Biomedical Engineering Reference
In-Depth Information
his or her own personality variables and from the patient's personality variables, from
the quality and significance of their relationship, from their communication and empathy
capacity, and the quality/quantity of the problems. Moreover, the efficacy of the interven-
tion is dependent upon external factors because familiar and social resources determine
the extratherapeutic environment of the patient. Particular programs for the training of
different cognitive abilities (memory, language, attention, etc.) have been developed and
are uninterruptedly re-adapted following the demands and characteristics of each patient.
The techniques used in CBT are aimed at producing effects in three spheres: cognition,
behavior, and physiology. In the cognitive sphere, the patients learn to activate cognitive
reorganizations and to modify negative emotions to render the beliefs more logical and
adaptive and the emotions more endurable (McGinn and Sanderson 2006).
The use of cognitive and behavioral principles and techniques that foster learning dur-
ing the rehabilitation process simultaneously address relational and emotional problems
that are obstacles to the success of rehabilitation therapy and the person's adjustment.
6.4 Cognitive Rehabilitation
True to the biopsychosocial approach mentioned earlier, cognitive rehabilitation begins
with an understanding of the current cognitive, emotional/behavioral, and psychosocial
functioning of the individual. The biopsychosocial approach or model was first articu-
lated by George L. Engel, a psychiatrist at the University of Rochester Medical Center in
Rochester, NY (1977). He stated that a pathophysiological view of illness and disability is
insufficient for understanding illness and he put forth a systems perspective of treatment
that considers the parts, the whole, and the dynamic interaction of biological, psychologi-
cal (emotional/behavioral), and social factors impacting the individual. Today, the bio-
psychosocial approach is used to guide all patient treatment and medical education at the
University of Rochester Medical Center, as well as many other programs around the world,
and is the foundation for the World Health Organization's International Classification of
Functioning, Disability, and Health (ICF) (WHO 2001).
With the biopsychosocial approach and the ICF framework as a foundation, the totality
of cognitive, emotional/behavioral, and psychosocial functioning of the individual is con-
sidered when planning interventions. As mentioned earlier, neuropsychological testing
and measurement are imperative to obtaining this understanding. The need to address the
individual's unique and individualized pattern of functioning is well recognized.
• People with the same impairments experience different kinds and degrees of inca-
pacity and vastly different restrictions on what actually happens in their lives.
Impairments are not proxies for disability; they give only one particular perspec-
tive on disability. Disability is the complete lived experience of nonfatal health
outcomes, not merely body-level decrements in functioning.
• The converse is also true: People can experience the same restrictions in what
they can do in their day-to-day lives although they have different impairments.
At the level of actual performance, the contrast is even greater. Impairments as
diverse as missing limbs and anxiety can both attract stigma and discrimination
that may limit a person's participation in work. (United Nations Economic and
Social Commission for Asia and the Pacific 2010).
