Pamela S. Klonoff

Cognitive retraining after traumatic brain injury and its role in facilitating awareness

This article explores the nature and rationale of cognitive retraining activities in a neuropsychologically oriented outpatient rehabilitation program. Daily performance on tasks of speed of information processing, memory, language, flexibility, and visuospatial problem solving provide valuable quantitative and qualitative data. Individualized compensatory strategies are developed. Patients learn about residual strengths and weaknesses and their impact on work performance. In this way cognitive retraining activities promote greater self-awareness, which facilitates better psychosocial functioning and return to productive work.

Cognitive, Personality, and Psychosocial Factors in the Neuropsychological Assessment of Brain-Injured Patients

The clinical neuropsychologist faced with the assessment of traumatic brain- injured adults (and other brain-dysfunctional patients) must eventually confront three interrelated diagnostic questions: 1. What is the nature and severity of higher cerebral dysfunction? 2. What is the patient’s personal reaction to these deficits? 3. What is the cumulative effect of these two dimensions on interpersonal or psychosocial adjustment?

Suicide in Patients With Traumatic Brain Injury: Risk and Prevention

Many patients sustaining traumatic brain injury (TBI) experience multiple deficits affecting cognition, personality, and physical independence. Often there is a dramatic and permanent change in work status, income, family life, support network, and quality of life. Clinical experience indicates that

Neuropsychological rehabilitation of young adults who suffer brain injury in childhood: Clinical observations

Abstract Young adults who suffer brain injury during childhood present clinically with predictable neuropsychological and psychosocial problems in young adulthood. This paper summarises clinical observations concerning four such patients, three of whom were treated within the context of a neuropsycho-logically oriented rehabilitation programme. The implications of these observations for the development of future rehabilitation programmes for children are considered briefly.

The relationship of neuropsychological variables to driving status following holistic neurorehabilitation.

Objective: The main objectives of the present study were to evaluate the cognitive and driving outcomes of a holistic neurorehabilitation program and to examine the relationship between the neuropsychological variables of attention, speed of information processing, and visuospatial functioning and driving outcomes. Methods: One hundred and twenty-eight individuals with heterogeneous neurological etiologies who participated in a holistic neurorehabilitation program. Holistic neurorehabilitation consisted of therapies focusing on physical, cognitive, language, emotional, and interpersonal functioning, including training in compensatory strategies. Neuropsychological testing was administered at admission and prior to starting driving or program discharge. Subtests of processing speed, working memory, and perceptual reasoning from the Wechsler Adult Intelligence Scale-III and Trail Making Test were included. Results: At the time of discharge, 54% of the individuals returned to driving. Statistical analyses revealed that at the time of discharge: the sample as a group made significant improvements on cognitive measures included in the study; the driving and non-driving groups differed significantly on aspects of processing speed, attention, abstract reasoning, working memory, and visuospatial functions. Further, at the time of admission, the driving group performed significantly better than the non-driving group on several neuropsychological measures. Conclusion: Cognitive functions of attention, working memory, visual-motor coordination, motor and mental speed, and visual scanning significantly contribute to predicting driving status of individuals after neurorehabilitation. Holistic neurorehabilitation facilitates recovery and helps individuals to gain functional independence after brain injury.

Milieu-Based Neurorehabilitation at the Adult Day Hospital for Neurological Rehabilitation

The Adult Day Hospital for Neurological Rehabilitation (ADHNR) has been providing a milieu-based rehabilitation program for persons with acquired brain injury at the Barrow Neurological Institute in Phoenix, Arizona, since January 1986. The ADHNR program was initially implemented by George P. Prigatano, PhD and Pamela S. Klonoff, PhD, based on a similar program at Presbyterian Hospital in Oklahoma City that Dr. Prigatano directed from 1980 to 1985. The Neuropsychological Rehabilitation Program at Presbyterian Hospital in Oklahoma City was a milieu-based program that assisted patients in becoming aware and acceptant of the neuropsychological consequences of their injuries, improving their personal reactions to their injury, and obtaining employment commensurate with their abilities (Prigatano et al., 1986). Morning hours were devoted to the remediation of and compensation for changes in cognitive, personality, and physical functioning. As time passed, the program was modified to include a structured work experience in order to enhance the effects of therapy within a work setting. The program emphasized developing a good working alliance, not only with patients, but also with family members.