Patient Stories

Matt: Regaining Independence After a Stroke

Matt was a senior executive leading more than 4,000 people when he suffered a debilitating stroke. For 17 months he received clinic-based cognitive rehabilitation, moving between 2 facilities, including a world-class medical institution. While therapy did help Matt gain important improvements in his cognitive functioning, when the program ended, he was left with significant higher-level cognitive deficits.

Matt’s stroke had affected his episodic memory as well as his executive functioning, including planning, carrying out a plan, and self-monitoring. Matt was unable to remember what he had recently done, or what he was supposed to do. He could not be safely left at home alone for more than an hour, was unable to carry out household tasks without supervision, and couldn’t prepare the simplest of breakfasts for himself.

Customizing a therapy approach

Fortunately, Matt’s language, personality, emotions and other mental capabilities were unaffected. He was very pleasant in conversation and retained his sense of humor. Both he and his wife enjoyed outdoor activities, taking care of their two homes and were active in their church, where Matt enjoyed greeting people when they arrived for services and events.

When he entered the Neuro-Hope’s program, Matt was 56 years old, and more than 1 ½ years post-stroke. His wife, who had experience with cognitive disabilities, had tried organizational strategies, such as using calendars and “To Do” lists to keep him on track, but these would inevitably get lost. She hoped that Matt could become self-sufficient enough during the day so she could continue her social activities and they both could continue to enjoy their vacation home.

Matt’s therapists identified Matt’s interest in caring for his home and yard, and realized that Matt had the skills needed to perform tasks around both of his homes. Additionally, Matt told the team he wanted to be able to make breakfast for himself.

Therapy was performed via Neuro-Hope's Advanced Telehealth Platform, and started with daily sessions that focused on a task that was important to Matt on that day.  Matt and one of his therapists would meet in the morning and select a task that was a priority of Matt’s.

Matt and the therapist would then discuss what he would need to do, breaking down the subtasks of the chosen activity, and Matt would type notes to himself using his word processor. This provided substantial structure for him, making it easier for him to function. If–or rather when--the schedule was misplaced, he could simply print another copy. Matt would carry his one-page printed schedule with him, make notes on it, and check off the subtasks he had completed.

An exception to this process was preparing breakfast.  For this task, Matt brought his computer into the kitchen, and he and his therapist would talk step by step making the meal. The first meal Matt prepared for himself was tea and toast, and was a key milestone, giving him meaningful independence. Later, Matt progressed to making simple lunches for himself, a vital step for both him and his wife.

An advantage of this approach is that each day Matt accomplished something in his natural environment, in the context of his life, and salient to him. This provided constant reinforcement that with this rehabilitation therapy, he would be able to make gains in his life. Earlier tasks that were chosen were simpler for him, although they were not necessarily simple. Activities early in therapy were to be completed in a single day.  Later in therapy, activities stretched to multiple days.    

A unique feature of Neuro-Hope's telehealth approach is the availability of therapists between sessions.  When Matt needed to, he could reach out to his therapist, get help resolving the issue, and continue with his day as planned.

Matt’s recovery resumes—and gains momentum

Matt’s recovery, which had stalled before he started with Neuro-Hope, began to resume. The complexity of the tasks he worked on each day gradually increased, and since therapy was continuing at home, Matt’s wife was able to observe him and recommend other activities and projects to his therapy team. Matt continued keeping track of his activities by writing them down and entering them into the Neuro-Hope calendar, which also served as a kind of diary.

A major step was expanding Matt’s therapy to include chores at church during the week. This added a social component, as Matt interacted with other church members, who were well aware of Matt’s situation and were willing participants in his recovery.

It was at this juncture that the cognitive deficits that hadn't been resolved by Matt's prior therapy at other rehabilitation facilities came into play and began to improve. His episodic memory of the activities he was performing was increasing–a gain enhancing his everyday functioning. Over time, the supervision Matt needed early on at home and church became unnecessary–when he needed help, his peers could count on him to ask for it. Importantly, as his independence increased, Matt’s wife became comfortable leaving him alone for several hours at a time.

Keys to engaging high-achieving people

Prior to his injury, Matt was what we call a High Achiever: people whose areas of expertise require high-level cognitive functioning. High Achievers typically have substantial control over their personal and professional lives, and tapping into a person’s areas of expertise or interest can be powerfully motivating for them.

Though returning to work wasn’t in Matt’s plans, he maintained friendships with his former colleagues, and became curious about his ability to work on technical activities. A coworker suggested an actuarial problem–a high-level mathematical problem of the sort that Matt routinely did as part of his job. He tackled the multiday project, working on the problem for 1 to 2 hours each day for several days, making good progress until he ran into difficulty. Instead of stopping there, Matt analyzed the problem and realized that his coworker had left out a crucial piece of data needed to complete the work. This was important, because Matt realized that a key part of his cognitive ability was still intact. Beyond the sense of accomplishment Matt felt, realizing this part of his identity had survived his injury was important to Matt, as it is for all the High Achievers that have worked with Neuro-Hope.

We often find that people we call High Achievers retain their expertise and abilities to perform related high-level cognitive tasks after brain injuries. Overlooked by traditional therapy models, these niche interests and abilities are the key to unlocking recovery of this subset of people.

Exceptional results: Matt regains independence

In Matt’s case, both his episodic and working memory improved as he continued therapy and tackled a variety of challenging tasks. He began to drive locally in his exurban town, and within a couple of months, was able to drive an hour into Boston, navigate aggressive city traffic, enjoy a day out and safely return home.

Matt was able to overcome enough of his cognitive disabilities to become completely independent in his retirement activities. He and his wife were able to achieve more than they hoped when they began the Neuro-Hope therapy program. While it was unlikely that he would ever need to use it again, Matt’s ability to solve the actuarial problem proved to him that he retained his high-level cognitive activities, which was important to his self-esteem.  This outcome could be considered remarkable, but in the Neuro-Hope program, significant gains in cognitive performance are typical.

Therapy outcomes that exceed expectations—within weeks

Neuro-Hope’s unique therapy enables the individual to choose their personal priority activities. By focusing on activities that matter to the patients, we ensure the tasks are interesting and provide enough challenge to ensure the patient’s engagement. As a result, successes are deeply rewarding, and patients enjoy the therapy.

Technology plays an important role. These days, we each have our own “Personal Technology Network” that consists of devices, apps, and online services that we use each day. Most people don’t realize the degree to which these devices and apps provide cognitive support in their daily lives. Our phones remember phone numbers, our calendars remind us of appointments, and we no longer worry about getting lost, thanks to GPS.

The day before a person has a brain injury, they are fully using their Personal Technology Network. As they begin their recovery, they are still able to use parts of their Personal Technology Network, and we build that into their therapy. Neuro-Hope therapists use the client’s Personal Technology Network to aid them in their performance of the therapy activities, and in many cases, the client can improve their use of their preferred technologies, helping them realize further improvements in cognitive performance.

Each person’s circumstances are unique. Neuro-Hope's approach to cognitive rehabilitation therapy embraces each client’s strengths and interests and incorporates them into a therapy model proven to show rapid improvement in cognitive function, so often within 1 - 3 weeks after beginning therapy.