Neuropsychological rehabilitation (Wilson)

Domain IX · Biomedical, neuro & digital · Barbara Wilson, Gracey, Evans · Ely, UK (Oliver Zangwill Centre)

What it is

Holistic neuropsychological rehabilitation is a programme model, not a single therapy. It is a post-acute, mainly day-programme service for adults with non-progressive acquired brain injury (traumatic brain injury, stroke, hypoxia, encephalitis and similar). An interdisciplinary team works on…

Format

• Referral and assessment: neuropsychological and interdisciplinary assessment leading to an interdisciplinary formulation covering cognitive, emotional, physical, linguistic, social and functional domains. In the OZC programme as described in 2021, clients attend a two-day interdisciplinary…
• Intensive day programme: individual therapy plus a fixed set of groups. The OZC groups named in Wilson et al. (2009) are: Understanding Brain Injury; Cognitive Group part 1 (attention and goal management) and part 2 (memory); Mood Management; Psychological Support; Communication; practically based…

Who practises it, and how they are trained or regulated

• Typical daily format (Barrow, 2000). Individual cognitive retraining first; cognitive group modules (3–8 weeks each); current events group weekly; datebook group twice weekly; group psychotherapy four times weekly; a 15-minute milieu session at the end of the morning; community outings weekly; a weekly relatives' group; individual therapy several times a week; staff team meetings four times weekly.
• Version followed: the Oliver Zangwill Centre (OZC, Ely, UK) holistic model as described by Wilson, Gracey, Evans and Bateman (2009) and the OZC team's account of its core components (Bateman et al., 2005); the Ben-Yishay (Rusk Institute, New York) and Prigatano (Oklahoma City, then Barrow Neurological Institute, Phoenix) milieu programmes as described by García-Molina and Prigatano (2022) and Klonoff et al. (2000);…
• Who delivers it, and the psychotherapist's role. Programmes are run by an interdisciplinary team led clinically by clinical neuropsychologists, with occupational therapists, speech and language therapists, physiotherapists, vocational staff and medical input as needed. In the UK the psychologists are practitioner psychologists registered with the Health and Care Professions Council (HCPC); the British Psychological…

Evidence status, as the guide reports it

• Evidence status (attributed). Cicerone et al. (2019, systematic review of literature 2009–2014) give post-acute comprehensive-holistic rehabilitation a Practice Standard (their highest level) for reducing cognitive and functional disability after traumatic brain injury or stroke, "regardless of…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• staff taking over; the same members dominating.
• staff rescuing tasks; overstimulation in public settings.
• embarrassment at video feedback; aphasia needing individual work.
• split teams; staff burnout; inconsistent responses to the same behaviour.
• low mood mistaken for apathy from frontal injury or the reverse; suicidal thinking (see 28).

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.