By Gianna Loscascio and Beth S. Slomine
Cambridge University Press
This book provides a comprehensive resource for the topic of cognitive rehabilitation for children with neurological disorders. The authors define the term cognitive rehabilitation broadly, describing it as “an intervention designed to compensate or ameliorate the impact of cognitive and behavioral effects following neurologic injury or illness”. Disciplines who traditionally deliver cognitive rehabilitation interventions include speech-language pathologists, occupational therapists, psychologists and neuropsychologists. Since children spend the majority of their time in school, teachers and therapists can also apply cognitive interventions to help children learn and thrive in an academic setting.
One strength of the book is the first section that provides evidence-based interventions written by specialists covering several core domains of cognition: Attention, memory, sensory perception, hemispatial neglect language/communication and executive functioning. Chapters 1-4 and Chapter 6 offer a specific focus on a cognitive domain that includes a definition of the intervention, available evidence and formation of practice recommendations for clinicians. The chapters also provide a description of developmental considerations, strategy training, and interventions utilizing technology. Each chapter also offers at least one case study of a child who participated in the domain intervention and describes outcomes. The chapters all end with a conclusion and recommendations for future directions for each domain discussed.
Children live in the context of a family environment and this aspect is recognized in Chapter 5 that focuses on family-based interventions. This chapter details the relationship between family functioning and children’s cognitive/behavioral outcomes and provides implications for family interventions. Evidence-based interventions described in this chapter include family problem solving therapy and parent skills training. The chapter also provides insights into technology interventions by describing telehealth intervention approaches that can serve families who live a distance from rehabilitation settings. A strong section of this chapter provides guidance on developmental considerations and the timing of the intervention. Case studies are included at the end for both family problem solving and parent skills training that provide information about changes as a result of the training.
Pharmacologic intervention is an area that is not typically covered in cognitive rehabilitation books and articles, especially for children. The authors describe a paucity of literature for prescribing medication for children as an intervention for cognition and behavior but do reference the evidence on how this type of intervention can impact outcomes in these domains. What is particularly helpful is the table the authors provide (Table 7.1) that illustrates key areas- medication names, mechanism of action, therapeutic targets and common adverse effects. A case study is presented but the authors make a point in their conclusion that because of the range of effects of acquired brain injuries and the age of the child, much more research is needed to provide evidence of the safety and efficacy of this type of intervention for children.
School is where children return to after an acquired brain injury but this location of service focuses on learning and the effects of health on learning rather than medical diagnosis and symptoms.
Therefore, cognitive rehabilitation as a medical service area is most likely not to happen in schools; however, focusing on areas of cognition and instructional strategies in classrooms are areas that offer cognitive interventions that can be addressed at school. The authors are experts in education and offer valuable tables of learning characteristics and instructional strategies than can be included in a child’s educational program (Table 8.1). They provide information on educational laws that can ensure students receive these services (Table 8.2). Case studies illustrate the ideas presented in the chapter.
The conclusion section offers insights on how educational interventions targeting strategies and creating an environment to enhance learning is good methodology for serving the needs of children with acquired neurologic disorders to help them learn and progress at school.
Transition to adulthood is an a critical time for children with acquired brain injury and one that is not typically covered in a cognitive rehabilitation text book. The authors identify areas important to adulthood to address for children that include self-management and health management.
Because cognition is a critical area related to acquired brain injury, Table 9.2 in the chapter covers the skills needed for independence in adulthood, necessary cognitive and behavior skills and questions designed to estimate if an adolescent meets those areas. The chapter offers a section on decision-making capacity and also includes techniques for skill training in executive functions, behavioral regulation and social competence to support decision making for adolescents in transition.
The last two chapters provide insight into how to support cognitive services in both healthcare and school settings. Chapter 10 discusses billing practices in the healthcare system and describes strategies for how to cover service reimbursement. Billing codes for psychotherapy, cognitive rehabilitation and behavior are discussed along with a comprehensive table (TABLE 10.1) that offers the codes, definition of services and the amount of time per session covered. Guidance for understanding both internal and external billing systems, authorization for services, documentation and peer review if described. What is particularly helpful are letter samples for justification of medical necessity and progress notes for documentation. Chapter 11 offers insights on how to ensure children receive needed cognitive services in both models of care -Healthcare and school settings. A significant gap for serving children that has been mentioned in previous reports and research is the connection between healthcare and school services and coordination of cognitive rehabilitation services after an acquired brain injury. The author proposes several recommendations to improve service access that includes education of professionals, building collaborations between agencies and case management of children.
In this comprehensive pediatric cognitive rehabilitation textbook for neurological disorders, Drs. Locascio and Slomine provide not only evidence supporting the importance of providing cognitive intervention to improve children’s outcomes, but also offer suggestions for this intervention in models of service delivery that children and their families experience (healthcare and school settings) and the family environment. They engaged specialists from diverse disciplines to write about the topics presented. Every chapter offers evidence, intervention ideas, a case study in implementation and conclusions. Each area of cognition and behavior impacted by acquired neurological disorders in children is addressed and further insights are offered on how to fund and advocate for services in healthcare settings as well as implement these ideas in school-based settings. The editors include chapters on important topics for children- family interventions and transition to adulthood that provide all inclusive information for across the childhood lifespan.
The book makes a unique and substantial contribution to the field by providing evidence and examples of interventions as well as health and school policies, laws, and reimbursement practices to support treatment of cognitive and behavioral effects of acquired neurological conditions. Further the authors writing about executive function intervention reference the work of Mark Ylvisaker, a pioneer in the field of cognitive rehabilitation. Mark advanced the field by describing a culture of rehabilitation for children what encompassed context sensitivity, direct and intensive instruction, making intervention personally meaningful, emphasizing strategic thinking and including intervention over the long term to shape academic habits for children through out their school career. These principals of intervention encompass all aspects of cognitive rehabilitation for children living with acquired neurological disorders in both healthcare and school settings. All disciplines that provide interventions for children can benefit from this all-inclusive resource.
About the Reviewer
Juliet Haarbauer-Krupa, PhD is Adjunct Faculty in the Department of Pediatrics, Emory University School of Medicine. She is a co-author with Mark Ylvisaker on the first book about cognitive rehabilitation in children, titled, Brain Injury Rehabilitation: Children and Adolescents (1985). She has been in the field for 30 years both as a clinician and a researcher and has over 100 publications and presentations on traumatic brain injury in children and adults.