Assessment and Cognitive/Behavioral Interventions in Moderate to Severe Traumatic Brain Injury Along the Healthcare Continuum

Abstract

Patients with moderate to severe traumatic brain injury (TBI) and their caregivers often present with new, worsening, or stable complaints related to cognitive impairment requiring intervention. Cognitive rehabilitation after TBI focuses on maximizing functional ability and independence by ameliorating the impact of cognitive impairment. This chapter aims to summarize evidence-based practices in cognitive rehabilitation in moderate to severe TBI considering acute, postacute, and late rehabilitation phases. Neuropsychologic assessment is proposed as a comprehensive method to better characterize cognitive impairment as well as to assist with differential diagnosis, treatment planning, monitoring recovery, and determining the efficacy of interventions. Conceptual approaches to cognitive rehabilitation are explained along with specific cognitive rehabilitation techniques, including restorative, compensatory, or metacognitive interventions, and recommendations to improve cognitive outcomes. Given that reduced awareness interferes with cognitive rehabilitation, assessment of and interventions for self-awareness deficits are also reviewed. The role of family members in patient s rehabilitation to maximize the quality of life and independence as well as the impact of TBI on the family are described. Several community reintegration and extended care programs depending on patients /caregivers needs are presented. Finally, cultural diversity issues in TBI rehabilitation are highlighted for consideration.