Principles of Cognitive Neurorehabilitation Introduction to Section 1

Cognitive neurorehabilitation is predicated on two fundamental principles: (1) that the brain has within it an inherent plasticity that enables it to recover from damage that gives rise to cognitive impairment, and (2) that individuals have the capacity to make behavioral adjustments necessitated by changing circumstances. At the same time, the development of the field rests on recognition of and adherence to other essential principles. Foremost are those principles that guide the conduct and assessment of research that ultimately fuels the development of successful rehabilitation programs. Too often, these principles receive insufficient attention and, as a result, the foundations on which treatment programs rest can be a little shaky. It is appropriate then that the first section of this book, which is intended to be comprehensive and broader in scope than the first edition, is devoted to some of the overriding principles that are central to cognitive neurorehabilitation, and to its continued development as a form of clinical practice within rehabilitation medicine. The first two chapters cover neuroplasticity and the brain's potential for reorganization in ways that make optimal use of residual resources in promoting cognitive recovery. Kolb and Gibb review principles that govern brain plasticity and factors that affect its expression following regional damage. In describing some of the cellular and physiological mechanisms underlying plasticity, Kolb and Gibb make the important point that the level of analysis must depend on the questions being asked. This has important implications for cognitive neurorehabilitation. For example, an understanding of alterations at the neuronal or neurotransmitter level are critical to the development of pharmacological therapies, whereas an appreciation of reor-ganisation of neural circuitry through neuroimaging, may be more relevant to designing behavioral therapies that invoke the use of appropriate strategies. The chapter broadly reviews research that demonstrates that brain plasticity is influenced by a wide range of factors that include age, etiology of damage, and type of experiences. Kolb and Gibb end with the interesting observation that brain plasticity may not always work in the patient's interest and cite, as an example, counter-productive changes that occur in relation to developmental disorders. This is important for cog-nitive neurorehabilitation because brain-damaged individuals often develop maladaptive responses and their neurophysiological imprint must be overcome for rehabilitation to proceed successfully. In their chapter, Hunter and McEwen focus on the relationship between adverse life experiences and chronic dysregulation of the neuroendocrine axis which, combined, increase the risk of …