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Mental Function Considerations in Rehabilitation

Original Editor - Yara Peterko

Top Contributors - Ewa Jaraczewska and Jess Bell  

Introduction

A person's mental health and cognitive abilities can shape their rehabilitation journey. Understanding how brain function and untreated mental distress affect overall health and engagement in rehabilitation helps healthcare professionals develop targeted, holistic treatment plans.

Occupational therapists and clinical psychologists play an important role in rehabilitation teams, addressing mental and behavioural health barriers that impede recovery progress. Specific factors like memory impairment, sleep disturbances, and emotional challenges can negatively impact a person's ability to engage with and benefit from rehabilitation programmes. When left unaddressed, these issues can reduce overall quality of life and increase a person's risk of psychological distress.

This article explores cognitive, emotional, and basic mental functions through a rehabilitation lens, focusing on memory, sleep and managing emotional distress, anxiety and low mood. It provides an overview of evidence-based rehabilitation interventions and practical tools that healthcare professionals can implement to enhance a person's mental functions throughout the rehabilitation process.

Mental Functions

"Mental functions are the functions of the brain, both global mental functions, such as consciousness, energy and drive, and specific mental functions, such as memory, language and calculation."[1]

In the rehabilitation framework, mental functions consist of (1) cognitive functions (e.g., memory and attention), (2) basic functions (e.g., sleep), and (3) emotional functions (e.g., managing feelings like anxiety and stress). Cognitive functions allow for information processing and storage, basic functions are fundamental for overall brain health and function, and emotional functions facilitate our ability to manage feelings.[2][3]

Memory

Memory is an example of a cognitive function.

Memory: Definition, Categories and Key Processes

Definition

Memory is defined "as the faculty of encoding, storing, and retrieving information."[4]

Categories

Memory can be broadly categorised into three types based on how long the information is retained: (1) immediate memory, (2) short-term memory, and (3) long-term memory. Immediate memory includes the initial stages of information processing and contains two subcomponents: sensory memory and working memory.[5][6][7]

Sensory memory is the initial stage of memory. Sensory input is momentarily retained in its unprocessed form. It consists of modality-specific stores (e.g., iconic for visual, echoic for auditory, haptic for tactile, and proprioceptive for body position memories).

Working memory is automatic. It temporarily stores and manipulates information, combining short-term memory with processing mechanisms. Working memory also interacts with long-term memory for information retrieval and storage, enabling complex tasks like mental arithmetic.

Short-term memory has limited capacity, holding information for brief durations. It functions as a component of working memory, specifically, the portion that temporarily holds the information being actively processed. There is, however, no active manipulation of this information.

Long-term memory can store unlimited information for a lifetime. It has two main categories: explicit memory, which involves conscious recall of facts and events, and implicit memory, which involves skills and procedures performed without conscious recollection.

If you are interested, you can read more about memory categories here.

Processes

We can break down memory into three key processes: (1) encoding, (2) storage, and (3) retrieval.[2]

Encoding is the process of changing information from sensory input into a format that can be stored within the memory system. There are different ways information can be encoded (e.g. as pictures (visual), as sounds (acoustic) and based on meaning (semantic).[8]

Storing is the retention of information over time. To store memories, the brain forms a memory trace of an experience. This trace represents the physical changes in the brain that correspond to a memory.

Retrieval refers to accessing stored information. If a person cannot remember something, it may be due to an inability to retrieve it. The retrieval of information from short- and long-term memory occurs via sequencing or association.

Information from short-term memory is stored and retrieved sequentially. For example, a person is asked to recall the fourth word from a list. To accomplish this task, the person mentally revisits the list from the beginning, retrieving each word in the original sequence until they arrive at the fourth item. This sequential retrieval process supports the linear organisation of information within our short-term memory.

Information from long-term memory is stored and retrieved by association. This means that information is accessed using cues or triggers connected to a specific memory.

The retrieval of information involves three steps: (1) recall, (2) recognition, and (3) relearning.

