The past, present and future of neuropsychological rehabilitation
Barbara Wilson
This presentation begins with a description of the early stages of neuropsychological rehabilitation from World War One until 1990. It includes accounts of the pioneering work of Goldstein, Poppelreuter, Luria and Zangwill, the development of the holistic rehabilitation movement by Ben-Yishay, and the influence of theoretical models from cognitive neuropsychology. This is followed by a discussion of present day neuropsychological rehabilitation covering the past twenty years. The main characteristics and principles of neuropsychological rehabilitation are considered and recent “cutting edge” developments highlighted. These include new treatment strategies for cognitive, emotional and psychosocial problems; new theoretical models to improve our understanding of the consequences of brain injury; and recognition of the need to find new ways to evaluate the efficacy of rehabilitation. The presentation concludes with a consideration of possible future developments in rehabilitation, including stronger links with basic neuroscience; better use of imaging procedures; collaboration with pharmaceutical companies; better evaluation of our programs; and the need to educate researchers and practitioners as to the meaning and importance of rehabilitation.
A abordagem multidisciplinar na reabilitação após lesão cerebral adquirida: o modelo da Rede Sarah de Hospitais/ Brasil
Lucia Braga
A reabilitação após lesão cerebral implica uma intervenção baseada no contexto de cada pessoa para que os ganhos sejam efectivamente transferidos para a vida que assim permitam melhor a sua auto-estima e qualidade de vida. Com este objectivo, desenvolvemos na Rede Sarah uma abordagem transdisciplinar que envolve a família e os pares e é realizada de forma individualizada segundo os interesses e capacidades de cada indivíduo. Todos os profissionais actuam de forma altamente integrada, compartilhando conhecimento, para que cada ser humano seja visto como um todo, considerando-se a interacção dinâmica de todos os aspectos biopsicosociais. Nesta comunicação vamos mostrar como se desenvolveu esta abordagem humanista, como hoje ela é praticada e se expandiu para vários centros, e ainda, alguns estudos randomizados controlados que demonstram a efectividade e os bons resultados deste modelo.
Quality of Life after Brain Injury – The QOLIBRI-questionnaire as a transcultural tool
Nicole von Steinbüchel
The QOLIBRI is a novel disease-specific health-related quality of life (hrQoL) instrument specifically developed for traumatic brain injury (TBI) that provides a profile of QoL in six domains with 37 items together with an overall score. It was simultaneously and cross-culturally developed in six languages, additional eight are currently validated.
Psychometric properties and factors associated with hrQoL of two international studies will be reported. A total of 1528 and 921 adults with TBI were enrolled (between 3 months to 15 years post-injury). The majority of participants (58%) had severe injuries as assessed by 24-hour worst GCS.
The QOLIBRI scales meet standard psychometric criteria (internal consistency, α= .75 to .89, test-retest reliability, r tt=.78 to .85). Test-retest reliability (r tt= .68 to .87) as well as internal consistency (α= .81 to .91) was also good in participants with lower cognitive performance. The QOLIBRI was developed and validated by exploratory and confirmatory factor analyses and Rasch modelling.
Systematic relationships were observed between QOLIBRI and GOSE, HADS, and SF-36. Within each scale participants with disabilities reported having low QoL in two to three times as many areas as those who showed good recovery. The main correlates of a total QoL score were emotional state functional status and comorbid health conditions. The QOLIBRI is the first tool to measure multi-nationally disease-specific health-related QoL after TBI. It assesses novel information not given by other currently available instruments especially valuable to monitor neuro-rehabilitative processes.
Reabilitação Neuropsicológica em Portugal: Estado-da-arte
Sara Cavaco
Brain injury rehabilitation in Portugal has been constructed in three different platforms: 1) early intervention in general hospitals; 2) post-acute inpatient or outpatient intervention in rehabilitation hospitals; and 3) vocational rehabilitation centers. In the last decade, these platforms have progressively evolved towards a more spatially distributed, integrated network and have demonstrated an increasing concern with the neurobehavioral sequelae of brain injury.