges and the like, in the area of cognitive retraining. No one set of providers, for example, rehabilitation hospitals personnel, should have a monopoly on “cognitive retraining” or other training modalities that are akin to cognitive retraining.
So, in conclusion, cognitive retraining should be covered by medical insurance. Cognitive retraining or educational instruction should also be an aspect of a fully comprehensive system of delivery to survivors who wish to move on from hospital settings and back into community life - with community supports where necessary. Hence, “cognitive retraining” (or other name) in local communities in local nonprofits, schools, colleges and the like for people with brain injuries should likewise be encouraged and funded.