Journal of the International Neuropsychological Society (2020), 26, 130–141

Copyright © INS. Published by Cambridge University Press, 2020.

doi:10.1017/S1355617719001024

Efficacy of Postacute Neuropsychological Rehabilitation for Patients

with Acquired Brain Injuries is Maintained in the Long-Term

Tal Shany-Ur1,2* Ayala Bloch1,3, Tali Salomon-Shushan1, Narkis Bar-Lev1, Limor Sharoni1 and Dan Hoofien1,2,4
1
The National Institute for the Rehabilitation of the Brain Injured, Recanati Rehabilitation Center, 89 Itzhak Sadeh St. Tel Aviv 6722820, Israel
2
Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem 91905, Israel
3
The Department of Behavioral Sciences, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
4
The Israeli Academic College, 87 Pinhas Rotenberg St., Ramat-Gan 52275, Israel

(RECEIVED February 28, 2019; FINAL REVISION July 20, 2019; ACCEPTED August 29, 2019)

Abstract

Objectives: We examined the long-term maintenance of treatment outcomes in patients with acquired brain injuries who
participated in community-based neuropsychological rehabilitation (NR) programs, in a prospective, within-subject,
longitudinal, partial double-blind cohort study. Methods: One hundred forty-three patients (39 females, mean
age 33.5 years) who had experienced a brain injury (BI) (mean time since injury 3.95 years) were referred to a postacute
community-based NR institute. Patients participated in one of the three programs aimed at improving their functional
outcome: comprehensive–holistic neuropsychological rehabilitation, vocational-focused neuropsychological
rehabilitation, and individual neuropsychological rehabilitation. Self-reported data regarding employment, community
integration, perceived quality of life (PQoL), and mood were collected at program start and end, and annually for
3 years post program completion. Group placement was based on clinical considerations, such that the study did not aim
to compare the programs, but rather to assess their long-term benefits. Results: Employment status and stability,
community integration, and PQoL improved significantly after program completion and continued to improve for the
following 3 years. The proportion of individuals with mood disturbances did not change during or after the programs.
Conclusions: A clear consensus regarding BI rehabilitation is that long-term maintenance of treatment outcomes is
imperative to its efficacy. Our findings suggest that postacute NR programs provide participants with various tools,
skills, and psychological perspectives that they continue to gain from and generalize to real life after program
completion, reflecting transformational processes with stable long-term benefits (JINS, 2020, 26, 130–141).
Keywords: Effectiveness, Neuropsychology, Therapy, TBI, Maintenance, Functioning

INTRODUCTION Vakil, & Donovick, 2001). The detrimental consequences of

BI also decrease the ability to integrate or reintegrate at work,
Brain injury (BI) often results in significant neuropsychologi-
and over 50% of patients experience chronic vocational insta-
cal deficits, particularly in cognition, emotion, and behavior
bility (Malec, 2001; van Velzen, van Bennekom, Edelaar,
(Cattelani, Zettin, & Zoccolotti, 2010; Doering & Exner,
Sluiter, & Frings-Dresen, 2009). These cognitive, emotional,
2011; Koponen et al., 2002). While some abilities improve
behavioral, and vocational difficulties, which often co-occur
over time, deficits frequently persist, with significant long-
with motor and/or sensory deficits, in addition to long-term
term consequences. One year following traumatic brain
psychological and financial costs, dramatically damage quality
injury (TBI), as many as 80% of patients have notable cog-
of life for patients and their families (Cuthbert et al., 2015;
nitive difficulties (Cicerone, 2007; Wilson, 2008) and over
Klonoff, 2010; Klonoff et al., 2006).
50% are depressed (Hibbard, Uysal, Kepler, Bogdany, &
BI is a widely recognized major public health problem
Silver, 1998; Hibbard et al., 2004). Although depression
with devastating personal and societal costs (Mar et al.,
may increase or decrease over time, its prevalence is
2011). As such, the role of services aimed at mitigating its
sustained 10 and even 20 years postinjury (Hoofien, Gilboa,
effects is crucial (Langlois, Rutland-Brown, & Wald,
*
2006). Recovery generally progresses in two phases, acute
Correspondence and reprint requests to: Tal Shany-Ur, Recanati
Rehabilitation Center, 89 Itzhak Sadeh St, Tel Aviv, Israel. E-mail: shany- and postacute, each associated with different standards of
ur.tal@mail.huji.ac.il treatment and care. During the acute phase, the physical
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