useful site, whether braces or a wheelchair might allow the person to navigate the community despite the paralysis, and even whether architectural modifications, urban planning, or transportation services could help overcome barriers to mobility. The treatment interventions used in physical rehabilitation include traditional drug and surgical treatments, as well as physical exercise, technology (e.g., braces, wheelchairs), skill training (e.g., learning how to use a wheelchair), and social policies and services (e.g., accessible transportation).
However, rehabilitation is not limited to improving physical disability. Cognitive rehabilitation attempts to enhance functioning and independence in patients with cognitive impairments as a result of brain damage or disease, most commonly following TBI or stroke. As with physical rehabilitation, cognitive rehabilitation may include interventions that aim to lessen impairments, or interventions that aim to lessen the disabling impact of those impairments. Interventions are applied through technology and other compensatory strategies that may allow the individual with cognitive impairment to accomplish important life activities and more fully participate in society.
Cognitive rehabilitation therapy (CRT) may sometimes be confused with cognitive behavioral therapy. It is important to distinguish between the two. While not mutually exclusive and sometimes delivered conjointly, these two therapies are certainly separate and distinct, differing in both treatment goals and techniques. CRT is used to rehabilitate thinking skills (e.g., attention, memory) impaired by a brain injury. Cognitive behavioral therapy is commonly used for a variety of emotional and psychiatric disorders, including mood, anxiety, and psychotic disorders, as well as sleep disturbance and chronic pain. Cognitive behavioral therapy typically centers on modifying maladaptive thoughts and emotional behaviors and using psychoeducation regarding symptoms and expectations for recovery. The latter technique also may be a component of CRT. Cognitive behavioral therapy includes training in anxiety management and how to recognize and reappraise distorted negative thoughts, and, for some disorders, exposure to anxiety-provoking or distressing stimuli with the intent of forming new adaptive emotional associations with the feared stimuli. The 2008 Institute of Medicine (IOM) report, Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence, provides a more comprehensive description of cognitive behavioral therapy.
The breadth of treatments included in CRT mirrors that of the World Health Organization’s International Classification of Functioning, Disability, and Health (WHO-ICF). As described in Chapter 1, the WHO-ICF framework recognizes impairments in body structures and functions (e.g., impaired memory) as a result of disease or injury, and limitations in activities and participation, i.e., the ability to carry out important daily activities