Background Information
The New York University Medical Center/Rusk Institute Brain Injury Day Treatment Program has been in existence since 1978. For the first six years (1978-83), it was operated as a model(clinical demonstration) program for holistic neuropsychological rehabilitation of traumatically head-injured persons. The program was fully funded by the Federal Government (NIHR). It was established to: (a) test, by a systematic research protocol, the clinical effectiveness of innovative cognitive, behavioral, and vocational remedial-rehabilitation techniques that were developed by the program; (b) determine which traumatically head-injured individuals are the best candidates for such a holistic program of rehabilitation; and, (c) spread the information among rehabilitation professionals acrossthe U.S. through workshops and printed publications. For relevant references, see the list of publications.
The Rationale for Holistic (Therapeutic Community) Neuropsychological Rehabilitation
The rehabilitation of a patient following a brain injury does not, and should not be expected to, follow the usual medical model (e.g., mending a broken leg; surgically removing or repairing an injured organ; treating an infection with antibiotics). When physiologic damage to the brain occurs (e.g., shearing/stretching of nerve tissue, bruising, ruptured blood vessels, creation of scar tissue, etc.), the damage is usually permanent and irreversible. In that sense, once brain damaged, always brain damaged. Rehabilitation is the fusing together of remedial interventions that are designed to deal with the functional consequences of the brain injury, meaning the ways it has affected the individual’s ability to live his or her life.
The rehabilitation of a brain-injured person is, thus, aimed at enabling the patient to regain, to the highest degree possible:
• competence and independence in
living arrangements, self-care, and in managing one's personal
affairs;
• competence and reliability in relating to others, i.e.,
interpersonal and social adjustment;
• competence and reliability in performing study and/or
work-related activities, which are relevant to the determination
of the patient's future work/study potential;
• a stable emotional adjustment to the disability, which
includes the calm acceptance of the permanence of one's brain
injury; the maintenance of a positive, that is, hopeful, outlook
on the future; and the improvement of one's self-esteem.
To achieve these aims, it is important to coordinate the cognitive remedial treatment with the other clinical management and therapeutic interventions, so that each will make the other possible. Thus, the patient will be able to translate the combined rehabilitation treatment into functional competence and stable adjustment in the personal, social, and vocational areas of his or her life. A separation of the cognitive remedial training interventions (i.e., those interventions aimed at making it possible for the patient to compensate for specific intellectual and behavioral impairments due to the brain injury) from the other clinical interventions (i.e., helping the patient accept his/her predicament; restoring a sense of hope; motivating and improving morale; teaching the patient ways of adjusting to his/her misfortune and how to exercise appropriate social judgment) will prevent the optimal rehabilitation of the brain-injured person.
Thus, the best program of neuropsychological rehabilitation of the brain-injured individual is one that addresses, systematically and in an integrated fashion, the cognitive/remedial, behavioral/emotional, interpersonal, and vocational aspects of the neuropsychological rehabilitation. The New York University Medical Center/Rusk Institute Brain Injury Day Treatment Program was designed to accomplish this task.
