Patients do not need daily monitoring, but may have poor tolerance to stress. The second goal of treatment is to prepare appropriate treatment steps and means-the effectiveness of treating communication disorders related to brain trauma. At present, Coelho, DeRuyter and Stein( 1996) have summarized the research on the effectiveness of cognitive rehabilitation therapy. They found that a large number of treatment techniques have been successfully applied to the attention, memory and behavior disorders of patients with various brain injuries. For the treatment of patients with severe cognitive communication disorders, their attention is mainly focused on strategies to develop compensation ability, such as using memory AIDS (such as dating manuals, watches with alarm clocks and detailed schedules). For patients with deep injuries, it is best to focus on improving the environment and providing a lasting support system (such as training caregivers to carry out daily activities on time). We also found that the single-topic multi-baseline design is very suitable for studying the effectiveness of these cognitive rehabilitation treatments.
Coelho et al. (1996) emphasized the retraining of social ability, the time and place of treatment in rehabilitation stage (such as the place where hospitals and schools work) and its effectiveness, and also emphasized the benefits of early intervention. Coelho et al. (1996) pointed out that language therapy for patients with brain trauma is helpful to understand and express language, and to improve conversation, reading and cognitive function. Compared with untreated patients, hospitalized patients with mild injuries received cognitive training. The speed of restoring the ability of daily living is similar. Compared with severe patients, the average recovery degree of patients who have received cognitive rehabilitation training is better than that of patients who have not received rehabilitation training. 2. Cognitive rehabilitation, also known as cognitive rehabilitation, embodies a treatment scheme aimed at improving the ability of daily living. Mainly to improve the ability of patients to process and interpret the received information. These two methods of cognitive rehabilitation are called restorative methods and compensatory methods. The repair method is based on repetitive neuronal circuits. Sexual exercises and drills promote the growth of neurons, and the basis of compensation methods is to avoid damaged functions as much as possible. Usually, the repair method is used first. If not, we can use the compensation method for a period of time, and these two methods can be used at the same time to improve our daily life ability.
Treatment of severe injury
Because the problems mainly lie in arousal, attention, orientation, pretreatment and post-traumatic amnesia, and the communication function is very limited, the corresponding treatment is to stimulate these problems at a basic functional level. For patients with early or slow recovery, the following sensory stimuli can be taken: (1) Give visual stimuli.
Attract the attention of patients and promote visual tracking. For example, if a glass ball with snowflakes or colorful pieces of paper is turned over, the snowflakes or colorful pieces of paper will flutter, or a colorful paper windmill will rotate with the wind.
(2) Providing positioning information to patients includes greeting them by saying their names; Identify their clinicians by name and title; Tell the patient the date, the name of the institution where the patient lives, the length of his/her residence, and the reason why he/she lives in the institution.
(3) give multi-sensory stimulation to promote auditory understanding. For example, put a soft ball in the patient's hand and help him squeeze the ball when he says "squeeze the ball".
(4) Stimulating the touch/taste of lips with flavored popsicles promotes meaningful oral activities and perception and recognition of taste and temperature. Olfactory stimuli (such as perfume, perfume, soap and vinegar, etc.). ) and additional taste stimuli (such as lemon extract) are also recommended to observe whether the patients have a consistent response and evaluate the nature of the response. If the patient recovers gradually, the clinician can begin to apply environmental transformation at an early stage. Ylvisaker and Szekeres( 1994) put forward some forms of environmental transformation. These activities include forming and practicing patients' daily life and forming patients' day (such as getting up, showering, dressing, eating breakfast and arranging treatment time); Visual clues, such as pictures of people's calendars, periodic symbols and posters of upcoming activities, can help patients gain and maintain control over their environment. 2. Treatment of moderate injury. The treatment at this stage includes continuing to carry out detailed environmental transformation to improve the cognitive impairment of patients. Adamovic proposed the following activities to strengthen cognition.
(1) perception
Visual and auditory perception tasks: tracking and scanning; Perception of sounds, words and objects (such as using large fonts, holding positions with fingers or cards, placing objects in the best field of vision, and repeatedly asking for deceleration through auditory mode to decompose smaller information units); Tracking or copying; Follow simple instructions; Named object
(2) Resolution
First, visually distinguish the shapes and sizes of colors, and then distinguish pictures, words, sentences and situations (for example, color matching, light and shade, circle or length, big or small, words, sentences and situations, theme and function) to see how many stimulation items patients can handle immediately. This is a gradual process from one to two, three, four or even multiple items at the same time.
