Cognitive Rehabilitation Services Research Articles

Traumatic Brain Injury and Cognitive Rehabilitation: Current Approaches to Research, Reimbursement, and Clinical Treatment

Traumatic Brain Injury and Cognitive Rehabilitation: Current Approaches to Research, Reimbursement, and Clinical Treatment

Expanding the Paradigm of Rehabilitation Sciences

Cognitive and Behavioral Rehabilitation: From Neurobiology to Clinical Practice. Jennie Ponsford (Ed.). 2004. New York: Guilford Press. 366 pp., $50.00 (HB).The World Health Organization estimates that approximately 90 million people, or 1.5% of the world population, are in need of rehabilitation services at any given point in time (WHO, 2003). Many of these individuals are at risk for long-term disability due to brain injury and disease. They range from the young, who increasingly survive early brain insults, to older adults, whose independence and every day functioning may be threatened by the onset of neurologic impairments. As medical advances improve survival rates and longevity, the number of those in need of cognitive and behavioral rehabilitation services to enhance functioning is likely to grow. This situation raises pressing questions, such as, who will get better with what rehabilitation treatment, and why?

Community-based cognitive rehabilitation services for persons with traumatic brain injuries in China.

The present study aims to explore the need for cognitive rehabilitation services (CRS) in the community for persons with brain injuries and to understand the level of knowledge and attitudes towards cognitive rehabilitation of health care professionals in the city of Guangzhou in southern China, including their use of innovative CRS. One hundred and fifty-five medical and allied health professionals responded to a self-administered questionnaire. Of this number, 128 completed questionnaires were returned; a response rate of 82.58%. Of the respondents, 95.4% agreed with the need to develop CRS in China. They identified four areas as those for which CRS is most urgently needed: language, memory, orientation and attention rehabilitation. The relative appropriateness of settings for such CRS delivery was ranked, from most to least, as the home, hospital and community, respectively. In prioritising the modes of CRS, it was suggested that the order of preference would be face-to-face, computer-assisted and online/web-based. Home-based intervention was also ranked top among the service treatment settings. The respondents also showed a preference for the innovative online mode, which they felt should be conducted in a home rather than a hospital setting.

Realising the Potential of Cognitive Rehabilitation for the Brain-Injured: Next Steps

AbstractContemporary psychological literature as well as the preceding papers (Mateer & Sohlberg, 2003; Wilson, 2003; Ylvisaker, 2003) emphasise the individual patient's personal ecological context as a crucial factor in the delivery of cognitive rehabilitation services. Testing and assessment procedures in neuropsychology have been enjoined to take increasing notice of the patient's historical, cultural and social background in providing services (American Psychological Association, 2003). Similarly, the design and delivery of treatment services must take into account how and where patients are living their lives post-injury. This has the benefit of moving cognitive rehabilitation from an emphasis on the more obvious or face-valid concerns about sterile “cognitive” models to individual ways of facilitating learning and information transfer improvement in the real world. In this way of approaching the problem, the patient's cultural and demographic context as well as their emotional adaptations are not confounding variables but critical design variables. The challenge now in delivering these paradigms of care is to show that they are appropriate and effective in some place in healthcare delivery systems, whether traditional or alternative. Questions of effectiveness of cognitive rehabilitation treatments and cost should be balanced in an equation relating to the probability of objective and demonstrable patient enhancement in living. Goals set and achieved must have consensual value that cannot be captured by traditional cost-benefit analysis in preventive or curative healthcare economic methodology. Cognitive rehabilitation as a family of interventions has little to no chance of being evaluated as efficacious using traditional treatment designs, using traditional neuropsychological measures as dependent variables, and involving research designs with crossover, sham or placebo conditions.

Managed care and rehabilitation: issues related to cognitive rehabilitation

Managed care has affected the delivery of services in all health care sectors, although its impact on rehabilitation has been slower to take effect. These changes have required clinicians to provide more efficient services that are demonstrated to have an impact on functional outcome. However, in order to be reimbursed for specific rehabilitation services, such as cognitive rehabilitation, it is necessary for clinicians to become more knowledgeable regarding managed care, service delivery, and reimbursement issues. This article describes the impact of managed care on health care in general and on rehabilitation specifically. In addition, current billing procedures and reimbursement issues as they relate to cognitive rehabilitation are discussed, and suggestions for ways to secure reimbursement are presented for all disciplines providing cognitive rehabilitation services.

Psychology: Current practice and training issues in treatment of cognitive dysfunction

Psychology has a primary role in cognitive rehabilitation along with other disciplines, but may be best qualified for evaluating specific cognitive abilities directing, cognitive-behavioral intervention programs, and measuring outcomes. Several specialties within psychology provide cognitive rehabilitation services; however, current training guidelines are not specific enough to ensure adequate training. These specialties all have areas of strength and limitations, but none of them has published guidelines specific to training in cognitive rehabilitation. In this paper we critique current guidelines, and make suggestions for training to be followed for those psychologists conducting CR.

Cognitive rehabilitation: advancing the stature of occupational therapy.

As occupational therapists, we can advance our stature in cognitive rehabilitation by first narrowing our scope of practice to become the team experts in compensatory strategy training, the domain of cognitive rehabilitation most consistent with our history and expertise. Supported and aided by our professional association, we must also intensify our contribution to this developing field through research and individual and professional involvement in transdisciplinary organizations. Increased involvement and leadership from occupational therapy promise to improve the prospect that cognitive rehabilitation services will improve day-to-day performance for survivors of brain injury.

Cognitive Rehabilitation Service Provision: Results of a Survey of Practitioners

Cognitive Rehabilitation Service Provision: Results of a Survey of Practitioners

A survey of accredited and other rehabilitation facilities: education, training and cognitive rehabilitation in brain-injury programmes.

Although it is routinely acknowledged that cognitive rehabilitation therapy comprises a major part of the services provided to survivors of brain injury, there continues to be no general consensus regarding the methods and training of those who provide cognitive rehabilitation services. This survey of 398 head-injury rehabilitation facilities includes information on which disciplines are providing and supervising cognitive rehabilitation therapy, which therapy formats are used, and a first attempt to define the costs and providers for cognitive therapy staff training in Commission on Accreditation of Rehabilitation Facilities (CARF) approved and other (non-CARF) facilities. The education and training of junior and senior staff members is compared, and respondents suggest changes in the education and training of those who provide cognitive rehabilitation therapy. The results of this survey suggest no significant differences in the organization and delivery of cognitive rehabilitation therapy in CARF and non-CARF programmes. They indicate that cognitive rehabilitation therapy and the education and training of providers deserve further study and definition, given the widespread provision of cognitive rehabilitative services.

Guidelines for Cognitive Rehabilitation1

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 t he 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.