Perspectives on rehabilitation of individuals with cognitive impairment after brain injury: Rationale for reconsideration of theoretical paradigms

Background: The frequency of cognitive impairment associated with traumatic brain injury (TBI) has led to the widespread use of cognitive rehabilitation as a discrete rehabilitative service. This service has become controversial in part because of disagreements regarding its theoretical base and implementation procedures, and in part because of insufficient experimental support. Objective: We outline two paradigms for cognitive rehabilitation that are interestingly different, both theoretically and procedurally. These paradigms are defined in relation to the goals of intervention, orientation to assessment, modalities of treatment, organization of treatment, and logistics of service delivery (setting, content, and provider). A rationale for each paradigm is described. Conclusion: We conclude with a call for (a) additional research into the effectiveness of interventions for individuals with cognitive impairment after TBI and (b) clinicians' thoughtful reflection on the foundations of their service.