Neurofunctional approach

Gordon Giles and Clarck Wilson in 1993

· acquired neurological impairments that affect cognitive functioning o TBI o Anoxic damage and other metabolic imbalances o Poisoning causing neurological damage o Infection o Some types of vascular accidents

· Most people improve following acute neuro damage · Rapid nature of recovery implicates neurophysiological processes other than learning o We can cause improvements by applying interventions.

o we now can justify the existence of OT by showing that improvements can be made using therapy.

· Remedial: the therapist attempts to train the client performing an actual (specific) functional task. (That is directed to a behavior of clinical importance) · Neurofunctional approach: Not successful unless trained to a point of automaticity (habitual enough to be self sustaining by the time the patient is discharged from the rehab setting) o ‘DO it until it’s automatic’

· Compensatory: to train clients in internal compensatory approaches with the goal of generalizability to novel situations - Often successful in lab settings but too effortful for clients in real life - B/c once they get home they don’t do it o Neurofunctional approach: Train clients in very specific behavioral routines without expectations of generalizability - Cognitive problems must be drilled specific tasks because they lack this generalizability

Remedial and compensatory strategies

Metacognitive functions
so that the individual can use retained executive skills to compensate for basic process deficits

Problem solving and reasoning

Car and Shepherd

Habits and routines

· Memory · Attention · Executive Functions · Self-Awareness · Metacognition

Explicit and implicit

a conscious and deliberate recall of factual knowledge and experiences

Explicit