Cognitive Rehabilitation Therapy for Traumatic Brain Injury Evaluating the Evidence (2011) / Chapter Skim
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4 Defining Cognitive Rehabilitation Therapy
4 Defining Cognitive Rehabilitation Therapy
Pages 75-88
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From page 75... ...
Likewise, for traumatic brain injury (TBI) , clinicians and researchers developed a range of therapies for attention, memory, and executive function impairments; treatments for social and behavioral problems; and programs for adjusting to disability.
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From page 76... ...
impaired by a brain injury. Cognitive behavioral therapy is commonly used for a variety of emotional and psychiatric disorders, including mood, anxiety, and psychotic disorders, as well as sleep disturbance and chronic pain.
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From page 77... ...
. AN EVOLVING DEFINITION OF CRT Specific cognitive and communication needs of patients with brain injury propelled the parallel development of CRT within multiple professional disciplines, including clinical psychology, neuropsychology, speechlanguage pathology, occupational therapy, physical therapy, and physiatry (i.e., rehabilitation medicine)
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From page 78... ...
advocacy organization for individuals with brain injury, summarizes this issue: "Theoretical models of cognitive rehabilitation vary along several different dimensions. Treatments may be process specific, focused on improving a particular cognitive domain such as attention, memory, language, or executive functions.
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From page 79... ...
These dichotomies include modular versus comprehensive, restorative versus compensatory, and contextualized versus decontextualized treatments. These dichotomies are not mutually exclusive categories by which to classify CRT treatments; they serve as important distinctions at understanding underlying cognitive processes and ways providers have attempted to treat cognitive deficits.
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From page 80... ...
Figures 4-1 and 4-2 illustrate the differences and overlap in these dichotomies. Restorative Versus Compensatory Treatments Restorative treatments are aimed directly at improving, strengthening, or normalizing specific impaired cognitive functions.
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From page 81... ...
§ Role in the important communication home AND/OR daily activities Memory § Environment § Educational in the person's Visuospatial § Compensatory: § Social support attainment physical and perception Lessening of § Disability supports/ § Community social Executive function § disabling impact of service status participation environment impaired cognitive § Transportation access § Quality of life domain, through § Family/ specific Adeguacy/quality of caregiver compensatory delivery of the CRT health strategies or intervention technologies § Appropriately trained providers § Standardized manuals and equipment/ facilities FIGURE 4-1 Model for modular CRT.
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From page 82... ...
Potential Mediators 82 Comprehensive and Moderators of CRT Comprehensive CRT Effectiveness Change Due to Outcomes: Comprehensive Personal factors Participation in Post-Acute TBI § Age CRT Society; § Coping Impairments Outcomes: Restorative: Quality of Life § Extent and type of Lessening of Activities physical comorbidities Improvements Impaired Cognitive impairment in one or Improvement and symptoms* and in: Domain more cognitive in ability to their treatment quality § Employment § Attention domains carry out § Substance abuse status § Language and important § Role in the communication daily activities AND/OR Environment home § Memory in the person's § Social support § Educational § Visuospatial physical and Compensatory: § Disability supports/ attainment perception social § Lessening of service status § Community § Executive function disabling impact environment § Transportation access participation of one or more § Quality of life impaired Adeguacy/quality of and well cognitive domains delivery of the being Deficit awareness § Increase in deficit comprehensive CRT § Family/ awareness intervention caregiver § Appropriately trained health Psychological co- AND/OR providers morbidity: § Standardized manuals § Fatigue Reduction in and equipment/ symptoms of § Anxiety facilities psychological co § Depression morbidity § PTSD Interference among treatment components*
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From page 83... ...
Contextualized Versus Decontextualized Treatments CRT interventions also differ in the degree to which they take place in the real world or use materials and tasks from the patient's everyday life. Decontextualized assessment and treatment targets specific cognitive processes often using artificial treatment tasks, such as pressing a key when a computer presents a number but not a letter.
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From page 84... ...
Modular treatments can also be either contextualized or decontextualized. As noted, modular treatments aimed at restoration, in particular, are likely to be decontextualized, in that they may seek to abstract the essence of a cognitive process from its natural context to more tightly focus the treatment.
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From page 85... ...
For example, if attention can be substantially improved in a patient who still has memory deficits, difficulty solving problems, and inappropriate social behavior, this may have little impact on employment or the development of social relationships. Comprehensive treatment programs, by targeting multiple impairments as well as skills for coping with residual impairments, may have more substantial life impact, but they provide no insight into the necessary or sufficient ingredients for a successful treatment outcome.
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From page 86... ...
CONCLUSION CRT is an umbrella term for a group of interventions that are used to support or ameliorate cognitive impairments, as well as the changes that occur in everyday functioning as a result of these impairments. Patients with TBI often have multiple identifiable cognitive impairments, coupled with mood or other behavioral disturbances, a reduced awareness of their own cognitive and behavioral limitations, and reductions in social competence.
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From page 87... ...
1998. Collaborative Brain Injury Intervention: Positive Everyday Routines.
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