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

Published online by Cambridge University Press:  03 May 2013

Kristen Dams-O'Connor  and
Wayne A. Gordon
Kristen Dams-O'Connor*
Affiliation:
Department of Rehabilitation Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, USA
Wayne A. Gordon
Affiliation:
Department of Rehabilitation Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, USA
*
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
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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.

Keywords

traumatic brain injuryneurorehabilitationexecutive functioning
Type
State of the Art Reviews
Information
Brain Impairment , Volume 14 , Issue 1: State of the art reviews in mental health after traumatic brain injury , May 2013 , pp. 51 - 62
Copyright
Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2013 

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References

Adcock, R.A., Dale, C., Fisher, M., Aldebot, S., Genevsky, A., Simpson, G. V., . . . Vinogradov, S. (2009). When top-down meets bottom-up: Auditory training enhances verbal memory in schizophrenia. Schizophrenia Bulletin, 35 (6), 1132–1141.CrossRefGoogle ScholarPubMed
Ashman, T.A., Gordon, W.A., Cantor, J.B., & Hibbard, M.R. (2006). Neurobehavioral consequences of traumatic brain injury. The Mount Sinai Journal of Medicine, New York, 73 (7), 999–1005.Google ScholarPubMed
Ashman, T.A., Spielman, L.A., Hibbard, M.R., Silver, J.M., Chandna, T., & Gordon, W.A. (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), S36–42.CrossRefGoogle ScholarPubMed
Barnes, D., Yaffe, K., Belfor, N., Jagust, W.J., DeCarli, C., Reed, B.R., . . . Kramer, J.H. (2009). Computer-based cognitive training for mild cognitive impairment: Results from a pilot randomized, controlled trial. Alzheimer Disease and Associated Disorders, 23 (3), 205–210.CrossRefGoogle ScholarPubMed
Ben-Yishay, Y., Rattock, J., Lakin, P., Piasetsky, E.B., Ross, B., Silver, S., . . . Ezrachi, O. (1985). Neuropsychological rehabilitation: Quest for a holistic approach. Seminars in Neurology, 5, 252–258.CrossRefGoogle Scholar
Bernstein, D.M. (1999). Recovery from mild head injury. Brain Injury, 13, 151–172.CrossRefGoogle ScholarPubMed
Brown, M., & Vandergoot, D. (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), 1–23.CrossRefGoogle ScholarPubMed
Buonomano, D.V., & Merzenich, M.M. (1998). Cortical plasticity: From synapses to maps. Annual Review of Neuroscience, 21, 149–186.CrossRefGoogle ScholarPubMed
Cicerone, K.D., Dahlberg, C., Kalmar, K., Langenbahn, D.M., Malec, J.F., Bergquist, T.F., . . . Morse, P.A. (2000). Evidence-based cognitive rehabilitation: Recommendations for clinical practice. Archives of Physical Medicine and Rehabilitation, 81 (12), 1596–1615.CrossRefGoogle ScholarPubMed
Cicerone, K.D., Dahlberg, C., Malec, J.F., Langenbahn, D.M., Felicetti, T., Kneipp, S., . . . Catanese, J. (2005). Evidence-based cognitive rehabilitation: Updated review of the literature from 1998 through 2002. Archives of Physical Medicine and Rehabilitation, 86 (8), 1681–1692.CrossRefGoogle ScholarPubMed
Cicerone, K., & Giacino, J. (1992). Remediation of executive function deficits after traumatic brain injury. NeuroRehabilitation, 2 (3), 12–22.CrossRefGoogle Scholar
Cicerone, K.D., Langenbahn, D.M., Braden, C., Malec, J.F., Kalmar, K., Fraas, M., . . . Ashman, T. (2011). Evidence-based cognitive rehabilitation: Updated review of the literature from 2003 through 2008. Archives of Physical Medicine and Rehabilitation, 92 (4), 519–530.CrossRefGoogle ScholarPubMed
