Intervention and Rehabilitation: Cognitive, Behavioral, and Psychosocial Approaches
Core concepts to master
Rehabilitation rests on neuroplasticity, compensation, and environmental adaptation. Know the distinction between restorative (impairment-focused) and compensatory (function-focused) approaches, and when each is appropriate. Cognitive rehabilitation targets attention, memory, and executive function through strategy training, external aids, and errorless learning. Behavioral approaches address agitation, disinhibition, and apathy. Psychosocial intervention includes psychoeducation, caregiver support, vocational adjustment, and mood treatment.
Evidence-based practice requires knowing which interventions have support (e.g., strategy training for executive dysfunction, external memory aids) versus those with weak evidence. Consider the patient's goals, environment, and capacity for learning.
Traps
Assuming restoration is always preferable to compensation. Ignoring generalization - skills trained in clinic may not transfer. Overlooking caregiver burden and mood as treatment targets. Applying a single approach regardless of injury chronicity or severity.
Rule of thumb
Match approach to residual capacity and goal: early/severe deficits favor compensation and environmental support; preserved learning capacity favors restorative strategy training. Always include the patient's real-world goals and caregivers in the plan.
Worked example: A patient with severe amnesia and preserved procedural learning benefits from errorless learning and external aids rather than repeated rote recall drills.