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• 1 Neuropsychological Rehabilitation (Wilson, 2008)

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• Major changes NR throughout the years

  1. Goal setting to plan rehabilitation programs
  2. Growing recognition that cognitive, emotional, and psychosocial difficulties should be addressed in rehabilitation
  3. Increasing use of technology to compensate for cognitive difficulties
  4. Realization that NR requires a broad theoretical base or indeed a number of theoretical bases

• Goal planning approach

  First the patient should be engaged in setting his or her goals. Second, the goals set should be reasonable and client centered. Third, patient's behaviour when a goal is reached should be defined in such a manner that anyone reading the plan would know what to do. >> SMART specific, measurable, achievable. realistic and timely

• Holistic programs include group and individual therapy in which patients are

  1. encouraged to be more aware of their strenghts and weaknesses
  2. helped to understand and accept these
  3. given strategies to compensate for cognitive difficulties
  4. offered vocational guidance and support

• Five factors predicted problems with social relationships

  1. loss of self-control
  2. emotional dysfunction
  3. adynamia
  4. personality change
  5. cognitive dysfunction

• Wilson argues that one model, or one group of models are insufficient

  • to determine what needs to be rehabilitated
  • to plan appropriate treatment for neuropsychological impairments
  • to evaluate response to rehabilitation.

• Oliver Zangwill Center based NR components

  1. Provide a therapeutic milieu
  2. Establish meaningful and functionally relevant goals for rehabiliation
  3. Ensure shared understanding
  4. Apply psychological interventions
  5. Manage cognitive impairments through compensatory strategies and retraining skills
  6. Work closely with families and carers

• Gainotti (1993) distinguishes three main factors causing emotional and psychosocial problems after brain injury

  1. neurological factors
  2. psychological factors
  3. psychodynamic factors
  4. ### premorbid personality (noemt Gainotti niet, maar wel relevant)

• 2 Evidence Based Cognitive Rehabilitation: Recommedations for Clinical Practice (Cicerone et al., 2000)

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• Intervention approaches for cognitive rehabilitation

  1. Reinforcing, strengthening, or reestablishing previously learned patterns of behaviour
  2. Establishing new patterns of cognitive activity through compensatory cognitive mechanisms for impaired neurologic systems
  3. Establishing new patterns of activity through external compensatory mechanisms such as personal orthoses or environmental structuring and support
  4. Enabling persons to adapt their cognitive disability> improve overall QoL

• Multi-modal Interventions for Cognitive Deficits

  Cognitive rehabilitation therapies directed at multiple areas of cognitive impairment can significantly improve neuropsychologic performance in those skill areas. Multimodal intervention may be considered for persons who have multiple areas of cognitive impairment, with specific interventions based on recommendations provided in the preceding sections.
  Rehabilitation for cognitive deficits that relies solely on repeated exposure and practice on computer-based treatment tasks without extensive involvement and intervention by a therapist is not recommended. 

• Visuospatial rehabilitation (Practice Standard)

  Recommended for persons with visuoperceptual deficits associated with visual neglect after right hemispheric stroke