Cicerone, K., Levin, H., Malec, J., Stuss, D., & Whyte, J. (2006). Cognitive rehabilitation interventions for executive function: Moving from bench to bedside in patients with traumatic brain injury. Journal of Cognitive Neuroscience, 18 (7), 1212–1222.CrossRefGoogle ScholarPubMed
Cicerone, K.D., Mott, T., Azulay, J., & Friel, J.C. (2004). Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 85 (6), 943–950.CrossRefGoogle ScholarPubMed
Cicerone, K.D., & Wood, J.C. (1987). Planning disorder after closed head injury: A case study. Archives of Physical Medicine and Rehabilitation, 68 (2), 111–115.Google ScholarPubMed
Dijkers, M.P., Brown, M., & Ashman, T. (2004). ‘Services’ may not be the answer to many needs after disability. Archives of Physical Medicine and Rehabilitation, 85, E12–13.Google Scholar
Donnelly, K., Donelly, J., Dunnam, M., Warner, G., Kittelson, C., Constance, J., . . . Alt, M. (2011). Relability, sensitivity, and specificitiy of the VA traumatic brain injury screening tool. Journal of Head Trauma Rehabilitation, 26 (6), 439–453.CrossRefGoogle Scholar
D'Zurilla, T. (1988). Problem-solving therapies. In Dobson, K. (Ed.), Handbook of cognitive-behavioral therapies. New York: Guilford Press.Google Scholar
D'Zurilla, T.J., & Goldfried, M.R. (1971). Problem solving and behavior modification. Journal of Abnormal Psychology, 78 (1), 107–126.CrossRefGoogle ScholarPubMed
D'Zurilla, T. J., & Nezu, A.M. (2001). Problem-solving therapies. In Dobson, K.S. (Ed.), Handbook of cognitive behavioral therapies (pp. 211–245). New York: Guilford Press.Google Scholar
Edwards, J.D., Wadley, V.G., Myers, R.S., Roenker, D.L., Cissell, G.M., & Ball, K.K. (2002). Transfer of a speed of processing intervention to near and far cognitive functions. Gerontology, 48 (5), 329–340.CrossRefGoogle ScholarPubMed
Edwards, J.D., Wadley, V.G., Vance, D.E., Wood, K., Roenker, D.L., & Ball, K.K. (2005). The impact of speed of processing training on cognitive and everyday performance. Aging & Mental Health, 9 (3), 262–271.CrossRefGoogle ScholarPubMed
Fasotti, L., Kovacs, F., Eling, P.A., & Brouwer, W.H. (2000). Time pressure management as a compensatory strategy training after closed head injury. Neuropsychological Rehabilitation, 10 (1), 47–65.CrossRefGoogle Scholar
Foxx, R.M., Martella, R.C., & Marchand Martella, N.E. (1989). The acquisition, maintenance, and generalization of problem-solving skills by closed head-injured adults. Behavior Therapy, 20 (1), 61–76.CrossRefGoogle Scholar
Frencham, K.A., Fox, A.M., & Maybery, M.T. (2005). Neuropsychological studies of mild traumatic brain injury: A meta-analytic review of research since 1995. Journal of Clinical and Experimental Neuropsychology, 27 (3), 334–351.CrossRefGoogle ScholarPubMed
Gordon, W.A., Cantor, J., Ashman, T., & Brown, M. (2006a). Treatment of post-TBI executive dysfunction: Application of theory to clinical practice. Journal of Head Trauma Rehabilitation, 21 (2), 156–167.CrossRefGoogle ScholarPubMed
Gordon, W.A., & Hibbard, M.R. (2005). Cognitive rehabilitation. In Silver, J.M., Yudoffsky, S.C. & McAllister, T.W. (Eds.), Neuropsychiatry of traumatic brain injury (2nd ed., pp. 655–660). Washington, DC: American Psychiatric Press.Google Scholar
Gordon, W.A., Zafonte, R., Cicerone, K., Cantor, J., Brown, M., Lombard, L., . . . Chandna, T. (2006b). Traumatic brain injury rehabilitation: State of the science. American Journal of Physical Medicine & Rehabilitation/Association of Academic Physiatrists, 85 (4), 343–382.CrossRefGoogle ScholarPubMed
Goverover, Y., Johnston, M.V., Toglia, J., & Deluca, J. (2007). Treatment to improve self-awareness in persons with acquired brain injury. Brain Injury 21 (9), 913–923.CrossRefGoogle ScholarPubMed
