| Current research of neurocognitive deficits of acquired brain injury stemming from stroke and head injury was reviewed. The literature on incidence, survival rate and early release from acute care service suggests an increased need for comprehensive rehabilitation programs. Historical milestones in neurosciences and its evolution into the specialized field of neuropsychology were discussed. Important accounts that preceded and influenced the emergence of cognitive rehabilitation were also recounted. Definitions of cognitive rehabilitation were presented. Relevant theoretical frameworks, concepts from experimental neurosciences such as neuroplasticity, consequences of disease, and clinical applications were discussed. A neurobehavioral rehabilitation program was designed and conceptualized based on Luria's theoretical framework, Sohlberg & Mateer's extensive clinical model of cognitive rehabilitation, Ben-Yishay & Prigatano's comprehensive approach, and on evidence-based research. A holistic approach framed the program. As such, the, treatment of cognitive sequelae and behavioral and emotional disturbances were incorporated. The Gate-Control Theory of pain was discussed, as well as the clinical applications of the biofeedback modality. Biofeedback treatment was included to address anxiety, stress and pain management. Multi-Cultural aspects in clinical settings were addressed. The program was designed to be implemented at Carlos Albizu University in Miami, Florida. It includes a description of staff, budget, admission criteria, equipment, instrumentation, and materials. A set of protocols for cognitive rehabilitation was designed based on recommendations from evidence-based research. Practice standards, guidelines and options, based on such extensive meta-analysis and research, were included. Three protocols were developed for the cognitive rehabilitation modality for the treatment of attention deficits, memory deficits and executive functions. In the biofeedback modality two protocols were developed. A protocol for pain management addresses musculoskeletal and neuropathic pain management. The protocol, for anxiety and stress management, can also be implemented for risk-prevention and medical conditions, such as hypertension. A discussion addresses recommendations for the implementation of the program, such as thorough involvement of the clinician, and planning for generalization of acquired skills to daily life activities through multimodal exposure. An important recommendation pertains to addressing both cognitive and behavior or personality disturbances, which seems to be best attained through the incorporation of a holistic approach. Thus, attention to multicultural aspects is relevant in order to address the meaning the patient endows to cognitive dysfunctions and behavioral disturbances. Initiation during the post-acute phase was also recommended, as well as including demographics and observing methodological rigor in future research such as implementing randomized controlled trials. Contributions of the design, such as providing protocols from evidence-based research, plausibility of the application in a multi-cultural context, and anchor for curricula development, as well as expectations of heuristic value were assessed. |
