Language and cognitive impairments are common consequences of stroke. These difficulties persist with 60% of stroke survivors continuing to experience memory problems, 50% attention deficits and 61% communication problems long after the onset of the stroke-related impairments. Such deficits are ‘invisible’ – evident only through patient report, behavioural observation or formal assessment. The impacts of such deficits are considerable and can include prolonged hospital stays, poorer functional recovery and reduced quality of life. Effective and timely rehabilitation of language (auditory comprehension, expressive language, reading and writing) and cognitive abilities (memory, attention, spatial awareness, perception and executive function) are crucial to optimise recovery after stroke. In this chapter we review the current evidence base, relevant clinical guidelines relating to language and cognitive impairments and consider the implications for stroke rehabilitation practice and future research. Speech and language therapy offers benefit to people with aphasia after stroke; intensive intervention, if tolerated, likely augments the benefits. Interventions for deficits in all non-language cognitive domains exist, but need refining and evaluating more thoroughly with a wider range of methodologies.
Neuropsychological deficits following brain injury include cognitive impairment, difficulties with emotion, changes in self-identity, impairment in insight, behavioural challenges and personality change. The reviews rehabilitation for neuropsychological problems and includes specific reference to mild traumatic brain injury and traumatic brain injury in children.
Rehabilitation has been defined in many ways, but in the broadest sense is concerned with maximising quality of life after injury or illness.1 More specifically, rehabilitation is about maximising the ability and opportunity of the person with brain injury to participate in those activities of daily living, work, education, leisure and relationships that are valued by that person. Wade discusses the importance of models of illness (and health) and highlights the value of the World Health Organization International Classification of Functioning, Disability and Health (ICF) as a framework for understanding the process of rehabilitation.
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