Neurofunctional Approach

1. Neurofunctional Approach
Marcella Matteo, Reina Salazar, Ashley Feigenbutz

2. 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

3. Populations
clients who are severely and globally impaired secondary to brain
injuries:
TBI
anoxic damage
diabetic coma
carbon monoxide poisoning,
infections (encephalitis, meningitis, etc)
vascular events like aneurysms

4. NFA Overview
1) Identification of the individual goals, motivational factors and rehab
needs
2) Clients strengths and factors associated with the impairment
3) Analysis of specific task performance
4) Development of re-training interventions appropriate for the client
5) Repetition to guide performance and internalized performance
models- Practice!
6) Use of feedback and reinforcement to promote engagement and self-
efficacy

5. 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.)

6. Assessments
Behavioral Inattention Test
Rivermead Behavioral Memory Test **
Test of Everyday Attention
Behavioral Assessment of the Dysexecutive Syndrome
Executive Function Performance Test (EFPT
developed after KTA): cooking, bills, medication,
telephone
Multiple Errands Test

7. 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

8. 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)

9. Intervention Approaches
Examples:
http://www.youtube.com/watch?v=JPdBmb-jRUg
http://www.youtube.com/watch?v=BMHYA5OdcYk

10. Additional resources
Remedial approach
http://strokengine.ca/intervention/index.php?page=topic&subpage=patient&i
d=42
Compensatory strategies
http://braininjuryeducation.org/Treatment/Compensatory-Strategies/

11. References
Giles, 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.