To help promote the development of better cognitive rehabilitation techniques, we believe it is important to go beyond assessment of the presence or absence of cognitive disabilities, to specify at a foundational level the nature of deficits. We are currently writing up several projects from an NIH supported study that was designed to provide better scientific evidence to guide cognitive rehabilitation by more fully characterizing the potential early-learning mechanisms of TBI patients, and by prospectively evaluating the recovery trajectories of both automatic and controlled cognitive processes. Participants with TBI and controls completed experimental tasks designed to assess automatic and more controlled components of visual search, semantic priming, and memory. These task were administered following the TBI patients emergence from post-traumatic amnesia (PTA), and then again at 2-, 6-, and 12-month follow-up intervals. We also tracked the recovery of other less studied but important cognitive processes, including time perception, prospective memory, temporal order memory, focused attention, and metamemorial abilities.
We recently completed a series of studies that focused on an important goal of rehabilitation; maximizing the patient’s ability to function independently and to reintegrate into the home and community. It has been argued that when the rehabilitation environment is more closely connected to the goals and activities that people aspire to complete in their everyday lives, patients will be more motivated to reach their rehabilitation goals and rehabilitation strategies will better generalize to everyday situations. This has led some medical rehabilitation facilitates to invest in simulated community environments, where facsimiles of grocery stores, restaurants, bus stations, cross walks, and recreational venues can help patients make a direct connection to real life challenges. Although theoretical rationale for use of simulated environments is sufficiently strong, there is little empirical support. The purpose of the project was twofold: First, we were evaluating the efficacy of a newly developed diagnostic instrument for use in the simulated community, the “Shopping Trip Task,” to predict patient reintegration into the home and community environment. Second, we were evaluating the efficacy of the simulated community environment in the treatment of cognitively impaired patients. We would like to expand this work to include interventions to support awareness of deficits in both patients and family members, and smart technologies for ecological momentary interventions.