Cognitive Rehabilitation Manual: Translating Evidence-Based Recommendations into Practice

The Cognitive Rehabilitation Manual was developed by the Cognitive Rehabilitation Task Force of the Brain Injury Interdisciplinary Special Interest Group (BI-ISIG) of the American Congress of Rehabilitation Medicine. The manual is intended to guide clinicians in planning and administering evidence-based cognitive rehabilitation treatments. It would be most suitable for beginning or intermediate clinicians who are treating patients in the post-acute phase of rehabilitation. Chapter 1 provides a general framework for organizing interventions into three distinct stages of treatment and recognizes the continuum of learning and support necessary to help patients acquire and ultimately generalize strategies and skills to real world contexts. Chapters 2–6 apply this framework to the rehabilitation of executive functions, memory, attention, hemispatial neglect, and social communication. The rehabilitation chapters begin with general descriptions of the impairments followed by broad treatment recommendations from the BI-ISIG. This is followed by descriptions of specific treatment protocols that have been endorsed in the literature. The manual is both ambitious and straightforward. Ambitious as it covers a wide range of cognitive impairments and different types of therapy approaches and distills the content into the most essential information. The handbook is straightforward in that it is procedural and uses list format to describe clinical protocols. Several features make it a very practical guide for busy clinicians. There are a number of generic and specific treatment forms that clinicians can photocopy and use to record treatment data. The provision of forms helps concretize the treatment procedures as clinicians have a structure for collecting and using treatment data. Another very practical feature is the provision of sample long-term and short-term treatment goals for the different treatment areas. Similarly, a number of the chapters provide scripts for how to introduce or explain treatment. Having exemplar wording for written treatment goals and discussions with clients is illustrative especially for clinicians somewhat new to cognitive rehabilitation. Another helpful feature is graphic decision trees that provide flowcharts for making clinician decisions and help to ensure that individual client profiles are accommodated. For example, for some interventions, a prerequisite skill would be intact awareness; the decision tree ensures a clinician will consider this information when selecting a treatment. Chapter 2, Rehabilitation for Impairments in Executive Functions, is particularly comprehensive. It describes strategy training for impairments in executive functions, problem solving, and behavioral and emotional dysregulation, including awareness deficits. Several treatment protocols are detailed in an easy-to-follow format and the rationale for the treatment components is explained well. The treatments described in the manual are selected based on a series of reviews supported by the BI-ISIG group of experts. At times, this results in a somewhat piecemeal collection of interventions that are not theoretically well linked. It also can result in a cursory overview of complex rehabilitation practices. Clinicians will need to have background information on neuropsychological functioning and assessment in order to select interventions best matched to client profiles. The manual does not address assistive technology which has become integral to cognitive rehabilitation; however, the evidence-based principles of training a memory notebook and the protocols that involve errorless learning and spaced retrieval could be applied to the more commonly used computer devices and electronic applications. This manual is set up as a handbook to facilitate administration of a range of cognitive interventions that have been described in the literature. It is neither intended to provide a comprehensive review of the field nor is it intended to be a one-size-fits-all cookbook. It addresses the “how to” questions more than “why” questions behind rehabilitation. Although it reviews interventions that have been experimentally evaluated, it also provides practical therapeutic suggestions that recognize rehabilitation involves a dynamic interaction between the clinician and the patient. The step-by-step techniques with sample protocols will make this a valuable resource for clinicians treating clients with acquired cognitive impairments.