Gray, J.M., Robertson, I., Pentland, B., & Anderson, S. (1992). Microcomputer-based attentional retraining after brain damage: A randomised group controlled trial. Neuropsychological Rehabilitation, 2 (2), 97–115.CrossRefGoogle Scholar
Hibbard, M.R., Rendon, D., Charatz, H., & Kothera, L. (2005). CBT in individuals with traumatic brain injury. In Freeman, S.M., & Freeman, A. (Eds.), Cognitive behavior therapy in nursing practice (pp. 189–220). New York: Springer.Google Scholar
Hibbard, M.R., Uysal, S., Kepler, K., Bogdany, J., & Silver, J. (1998). Axis I psychopathology in individuals with traumatic brain injury. Journal of Head Trauma Rehabilitation, 13 (4), 24–39.CrossRefGoogle ScholarPubMed
Hibbard, M.R., Uysal, S., Sliwinski, M., & Gordon, W.A. (1998). Undiagnosed health issues in individuals with traumatic brain injury living in the community. Journal of Head Trauma Rehabilitation, 13 (4), 47–57.CrossRefGoogle ScholarPubMed
Honda, T. (1999). Rehabilitation of executive function impairments after stroke. Topics in Stroke Rehabilitation, 6 (1), 15–22.CrossRefGoogle ScholarPubMed
Hux, K., Reid, R., & Lugert, M. (1994). Self-instruction training following neurological injury. Applied Cognitive Psychology, 8 (3), 259–271.CrossRefGoogle Scholar
Jorge, R.E., Robinson, R.G., Starkstein, S.E., & Arndt, S.V. (1994). Influence of major depression on 1-year outcome in patients with traumatic brain injury. Journal of Neurosurgery, 81 (5), 726–733.CrossRefGoogle ScholarPubMed
Kastner, S., De Weerd, P., Desimone, R., & Ungerleider, L.G. (1998). Mechanisms of directed attention in the human extrastriate cortex as revealed by functional MRI. Science, 282 (5386), 108–111.CrossRefGoogle ScholarPubMed
Kastner, S., & Ungerleider, L.G. (2000). Mechanisms of visual attention in the human cortex. Annual Review of Neuroscience, 23, 315–341.Google ScholarPubMed
Klonoff, P.S., Lamb, D.G., & Henderson, S.W. (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), 1535–1537.CrossRefGoogle ScholarPubMed
Klonoff, P.S., Lamb, D.G., Henderson, S.W., & Shepherd, J. (1998). Outcome assessment after milieu-oriented rehabilitation: New considerations. Archives of Physical Medicine and Rehabilitation, 79 (6), 684–690.CrossRefGoogle ScholarPubMed
Levack, W.M., Kayes, N.M., & Fadyl, J.K. (2010). Experience of recovery and outcome following traumatic brain injury: A metasynthesis of qualitative research. Disability and Rehabilitation, 32 (12), 986–999.CrossRefGoogle ScholarPubMed
Levine, B., Robertson, I.H., Clare, L., Carter, G., Hong, J., Wilson, B.A., . . . Stuss, D.T. (2000). Rehabilitation of executive functioning: An experimental-clinical validation of goal management training. Journal of the International Neuropsychological Society, 6 (3), 299–312.CrossRefGoogle ScholarPubMed
Lezak, M.D., Howieson, D.B., & Loring, D.W. (2004). Neuropsychological assessment (4th ed.). Oxford: Oxford University Press.Google Scholar
Lezak, M.D., & O'Brien, K. P. (1990). Chronic emotional, social, and physical changes after traumatic brain injury. In Bigler, E.D. (Ed.), Traumatic brain injury: Mechanisms of damage, assessment, intervention, and outcome (pp. 365–380). Austin, Texas: Pro-Ed.Google Scholar
Luria, A.R. (1963). Restoration of function after brain injury. New York: Basic Books.Google Scholar
Luria, A.R., & Tsvetkova, I.D. (1964). The programming of constructive abilities in local brain injuries. Neuropsychologia, 2, 95–95.108.CrossRefGoogle Scholar
Mahncke, H.W., Bronstone, A., & Merzenich, M.M. (2006). Brain plasticity and functional losses in the aged: Scientific bases for a novel intervention. Progress in Brain Research, 157, 81–109.CrossRefGoogle ScholarPubMed
