Skip to main content
×
Home
    • Aa
    • Aa
  • Access

Integrating Interventions after Traumatic Brain Injury: A Synergistic Approach to Neurorehabilitation

  • Kristen Dams-O'Connor (a1) and Wayne A. Gordon (a1)
  • DOI: http://dx.doi.org/10.1017/BrImp.2013.9
  • Published online: 03 May 2013
Abstract

Deficits in attention, processing speed and executive functioning are among the most commonly reported and functionally limiting cognitive impairments among individuals with TBI. Changes in mood can exacerbate cognitive deficits and reduce life quality. Contemporary hierarchical models of cognitive functioning suggest that attention/arousal processes underlie and support higher-order functions. Building on decades of clinical research, a synergistic, integrative approach to neurorehabilitation is described, which combines bottom-up and top-town cognitive interventions in addition to psychotherapeutic interventions for mood. This approach is intended to address directly impairments in both foundational (i.e., attention) and higher-order (i.e., executive functions) processes. Executive dysfunction is addressed in a top-down fashion through the application of a series of problem-solving and emotional regulation modules that teach and integrate strategies that can be generalised across situations with practice. Attention, arousal and information processing are necessary prerequisites of successful higher-order thinking, attention skills, and are addressed in a bottom-up fashion through intensive individualised attention and processing training tasks. Combining top-down and bottom-up approaches within a comprehensive day-treatment programme can effect a synergistic improvement of overall functioning.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Integrating Interventions after Traumatic Brain Injury: A Synergistic Approach to Neurorehabilitation
      Your Kindle email address
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Integrating Interventions after Traumatic Brain Injury: A Synergistic Approach to Neurorehabilitation
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Integrating Interventions after Traumatic Brain Injury: A Synergistic Approach to Neurorehabilitation
      Available formats
      ×
Copyright
Corresponding author
Address for correspondence: Kristen Dams-O'Connor, PhD, Assistant Professor, Department of Rehabilitation Medicine, Ichan School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1240, New York, NY 10029, USA. E-mail: Kristen.dams-o'connor@mountsinai.org
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

R.A. Adcock , C. Dale , M. Fisher , S. Aldebot , A. Genevsky , G. V. Simpson , . . . S. Vinogradov (2009). When top-down meets bottom-up: Auditory training enhances verbal memory in schizophrenia. Schizophrenia Bulletin, 35 (6), 11321141.

T.A. Ashman , L.A. Spielman , M.R. Hibbard , J.M. Silver , T. Chandna , & W.A. Gordon (2004). Psychiatric challenges in the first 6 years after traumatic brain injury: Cross-sequential analyses of axis I disorders. Archives of Physical Medicine and Rehabilitation, 85 (4 Suppl 2), S3642.

D. Barnes , K. Yaffe , N. Belfor , W.J. Jagust , C. DeCarli , B.R. Reed , . . . J.H. Kramer (2009). Computer-based cognitive training for mild cognitive impairment: Results from a pilot randomized, controlled trial. Alzheimer Disease and Associated Disorders, 23 (3), 205210.

Y. Ben-Yishay , J. Rattock , P. Lakin , E.B. Piasetsky , B. Ross , S. Silver , . . . O. Ezrachi (1985). Neuropsychological rehabilitation: Quest for a holistic approach. Seminars in Neurology, 5, 252258.

D.M. Bernstein (1999). Recovery from mild head injury. Brain Injury, 13, 151172.

M. Brown , & D. Vandergoot (1998). Quality of life for individuals with traumatic brain injury: Comparison with others living in the community. The Journal of Head Trauma Rehabilitation, 13 (4), 123.

D.V. Buonomano , & M.M. Merzenich (1998). Cortical plasticity: From synapses to maps. Annual Review of Neuroscience, 21, 149186.

K.D. Cicerone , C. Dahlberg , K. Kalmar , D.M. Langenbahn , J.F. Malec , T.F. Bergquist , . . . P.A. Morse (2000). Evidence-based cognitive rehabilitation: Recommendations for clinical practice. Archives of Physical Medicine and Rehabilitation, 81 (12), 15961615.

