Finding the Right Treatment Combinations: Changes in Rehabilitation Over the Past Five Years
Progress toward finding the right treatment combinations has advanced along a number of fronts in the past 5 years. These include developments in identifying behavioral characteristics at both ends of severity in the recovery from traumatic brain injury. At the most severe end is the application of newer assessment devices, and at the opposite end is the clarification of the definition of minor traumatic brain injury. In the middle range there have been two major developments. First, there has been a proliferation of therapeutic modalities to establish competence in functional settings. Among them are the increase of group methods, the applications of the family coach model as a tool, the use of supported employment, and the introduction of computers for orthotic devices or cognitive aids. Second, there has been a large number of reports on varieties of cognitive remediation. These reports are reviewed with regard to the nature of outcomes that are achieved and their experimental designs. Along with the increase and diversity of procedures, there is a reemphasis on psychological constructs related to ego psychology such as awareness and self-efficacy as relevant modulating variables in facilitating response to treatment.
The ideal situation is one in which a patient with a known condition is treated with a known intervention toward a known outcome. In practice, we treat patients with partial knowledge of their conditions, with partial knowledge of the effects of interventions, and with