Recall is the active retrieval of information without cues. Recognition involves identifying previously learned information, often through comparison. Relearning is necessary when there are memory gaps, and a person must revisit the information previously learned.

If you're interested in learning more about "what memory is", please watch this fascinating conversation between two scientists:

[9]

Changes in Memory

Age-related Memory Changes

Age-related memory changes are common. They "may be related to slowed processing speed, reduced ability to ignore irrelevant information, and decreased use of strategies to improve learning and memory."[10]

Various aspects of memory can be affected, including:[10]

  • delayed free recall:[11] e.g., remembering a grocery list without prompts
  • source memory: [12] e.g., recalling if a fact was from TV, newspaper, or a friend
  • prospective memory:[13] e.g., remembering to take medication before bed
Noticeable and Consistent Decline in Memory

People may perceive a noticeable, persistent decline in their memory. This may include a decrease in cognitive capacity, unrelated to acute events. A person's perceived level of memory impairment might not accurately reflect their actual level of function; some people may overestimate their abilities while others underestimate their abilities, regardless of objective test results.[14]

Meta memory is an individual's awareness of their memory abilities. Some individuals are aware and can adapt quickly and effectively, while others may be less aware and delay seeking help.[2]

Difficulty with Daily Activities

Subtle signs of memory problems may manifest as difficulties completing daily tasks. These challenges may be observed by family members. When family members raise concerns about a person's memory, they should be taken seriously, as early intervention helps ensure optimal management of memory issues.

Memory Rehabilitation

There are a range of rehabilitation interventions to help people regain confidence and overcome memory issues.[2] The main objectives for memory rehabilitation include increasing a person's independence, improving a person's capacity to perform daily tasks, and lessening the emotional effects of memory loss.[2]

These objectives can be accomplished through general and specialised therapeutic interventions and assistive technology. These categories of interventions are discussed in detail in the next sections.

General Interventions

Occupational therapists and psychologists are primarily involved in cognitive training. However, other healthcare professionals can provide education to patients on how to use assistive devices, like pill organisers, alarms, and reminders.

Please see Considerations in Training Elderly People How to Use Electronic Assistive Devices if you would like to read more about how rehabilitation professionals can help older adults learn to use and benefit from electronic assistive devices.

Specialised Therapeutic Interventions

Clinical psychologists and occupational therapists can offer specialised therapeutic memory interventions, including restorative strategies and knowledge acquisition approaches. Other specialised interventions include group therapy and support groups.

Restorative strategies

The goal of restorative strategies is to restore pre-morbid function through practice and re-training. While traditional methods involve repetitive drills and practice exercises, computer-assisted cognitive rehabilitation (CACR) is increasingly available. CACR offers personalised, adaptive, and immersive training using software and virtual reality.[15] These strategies help to strengthen memory pathways through targeted exercises and repeated practice, providing clients with meaningful occupations to participate in.[2]

Knowledge Acquisition Approach

The knowledge acquisition approach can be used to help patients recall when and how to perform specific, relevant daily living activities, such as dressing or bathing. This approach, which does not aim to improve overall memory function, uses strategies like vanishing cues, errorless learning, and spaced retrieval. These strategies have shown positive outcomes for patients with memory impairment.[15]

Errorless learning is a teaching method that aims to eliminate errors as much as possible during learning. It is believed that by preventing or reducing inappropriate responses, memory performance can be improved, particularly in people who are less able to correct errors.[15]

Vanishing cues is a method where support, such as notes and reminders, is gradually withdrawn. This method, which relies on implicit memory, requires numerous learning trials and can be time-consuming.[15] Sometimes, tools like calendars, planners, smartphone reminders, and sticky notes are needed permanently to manage appointments, tasks and important details if memory pathways cannot be fully restored.[2]

Spaced retrieval is a strategy that improves memory retention by presenting and testing information over progressively longer intervals. It corrects errors immediately, provides missed information, and adjusts retrieval intervals to enhance learning.[15]

