Objective: Presentation and exemplification of a specific therapeutic paradigm for the comprehensive post-acute neurorehabilitation of brain injuries of profound severity. Method: A case study examined the recovery of a 21-year-old man with a traumatic brain injury of profound severity, as indicated by coma duration of 3 months and post-traumatic amnesia duration of 12 months. After post-traumatic amnesia lifted, he received 12 months of intensive, full-service hospital based neurorehabilitation of a conventional, interdisciplinary design. After discharge, he and his mother requested admission to an intensive, post-acute holistic neuropsychological rehabilitation program of transdisciplinary design (in the tradition of the Tel Aviv program created by Ben-Yishay and associates). At that time, he was 100% dependent in all functions except toileting, indicating the essential failure of his unusually extensive program of conventional rehabilitation. His application for admission to the new program was denied, as he did not meet the minimum requirements for autonomous functioning. Instead, an innovative course of dyadic rehabilitation was implemented. His mother was trained to supervise treatment in real-life settings, minimizing the generalization requirements. Mother was a retired nurse who understood and accepted the need for a “tough love” approach to therapy, and she accepted and held herself to strict standards regarding cuing and assistance. Some of the sessions were manualized. Results: The affection and trust between mother and son facilitated therapeutic impact and carryover. They were successful in establishing a fully autonomous morning routine at home, as well as effective use of a memory notebook in which he recorded and from which he retrieved practical information without cuing or assistance. They were successful in teaching him to use public transportation to travel to and from the community unaccompanied. He recorded instructions for errands and performed them error free with no assistance. He was also trained to keep his medical appointments with no assistance, relating personal and familial questions about his medical condition and making audio recordings of the physician's summary and recommendations. At discharge, the dyad had developed detailed plans for job coaching leading to autonomous employment in a low-demand entry level job.
A Survivor-Caregiver Dyad as the 'Agent Of Change' in the Neurorehabilitation of Traumatic Brain Injury of Extreme Severity
L Schutz; A-84
A Survivor-Caregiver Dyad as the 'Agent Of Change' in the Neurorehabilitation of Traumatic Brain Injury of Extreme Severity. Arch Clin Neuropsychol 2015; 30 (6): 517. doi: 10.1093/arclin/acv047.84
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