Read the following discussion for an inside look at The Cognitive Community Group at Mt. Washington Pediatric Hospital. This group supports children in their recovery from brain injury. Kathy Gray, MOT, OTR/L, CBIS (Certified Brain Injury Specialist) and Amanda Smith, M.A., CCC-SLP, Speech Language Pathologist/Clinical Specialist are co-leaders of the group.
What is the Cognitive Community Group?
Kathy: The Cognitive Community Group involves individuals with acquired brain injury -- either traumatic or non-traumatic. It's a group that facilitates creating independence for when they leave the hospital. We want to give them many of the tools that they have here to go back into the community and be as independent as possible with school, with home, with friends, and with their self-care and their thinking skills and cognition.
How is this program different from those at other hospitals?
Kathy: This program is very interdisciplinary. We depend on input from all therapists, and we want to know what they [the children] are doing in PT (Physical Therapy), in Speech (Therapy), in OT (Occupational Therapy). We want to take all of those skills together at once, and we want them to go into the community and practice them.
You know, I think a lot of other facilities focus more on individual treatment. We want them to have an interactive therapy with their peers, and we want them [the children] to take the lead. We often say that we are flies-on-the-wall during the cognitive group -- it's the emphasis on practicing in the community before being sent home.
What do you tell parents will be happening to help their child recover?
Kathy: We tell them they will be with their peers, and that this is a group where they will work on all the different thinking skills that can be damaged as a result of a brain injury: being able to problem solve, being able to make a decision, manage time, initiate conversation, initiate an activity. Also, what is their [children's] safety awareness like? We practice that in a group setting here in the hospital -- we often plan for an activity, and then we'll implement that activity out in the community. We want to see all those thinking skills generalized and used together.
I'd imagine it can really boost their confidence when they go home, since they've already practiced their skills in the community.
Amanda: Right, because they have the support from us, and support from other therapists and their peers in a structured, safe setting -- and we work on transitioning them into the community. We also work with parents to problem solve for home situations, too. A lot of our patients will attend the group while they are inpatients, and then once they leave and go home, we'll have them continue to come back to join the group -- so they're going to school and getting therapies, but then they are still participating in the Cognitive Community Group weekly. This way, they can work on the different skill sets that are needed for different community settings, such as home, peers, school, etc.
So, what's a typical session like?
Amanda: We usually start the groups with completing the agenda, things we did during the week. We talk about last week's activity. Maybe we baked cookies the week before. We talk about how that activity went, what could have gone better, and we problem-solve through that. For example, two weeks ago we did Wii bowling. We had two teenagers who bowled on the Wii, and they worked together, figuring out how to play. Then, last week they worked together completing the agenda to plan an outing to a bowling alley. So, that takes up most of the session, planning where to go, how we will get there, how much money we need, what do we need to wear, and how are we going to set up all of this. And then this week, tomorrow, we're actually going to go to the bowling alley. So, it's pretty independent. We let them decide where they want to go, and then we'll work with them to try to plan it.
Is it grouped by age?
Amanda: We would like that, but sometimes that's not always realistic, so we'll make it work with whatever ages we have. So, if we have an 8-year-old and a 15-year-old, the 15-year-old will take more of the lead, and with the 8-year-old, we would plan appropriate activities.
Kathy: In the real world, you're going to interact with individuals of all different ages, so what is their response? If the 8-year-old starts to break down, what's the 15-year-old's response? We want them to practice that. And, if he has siblings and cousins, we want him to practice his response and what he can do to help.
Amanda (adding): Also, they learn what kind of language is appropriate? How do you communicate with an 8-year-old versus a 16-year-old?
Kathy: There are so many different levels of recovery in brain injury, so there are typical symptoms that occur at different levels, and we want them to practice overcoming them, compensating and/or inhibiting different responses.
In summary, what is the overall goal of the Cognitive Community Group?
Amanda: Our overall goal for CCG is to provide the patients with the tools and skills that they will need to be safe and successful in their transition from hospital to home and community.