How to do Cognitive Rehabilitation Therapy
A Guide for All of Us, Parts 1 and 2

Kit Malia & Anne Brannagan

These two books (Part 1 and Part 2) cover the areas as listed below.

In Part 1 we set out the theoretical underpinnings for how to do CRT. In Part 2 we focus on the practical implementation of the work and we illustrate this with examples from our own experience. The purpose is to enable you to better understand how you can apply the principles in your clinical practice.

The books have been designed specifically for therapists and families coping with brain injury rather than academics. We have presented the information in an easily readable format - which encourages the reader to dip in and out of the books rather than having to read them from cover to cover. The user-friendly text is 'peppered with' icons, pictures and case studies throughout. Ideally the books should be read as a pair.

Excerpt from Section 1: Introduction
'We have provided Cognitive Rehabilitation Therapy (CRT) for people with acquired brain injury (ABI) over the last 23 years. The causes of these brain injuries have been varied, as have the settings in which we have provided this work (schools, home, inpatient rehabilitation centres, community settings, and support groups). During this time we have seen the value of cognitive rehabilitation for these individuals. We have become passionate about the need for Cognitive Rehabilitation Therapy and strive to ensure that people with brain injury, family members and therapists throughout the UK and abroad understand this crucial area of intervention.

We have done this by running practical training courses in Cognitive Rehabilitation Therapy (CRT) for therapists, relatives, care workers and support groups over the last 8 years around the world, and by producing materials that can be used by these groups of people.

As of 2005 a total of 6500 people have been trained on the 145 courses, which have been run throughout the UK, Europe and USA. Further details about these training courses can be found on our web site:

Writing down our experiences in a book that can be used by others to improve the cognitive skills of individuals with acquired brain injury seemed the next logical step. The need for this book was underpinned by 4 other factors:

(a) A reported need for practical information on cognitive rehabilitation for brain injured individuals, their carers and the staff working with them

(b) A recent requirement to address cognitive issues according to both the National Clinical Guidelines for ABI and the National Clinical Guidelines for Stroke (2nd Edition)

(c) The continued bias of traditional brain injury rehabilitation towards physical rather than cognitive skills

(d) The observation that therapists and relatives need help to translate research findings into everyday practice

It has become evident to us that there is a need for a practical hands on 'How to Do Stuff' manual. The information provided in this book is solidly grounded in the published research findings from around the world, and also on our personal experiences. We have applied everything that is in this book in our own clinical practice during the last 23 years. It Works!

Ideally this book should be read in conjunction with the wealth of publications that focus on the theory - the 'why'.


This is a HOW Manual to complement the WHY Materials.'


Book One Contents (208 pages)

Section 1: Introduction 'So What's it all about?'

Chapter 1 Why we wrote this book

Why we wrote this book
The need for practical information
The requirement to deal with cognitive problems
The physical bias of rehabilitation - 'Descartes error'
The need to translate theory into practice
Who is this book for?
Continuous professional development

Chapter 2 What is Cognitive Rehabilitation Therapy (CRT)?
What is cognition?
Who has cognitive problems?
What is CRT?
The 4 components of CRT
Cognitive Therapy vs Cognitive Rehabilitation
Limitations of CRT
Bottom up or Top down
Who can do CRT?
The need for CRT to cross disciplinary boundaries
The need for all staff to understand cognition
An integrated model of CRT
How do staff get trained?
What makes a good Cognitive Rehabilitation therapist?

Chapter 3 Why treat cognitive problems?

Because brain injury is common
Because cognitive problems are very common
Because cognitive problems persist
Because they prevent independent living
Because they can get worse
Because they cause major family problems
Because the brain is plastic

Chapter 4 The history of CRT
Our hall of fame
Our guiding principle
Where has CRT come from?

Section 2: Basic Principles

Chapter 5 Understanding how the brain works
Overview of the brain
The 4 major components
The 4 lobes
How does the brain work?

