Cognitive Rehabilitation: An Integrative Neuropsychological Approach

Canadian Psychology, Nov 2002 by Gail Eskes

MCKAY MOORE SOHLBERG and CATHERINE A. MATEER Cognitive Rehabilitation: An Integrative Neuropsychological Approach New York: The Guilford Press, 2001, 512 pages (ISBN 1-57230-613-0, US$55, Hardcover)

Sohlberg and Mateer's 1989 book, Introduction to Cognitive Rehabilitation, provided one of the first comprehensive and theoretically based yet practical textbooks in the relatively new field of cognitive rehabilitation of individuals with acquired brain injury. This new book of theirs gives us once again an innovative perspective on the field. Although the emphasis on cognitive rehabilitation is maintained, the new text is considerably wider in scope and presents excellent discussions of other important contextual issues surrounding rehabilitation, including emotional and behavioural issues, working with families, and environmental/technological influences. The goal of the text is to provide clinicians with a "theoretically based, yet eminently practical handbook" that bridges the "ever-expanding knowledge of cognitive and behavioral neuroscience with applied rehabilitation" (p. xii).

The underlying themes of the book are introduced in the four chapters in Part 1, which present the underlying fundamentals of the practice of cognitive rehabilitation and include chapters on introductory general principles (Chapter 1), a review of the major types of neurological disorders and accompanying cognitive impairments (Chapter 2), variables associated with plasticity and recovery (Chapter 3), and approaches to assessment (Chapter 4). Broadly speaking, the four principles may be summarized as follows: (1) The clinical approach is person-focused, rather than discipline-focused, and the importance of teamwork that can support client goals and treatment from multiple perspectives without concern for discipline boundaries is emphasized; (2) the client and family are considered important members of the team in setting functional goals and carrying out interventions; (3) current concepts in cognitive and behavioural neuroscience should form the basis of any intervention and systematic assessment and evaluation of outcomes is critical; and (4) the rehabilitation professional is encouraged to take an eclectic approach and use a variety of techniques to improve cognitive abilities and teach new compensatory skills in the context of behavioural and emotional issues. The importance of improving functional skills, rather than performance on cognitive tests, is emphasized.

These four principles are highlighted in the subsequent six chapters on intervention in Part II. Each of these chapters follows the same organization and begins with an overview of current concepts and models of the particular cognitive process and how it is typically affected by brain injury. The implications of these current concepts for the assessment and management of the disorders are discussed, forming a very useful basis from which to approach any identified problems. Various approaches and techniques are then presented, which include specific training protocols to target disturbed abilities, teaching of compensatory strategies, the use of environmental aids, involving the family and providing psychosocial support. Functional goals are emphasized, and set within the context of client and family strengths, motivation and ability to participate in the rehabilitation process. Appendices provide useful examples of assessment tools, record-keeping score sheets, and patient handouts.

In terms of rehabilitation for specific cognitive disorders, there is a focus on intervention strategies for disorders of attention, memory, and executive function (Chapters 5-8). These processes are commonly targeted in neuro-rehabilitation programs, are important to day-to-day functioning, and are interdependent abilities that interact in complex ways. Assessment and management of disorders of awareness are found in Chapter 9 and communication issues are discussed in Chapter 10, with a focus on the more cognitive aspects underlying communication (e.g., pragmatics, or the use of linguistic skills in specific contexts).

Part III broadens the scope of the cognitive rehabilitation approaches by presenting chapters on management of behavioural issues (Chapter 11) and emotional disturbances (Chapter 12). Again, the emphasis is on concepts and models providing the background for management approaches. Chapter 13 presents a thoughtful discussion of the impact of brain injury on families, and how the inclusion of families in setting goals and delivering interventions can significantly enhance rehabilitation outcomes.

Finally, Part IV addresses cognitive rehabilitation approaches in special populations (i.e., children and clients with mild traumatic brain injury).

Does the text meet the goals of the authors? The answer is a resounding yes. This is an extremely useful, practical, and solid handbook for the rehabilitation practitioner. The value of the book stems from the strong knowledge base and experience of the authors, the clear writing style that presents today's most complicated cognitive theories in a readable and highly understandable form, the comprehensiveness of the material presented, and the extremely practical nature of the suggested approaches and materials provided. The broader scope of discussions about the impact of emotional issues, family systems, etc., on outcome provides an extremely valuable context within which to view standard cognitive rehabilitation practices. It is clear that the authors were well aware of the current models of the health care system in both the U.S. and Canada. They emphasize short-term, measurable functional outcomes, with long-term needs supported by the family and community resources.