Research

Introduced in the 1980s, the neurofunctional approach (NFA) is one of the few interventions designed primarily for clients with severe deficits following traumatic brain injury (TBI). Specifically the NFA was intended for those individuals who were limited in their ability to solve novel problems or generalize skills from one setting to another and whose lack of insight limited their engagement in the rehabilitative process.

The NFA is a client-centered, goal-driven approach that incorporates the principles of skill learning and promotes the development of routines and competencies in practical activities required for everyday living. Programmes based on the NFA are developed specifically to meet each client’s unique needs, using a range of evidence-based interventions.

Recently the NFA has been found to be more effective than cognitive-retraining for some individuals with moderate-to-severe TBI who have deficits in activities of daily living. This paper aims to define the core features of the NFA, outline the theoretical basis on which it is founded and consider implications of the findings for rehabilitation after TBI in general. The NFA is highly relevant for clients living in the community who require a case manager to direct an integrated, rehabilitation programme or provide structured input for the long-term maintenance of skills.

To examine memory skills, at acute, 6- and 12-monthly stages, following childhood traumatic brain injury (TBI). Research design : Prospective, longitudinal, between-group design, comparing pre-injury and postinjury intellectual and memory measures, across three levels of injury severity.

Investigation of memory skills in a group of 76 children who had sustained a mild, moderate or severe TBI. Specific tests were used to measure immediate and short-term memory, and more complex multi-trial learning.

The severe TBI group exhibited greater deficits on memory tasks, irrespective of modality, in the acute, 6- and 12-month post-injury stages, in comparison to mild and moderate TBI groups. Performance was dependent on both injury severity and task demands.

Memory difficulties are present during the acute, 6- and 12-months following childhood TBI. With a clearer understanding of the memory deficits following TBI, appropriate strategies can be taught and interventions implemented for these children.

Disruptions to executive function (EF) may occur as a result of traumatic brain injury (TBI), in the context of direct damage to frontal regions or in association with disruption of connections between these areas and other brain regions. Little investigation of EF has occurred following TBI during childhood and there is little evidence of possible recovery trajectories in the years post-injury. The present study aimed to (i) examine whether a dose-response relationship exists between injury severity and EF; (ii) document recovery of EF in the 2 years post-injury and (iii) determine any additional predictors of outcome in the domain of EF.

The study examined EF in a group of 69 children who had sustained a mild, moderate or severe TBI. Four components of EF were assessed: (i) attentional control; (ii) planning, goal setting and problem solving; (iii) cognitive flexibility; and (iv) abstract reasoning.

Children sustaining severe TBI at a young age are particularly vulnerable to impairments in EF. While these difficulties do show some recovery with time since injury, long-term deficits remain and may impact on ongoing development.