Intensive Cognitive and Communication Rehabilitation (ICCR)

Academic Coursework

Every day includes academic courses typically in introductory to intermediate topics included in a liberal arts education. These have ranged from Introduction to Psychology, Introduction to Economics, Personal Finance, and US History.

Speech Language Therapy

Each student participates in two, one-hour sessions of speech and language therapy each week, which are specifically tailored to address each student’s area of need. The therapist works with them individually on tasks to address the speech, language, and cognitive skills required to meet their goals of returning to the academic setting. They have been provided a Skill Book, which includes a calendar, schedule, detailed descriptions of strategies to facilitate learning and practical applications.

Technology Training

Following classes, the students participate in technology or computer-guided work to address their cognitive-linguistic skills. This includes systematic app-based therapy, and supported practice with other technology, such as forming study groups, creating and organizing material in a word document, checking and drafting emails, and reviewing lecture material on the internet.

ICCR integrates the strongest elements of evidence-based practice into one comprehensive program to target cognitive-linguistic goals at all levels. From individual sessions to group therapy, from the computer to the classroom, we hope to provide students with the skills and tools necessary to set their own goals and then to achieve them.

• First, quantitative outcomes over the program’s adjustment appeared relatively stable. In fact, participants demonstrated improvements in their cognitive and communication performance.
• Second, participants who previously were unable to participate because of their geographic location were able to enroll in the program.
• Finally, these observations presented new opportunities to serve young adults with ABI with specialized remote therapy, when they otherwise did not have access.

o Meet via Zoom to discuss observation experience, complete intake documents, and request medical records to gain information about your past medical history.

o Complete in person or videoconference standardized testing with ICCR staff to understand your communication and cognition skills and difficulties and whether they are aligned with the program design / offerings.

o Review all of the above information and make a final decision about enrollment and which semester to begin the program.

Q. How do I observe a class session?
o Let us know that you are interested by phone (617-353-2706), or email (brainrec@bu.edu).
o Observations are over videoconference.
o The team will offer you observation times and days, which typically fall between 10am and 4pm EST. 

• If you are located accessibly to Boston, you may still be asked to come to our laboratory before and after the program to complete your testing sessions in person.
• If you are not accessible to Boston at all, you will be able to complete your testing over videoconference.

Q. Are there any required books?
A. No, however students can always choose to trial academic materials on their own with staff guidance.

Q. Are there any materials I need?
o Accessing the program over Zoom requires a reliable internet connection. In addition, a device that is videoconference compatible is necessary for participating in testing and program. Most participants have an iPad and personal laptop/tablet that they use so that they are comfortable with them when they transition to college.
o If you are concerned about materials or technology, you can discuss potential solutions with the guidance of the ICCR team.

Q. Are there any classroom lectures?
A. Yes. There are traditional lectures every day from 10-11am. The lectures are video recordings from classes taught at Yale, Stanford University, Khan Academy, etc. You will watch them uninterrupted (just as if you were in the class live) and then, discuss afterward with a speech-language pathologist from 11am-1pm. Here is a link to an example lecture: https://oyc.yale.edu/psychology/psyc-110/lecture-2

Q. Will I get to meet my classmates in person?

A. Yes! Although ICCR runs via Zoom, there are many opportunities to connect with your peers in the program. Some peers choose to exchange contact information and study together outside of ICCR, connect on social media, or practice communication skills through conversations. ICCR hosts one social lunch hour on Zoom each week of ICCR (exception: holidays) to provide supported social communication with program staff. In addition, the program hosts an In-Person Immersion Week in Boston that is an optional opportunity for students to travel to the city and complete post-semester evaluations in person, as well as partake in social activities with program staff and peers.

Q. Does the program cost money?
A. The program currently is offered for a flat rate each semester for participants. At this time, we operate via private pay. Please contact our laboratory to learn more.

Q. I’m interested and want to get started! What do I do now?
A. Let us know that you are interested by phone (617-353-2706), or email (brainrec@bu.edu).

Evidence Base

ABI is a leading cause of disability in adults, with stroke and TBI among the most common causes of ABI. Young adults are one particular group that is notably affected by ABI, and the incidence rate of ABI in this age group continues to climb. In general, young adulthood is a time where many milestones are reached that are considered societal standards for independence and success. Higher education is prominent among these milestones and is associated with establishing a career. Unfortunately, a brain injury negatively impacts the cognitive and communication processes that are vital to success as a college student, such as memory, language, and attention. Therefore, this unique group of individuals often struggles to make this transition to higher education, limiting their ability to advance to a career and gain financial and living independence.

Cognitive Rehabilitation

The typical continuum of care for brain injury rehabilitation includes acute, inpatient, outpatient, and community settings. Cognitive Rehabilitation (CR) is the most common, and gold standard, method of intervention for cognitive impairment after ABI.

