Rehabilitation is a process whereby people who are disabled by injury or disease work together with professional staff, relatives and members of the wider community to achieve their optimum physical, psychological, social and vocational well-being (McLellan 1991). Neuropsychological rehabilitation (NR) is concerned with the amelioration of cognitive, emotional, psychosocial and behavioural deficits caused by an insult to the brain. NR is one of many fields needing a broad theoretical base incorporating frameworks, theories and models from many different areas. Being constrained by one theoretical model can lead to poor clinical practice. The starting point for any rehabilitation programme is the patient and his or her family. In addition to background and ethnic and social issues, the nature, extent, and severity of brain damage should be determined. Current problems, including cognitive, emotional, psychosocial, and behavioural, need to be assessed. Behavioural or functional assessments can be used to complement standardised assessment procedures. Having identified problems, the rehabilitation programme can be planned. Patients, families and staff need to negotiate meaningful, functionally relevant and attainable goals. There is plenty of evidence to show that neuropsychological rehabilitation is clinically effective. Cicerone and his colleagues, for example, in a meta-analysis, found that such programmes can improve community integration, functional independence, and productivity, even for patients who are many years post injury (Cicerone et al 2011). Van Heughten et al 2012) looked at 95 randomised control trials carried out between 1980 and 2010 and concluded that there is a large body of evidence to support the efficacy of cognitive rehabilitation.
The Oliver Zangwill Centre for Neuropsychological Rehabilitation opened in 1996 following three years of negotiations between the Medical Research Council (MRC) and the local National Health Service (NHS) Trust. The centre is probably unique in that it is a partnership between a health care provider, the NHS, and a research funding body, the MRC. The Centre aims to provide an excellent clinical rehabilitation service influenced by and contributing to research into the rehabilitation of survivors of brain injury. We 1) provide a therapeutic milieu, 2) make certain that the goals set for clients are meaningful and functionally relevant, 3) ensure shared understanding between staff, clients and families, 4) apply psychological interventions to the cognitive, emotional and psychosocial difficulties encountered by the clients, 5) manage cognitive impairments through compensatory strategies and retraining of skills and, 6) work closely with families and carers. Patients are between 16- 60 years old, with non-progressive brain injuries and living with cognitive, emotional and psychosocial problems. Treatment is offered for six months. For the first six weeks patients attend four days a week from 10 in the morning until four in the afternoon. This is the intensive phase. For the second twelve weeks, the integration phase, patients attend two days a week. For the rest of the week they are reintegrating into work or higher education or else they are leaning to be more independent. Therapy involves both group and individual therapy which addresses their cognitive, emotional and psychosocial needs. This is centered around goal attainment. One survey showed that most patients achieved the goals set. Although the treatment follows a holistic (otherwise known as an intensive or milieu oriented approach) it is heavily influenced by a number of theories, models and frameworks.