Cognitive Strategies useful during Rehabilitation

WHAT: In the case study described you are an athletic trainer working with a volleyball player who is now in rehabilitation after anterior cruciate ligament (ACL) surgery.  She’s estimated to return to practice 6-8 weeks post operation.  The issue at hand is whether or not to incorporate cognitive skills during this athlete’s rehabilitation process and which ones will be most effective. 

SO WHAT: Rehabilitation for any injury definitely has its ups and down which you can help control by encouraging her to use cognitive strategies.  Some cognitive strategies such a goal setting, self-talk, and attention control for example are all skills which can be incorporated during the rehabilitation process.  Using these skills can help her make rehabilitation more effective so she will be able to return to play well prepared.  Its possible cognitive skills may not be effective and because no two cases are the same it’s important to be able to change your plan and have multiple options which can be adapted depending on the individual, setting, and time. 

NOW WHAT: During the rehabilitation process the first thing I would do is sit down with the athlete and find out how she feels about the injury, surgery, the rehabilitation process, and returning to play.  The next thing I would do is sit down with this athlete and helps her set goals, short term goals for the rehab process and long term goals for returning to play.  I would encourage her to set S.M.A.R.T. goals.  S.M.A.R.T. is an acronym for a number of ideal criteria that should be considered when setting rehabilitation goals.  Ideal goals should be Specific, Measurable, Achievable, Realistic, and Timely.  When setting rehabilitation goals it’s important to avoid common goal setting problems including: failure to monitor goal progress and readjust goals, failure to recognize individual differences, failure to set specific and measurable goals, and setting to many goals.

          Another effective cognitive skill this athlete can try is attention control and concentration.  She can use Attention Control Training (ACT) to improve her ability to shift attention styles.  ACT involves assessing individual attention strengths and weaknesses, the attention demands of sport, and personal characteristics that affect behavior under pressure.  ACT can be effective but it takes training.  Other simpler attention control ideas can also be effective for example: avoiding distractions, mental rehearsals, and biofeedback.

The next cognitive strategy I would recommend she use is self-talk, which is when a person thinks and makes perceptions and beliefs conscious.  During rehabilitation athletes can use self-talk to correct bad habits, for example bending his/her leg during straight leg raises, focusing attention, for example when doing quadriceps contraction exercises, and building self-confidence, for example getting back to doing the activities he/she was able to do prior to injury.  One effective use of self talk is the idea of thought stopping.  Thought stopping is when a person uses a cue to interrupt unwanted thoughts as they occur and then substitutes a positive thought.  Another use of self-talk is changing negative thoughts to positive ones, similar to thought stopping, which can also be very constructive in stressful situations.  Another effective self-talk technique is countering, which is similar to the above two techniques.  Countering is an internal debate using reason to counter negative thoughts with positive thoughts.  The last effective use of self-talk is the technique of reframing, or when an athlete views the situation in a more positive way, for example learning new skills and developing as a higher level player rather than having negative thoughts about the injury and rehabilitation process.  I think self-talk is by far the most effective cognitive skill an athlete can use during the rehab process.

CONCLUSION: In conclusion, I would definitely use cognitive strategies during this athlete’s rehabilitation process so she is able to return to play well prepared.  After evaluating several cognitive strategies I feel setting S.M.A.R.T. goals and using effective self-talk could possibly be the most effective during the rehabilitation process.  Again all athletes and situations are different so no cognitive skills will be effective 100 percent of the time but being able to change your rehabilitation  plan is extremely important.

REFERENCES:   

Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champain, IL: Human Kinetics

Siegert, Richard, and William Taylor. "Theoretical aspects of goal-setting and motivation in rehabilitation." Disability and Rehabilitation 26.1 (2004): 1-8. Print.