Chapter 6 The importance of structure
Why is structure important?
Different levels of structure
Simplifying the complexity of cognition

Chapter 7 The importance of practice
How we learn new skills
The well trodden path
The postal sorting office
What happens after brain injury - finding a new path

Chapter 8 Metacognition
Defining metacognition
Why do we need metacognition?
Building metacognition into the exercises and strategies

Chapter 9 Insight / Awareness
The importance of awareness - the golden key
A practical model - how to understand awareness
Different types of awareness
Self concept

Chapter 10 The interaction between cognition, emotions and behaviour

What are psychosocial skills?
Interaction - it's a two way street

Chapter 11 Therapeutic milieu

CRT as part of a multidisciplinary approach

Chapter 12 The importance of goal setting
Goals are the directors
SMART goals
Examples of goals

Section 3: Assessment and Treatment

Chapter 13 How to assess
What is the purpose of assessment?
Types of assessment
Important points about assessment
Selecting the right test
Guidelines for test administration
Repeatable batteries

Chapter 14 Treatment approach #1: Education

The need for education
You are a teacher
The content of an educational programme

Chapter 15 Treatment approach #2: Process training
Process training - what is it?
The process training cycle
Does process training work?
The systems approach
Scientific efficacy
How does process training work?
Examples of process training
How to design tasks for process training
Ideas of how to grade activities

Chapter 16 Treatment approach #3: Strategy training

The use of strategy training
The difficulties with strategy training
The benefits of strategy training

Chapter 17 Treatment approach #4: Functional activities training

The end of the rainbow
Using functional activities to improve cognition
Some issues related to functional activities training
How to use functional activities to treat cognitive problems

Chapter 18 Integrating the 4 treatment approaches
Integration of the 4 approaches to CRT

Section 4: Evaluation

Chapter 19 Issues to take into account

Impairment, activity limitation or participation?
How does cognition fit into this model?
Well being
Sources of knowledge informing outcome
Phrasing the correct question
Biased opinions
Difficulties with comparisons between experiences or studies

Chapter 20 The efficacy of CRT
But is CRT valuable?
Flaws of the studies
To be aware, or not to be aware
Therapist/Researcher role
Summaries of the 6 reports, 1999-2005

Chapter 21 Measuring outcomes
Standard outcome measures
Goal achievement
Reassessment on standardised tests
Goal attainment scaling
Quality of life/Patient or carer satisfaction reports
Functional gains



Book Two Contents (227 pages)

Section 5: Using the cognitive treatment modules

Chapter 22 The 5 cognitive modules
Simplifying the complexity
Why we have simplified cognition
What are the 5 modules?

Chapter 23 Organisation of the 5 cognitive modules

Using models to explain cognitive function
A model helps us conceptualise
Why do we use models?

Chapter 24 Attention
Start at the very beginning
Components of attention
Neural networks of attention
Education about attention
Tips on how to educate patients
How to assess attention
How to treat attention problems

Chapter 25 Visual Processing
What is visual processing?
The top down approach
A model of visual processing
How to assess visual processing skills
How to treat visual processing problems

Chapter 26 Information Processing
What is information processing?
A model of information processing
How to assess information processing
How to treat information processing problems

Chapter 27 Memory
What is memory?
An information processing model of memory
Working memory
How to assess memory
How to treat memory problems

Chapter 28 Executive functions
What are executive functions?
Components of executive functions
A model of executive functions
The link with information processing
Understanding the model
How to assess executive functions
How to treat executive functions

Section 6: Adapting CRT to your specific situation

Chapter 29 How to do CRT in different settings
The Slinky model
Doing CRT in the acute setting
Doing CRT in the post acute setting
Doing CRT in the home/community setting
Doing CRT in Headway/support groups
Doing CRT in long term care settings

Chapter 30 How to do CRT with different diagnostic groups

Doing CRT with people following stroke
Doing CRT with minimally responsive patients
Doing CRT with children
Doing CRT with people with progressive conditions
Doing CRT with the elderly

The Way Forward

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