Neurofunctional Approach

Marcella Matteo, Reina Salazar, Ashley Feigenbutz

Neurofunctional Approach (NFA)NFA is a client-centered and goal driven approach that targets function, not impairment. (Katz, 2011).Used to rehabilitate clients with acquired brain injuries. Occupation-based model which emphasizes “learning by doing”.bottom up approach

Populationsclients who are severely and globally impaired secondary to brain injuries: TBIanoxic damage diabetic coma carbon monoxide poisoning, infections (encephalitis, meningitis, etc) vascular events like aneurysms

NFA Overview1) Identification of the individual goals, motivational factors and rehab needs2) Clients strengths and factors associated with the impairment3) Analysis of specific task performance4) Development of re-training interventions appropriate for the client5) Repetition to guide performance and internalized performance models- Practice!6) Use of feedback and reinforcement to promote engagement and self-efficacy

Theoretical Principles-intervention is targeted towards functional goals for the client-interventions are adapted to the client’s level of ability-daily practice and the formation of habits and routines help to develop skills-automaticity is developed through compensatory strategies-use environmental supports-enhance goal commitment through social psychological principles (i.e. support groups, goal setting groups, etc.)

AssessmentsBehavioral Inattention TestRivermead Behavioral Memory Test **Test of Everyday AttentionBehavioral Assessment of the Dysexecutive SyndromeExecutive Function Performance Test (EFPT developed after KTA): cooking, bills, medication, telephoneMultiple Errands Test

NFA Intervention Principles-identify client goals, motivation, and needs-consider client strengths and neurological impairment when designing intervention-analyze task demands-develop retraining interventions appropriate to client abilities-use repetition to develop internalized performance & guide future performance-use feedback & reinforcement

Intervention Approaches -Cognitive retraining -Retraining of cognitive skills in task context -Compensatory strategy training-Specific-Task training (& Task Analysis)-Chaining -Cues: System of Least Prompts, Time-Delay procedures-Reinforcement-Errorless Learning (Scaffolding Correct Performance)-structured Practice, Overlearning (practice skill beyond point of mastery)

Intervention Approaches Examples:http://www.youtube.com/watch?v=JPdBmb-jRUg

http://www.youtube.com/watch?v=BMHYA5OdcYk

Additional resources Remedial approachhttp://strokengine.ca/intervention/index.php?page=topic&subpage=patient&id=42

Compensatory strategies http://braininjuryeducation.org/Treatment/Compensatory-Strategies/

ReferencesGiles, G. (2011). A neurofunctional approach to rehabilitation after brain injury. In Katz, N.

Cognition, occupation and participation

across the lifespan. (pp. 370-381). Bethesda, MD.