Using one single CR approach in isolation may not be beneficial to all individuals. Therefore, integrated CR that includes the most advantageous components of each CR type may be warranted for this population, which is why ICCR was developed.

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Program Rationale

ICCR’s program first takes a functional approach, allowing students to get much-needed practice implementing strategies that will be relevant in a university setting (classroom activities, exam preparation and performance, and essay writing, and to do so in a supportive, slower-paced environment. Simultaneously, ICCR utilizes impairment-based program, providing students with direct therapy for specific cognitive-linguistic goal areas. Both impairment-based and functionally based program approaches have been shown to improve communication skills after brain injury in an intensive environment; ICCR unifies these two, which promotes transfer of gains to real-life contexts – namely, academic environments.

program Overview

ICCR’s remote program program is delivered six hours per day and four days per week. There is a one-hour lunch break each day. Each day of program, participants receive an email with a schedule, document attachments, and videoconferencing links that they will need throughout the day. The program includes the following key components: 1) lecture-based courses (e.g., Biology, Psychology); 2) seminar-based courses (e.g., US History, Writing, Public Speaking, Personal Finance); 3) application- (e.g., Constant Therapy) and/or tech-focused therapy (e.g., online study groups, tech-based study resources, college research and applications); and 4) individual CR sessions (i.e., two, one-hour sessions weekly). One speech-language pathologist serves as the primary therapist in the classroom, while another speech-language pathologist is the primary therapist in individual CR sessions.

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Group (Classroom-Based) program

The objective is to encourage group level metacognition and integration of executive function and memory strategies in a seminar-based and blended context, and to also facilitate reciprocal carryover between discussions and students’ independent work.

Individual Therapy

Individual goals are established and targeted within 1:1 therapy sessions conducted twice weekly within the construct of ICCR.

Over the course of each semester, therapy targets 3-4 measurable short-term objectives per the primary discretion of the supervising speech-language pathologist, as well as 1-2 personally relevant quantifiable therapy outcomes generated by the client.

Functional, Application, Tech-Based Therapy

Participants are assigned to different “Tech Time Groups” on a rotating basis, which include: 1) application-based therapy (i.e., Constant Therapy), 2) college and career planning (e.g., college research, sending emails, completing essays, applications, etc.), and 3) assistive technology resources (e.g., practicing speech to text or text to speech, using web-based study portals, setting alarms or reminders, organizing an online calendar, etc.).

These types of activities give participants opportunities to complete self-guided tasks with minimal therapist supervision, serving the purpose of expanding on skills targeted in individual cognitive rehabilitation, which also then provides greater opportunity for individual program to directly target domains requiring a higher level of support or supervision. The therapist monitors performance live via videoconference and engages with participants on an as-needed basis dependent on their success with the task they are engaged in.

Quantitative Data Analysis

Classroom Performance

Performance in the lecture-based courses is quantitatively measured via the administration of the same 36-question cumulative exam before and after each semester. Participants complete the exam independently using an online portal and are encouraged to utilize test-taking strategies throughout.

Individual Therapy Performance

Memory Probes are administered each therapy session. They range in complexity on a scale from one to twelve and cover the sub-domains of Immediate Memory, Working Memory, Short-Term Recall, and Delayed Recall.

The primary individual-therapy therapist also develops Pre- and Post-Semester Therapy Probes to match participants’ individual program goals in both domain and complexity level (i.e., a structured scheduling exercise for a participant with goal targeting moderately complex problem-solving). These probes are administered within individual sessions at the following times during the semester: at baseline (i.e., first or second week of program), at midterm (i.e., week six of program); and at final (week ten of program). Performance on the probes can be obtained by multiplying percent accuracy by complexity level.

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Higher Education

The ICCR Program measures the functional goal of return or entry to higher education through close transitional coaching and support to participants upon their discharge from the program. In the first 6 months in particular, the ICCR team offers coaching to program graduates through videoconference, phone, and email, as well as provides written and verbal documentation to institutions to support the establishment of academic accommodations.

Program alumni are also contacted intermittently to assess status of college enrollment, solve problems related to access, and make recommendations for additional therapeutic and/or community resources.

Our Recent Paper

• The Intensive Cognitive-Communication Rehabilitation Program for Young Adults With Acquired Brain Injury

This study investigated the effects of an ICCR program for young individuals with chronic acquired brain injury.

After ICCR, participants showed gains in their cognitive–linguistic functioning, classroom participation, and individual therapy. They also demonstrated improvements outside the classroom and in their overall well-being.

Past Articles in the Press

• POV: Setting the Record Straight on Traumatic Brain Injury
• CSD Program Makes College Possible After Brain Injury
• A New Semester
• Grit Teamwork Boost This Sibling Duo at Framingham State
• After Son’s Brain Injury Harvard Chaplain Trace Evolution Grief Gratitude and Belief

Federal and State Resources

• The Brain Injury Association of America
• The National Aphasia Association
• The Brain Injury Association of Massachusetts