Malec, J.F. (2001). Impact of comprehensive day treatment on societal participation for persons with acquired brain injury. Archives of Physical Medicine and Rehabilitation, 82 (7), 885–895.CrossRefGoogle ScholarPubMed
Malec, J.F., & Basford, J.S. (1996). Postacute brain injury rehabilitation. Archives of Physical Medicine and Rehabilitation, 77 (2), 198–207.CrossRefGoogle ScholarPubMed
Mateer, C.A. (1999). Executive function disorders: Rehabilitation challenges and strategies. Seminars on Clinical Neuropsychiatry, 4, 50–59.Google ScholarPubMed
McDonald, B.C., Flashman, L.A., & Saykin, A.J. (2002). Executive dysfunction following traumatic brain injury: Neural substrates and treatment strategies. NeuroRehabilitation, 17 (4), 333–344.CrossRefGoogle ScholarPubMed
Meichenbaum, D., & Cameron, R. (1974). The clinical potential of modifying what clients say to themselves. Psychotherapy: Theory, Research and Practice, 11 (2), 103–117.CrossRefGoogle Scholar
Meinzer, M., Djundja, D., Barthel, G., Elbert, T., & Rockstroh, B. (2005). Long-term stability of improved language functions in chronic aphasia after constraint-induced aphasia therapy. Stroke; a Journal of Cerebral Circulation, 36 (7), 1462–1466.CrossRefGoogle ScholarPubMed
Merzenich, M.M., Tallal, P., Peterson, B., Miller, S.L., & Jenkins, W.M. (1999). Some neurological principles relevant to the origins of – and the cortical plasticity-based remediation of –developmental language impairments. In Grafman, J. (Ed.), Neuronal plasticity: Building a bridge from the laboratory to the clinic (pp. 169). New York: Springer-Verlag.CrossRefGoogle Scholar
Nelson, L., Yoash-Gantz, R., Pickett, T., & Campbell, T. (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.CrossRefGoogle ScholarPubMed
Niemann, H., Ruff, R.M., & Baser, C.A. (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), 811–817.CrossRefGoogle ScholarPubMed
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, 974–983.CrossRefGoogle Scholar
O'Callaghan, M.E., & Couvadelli, B. (1998). Use of self-instructional strategies with three neurologically impaired adults. Cognitive Therapy and Research, 22 (2), 91–107.CrossRefGoogle Scholar
Ownsworth, T.L., & Mcfarland, K. (1999). Memory remediation in long-term acquired brain injury: Two approaches in diary training. Brain Injury, 13 (8), 605–626.CrossRefGoogle ScholarPubMed
Parish, L., & Oddy, M. (2007). Efficacy of rehabilitation for functional skills more than 10 years after extremely severe brain injury. Neuropsychological Rehabilitation, 17 (2), 230–243.CrossRefGoogle ScholarPubMed
Poggel, D.A., Kasten, E., & Sabel, B.A. (2004). Attentional cueing improves vision restoration therapy in patients with visual field defects. Neurology, 63 (11), 2069–2076.CrossRefGoogle ScholarPubMed
Polley, D.B., Steinberg, E.E., & Merzenich, M.M. (2006). Perceptual learning directs auditory cortical map reorganization through top-down influences. Journal of Neuroscience, 26 (18), 4970–4982.CrossRefGoogle ScholarPubMed
Prigatano, G.P. (1999). Principles of neuropsycholgical rehabilitation. New York: Oxford University Press.CrossRefGoogle Scholar
Prigatano, G.P., & Schacter, D.L. (1991). Awareness of deficit after brain injury: Clinical and theoretical issues. New York: Oxford University Press.Google Scholar
Rassovsky, Y., Satz, P., Alfano, M.S., Light, R.K., Zaucha, K., McArthur, D.L., . . . Hovda, D. (2006). Functional outcome in TBI II: Verbal memory and information processing speed mediators. Journal of Clinical and Experimental Neuropsychology, 28 (4), 581–591.CrossRefGoogle ScholarPubMed
Rath, J.F., Simon, D., Langenbahn, D.M., Sherr, R.L., & Diller, L. (2003). Group treatment of problem‐solving deficits in outpatients with traumatic brain injury: A randomised outcome study. Neuropsychological Rehabilitation: An International Journal, 13 (4), 461–488.CrossRefGoogle Scholar