K.D. Cicerone , C. Dahlberg , J.F. Malec , D.M. Langenbahn , T. Felicetti , S. Kneipp , . . . J. Catanese (2005). Evidence-based cognitive rehabilitation: Updated review of the literature from 1998 through 2002. Archives of Physical Medicine and Rehabilitation, 86 (8), 16811692.

K.D. Cicerone , D.M. Langenbahn , C. Braden , J.F. Malec , K. Kalmar , M. Fraas , . . . T. Ashman (2011). Evidence-based cognitive rehabilitation: Updated review of the literature from 2003 through 2008. Archives of Physical Medicine and Rehabilitation, 92 (4), 519530.

K. Cicerone , H. Levin , J. Malec , D. Stuss , & J. Whyte (2006). Cognitive rehabilitation interventions for executive function: Moving from bench to bedside in patients with traumatic brain injury. Journal of Cognitive Neuroscience, 18 (7), 12121222.

K.D. Cicerone , T. Mott , J. Azulay , & J.C. Friel (2004). Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 85 (6), 943950.

K. Donnelly , J. Donelly , M. Dunnam , G. Warner , C. Kittelson , J. Constance , . . . M. Alt (2011). Relability, sensitivity, and specificitiy of the VA traumatic brain injury screening tool. Journal of Head Trauma Rehabilitation, 26 (6), 439453.

T.J. D'Zurilla , & M.R. Goldfried (1971). Problem solving and behavior modification. Journal of Abnormal Psychology, 78 (1), 107126.

J.D. Edwards , V.G. Wadley , R.S. Myers , D.L. Roenker , G.M. Cissell , & K.K. Ball (2002). Transfer of a speed of processing intervention to near and far cognitive functions. Gerontology, 48 (5), 329340.

J.D. Edwards , V.G. Wadley , D.E. Vance , K. Wood , D.L. Roenker , & K.K. Ball (2005). The impact of speed of processing training on cognitive and everyday performance. Aging & Mental Health, 9 (3), 262271.

L. Fasotti , F. Kovacs , P.A. Eling , & W.H. Brouwer (2000). Time pressure management as a compensatory strategy training after closed head injury. Neuropsychological Rehabilitation, 10 (1), 4765.

R.M. Foxx , R.C. Martella , & N.E. Marchand Martella (1989). The acquisition, maintenance, and generalization of problem-solving skills by closed head-injured adults. Behavior Therapy, 20 (1), 6176.

K.A. Frencham , A.M. Fox , & M.T. Maybery (2005). Neuropsychological studies of mild traumatic brain injury: A meta-analytic review of research since 1995. Journal of Clinical and Experimental Neuropsychology, 27 (3), 334351.

W.A. Gordon , J. Cantor , T. Ashman , & M. Brown (2006a). Treatment of post-TBI executive dysfunction: Application of theory to clinical practice. Journal of Head Trauma Rehabilitation, 21 (2), 156167.

W.A. Gordon , R. Zafonte , K. Cicerone , J. Cantor , M. Brown , L. Lombard , . . . T. Chandna (2006b). Traumatic brain injury rehabilitation: State of the science. American Journal of Physical Medicine & Rehabilitation/Association of Academic Physiatrists, 85 (4), 343382.

Y. Goverover , M.V. Johnston , J. Toglia , & J. Deluca (2007). Treatment to improve self-awareness in persons with acquired brain injury. Brain Injury 21 (9), 913923.

J.M. Gray , I. Robertson , B. Pentland , & S. Anderson (1992). Microcomputer-based attentional retraining after brain damage: A randomised group controlled trial. Neuropsychological Rehabilitation, 2 (2), 97115.

M.R. Hibbard , S. Uysal , M. Sliwinski , & W.A. Gordon (1998). Undiagnosed health issues in individuals with traumatic brain injury living in the community. Journal of Head Trauma Rehabilitation, 13 (4), 4757.

