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Holistic Neurorehabilitation – Theoretical and Clinical Perspectives

Jaana Sarajuuri


Frank Humle
Sanna Koskinen
Wolfgang Kuehne
Arwen Pel
Jaana Sarajuuri
Martie Vink 

The main elements of the holistic neurorehabilitation programs include promotion of a therapeutic milieu, psychotherapy and cognitive remediation, supported work trials, family guidance, and follow-up procedures. The psychotherapeutic process is vital for helping patients to achieve a sense of identity, to learn to behave in their own best self-interests, to cope with the demands of the situations he or she is confronted with, and to construct life after brain injury. Due to disabling cognitive, behavioural, and emotional changes after TBI, patients cannot be adequately treated with conventional psychotherapy, therefore neuropsychotherapy is needed. The key features of the program development and neuropsychotherapeutic elements as an integrative part of holistic rehabilitation programs are discussed.

Changes in identity are a common phenomenon after brain injury. In clinical practice, helping people to deal with these changes is a challenge, as discrepancy between the current and pre-injury self-image is found to be related to psychological distress. In the holistic milieu group approach, the group offers a social environment in which the building of a new, realistic self-image can take place. A case report will be presented as an illustration of this process of growing from emotional distress to emotional reintegration. Also data from an evaluation study concerning emotional well-being will be presented.

Participation in work life is one of the major goals for many clients after TBI. This goal is associated with self-esteem, social integration and autonomy. Methods for including work trials into holistic programs and for evaluating their impact on the rehabilitation outcome, as well as data on patients‘ satisfaction with the work trials will be discussed.

There is evidence that a holistic neuropsychologically oriented rehabilitation has an effect on overcoming the consequences after stroke and traumatic brain injury. Research findings of a recently concluded RCT-study whether the principles of holistic rehabilitation can be applied to the treatment of patients with post-concussional syndrome will be provided, and the outcome regarding work life integration and quality of life will be discussed.