NeuroRehabilitation - Volume 2, issue 3

Article Type: Other

DOI: 10.3233/NRE-1992-2301

Citation: NeuroRehabilitation, vol. 2, no. 3, pp. iv-iv, 1992

Authors: Gordon, Wayne A.

Article Type: Introduction

DOI: 10.3233/NRE-1992-2302

Citation: NeuroRehabilitation, vol. 2, no. 3, pp. vi-vi, 1992

Authors: Malec, James | Schafer, David | Jacket, Mary

Article Type: Research Article

Abstract: The format and procedures of comprehensive-integrated (C-I) postacute outpatient brain injury rehabilitation are reviewed. Similarities between a C-I program and traditional medical rehabilitation and the specific roles of both restorative and compensatory cognitive rehabilitation in a C-I program are discussed. The process of C-I programming is described from the perspectives of staff and participants, and the specific contributions of restorative cognitive rehabilitation to this process are identified. Outcomes for the Mayo C-I program are presented, including goal attainment, behavioral changes, and work and living independence. At one-year follow-up, 85% of program graduates were in unsupervised living; 50% were in competitive …employment; and an additional 23% were in transitional, supported, or sheltered work. Show more

DOI: 10.3233/NRE-1992-2303

Citation: NeuroRehabilitation, vol. 2, no. 3, pp. 1-11, 1992

Authors: Cicerone, Keith D. | Giacino, Joseph T.

Article Type: Research Article

Abstract: Disturbances in executive functioning in patients with traumatic brain injury reduce the capacity for behavioral adaptation and regulation, although specific cognitive abilities are often preserved in these patients. In rehabilitation, the spontaneous and self-directed use of strategies is a hallmark of effective executive control. This article describes several interventions directed at the remediation of executive functioning: self-prediction for treatment of anticipatory deficits, self-instructional training for planning deficits, and self-monitoring training. Training may result in either the implementation of specific behavioral routines to compensate for disturbed executive control or, less often, the reestablishment of internally mediated self-regulatory processes.

DOI: 10.3233/NRE-1992-2304

Citation: NeuroRehabilitation, vol. 2, no. 3, pp. 12-22, 1992

Authors: DeLuca, John

Article Type: Research Article

Abstract: Unawareness of deficit is a frequent consequence of brain injury. One striking manifestation of unawareness is confabulation-the spontaneous fabrication of false memories or the temporal displacement of real events, usually associated with frontal lobe impairment. This article outlines an interdisciplinary approach to rehabilitation for confabulation in the treatment of patients with aneurysm of the anterior communicating artery. A three-tiered approach is employed based on published studies on levels of unawareness. Treatment at level 1 is geared toward improving intellectual awareness, the ability to understand that one has an impairment. Level 2 addresses emergent awareness, the ability to recognize a problem …when it is occurring. Level 3 of the intervention involves improving the ability to anticipate that a problem (confabulation) is going to occur. The use of this three-tiered program for treatment of confabulation can serve as a model for treatment of various other cognitive impairments often observed after brain injury. Show more

DOI: 10.3233/NRE-1992-2305

Citation: NeuroRehabilitation, vol. 2, no. 3, pp. 23-30, 1992

Authors: Rattok, Jack | Ross, Barbara P.

Article Type: Research Article

Abstract: Cognitive remediation has become a major part of rehabilitation programs for the traumatically head injured. This article discusses the clinical development of cognitive remediation and describes its current practice in a variety of rehabilitation settings. Problems concerning delivery of service, length of treatment, and medical consultation are addressed. The efficacy of cognitive treatment and its practical outcomes are explored. It is concluded that empirical research is needed to provide further validation of the effectiveness of cognitive rehabilitation.

DOI: 10.3233/NRE-1992-2306

Citation: NeuroRehabilitation, vol. 2, no. 3, pp. 31-37, 1992

Authors: Raskin, Sarah A. | Gordon, Wayne A.

Article Type: Research Article

Abstract: This article presents three case studies of individuals with acquired cognitive deficits. For each case, detailed descriptions of cognitive remediation procedures are provided. The cases demonstrate that retraining techniques, compensation strategies, or a combination of both are all effective in producing improvements in the individual’s level of daily functioning. These cases also demonstrate that remediation is skill and domain-specific and thus there was no improvement in neuropsychological functioning outside of the domain remediated. The important aspects of remediation are that the treatment be individually tailored, that it be hierarchically organized so that each successive level of treatment is based on …intact or remediated functions, and that generalization be built into the treatment protocol. Show more

DOI: 10.3233/NRE-1992-2307

Citation: NeuroRehabilitation, vol. 2, no. 3, pp. 38-45, 1992

Authors: Waxman, Richard | Gordon, Wayne A.

Article Type: Research Article

Abstract: As a complement to individually administered cognitive rehabilitation, the group modality provides a unique opportunity from which patients with traumatic brain injury (TBI) with varying degrees of confusion and disorientation can achieve significant remedial benefits. These include opportunities for social learning, cooperative problem solving, and improved interpersonal-intragroup communication. In addition, these benefits enhance the resolution of primary cognitive deficits in areas of orientation, attention, immediate and delayed memory, and problem solving. In this article, group remediation programs are discussed in the context of remediation strategies and cuing techniques designed to facilitate cognitive functioning. Two group-administered cognitive remediational programs, group orientation …and Group Think, are described. Patients with traumatic brain injury who exhibit persistent or resolving posttraumatic amnesia are seen twice daily for group orientation. The primary objective of this program is to provide patients within a group setting with cognitive strategies and cuing techniques that can assist orientation. Patients who demonstrate resolution of disorientation and gross memory disorders but continue to exhibit difficulties with abstract thinking and problem solving are provided with the Group Think program. While participants are encouraged to use their improving memory skills, their efforts are directed toward developing problem-solving abilities and facilitating group cooperation and interpersonal communication. Show more

DOI: 10.3233/NRE-1992-2308

Citation: NeuroRehabilitation, vol. 2, no. 3, pp. 46-54, 1992

Authors: Jutagir, Rajendra

Article Type: Research Article

Abstract: The increasing size of the elderly population, and high estimates of cognitive impairment in this population, have focused interest on remediation of cognitive decline in older persons. Cognitive loss can be due to disease processes such as Alzheimer’s disease and multiinfarct dementia. Studies are reviewed which suggest that remediation can have an impact on demented patients. For persons who show normative cognitive decline with aging, a considerable body of research also indicates that cognitive function can be optimized. Recommendations are made for maximizing the impact of training in both demented and normal persons.

DOI: 10.3233/NRE-1992-2309

Citation: NeuroRehabilitation, vol. 2, no. 3, pp. 55-61, 1992

Authors: Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine

Article Type: Research Article

Abstract: Impairment of cognitive processes is a frequent and common consequence of brain dysfunction. This article represents the cumulative efforts of rehabilitation professionals to develop a set of guidelines for the provision of cognitive rehabilitation services to persons with brain injuries. Despite the widespread and common practice of individuals and facilities to provide cognitive rehabilitation to brain injury survivors, a consensus on the definition and clinical practice of cognitive rehabilitation has been lacking. A set of guidelines was therefore developed with broad-based input from professionals and practitioners associated with cognitive rehabilitation. Definitions, qualifications of independent practitioners, treatment structure, service evaluation, representation …to the public, and responsibilities to the client and community are addressed. The guidelines are provided to help foster the systematic development of clinical practices, encourage general research activities, and promote professional development in cognitive rehabilitation. Show more

DOI: 10.3233/NRE-1992-2310

Citation: NeuroRehabilitation, vol. 2, no. 3, pp. 62-67, 1992