Revisiting the neurofunctional approach: Conceptualizing the core components for the rehabilitation of everyday living skills

Abstract

BackgroundBackground: 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.Description of the approachDescription of the approach: The NFA is a client-centred, 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.Recent evidenceRecent evidence: 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.

Integrated Behavioral Intervention and Person-Centered Therapy Within Community-Based Treatment of an Adult With Acquired Brain Injury

“…She lived in a community-based group home for individuals with acquired brain injuries and received individualized (1:1) support from care providers throughout her awake hours. The care providers implemented instructional and training procedures with Natalie according to a neurofunctional rehabilitative model that focused on self-care, daily living, vocational, and safety skills (Clark-Wilson et al, 2014).…”

The interrelationship of functional skills in individuals living in the community, following moderate to severe traumatic brain injury

“…During IADL tasks the client needs to use executive functions to adapt responses to novelty and changing environmental demands. Although IADL tasks can become easier with practice, because of the need for novel problemsolving, they do not become fully automatic (30,31).…”

Implementation Intentions for Self-Selected Occupational Therapy Goals: Two Case Reports

“…Future versions of this intervention approach should include more and varied practice opportunities for anticipating and identifying triggers. Because successful use of implementation intentions appears to require self-awareness, anticipation, and the ability to generate new potential responses, this approach may not be appropriate for people with severe cognitive impairment (Clark-Wilson et al, 2014).…”

“…This difficulty may explain why people often act in ways that are contrary to their intentions (Gollwitzer, 1999). Therefore, MSI may not in and of itself advance enactment of goal behaviors, because successful strategy implementation is contingent on intact functioning of the impaired cognitive skills it is designed to circumvent (Clark-Wilson, Giles, & Baxter, 2014).…”