Strengthening goal-directed functioning after traumatic brain injury

Handb Clin Neurol. 2019;163:435-456. doi: 10.1016/B978-0-12-804281-6.00023-9.


Acute trauma to the brain can lead to chronic changes in an individual's neurologic functioning, with some of the most debilitating and far-reaching consequences leading to compromised goal-directed functioning. Underlying sources of dysfunction can be dynamic, complex, and challenging to effectively address. This chapter delineates key principles that can be valuable for improving goal-directed functioning. The chapter is grounded in neuroscience and theoretical underpinnings while emphasizing practical approaches to maximizing functional improvements in an individual's personal life. Rehabilitation efforts can be maximized by taking into account multiple levels and facets of goal-directed functioning in cohesive, individualized treatments. Core functions subserved by prefrontal cortical networks may be targeted and strengthened through specific approaches to training. Optimization of functioning may require unraveling and addressing some of the many factors that can modulate brain processes. We dedicate special emphasis to considering the regulation of cognitive-emotional functioning during goal pursuit, especially pertinent to treatment of combined physical and experiential trauma that is a hallmark of military service injuries. These foundations point to frontiers for innovation in strengthening goal-directed functioning after brain injury.

Keywords: Attention; Executive functioning; Military veterans; Post-traumatic stress disorder; Rehabilitation; Sleep; Training; Traumatic brain injury; Working memory.

Publication types

  • Review

MeSH terms

  • Brain Injuries, Traumatic / physiopathology
  • Brain Injuries, Traumatic / rehabilitation*
  • Cognition / physiology*
  • Goals*
  • Humans
  • Neurological Rehabilitation / methods*
  • Recovery of Function / physiology