Group Therapy and Support Groups

Occupational therapists and other rehabilitation professionals can incorporate group therapy and support groups in a memory rehabilitation programme. The goal of these groups is to offer emotional support and improve social well-being for patients with memory impairments. Group therapy and support groups can reduce isolation and foster understanding by connecting individuals with similar challenges. Involving families can provide additional support and encourage independence. Group activities can include exercises, mindfulness practice, and stress management to improve memory function. However, research shows that group memory rehabilitation programmes may not be effective for every patient or all types of memory impairment.[16]

Assistive Technology for Memory Rehabilitation

Assistive technology can increase independence and quality of life for individuals with memory challenges. Selecting assistive technology for memory requires careful consideration. For optimal gains, rehabilitation professionals must assess each person's needs and preferences and recommend devices and strategies that align with their lifestyle.

Here are examples of assistive technology that can help with memory rehabilitation:[2]

  • smart devices, like smartphones and tablets with reminder apps and voice assistance, can be personal assistants—they help users manage medication, daily tasks, and information retrieval
  • smart watches provide discreet reminders for medication, appointments, and physical activity
  • electronic diaries allow easy logging and tracking of plans, tasks, and notes
  • smart home systems can automate lighting, provide medication reminders, and support daily routines, reducing stress and enhancing safety

Sleep

Sleep is an example of a basic function. It supports key brain functions, such as memory, learning, and emotional regulation,[17] and is essential for physical and mental health.

Sleep disruption negatively impacts well-being and daily functioning. Healthy adults who consistently get seven or more hours of sleep per night show improvements in working memory and response inhibition[18] (i.e. the ability to suppress inappropriate actions or responses[19]). Conversely, insufficient sleep can impact decision-making and emotional and physical health.[2]

Sleep is measured in terms of its quality, duration, continuity, timing, satisfaction and regularity, as well as daytime functioning.[20]

Factors Affecting Sleep

Three main factors can cause sleep disturbances:

  • environmental factors, such as noise, lighting and an irregular sleep schedule
  • psychosocial factors, such as anxiety, depression and trauma
  • individual factors:
    • medical issues, such as chronic pain, neurological disorders, and sleep-specific conditions, like insomnia or sleep apnoea
    • behaviours, such as poor sleep hygiene, tobacco use, and consumption of caffeine and alcohol

If you would like to learn about sleep hygiene for different age groups, please see: Sleep Hygiene.

Reasons for Seeking Help for Sleep Disturbances

People seeking help for sleep may experience:

  • daytime sleep problems, such as daytime fatigue, mood changes, trouble concentrating, memory lapses and a general decline in productivity
  • nighttime sleep problems, including difficulty falling asleep, waking up multiple times during the night and getting up too early, or unexplained
  • physical symptoms, like unexplained headaches, frequent colds, high blood pressure, loud snoring, gasping for air, or pauses in breathing during sleep

Please note that sleep specialists tend to be occupational therapists and psychologists who focus on sleep disorders. Physiotherapists can also provide advice on exercise to support better sleep.[21][22]

Sleep Rehabilitation

Relaxation and stress reduction techniques are important components of sleep rehabilitation. Relaxation techniques include listening to calming music, progressive muscle relaxation, and breathing exercises. Techniques for stress reduction include setting boundaries between work and home, avoiding stressful activities in bed (like paying bills or answering work emails), and seeking support from loved ones when overwhelmed.[2]

Various behavioural techniques can also enhance sleep quality, such as keeping a consistent sleep schedule, limiting or strategically timing naps, avoiding stimulants, and creating a relaxing bedtime routine. It's important to ensure that a client's routine aligns with their natural sleep-wake patterns.[2] In addition, melatonin supplements may be beneficial.[2]

It's also possible to alter certain environmental elements. Creating a dark, quiet, and comfortable space for rest can be beneficial.[23] Social factors, such as human or animal sleep partners, should also be considered when designing sleep interventions.[24]

Assistive technology products are also available, such as specifically designed pillows, weighted blankets, and other sleep aids.[25]

In the following optional video, Dr Tracey Marks talks about sleep as a pillar of mental strength:

[26]

Emotional Distress, Anxiety and Low Mood

Managing emotional distress, anxiety and low mood are examples of emotional functions.