T. Honda (1999). Rehabilitation of executive function impairments after stroke. Topics in Stroke Rehabilitation, 6 (1), 1522.

K. Hux , R. Reid , & M. Lugert (1994). Self-instruction training following neurological injury. Applied Cognitive Psychology, 8 (3), 259271.

R.E. Jorge , R.G. Robinson , S.E. Starkstein , & S.V. Arndt (1994). Influence of major depression on 1-year outcome in patients with traumatic brain injury. Journal of Neurosurgery, 81 (5), 726733.

S. Kastner , De P. Weerd , R. Desimone , & L.G. Ungerleider (1998). Mechanisms of directed attention in the human extrastriate cortex as revealed by functional MRI. Science, 282 (5386), 108111.

P.S. Klonoff , D.G. Lamb , & S.W. Henderson (2000). Milieu-based neurorehabilitation in patients with traumatic brain injury: Outcome at up to 11 years postdischarge. Archives of Physical Medicine and Rehabilitation, 81 (11), 15351537.

P.S. Klonoff , D.G. Lamb , S.W. Henderson , & J. Shepherd (1998). Outcome assessment after milieu-oriented rehabilitation: New considerations. Archives of Physical Medicine and Rehabilitation, 79 (6), 684690.

W.M. Levack , N.M. Kayes , & J.K. Fadyl (2010). Experience of recovery and outcome following traumatic brain injury: A metasynthesis of qualitative research. Disability and Rehabilitation, 32 (12), 986999.

B. Levine , I.H. Robertson , L. Clare , G. Carter , J. Hong , B.A. Wilson , . . . D.T. Stuss (2000). Rehabilitation of executive functioning: An experimental-clinical validation of goal management training. Journal of the International Neuropsychological Society, 6 (3), 299312.

A.R. Luria , & I.D. Tsvetkova (1964). The programming of constructive abilities in local brain injuries. Neuropsychologia, 2, 9595.108.

H.W. Mahncke , A. Bronstone , & M.M. Merzenich (2006). Brain plasticity and functional losses in the aged: Scientific bases for a novel intervention. Progress in Brain Research, 157, 81109.

J.F. Malec (2001). Impact of comprehensive day treatment on societal participation for persons with acquired brain injury. Archives of Physical Medicine and Rehabilitation, 82 (7), 885895.

J.F. Malec , & J.S. Basford (1996). Postacute brain injury rehabilitation. Archives of Physical Medicine and Rehabilitation, 77 (2), 198207.

D. Meichenbaum , & R. Cameron (1974). The clinical potential of modifying what clients say to themselves. Psychotherapy: Theory, Research and Practice, 11 (2), 103117.

M. Meinzer , D. Djundja , G. Barthel , T. Elbert , & B. Rockstroh (2005). Long-term stability of improved language functions in chronic aphasia after constraint-induced aphasia therapy. Stroke; a Journal of Cerebral Circulation, 36 (7), 14621466.

L. Nelson , R. Yoash-Gantz , T. Pickett , & T. Campbell (2009). Relationship between processing speed and executive functioning performance among OEF/OIF veterans: Implications for postdeployment rehabilitation. Journal of Head Trauma Rehabilitation, 24 (1), 32.

H. Niemann , R.M. Ruff , & C.A. Baser (1990). Computer-assisted attention retraining in head-injured individuals: A controlled efficacy study of an outpatient program. Journal of Consulting and Clinical Psychology, 58 (6), 811817.

NIH Consensus Development Panel on Rehabilitation of Persons with Traumatic Brain Injury. (1999). Rehabilitation of persons with traumatic brain injury, Journal of the American Medical Association, 282, 974983.

M.E. O'Callaghan , & B. Couvadelli (1998). Use of self-instructional strategies with three neurologically impaired adults. Cognitive Therapy and Research, 22 (2), 91107.

T.L. Ownsworth , & K. Mcfarland (1999). Memory remediation in long-term acquired brain injury: Two approaches in diary training. Brain Injury, 13 (8), 605626.