(3) organization
Organizational ability includes the classification or grouping of things, which is based on their physical attributes, meaningful units, functions, similarities and differences (for example, grouping objects according to circle or rectangle, big or small; Grouping words according to fruits, vegetables or cities) Termination activities include identifying missing elements of pictures, letters, words, sentences, stories, dialogues and situations, and sorting activities include visual information (for example, from small to large, from bright to dark); Pinyin alphabetical order (for example, from B to L), word order, sentence order (for example, the signatures of several parts of a letter-the main conclusion of the date and address letter are arranged in the correct order); Order functional activities (such as bathing, making tea, frying eggs and shopping)
(4) Memory
The treatment of memory disorder includes internal remedy and external memory assistance. Internal methods include repetition, association and memory. External memory AIDS include calendars, schedules, notes, daily records/diaries, memos, lists, structured daily life, reminders, tape recorders and alarm clocks.
(5) Reasoning/problem solving
Explain several kinds of reasoning, first of all, the most specific (such as whether your car is suitable for this parking space), and then extend to more abstract reasoning (such as in a large shopping mall, where you forgot to park your car, and figure out where it is by thinking about which mall entrance you came in from, which store you bought first, which section of the department store you are advanced in, etc. Other activities can include simple arithmetic problems, simple maze design and analogy.
3. Treatment of minor injuries
(1) Implementation and behavior issues
Due to frontal lobe injury, patients with brain trauma often have problems in executive function and behavior. Lei Zhake (1982) described executive function as the ability to think about goals (for example, graduates regard the theme of term papers as part of the curriculum requirements for obtaining graduation degrees) and the ability to form plans (for example, should graduates think about whether the format of papers should be experimental design, case studies, literature review and analysis, etc.). ), and whether the diagnosis and treatment of symptoms and causes or any combination of these aspects should be covered), the ability to successfully implement the plan (for example, graduate students go to the library to test whether the topic is applicable, collect and analyze data, classify and hand it over to the tutor in time), and the behavioral problems of patients with brain trauma include anxiety, depression, withdrawal, aggressive behavior, irritability, low response and poor self-control. And the damage of some brain regions dominated by inattention (such as frontal lobe and temporal lobe) can directly lead to these behavioral problems, while the damage of brain regions dominated by cognition (such as attention perception and memory orientation) can also indirectly lead to these behavioral problems. When patients try their best to cope with this damage, abnormal behavior will occur.
Behavioral problems may also occur when patients try to cope with complex injuries (such as amputation), or because some environmental factors prompt patients to have abnormal reactions and confrontation (for example, adapting to noisy or stuffy rooms and getting used to personnel departments). Many times, when patients recover their cognitive ability, executive ability and language ability and adapt to the environment, behavioral problems will be reduced. Some patients may need additional treatment (such as consulting medication). Problems in executive function and behavior can appear in the first two stages of recovery, but in the last stage, it is most obvious that patients with brain trauma plan to return to society and undertake and complete daily activities (such as dressing for breakfast and preparing for school or work) intertwined with a large number of social activities, which of course involve the use of language.
(2) executive function defect
① Flexibility of reaction: Ask patients questions and let them come up with various solutions. If the patient can only propose one or two solutions, you can provide options. Patients must find the best options and explain why these options are superior to others. ② Reasoning and explanation: Let the patient explain some phenomena, give options by answering questions such as "Why" and let him explain his own answers, so that the patient can arrange the order of events in the form of pictures or story lines. And explain your choice in a related activity, provide patients with an absurd plot, and then let them explain why it is illogical. If patients have difficulty in oral reasoning and explanation, it is helpful for patients to provide options to help them find out the main points and draw logical conclusions. 3 problem solving: patients' ability to solve problems is often limited. Because their ability to adopt other ideas or consider alternatives is limited, they will miss the relevant details or encounter difficulties in choosing the most important factor from the unimportant factors. There are two solutions: A. Real-time: In the activity, observe the patient's ability to identify and solve problems when they occur. In addition, set a situation where patients will inevitably encounter problems and observe the ability of patients to solve these problems. B. Hypothesis: During the conversation, ask the patients, and if there are some problems, they will. Patients with cognitive communication disorders may not be able to consider hypothetical situations because they are concrete and self-centered. In addition, their oral problem-solving ability may exceed their actual problem-solving ability.