Intense feelings of sadness, frustration, and hopelessness can manifest as emotional distress, anxiety and low mood. These are commonly triggered by challenging life events, including loss, conflict, and major life changes.[2]

Emotional distress can be defined "as general negative, cognitive, and emotional symptoms that often stem from difficulties coping with stressors."[27]

Anxiety "is that heightened sense of worry or fear that just won't go away. It can feel overwhelming and even cause physical symptoms like restlessness, tension, or a racing heart."[2]

Low mood is when "sadness lingers, motivation drops, and even things that once brought joy start to feel meaningless."[2]

Rehabilitation in Emotional Distress, Anxiety, and Low Mood

The following interventions can be implemented to help people who are experiencing emotional distress, anxiety and low mood.

A healthy lifestyle can support daily functioning. Rehabilitation professionals can provide education on maintaining a healthy diet, including eating regularly and avoiding alcohol, engaging in regular physical activity, such as daily walks, and sleep hygiene, such as sticking to a consistent bedtime. Focusing on small lifestyle changes, like setting realistic goals, starting with simple and manageable tasks, and gradually taking on more responsibilities can prevent a person from becoming overwhelmed.[2]

Building strong social connections can be beneficial. Rehabilitation professionals can encourage a person to stay connected with others through simple acts, such as talking to friends.[2] Similarly, support groups and participating in community events can reduce a person's sense of isolation and contribute to good mental health. Revisiting old hobbies can be a good place to start, as they offer a structured activity that may reignite a sense of enjoyment.[2]

Identifying and reshaping negative thoughts by teaching a patient to adopt a more positive and proactive mindset can be beneficial. For example, encourage thoughts such as "I'm doing what I can to improve my well-being". Writing down thoughts can also help patients create distance from negativity and allow them to view challenges more objectively.[2]

Helping patients learn how to relax may also be beneficial. Techniques, like deep breathing exercises and progressive muscle relaxation, work by slowing down the nervous system and relieving physical tension.[2]

If you would like to find out more about anxiety and low mood and interventions for these conditions, please see: Psychological Support in Rehabilitation.