L. Parish , & M. Oddy (2007). Efficacy of rehabilitation for functional skills more than 10 years after extremely severe brain injury. Neuropsychological Rehabilitation, 17 (2), 230243.

D.A. Poggel , E. Kasten , & B.A. Sabel (2004). Attentional cueing improves vision restoration therapy in patients with visual field defects. Neurology, 63 (11), 20692076.

D.B. Polley , E.E. Steinberg , & M.M. Merzenich (2006). Perceptual learning directs auditory cortical map reorganization through top-down influences. Journal of Neuroscience, 26 (18), 49704982.

Y. Rassovsky , P. Satz , M.S. Alfano , R.K. Light , K. Zaucha , D.L. McArthur , . . . D. Hovda (2006). Functional outcome in TBI II: Verbal memory and information processing speed mediators. Journal of Clinical and Experimental Neuropsychology, 28 (4), 581591.

J.F. Rath , D. Simon , D.M. Langenbahn , R.L. Sherr , & L. Diller (2003). Group treatment of problem‐solving deficits in outpatients with traumatic brain injury: A randomised outcome study. Neuropsychological Rehabilitation: An International Journal, 13 (4), 461488.

M. Rieger , & S. Gauggel (2002). Inhibition of ongoing responses in patients with traumatic brain injury. Neuropsychologia, 40 (1), 7685.

R. Ruff (2005). Two decades of advances in understanding of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 20 (1), 518.

A. Serino , E. Ciaramelli , A.D. Santantonio , S. Malagu , F. Servadei , & E. Ladavas (2007). A pilot study for rehabilitation of central executive deficits after traumatic brain injury. Brain Injury, 21 (1), 1119.

J.M. Silver , J.W. McAllister , & S.C. Yudofsky (2005). Textbook of traumatic brain injury (1st ed.). Washington, DC: American Psychiatric Publishing.

G.E. Smith , P. Housen , K. Yaffe , R. Ruff , R.F. Kennison , H.W. Mahncke , . . . E.M. Zelinski (2009). A cognitive training program based on principles of brain plasticity: Results from the improvement in memory with plasticity-based adaptive cognitive training (IMPACT) study. Journal of the American Geriatrics Society, 57 (4), 594603.

M. Sohlberg , & C. Mateer (1987). Effectiveness of an attention training program. Journal of Clinical and Experimental Neuropsychology, 9, 117130.

M. Sohlberg , C.A. Mateer , & D. Stuss (1993). Contemporary approaches to the management of executive dyscontrol. Journal of Head Trauma Rehabilitation, 8, 4558.

M.C. Stratton , & R.J. Gregory (1995). After traumatic brain injury: A discussion of consequences. Brain Injury, 8 (7), 631645.

W. Sturm , K. Willmes , B. Orgass , & W. Hartje (1997). Do specific attention deficits need specific training? Neuropsychological Rehabilitation, 7, 81103.

D.T. Stuss , T. Shallice , M.P. Alexander , & T.W. Picton (1995). A multidisciplinary approach to anterior attentional functions. Annals of the New York Academy of Sciences, 769, 191211.

R. Sun , & X. Zhang (2004). Top-down versus bottom-up learning in cognitive skill acquisition. Cognitive Systems Research, 5, 6389.

L.A. Tiersky , V. Anselmi , M.V. Johnston , J. Kurtyka , E. Roosen , T. Schwartz , . . . J. Deluca (2005). A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 86 (8), 15651574.

D.Y. von Cramon , G. Matthes-von Cramon , & N. Mai (1991). Problem-solving deficits in brain-injured patients: A therapeutic approach. Neuropsychological Rehabilitation, 1, 4564.

P. Webb , & R. Glueckauf (1994). The effects of direct involvement in goal setting on rehabilitation outcome in persons with traumatic brain injury. Rehabilitation Psychology, 39 (3), 179188.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Brain Impairment
  • ISSN: 1443-9646
  • EISSN: 1839-5252
  • URL: /core/journals/brain-impairment
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: