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Type: Post-Concussion Care, TBI, Cognitive Rehabilitation
Location: Toronto, ON, Canada
Size: 13+ Clinicians (Kinesiologists, Psychotherapist, Nurse, MDs)
HappyNeuron Pro user since: 2020
Clinic needed a digital tool to help provide cognitive rehabilitation to patients with concussions.
Dr. Taher Chugh, Sports Medicine, MD, CCFP(SEM), FCFP. Dip Sports Med
Medical Director of the Toronto Concussion Clinic
Dr. Taher Chugh serves as the medical director of the Toronto Concussion Clinic. His background is in both family and sports medicine. Dr. Chugh has worked with patients in inpatient care, family practice, urgent care and sports medicine which allows him to treat patients across the concussion spectrum. Dr. Chugh provides cognitive rehabilitation services for his clients struggling with concussion in helping them get back to work and adjusting to life post-concussion.
“I needed a way to help my clients practice cognitive skills while habituating them to a computer screen. This allows my clients to have a similar experience like they would encounter in a working environment” – Dr. Taher Chugh
Oftentimes, clients with concussions struggle looking at computer screens for long periods of time. Using HappyNeuron Pro, Dr. Chugh wanted to adequately challenge his patients while habituating them to looking at screens for longer periods of time. This habituation to screen tolerance is essential for helping clients get back to work, as many jobs have a computer usage requirement.
Dr. Chugh runs his program with the help of a clinical assistant. The clinical assistant uses HappyNeuron Pro and facilitates Dr. Chugh’s programs. HappyNeuron Pro is designed to put the therapist in control. Any therapist, such as an OT, SLP, or psychologist is able to use HappyNeuron Pro easily with clients.
“I can delegate HappyNeuron Pro to my clinical assistant. They are able to use it with clients who may not need as much assistance as others. However, if a client had more significant difficulties, I am able to work with them”. – Dr. Taher Chugh
However, Dr. Chugh also uses HappyNeuron Pro one-on-one with his patients. When he works with his patients using HappyNeuron Pro, he is better able to understand a client’s difficulties that may not be evident in other tasks. He is able to see a client’s cognitive sensitivities as a result of their concussion while they perform cognitive tasks.
“When a client begins an exercise, they often have no approach. As they get familiar with the exercise, they develop an approach but do not stick with it. This can lead to emotional frustration, or ‘choking.’” – Dr. Taher Chugh
Concussions can cause a person to become depressed, anxious, or frustrated as they may experience cognitive deficits that interfere with their ability to perform daily life activities. Dr. Chugh is sensitive to the emotional and psychological state of his clients, as negative emotional experiences can interfere with performance on cognitive tasks. One way Dr. Chugh helps his clients maintain a healthy emotional state by using biofeedback techniques.
“[One client] I work with struggles with the exercise “Restaurant”. Using biofeedback, I am able to help this client regulate their autonomic nervous system to stay calm while completing the exercise.” – Dr. Taher Chugh
Sleep, cognitive function, and psychological status are all interconnected. Clinical providers working with clients that have experienced a concussion or brain injury must address these different areas that can impact a client’s ability to function. One aspect of psychological functioning that Dr. Chugh sees as essential for a client’s recovery is resilience. Resilience is important to develop as it helps a person face an obstacle and be able to persevere through it to solve a problem at hand.
“I do not like switching from an exercise that is difficult for a client, as this can be demoralizing to the client and can encourage them to avoid challenges. Working with my clients, I encourage them to break up exercises into smaller steps and resume them. I work with them on taking time to complete tasks and not quitting.” – Dr. Taher Chugh
A concussion occurs when force is applied to the head. This force causes the brain to make contact with the skull, resulting in tissue damage. Depending on the nature of the concussion, a client may experience one or more cognitive deficits. Working on cognitive functioning can help clients build back the necessary skills to resume activities that bring them joy and allow them to live independently. Many people living with concussion and brain injury experience a loss of control, due to needing help or modifications to participate in life activities. Cognitive rehabilitation can help clients build these skills, which in turn can help them have a sense of control over their lives.
“Improving control allows the client to see that they can do something that is challenging. This helps the client build confidence in themselves, which in turn brings optimism.” – Dr. Taher Chugh
“Cognitive rehabilitation is like going to the gym. As long as you exercise properly and employ the exercises properly, you will get the benefit of the exercise. If you leave clients on their own without support, sometimes clients may “hack” exercises in finding a way to complete them easier without going through the proper challenge to get the cognitive practice that they need. This is why one-on-one interaction is essential, as the clinical provider can prevent the client from ‘hacking’ the exercise.” – Dr. Taher Chugh
Cognitive rehabilitation therapy can be provided using digital tools, paper and pencil exercises, and multimedia content that targets the cognitive functions that the client is struggling with. Clinical providers also provide concussion education to the client and their support team to help the client and their support team adjust to life post-concussion. An active ingredient in a client’s therapy success is the guidance and time with a clinical provider. Without guidance, clients may devise ways to avoid obstacles, which prevents them from getting the full benefit of completing cognitive exercises.
In the future, Dr. Chugh will be employing a resilience program to help clients learn how to handle obstacles while also addressing common cognitive difficulties experienced as a result of concussion. This program will provide clients with group therapy that will allow them to learn about the decision making process and how to make better choices, as well as provide them with education on developing and utilizing their own support system for recovery.
Incorporating HappyNeuron Pro into the program so that clients can practice cognitive skills which in turn may help with their psychological function, sleep, and overall wellness.
By incorporating HappyNeuron Pro into the program, Dr. Chugh found that patients are more able to complete difficult tasks and therefore gain confidence and a sense of control over their lives.
You can visit their website here: torontoconcussion.ca
Please also listen to Dr. Chugh’s talk “An Athlete’s Mindset for Cognitive Healing”.
Pulling from our decades of experience in Cognitive Therapeutics, we aim to help you enrich your practice through the use of digital and paper tools.
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