THE Challenge 2019 Vol. 13 Iss. 3 Finding Cures for Brain Injury

High quality PCPO programs use evidence-based
interventions, that is, interventions that have been found
to be effective by the best scientific evidence available.
Research to establish the effectiveness of interventions
controls for nonspecific effects, also known as placebo
effects, like belief or expectation on the part of the
therapist or the participant that the intervention will
be effective. However, in clinical work, good therapists
who are using methods that have scientific support also
make the most of nonspecific effects and work to help
participants feel motivated and successful and to look
forward to therapy. A positive therapeutic alliance can
create a powerful nonspecific effect.
Good therapists also encourage the participation of
family and close others to the degree that is comfortable
for the participant. Close others provide emotional
support for participants and help reinforce participants
in practicing skills learned in therapy in their daily life.
A participant’s brain injury and rehabilitation are
also often stressful for his or her close others. These
individuals may need support, including psychological
or family therapy if the stress and distress is severe.
From the very beginning of therapy, the rehabilitation
team plans with participants and their close others
for transferring skills learned in therapy to real life
and maintaining gains after discharge. Such efforts
often include independent living trials and trials of
work or school. Post-discharge planning often involves
assisting the participant to engage with other sources
of environmental and social support in addition to
close others. The discharge plan also typically includes
a schedule for follow-up by rehabilitation providers to
make sure progress made in rehabilitation is maintained
with an option for further rehabilitation if gains are
being lost.
PCPO finds its roots in the early work of brain injury
rehabilitation pioneers and is also reflected in more
contemporary approaches like Cognitive Orientation
to daily Occupational Performance (CO-OP). The
principles of PCPO described here are currently used
in residential, outpatient, and community-based
post-hospital brain injury rehabilitation programs in
the United States and other countries as well as in the
U.S. Veterans Administration.
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