Resources

References

  1. ↑ International Classification of Functioning, Disability, and Health. World Health Organization. 2007
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 Peterko Y. Mental Function Considerations in Rehabilitation Course. Physiopedia Plus, 2025.
  3. ↑ Sen A, Tai XY. Sleep Duration and Executive Function in Adults. Curr Neurol Neurosci Rep. 2023 Nov;23(11):801-813.
  4. ↑ Zlotnik G, Vansintjan A. Memory: An Extended Definition. Front Psychol. 2019 Nov 7;10:2523.
  5. ↑ Cowan N. What are the differences between long-term, short-term, and working memory? Prog Brain Res. 2008;169:323-38.
  6. ↑ Camina E, Güell F. The Neuroanatomical, Neurophysiological and Psychological Basis of Memory: Current Models and Their Origins. Front Pharmacol. 2017 Jun 30;8:438.
  7. ↑ Purves D, Augustine GJ, Fitzpatrick D, et al., (editors). Temporal Categories of Memory. Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates; 2001.
  8. ↑ McLeod S. Memory Stages: Encoding Storage And Retrieval.2023. Available from https://www.simplypsychology.org/memory.html [last access 15.4.2025]
  9. ↑ University of California Television. The Anatomy of Memory - On Our Mind. Available from: https://www.youtube.com/watch?spTE65zX6Oo [last accessed 20/4/2025]
  10. ↑ 10.0 10.1 Harada CN, Natelson Love MC, Triebel KL. Normal cognitive aging. Clin Geriatr Med. 2013 Nov;29(4):737-52.
  11. ↑ Thomson M, Stamps W. Memory Recall: Cued or Free. Undergraduate Psychology Research Methods. 2007;1(5): Article 2.
  12. ↑ Guo J, Shubeck K, Hu X. Relationship Between Item and Source Memory: Explanation of Connection-Strength Model. Front Psychol. 2021 Sep 29;12:691577.
  13. ↑ Crystal JD, Wilson AG. Prospective memory: a comparative perspective. Behav Processes. 2015 Mar;112:88-99.
  14. ↑ Cappa SF, Ribaldi F, Chicherio C, Frisoni GB. Subjective cognitive decline: Memory complaints, cognitive awareness, and metacognition. Alzheimers Dement. 2024 Sep;20(9):6622-6631.
  15. ↑ 15.0 15.1 15.2 15.3 15.4 Gopi Y, Wilding E, Madan CR. Memory rehabilitation: restorative, specific knowledge acquisition, compensatory, and holistic approaches. Cognitive Processing. 2022;23(4):537-557.
  16. ↑ das Nair R, Bradshaw LE, Carpenter H, Clarke S, Day F, Drummond A, Fitzsimmons D, Harris S, Montgomery AA, Newby G, Sackley C, Lincoln NB. A group memory rehabilitation programme for people with traumatic brain injuries: the ReMemBrIn RCT. Health Technol Assess. 2019 Apr;23(16):1-194.
  17. ↑ Chong Z. The Influence of Sleep on Cognitive Function and Mental Health. Neurosci. Psych. Open Access. 2024;7(4):245-246.
  18. ↑ Zimmerman ME, Benasi G, Hale C, Yeung LK, Cochran J, Brickman AM, St-Onge MP. The effects of insufficient sleep and adequate sleep on cognitive function in healthy adults. Sleep Health. 2024 Apr;10(2):229-236.
  19. ↑ Verbruggen F. Response inhibition. In: Zeigler-Hill V, Shackelford T. Editors. Encyclopedia of personality and individual differences. Springer: Cham, 2017.
  20. ↑ St-Onge MP, Aggarwal B, Fernandez-Mendoza J, Johnson D, Kline CE, Knutson KL, Redeker N, Grandner MA; American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Quality of Care and Outcomes Research. Multidimensional Sleep Health: Definitions and Implications for Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes. 2025 Apr 14:e000139.
  21. ↑ Viana VA, Esteves AM, Boscolo RA, Grassmann V, Santana MG, Tufik S, de Mello MT. The effects of a resistance training session on sleep patterns in the elderly. Eur J Appl Physiol. 2012 Jul;112(7):2403-8.
  22. ↑ Xie Y, Liu S, Chen XJ, Yu HH, Yang Y, Wang W. Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Psychiatry. 2021 Jun 7;12:664499.
  23. ↑ Blume C, Garbazza C, Spitschan M. Effects of light on human circadian rhythms, sleep and mood. Somnologie (Berl). 2019 Sep;23(3):147-156.
  24. ↑ Ho ECM, Siu AMH. Occupational Therapy Practice in Sleep Management: A Review of Conceptual Models and Research Evidence. Occup Ther Int. 2018 Jul 29;2018:8637498.
  25. ↑ Occupational Therapy for Sleep Disturbances. Available from https://www.theotcentre.co.uk/difficulties-treated-with-occupational-therapy-and-si-therapy/sleep-disturbances [last access 20.4.2025]
  26. ↑ Dr. Tracey Marks. Why Sleep Matters: Expert Guide to Mental Resilience. Available from: https://www.youtube.com/watch?FEjg0iVl6Tc [last accessed 20/4/2025]
  27. ↑ Geraghty AW, Holt S, Chew-Graham CA, Santer M, Moore M, Kendrick T, Terluin B, Little P, Stuart B, Mistry M, Richards A, Smith D, Newman S, Rathod S, Bowers H, van Marwijk H. Distinguishing emotional distress from mental disorder in primary care: a qualitative exploration of the Four-Dimensional Symptom Questionnaire. Br J Gen Pract. 2024 Jun 27;74(744):e434-e441.
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