Need for Greater Neurocognitive Rehabilitation in LTC
In long-term care rehabilitation is a very important part of treatment for many residents. Rehabilitation is a very important part of the interdisciplinary team process that focuses on helping those with physical impediments regain much, it not all, of their physical ability that is often lost through a myriad of physical problems. However, a great deal of rehabilitation focuses on regaining the physical problems that were lost, such as fine motor movement and gross motor movement.
Even when individuals have cerebral infarcts (strokes), the emphasis is often on gaining, to some level, the lost physical function that often accompanies this problem. Many rehabilitation programs will often emphasize that they do provide some level of neurological rehabilitation, but this is often based on the neuromuscular innervations that take place during physical movement exercises.
What is often missing in many rehabilitation programs for residents is a true neurocognitive rehabilitation program that focuses on enhancing the brain and overall nervous system. With this type of program the focus in not just on enhancing the physical mobility that is often lost through illness and disease, but also the neurological and cognitive loss that is often part of disease, illness, and even inactivity.
Neurocognitive rehabilitation is a multidisciplinary approach, which is not just dependent on any one area of specialty. Unfortunately, most individuals in long-term care environments are not informed about the need for neurocognitive rehabilitation and furthermore, most fail to have any training in this area. This is quite perplexing, especially since our brain is the essence of who we are. With damage to our neurocognitive resources, we can strengthen the limbs through rehabilitation yet fail to improve the individual as a human entity.
We are seriously behind in the area of neurocognitive rehabilitation. This is unfortunate since there have been tremendous advancements made in the neurosciences. We now know the brain is not a post-mitotic organ, fixed with all the brain cells and connections one needs for the rest of their lives. Research has demonstrated that active neurocognitive activity can lead to growth of brain cells in certain areas of the brain as well as changing the cerebral landscape of the brain by making new connections to enhance our ability to cognitively engage in many tasks with greater proficiency. Therefore the brain is not a fixed organ and can change. However, when it is negatively changed through disease, we often feel that we cannot reverse these changes, or that if a neurocognitive reversal does happen, it will be predicated on the person's own healing mechanisms.
Given our knowledge of the regenerative potential of the human brain and its ability to adapt and change through developing alternative pathways even when the previous ones can no longer function, it becomes incumbent on long-term care professionals to become more involved in the neurocognitive rehabilitation potential that remains untapped in this area. However, inserting this new type of paradigm to deal with enhancing a person's life will not be an easy task. Since most individuals are not familiar with this area, and are even less familiar with the brain and its hidden capacity for change, it will take a considerable amount of training and education to foster the growth of this area.
Brain science has come too far to not employ much of the knowledge that we have gained to assist in rehabilitating long-term care residents' brains. We now know that many pathways and alternative pathways can help with many of the neurocognitive deficits that exist among many individuals. Like an open patch of ground surrounded by a weeded area, the open area will be taken over by weeds if the patch of ground is not cared for.
This is somewhat similar in the brain. An insult to a particular area of the brain will be grown over with other areas that are adjacent to it. However, if we target the neurological areas that need to be addressed a territorial invasion will not happen and the landscape that was faced with a physical insult will start to respond. Moreover, in some cases if the area cannot respond new pathways are created.
So it only makes sense to start addressing many of the important brain rehabilitation needs that exist among this population. However, to do so it requires a great deal of teamwork, starting with the rehabilitation therapists, to activities, social services and nursing. Furthermore, this type of intervention is not only for those that need rehabilitation services. It is a type of intervention that should at some level exist for all residents. Because of the special needs that many older adults face on this level, one has to wonder how many more residents would lead more alert lives and possibly forestall the impacts of dementia for a few more years if they were provided with this service. All staff needs to be involved in producing a paradigm shift that starts to focus in greater detail on the resident's neurocognitive needs. This will be a daunting task to implement but the benefits will surely outweigh any costs.