Models of Exceptional Adaptation in Recovery After Traumatic Brain Injury

Abstract

In interviews, they attributed their successes to continuing reliance on, and ongoing elaboration and modification of, cognitive compensation strategies. Unlike their disabled cohorts, they implement a deliberate procedure for self-corrective self-management that minimizes the functional impact of their permanent deficits.

Response actions to difficulties in using everyday technology after acquired brain injury

“…This indicates that they might have the potential to overcome their more ineffective response actions if they get support to transfer or generate more efficient ones. By supporting people with ABI to identify errors in their actions during task performance, they could be able to prevent known difficulties and learn to plan when a compensatory response action is needed and choose the most efficient one (32,42,43).…”

Evaluation of cognitive rehabilitation as a treatment paradigm

“…Treatment is usually conducted for 5-8 hours on 4-5 days per week across a fixed duration of weeks, with the total contact hours varying from 400-1200. Although a small number of full-featured holistic programmes have been developed in the US [7,8,10,23,[31][32][33][34][35], this model never approached defining the standard of care.…”

“…Many of these programmes also attempt to create a transdisciplinary 'united front' in which multiple therapists jointly address key deficits as soon as they become fully amenable to training (the 'zone of proximal development' [40,41]) by the use of a shared behavioural intervention protocol [42]. Therapy rationales are almost always derived from theories of normal neurocognitive function, neuropathology and neurorehabiliation [3,7,11,23,25] rather than empirical rules of thumb or the logic of alien practices such as physical rehabilitation or special education. Although treatment plans are typically individualized, certain strategems have proven so broadly effective that they have become staples in CR programmes: notebooks and other informationrecording devices to compensate for impaired declarative (content) memory, daytimers, alarms or pagers to support impaired prospective memory and time management and problem-solving algorithms or routines [9,12,32].…”

“…These are straw-man arguments: Model One/Two programmes intend neither to eliminate cognitive deficits nor to repair damaged neurons [25], but rather to reduce disability and improve participation and adaptive fitness [2,3,29]. They seek to achieve these goals mainly by compensating for residual deficits, not by restoring skills [11,23,24,32,49].…”

“…Toward this end, CR is defined here as a systematic, theory-based programme of integrated didactic, experiential, procedural and psychosocial training activities, conducted to restore cognitively compromised adaptation, including decrements in interpersonal and vocational participation, self-awareness and self-determination [23]. A focus on the psychosocial/emotional aspects of recovery is central, as defective insight and the consequent dearth of adjustive motivation are major rehabilitative obstacles in TBI [2,[24][25][26].…”