Bridging bottom-up to top-down approaches in brain injury rehabilitation

Traumatic brain injury (TBI) survivors with complex impairments face the challenge of encoding and acquiring new information (Ptak et al., 2010). A TBI survivor with global aphasia may not understand a simple task, such as brushing their teeth, without context. Therapists can use task-specific training models for performing a task with no errors. This bottom-up approach, also known as errorless learning (ELL), allows activities to occur through repetition and function (Giles, 2010). It allows occupational therapy practitioners (OTPs) to focus on each task separately, as a blocked or isolated activity (Skidmore, 2015). The intention is to build the client’s confidence and self-esteem while reducing frustration, which is common among TBI survivors.