(e.g., remembering weekly appointments) and the ability to participate in society (e.g., employment, home, school, or community). Activity and participation limitations result when the person with the impairment(s) interacts with the physical and social environment. For example, an individual with TBI may have difficulty learning and remembering new information. With repeated training, the individual may be able learn some basic routines, such as writing appointments and other important information down in a daily planner and consulting it frequently. These routines enable the person to keep track of a schedule and other important tasks despite memory impairment. Several professional organizations endorse the use of the WHO-ICF for characterizing CRT, including the American Occupational Therapy Association, the American Physical Therapy Association, and the American Speech-Language-Hearing Association (American Occupational Therapy Association 2011; American Physical Therapy Association 2003; American Speech-Language-Hearing Association 2003b).

AN EVOLVING DEFINITION OF CRT

Specific cognitive and communication needs of patients with brain injury propelled the parallel development of CRT within multiple professional disciplines, including clinical psychology, neuropsychology, speech-language pathology, occupational therapy, physical therapy, and physiatry (i.e., rehabilitation medicine) (Prigatano 2005). Collaboration with academic colleagues in other disciplines such as cognitive psychology also occurred. The various disciplines share a common goal: each intends to help patients with cognitive impairments function more fully, either by focusing on the impairment itself or the activities affected by the impairment (as described by the WHO-ICF framework). Chapter 5 provides full descriptions of the disciplines and providers of CRT, and their approaches to treatment.

The heterogeneity of the possible interventions makes it challenging to narrowly define the concept of CRT, or how to effectively apply it. Current definitions of CRT focus on the intention to improve or accommodate one or more impaired cognitive functions, rather than on the contents or active ingredients of treatment. Intentional definitions can limit the interpretation of CRT evidence since treatment efficacy and effectiveness depend more on the contents and processes of treatment than the intention of the clinician providing it. Table 4-1 includes assembled definitions of CRT based on intent.

The most commonly referenced definition of CRT is interdisciplinary, endorsed by the Brain Injury Interdisciplinary Special Interest Group (BI-ISIG) of the American Congress of Rehabilitation Medicine (ACRM). This description allows for comprehensive, interdisciplinary rehabilitation programs with interventions to restore or reorganize function, compensate



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