Patient Stories

Eileen: Recovering Her Organizational Skills

Eileen was 46-year-old, suffering from solvent-encephalopathy, and three years post exposure. Solvent encephalopathy involves diffuse damage to the brain from organic chemical vapors and functionally is similar to traumatic brain injury. Post injury, Eileen experienced broad executive dysfunction, affecting not only planning, organization and problem solving, but also an inability to respond with action to upcoming events. She would be aware of an event and the consequences of her inaction, but unable to link the two together. Conventional cognitive rehabilitation therapy had been ineffective.

Therapy began with a list of upcoming events. One of those was the beginning of the school year for her children. This is a compound, complex activity extending over weeks, involving some tasks with limited control (scheduling doctors’ appointments), some which needed to be completed before school began, and some which could slide until after school began. Therapy sessions involved identifying the many tasks that needed to be done, what those tasks involved, finding time to do them and ensuring the tasks were completed.

The therapist discovered one of the patient’s problems was difficulty in structuring tasks. Word processors are excellent tools for structuring tasks. Neuro-Hope’s Collaboration Therapy sessions are basically a conversation between therapist and patient structuring what needs to be done. The therapist doesn’t tell the patient what to do, rather she asks leading questions requiring the patient to come up with the answers. Using a word processor, the patient types in the specifics of what needs to be done. If medical form needs to be filed, a doctor’s appointment is required, which needs to be scheduled and she and the children must be available at the appointment time.

With a word processor, the various tasks needed for the event can be listed and separated along the page. As the patient identifies more details, she can move the cursor – with guidance from the therapist – to the location in the process where a particular task should go. The word processor supports a patient’s non-linear thinking. The document that emerges is a linear, well-organized structure of what needs to be done.

The Neuro-Hope application based “Cell-Minder” module was used to plan for when and where these many tasks would take place. Cell-Minder was the therapy tool Eileen used to give herself reminders throughout the day. Beginning the first day of therapy, Eileen was worked between therapy sessions. She was able to experience early success with the scheduling of the doctor’s appointments and then a series of successes as she completed each of the tasks in a complex process. When something didn’t go smoothly, it was a learning event which could help get things back on track.

Eileen had daily therapy sessions and added other activities to her schedule, even before completing the school preparation. She saw how different software features could help her. She would ask for specific features which were quickly customized and added to her software. Her level of cognitive functioning increased rapidly and along with her level of self-sufficiency. Therapy sessions took on a different flavor as she described to her therapist what she had been doing in between sessions and how she was able to address a broader set of activities in her personal life. Eileen was discharged after 4 months.