Rieger, M., & Gauggel, S. (2002). Inhibition of ongoing responses in patients with traumatic brain injury. Neuropsychologia, 40 (1), 76–85.CrossRefGoogle ScholarPubMed
Ruff, R. (2005). Two decades of advances in understanding of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 20 (1), 5–18.CrossRefGoogle ScholarPubMed
Scherzer, B.P. (1986). Rehabilitation following severe head trauma: Results of a three-year program. Archives of Physical Medicine and Rehabilitation, 67 (6), 366–374.Google ScholarPubMed
Serino, A., Ciaramelli, E., Santantonio, A.D., Malagu, S., Servadei, F., & Ladavas, E. (2007). A pilot study for rehabilitation of central executive deficits after traumatic brain injury. Brain Injury, 21 (1), 11–19.CrossRefGoogle ScholarPubMed
Shallice, T. (1981). Neurologic impairment of cognitive processes. British Medical Bulletin, 37, 187–192.CrossRefGoogle ScholarPubMed
Silver, J.M., McAllister, J.W., & Yudofsky, S.C. (2005). Textbook of traumatic brain injury (1st ed.). Washington, DC: American Psychiatric Publishing.Google Scholar
Simon, D. (2001). Enhancing emotional control in persons with acquired brain damage (abstract). Rehabilitation Psychology, 46, 330.Google Scholar
Smith, G.E., Housen, P., Yaffe, K., Ruff, R., Kennison, R.F., Mahncke, H.W., . . . Zelinski, E.M. (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), 594–603.CrossRefGoogle ScholarPubMed
Sohlberg, M., & Mateer, C. (1987). Effectiveness of an attention training program. Journal of Clinical and Experimental Neuropsychology, 9, 117–130.CrossRefGoogle ScholarPubMed
Sohlberg, M., Mateer, C.A., & Stuss, D. (1993). Contemporary approaches to the management of executive dyscontrol. Journal of Head Trauma Rehabilitation, 8, 45–58.CrossRefGoogle Scholar
Sohlberg, M.M., Avery, J., Kennedy, M., Ylvisaker, M., Coelho, C., Turkstra, L., . . . Yorkston, K. (2003). Practice guidelines for direct attention training. Journal of Medical Speech-Language Pathology, 11 (3), 19-20–29.Google Scholar
Stratton, M.C., & Gregory, R.J. (1995). After traumatic brain injury: A discussion of consequences. Brain Injury, 8 (7), 631–645.CrossRefGoogle Scholar
Sturm, W., Willmes, K., Orgass, B., & Hartje, W. (1997). Do specific attention deficits need specific training? Neuropsychological Rehabilitation, 7, 81–103.CrossRefGoogle Scholar
Stuss, D., & Benson, D. (1986). The frontal lobes. New York: Raven Press.Google Scholar
Stuss, D.T., Shallice, T., Alexander, M.P., & Picton, T.W. (1995). A multidisciplinary approach to anterior attentional functions. Annals of the New York Academy of Sciences, 769, 191–211.CrossRefGoogle ScholarPubMed
Sun, R., & Zhang, X. (2004). Top-down versus bottom-up learning in cognitive skill acquisition. Cognitive Systems Research, 5, 63–89.CrossRefGoogle Scholar
Tiersky, L.A., Anselmi, V., Johnston, M.V., Kurtyka, J., Roosen, E., Schwartz, T., . . . Deluca, J. (2005). A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 86 (8), 1565–1574.CrossRefGoogle ScholarPubMed
von Cramon, D.Y., Matthes-von Cramon, G., & Mai, N. (1991). Problem-solving deficits in brain-injured patients: A therapeutic approach. Neuropsychological Rehabilitation, 1, 45–64.CrossRefGoogle Scholar
Webb, P., & Glueckauf, R. (1994). The effects of direct involvement in goal setting on rehabilitation outcome in persons with traumatic brain injury. Rehabilitation Psychology, 39 (3), 179–188.CrossRefGoogle Scholar
Wilson, B.A. (1997). Cognitive rehabilitation: How it is and how it might be. Journal of the International Neuropsychological Society, 3 (5), 487–496.CrossRefGoogle ScholarPubMed