Holistic neuropsychological rehabilitation in Finland: The INSURE program—a transcultural outgrowth of perspectives from Israel to Europe via the USA

G iven the interaction of cognitive, behavioural, psychological, and physical factors resulting from traumatic brain injury (TBI), a comprehensive, multidisciplinary, and neuropsychologically oriented rehabilitation could prove to be particularly promising and efficacious in the neuropsychological rehabilitation of post-acute brain-injured individuals. Kurt Goldstein, an eminent pioneer in the development of holistic rehabilitation, stated that brain-injured patients need environments that help them to avoid catastrophic reactions. In his view, the tasks of rehabilitation are to create, for the brain-injured individual, an environment that will minimize the chances for the occurrence of catastrophic responses. In this environment, the individual can engage optimally in various remedial activities, which will gradually culminate in the individual finding new meaning in life after rehabilitation. Yehuda Ben-Yishay incorporated many of Goldstein’s ideas and developed a milieu or holistic rehabilitation program in 1978 in New York. The emerging role of psychotherapy for patients and their family members was characteristic of the Neuropsychological Rehabilitation Program that Prigatano established in 1980 in Oklahoma. In Europe, Anne-Lise Christensen, who was also influenced by the work of A. R. Luria, started a holistic program at Copenhagen University in 1985. Based on these pioneering programs, several similar programs were established in Europe. A Finnish program, INSURE, was established in 1993 in Helsinki. The INSURE program is a post-acute, interdisciplinary, 6-week rehabilitation program for selected groups of TBI patients. The core of the program is neuropsychological rehabilitation and psychotherapy with vocational interventions, and follow-up support. In recent years, a holistic rehabilitation program was also established in Turku for children with acquired brain injury. The European Holistic Working Group was founded in 2001, and the authors will also discuss their personal experiences and future of holistic neurospychological rehabilitation in terms of ongoing research work, computer-administered cognitive remediation, and quality of life assessment.