By Trish Bogucki
On August 24, 2017 I sat down with my cognitive therapist Olivia Bell at a local restaurant to discuss her views on cognitive therapy (CT) and how NPH patients might benefit from it. This is the first part of our interview and it covers who benefits from CT, how to find a therapist, and how to get the most out of the therapy appointments.
Trish: Thanks Olivia for agreeing to discuss cognitive therapy for the Hydrocephalus Association blog. Let’s start by having you tell us your title, where you work and how long you have been there?
Olivia: I am a Speech Language Pathologist with a Bachelors of Arts in Speech-Language Pathology and a Masters of Arts in Communication Sciences and Disorders. I work at The Valley Hospital in Ridgewood, New Jersey and have been with this organization for just about 3 years.
Trish: What kind of training and experience do you need to become a Cognitive Therapist?
Olivia: Depending on the facility where you work, the primary “cognitive therapists” may differ in terms of their training/experience (i.e., Speech-Language Pathologist vs Occupational Therapist). At The Valley Hospital, our Speech-Language Pathologists all have master degrees and a Certificate of Clinical Competence in Speech-Language Pathology. We also make it a point to attend conferences and complete Continuing Education Hours that relate to cognitive therapy in order to sharpen our skills and learn about the latest therapy approaches.
Trish: What kinds of neurological conditions do you see that benefit from cognitive therapy?
Olivia: I like to encourage any patients with cognitive deficits to seek out cognitive therapy as soon as they notice a difference in functioning. Goals will likely vary from patient to patient and the plan of care will likely differ for each individual (i.e., improvement vs maintenance), but it is always worth attempting as each and every patient is different. I would suggest at least completing an evaluation and speaking further with a skilled therapist to discuss options and if cognitive therapy is in fact recommended.
Trish: I have been asked: how does an NPH patient go about finding a cognitive therapist?
Olivia: Speaking with your medical doctors is certainly an easy option. Cognitive therapy is unfortunately an area that is often times overlooked. Because there are not many people/professionals that know about this type of therapy, referrals for cognitive therapy are not as common as they perhaps should be. In addition to your own medical doctors, I recommend calling hospitals in the area and speaking with the Speech-Language Pathology department. If for nothing else, they may be able to help to point you in the right direction. You can also search for local therapists on the American Speech-Language-Hearing Association’s webpage (www.asha.org). This is our governing body and is a wonderful resource for cognitive therapy and many other services provided by Speech-Language Pathologists and Audiologists.
Trish: In my case it was my neurosurgeon who referred me when I eventually complained of ongoing memory issues. You did an evaluation and recommended weekly appointments.
Once a patient starts seeing a cognitive therapist what are some things they can do to maximize their results from CT?
Olivia: Practice is first and foremost. It is absolutely crucial that our patients are practicing on their own and are attempting to carry-over the skills taught in therapy into their everyday lives. A few hours of formal therapy per week with a skilled therapist is not enough for progress to occur if there is no attempt at carry-over. In order for therapy to be functional, the therapist, caregiver, and patient must work together to determine functional goals to improve the patient’s overall functional abilities.
Trish: In my case we met only one hour a week but I did several hours of homework each week between appointments – working on brain games on my computer plus flash cards and extracting facts from news articles. My husband tried the brain games too, and he was the one who found the articles for me to work on so it became a bit of a family activity.
Let’s move on to the financial aspects of CT – I have been asked several times whether Medicare covers CT? If so, for how long?
Olivia: If a patient has regular Medicare as their primary insurance, they begin with an allotment of money (a bit less than $2000.00). Every time the patient comes for therapy, a certain amount of money (depends on the charge/service and the facility) is deducted from that “pot” of money. If patient has a Medicare replacement plan (I believe this is what it’s called), the patient has forfeited Medicare rules and now must follow the rules of that insurance company (i.e., United Health Care’s rules regarding whether or not they cover cognitive therapy). My suggestion is that regardless of the patient’s insurance company/plan, patients or caregivers always clarify their benefits to ensure they have coverage for the specific therapy in question. Insurance plans are constantly changing so it’s not a bad idea to double check your benefits!
Trish: That’s great – plans vary so much on therapy allocations.
Some NPH caregivers asked: does it makes sense to start CT even before shunt surgery?
Olivia: Sometimes medical, surgical, pharmacological interventions must take place in order for gains to be made in therapy and overall basic functioning. It is not likely that cognitive therapy alone will completely improve a deficit such as hydrocephalus. Thus, shunt surgery may be recommended by your doctors. However, it’s never a bad thing to be proactive. As I said before, I encourage all patients to seek out assistance as soon as they see a change, in this case, cognitive deficits. Although formal therapy may not begin weekly until shunt surgery is completed, meeting with a skilled therapist prior to surgery may give the patient a chance for further education, may allow for development of a plan of care, may provide patients with exercises to work on until shunt surgery occurs, and allow for discussion of a plan of care once shunt surgery is completed if deficits are still present.
Trish: The only regret I have about cognitive therapy is that I didn’t start it immediately after my surgery (like I did with PT) – cognitive therapy has helped me so much!
Postscript: The second half of this interview will be posted in a few weeks – please check back to learn more!