Neurofunctional Approach

Neurofunctional Approach

1. Neurofunctional Approach Marcella Matteo, Reina Salazar, Ashley Feigenbutz

2. Neurofunctional Approach (NFA) NFA is a client-centered and goal driven approach that targets function, not impairment. (Katz, 2011). Used to rehabilitate clients with acquired brain injuries. Occupation-based model which emphasizes “learning by doing”. bottom up approach

3. Populations clients who are severely and globally impaired secondary to brain injuries: TBI anoxic damage diabetic coma carbon monoxide poisoning, infections (encephalitis, meningitis, etc) vascular events like aneurysms

4. NFA Overview 1) Identification of the individual goals, motivational factors and rehab needs 2) Clients strengths and factors associated with the impairment 3) Analysis of specific task performance 4) Development of re-training interventions appropriate for the client 5) Repetition to guide performance and internalized performance models- Practice! 6) Use of feedback and reinforcement to promote engagement and self-efficacy

5. Theoretical Principles -intervention is targeted towards functional goals for the client -interventions are adapted to the client’s level of ability -daily practice and the formation of habits and routines help to develop skills -automaticity is developed through compensatory strategies -use environmental supports -enhance goal commitment through social psychological principles (i.e. support groups, goal setting groups, etc.)

6. Assessments Behavioral Inattention Test Rivermead Behavioral Memory Test ** Test of Everyday Attention Behavioral Assessment of the Dysexecutive Syndrome Executive Function Performance Test (EFPT developed after KTA): cooking, bills, medication, telephone Multiple Errands Test

7. NFA Intervention Principles -identify client goals, motivation, and needs -consider client strengths and neurological impairment when designing intervention -analyze task demands -develop retraining interventions appropriate to client abilities -use repetition to develop internalized performance & guide future performance -use feedback & reinforcement

8. Intervention Approaches -Cognitive retraining -Retraining of cognitive skills in task context -Compensatory strategy training -Specific-Task training (& Task Analysis) -Chaining -Cues: System of Least Prompts, Time-Delay procedures -Reinforcement -Errorless Learning (Scaffolding Correct Performance) -structured Practice, Overlearning (practice skill beyond point of mastery)

9. Intervention Approaches Examples: http://www.youtube.com/watch?v=JPdBmb-jRUg http://www.youtube.com/watch?v=BMHYA5OdcYk

10. Additional resources Remedial approach http://strokengine.ca/intervention/index.php?page=topic&subpage=patient&id=42 Compensatory strategies http://braininjuryeducation.org/Treatment/Compensatory-Strategies/

11. References Giles, G. (2011). A neurofunctional approach to rehabilitation after brain injury. In Katz, N. Cognition, occupation and participation across the lifespan. (pp. 370-381). Bethesda, MD.