Introduction

Over the past 25 years or so there have been a number of major changes in neuropsychological rehabilitation. First it is now much more of a partnership than it was in the 1970s and 80s. Then doctors, therapists and psychologists decided what patients should and could hope to achieve from rehabilitation programmes. Now we discuss with families and patients what they hope to get from rehabilitation and we try to accommodate to this at least in part. Second, rehabilitation has moved well beyond the drills and exercise approach. We no longer find it acceptable to sit people in front of a computer or workbook in the belief that such exercises will result in improved cognitive and, more importantly, social functioning. Third, rehabilitation staff now follow a goal setting approach when planning rehabilitation programmes. Clients, families and staff negotiate appropriate goals and determine how these are to be achieved. Fourth, there is increasing recognition that the cognitive, emotional, social and behavioural consequences of brain injury are interlinked and all should be addressed in the rehabilitation process. Fifth, technology is playing a larger part than ever before in helping people with cognitive deficits compensate for their problems. Sixth, it is now more widely accepted that no one model, theory or framework is sufficient to deal with the many and complex difficulties faced by people with neuropsychological impairments following an injury or insult to the brain.