Two Approaches to Neurocognitive Rehabilitation: Skills or Strategies.
Occupational therapists can assist clients with neurocognitive disorders from neurological insult or injury re-develop skills via practicing those skills to the point where they become automatic (the development of knowledge without conscious decision-making), or can attempt to teach clients strategies that the client can tailor for themselves and can apply to novel problems encountered in daily life. Evidence suggests that both approaches can be successful, however those individuals most likely to benefit from this different approaches have not been clearly identified. It is further argued that attempts to remediate “pure” cognitive processes have largely been ineffective and that occupational therapists central aim should be to address abilities and participation and not cognitive impairments. The core concepts underlie the application of these principles are reviewed. The relatively new construct of functional cognition defined as the ability to use and integrate thinking and processing skills to accomplish complex everyday activities is seen as a way to inform treatment decisions.
Dr. Gordon Muir Giles earned a Bachelor’s degree in Political Philosophy from the University of Warwick, UK, and a Graduate Diploma in Occupational Therapy from St. Andrews School of Occupational Therapy, he received an MA., and Ph.D. in Clinical Psychology from the California School of Professional Psychology, Alameda, CA. Dr. Giles was a senior occupational therapist at the first program for neurobehavioral disorders for brain-injured people in the world, the Kemsley Unit of St. Andrew’s Hospital, UK. An internationally recognized expert in the field, Dr. Giles developed the first publicly funded long-term neurobehavioral program in the USA, West of the Mississippi, and his work has served as a model for subsequent program worldwide. In the late 1980s and early 1990s Dr. Giles in collaboration with Jo Clark-Wilson developed the neurofunctional approach to brain injury rehabilitation which has been described as the only approach to be effective in functional skills rehabilitation 10 years post injury, and is the only approach shown to accelerate the recovery process during post traumatic amnesia. Recently Dr. Giles has been working with AOTA and a team of outstanding occupational therapy researchers to forward the concept of functional cognition as a central concern of occupational therapists. Dr. Giles is a Professor at Samuel Merritt University in Oakland California and Director of Neurobehavioral Services at Crestwood Behavioral Health, Inc. he lives and works in the San Francisco Bay Area.