(4) Abstract thinking A. Reasoning: Let patients explain the implied meaning in the notes and tell them a story, then let them find out the key elements, explain the relevant factors and reasons, and explain the story that will happen in the future. If patients need help, give them words and abstract choices. When they provide answers, let them explain the reasoning process of making this reaction.
B. Humor: Let the patient listen to a joke and explain its humor, then let the patient tell a joke and let the patient explain why a cartoon or joke is so interesting. If the patient needs help, it is helpful to provide examples of alternatives or misunderstandings.
C. Tasks with different meanings: Ask the patient to explain all the meanings of a given word or phrase, and use this word to make sentences with different meanings of the same word. If they need help, offer options or ask yes/no questions about these meanings.
D. Visualized language: let patients explain slang or rhetoric to present some words with multiple meanings, let patients explain their meanings and present a sentence with vague meanings, or a phrase with two meanings, so that patients can find the correct meaning from the context. In addition, examples of misuse of slang are given for patients to correct.
E. Psychological task theory: let the patient explain how everyone feels differently in a given situation, and let the patient identify the emotions of people in the picture, who have different facial expressions; Let patients distinguish between jokes and lies; Distinguish between vividness and literariness; It is a very helpful option to distinguish between talking about facial features and the emotions and negativity they convey, and ask patients to explain their answers ⑤ Divergent thinking: in a given time, ask patients to say as many items as possible in a category, ask patients to propose more than one solution to the problem, choose items different from other items, and explain why they write down a list. Provide patients with ways to answer sub-category questions as a way to improve their ability. 6 The handling of executive function problems can also include the following contents: a. Decompose complex and arduous tasks into smaller parts. Let others write down complicated instructions and schedules. Make a regular and regular schedule for daily activities. Get help from family, friends and colleagues. So as to encourage patients to enter daily life activities calmly. E. keep the property in the designated place. F arrange workshops, and reserve specific time to deal with complex work tasks (i.e. time for patients to rest and stay awake). G. Set time limits for dealing with complex work tasks (use alarm clocks and timers). Use a written timetable for daily activities and arrangements. So that it can be checked after completion. Use an alarm clock or timer to remind appointments and other scheduled tasks or transactions. J use the work log so that patients and/or others can record the activities of the day. K. Set up signs or instructions in important places to remind some activities (such as "Do you have a key?" (3) Language and Conversation Problems Among the language categories, the most easily influenced in social activities is that social needs mix cognition, social behavior, execution and language ability. The language of patients with traumatic brain injury is considered irrelevant, confusing and inappropriate in content and length. The narrative language problems after traumatic brain injury include the reduction of conjunctions, the reduction of information transmission, the use of vague pronouns and the slow speech speed. Excessive fluency and hearing impairment caused by using short sentences are common problems in brain trauma. Good understanding of subject information, poor understanding of detailed information. In view of the problems existing in language, especially in conversation, the following suggestions can be taken: 1. Use manuscripts (such as going to restaurants and supermarkets) to generate real or imaginary experience descriptions.
2. Record the topic of any conversation.
3. Check the relevant points.
4. Remind others before changing the subject.
5. Retell important comments and check yourself. 6. When you are confused about what others say, ask for explanation or repetition.
7. Look at other people and make sure they express your point clearly.
8. Observe the other person's facial expression, or ask if the other person has made your point clear.
9. Practice retelling a story (for example, browse a picture story and then express it orally).
10. Practice making up stories (for example, look at a picture of a single action and then make up a story for it). The third goal of treatment is to encourage patients and caregivers to continue rehabilitation treatment outside the hospital.
Four. The skills of treating attention deficit and improving attention include the following: 1. Reduce interference.
For example, turn off the radio, TV or harsh machinery, close the curtains, close your eyes and use earplugs.
Avoid crowded places
For example, after work, go shopping by car, go shopping on the street and chat with a few people. If it is an inevitable crowd, you can bring someone who can help, or be a guide when necessary.
Attention fatigue
For example, let patients often rest when they are at a loss or close to information overload.
4. Avoid interruptions
For example, ask the patient to unplug the telephone line or use the answering machine, use the "Do not disturb" sign, and ask others not to disturb, and only do one thing at a time.
5. Ensure adequate sleep and exercise.
Napping and physical exercise are both helpful to sleep and attention.
ask for help
For example, ask the patient to tell someone he or she trusts and ask for help, and if necessary, ask for help on the above projects.