Since the end of World War II, the strictly medical management of and rehabilitative interventions for persons with various disabilities (including those following stroke and head trauma) have been supplemented by various paramedical remedial or functionally enhancing services (e.g. physical and occupational therapies, speech therapy, and psychological and vocational counseling). However, such interventions (which have come to be accepted as part of conventional rehabilitation programs) have been useful primarily in the case of the more severely impaired and functionally incapacitated individuals who do not require custodial care. Such services, however, have proved to be inadequate in the case of brain-injured individuals with milder forms of cognitive or functional impairments that, nevertheless, prevent the ‘smooth’ reintegration of these individuals with their families or their return to work.

The failure of the amalgam of conventional rehabilitative approaches to adequately accommodate the needs of so-called minimally or mildly braininjured persons prompted serious examination of the premises and theoretical considerations on which the various physical, neurocognitive, and neurobehavioral rehabilitative practices were based. Such examinations were accompanied by numerous clinical research studies that were aimed at establishing the efficacy, external validation, and theoretical plausibility of specific remedial techniques employed by rehabilitation professionals. There was much skepticism as to whether anything could be done to help individuals with brain damage once neurons were destroyed or damaged. Much of the research activities from the 1950s through the 1970s were driven by the desire to formulate empirically based therapies, strategies, and measurements in a search to develop evidence for the efficacy and usefulness of neuropsychological rehabilitation. By the early 1970s, some students of the field^1,2 concluded that Kurt Goldstein’s ‘organismic’ theory of human nature^3,4 provided a conceptual foundation for a framework for neuropsychological rehabilitation. Goldstein applied his ideas in actual rehabilitative work with brain-injured war veterans of World War I.⁵ Similarly, based on neuroatomical and neurophysiological studies on animals, others, such as Moore⁶ and Bach-y-Rita,⁷ offered a rationale for rehabilitative interventions for people with acquired brain injuries.

In three seminal papers, Goldstein^8–10 articulated his key ideas concerning the rehabilitation of brain-injured persons. These ideas were later operationalized and systematically implemented in a two-year pilot study with Israeli braininjured war veterans.¹¹ Subsequently, based on a five-year US governmentfunded clinical research project, an intensive day program for post-acute neuropsychological rehabilitation of brain-injured persons was established at the New York University (NYU) Medical Center’s Rusk Institute.^12–15 The NYU program has been acknowledged as the model for similar (holistic) programs and variations of holistic programs now in existence in 11 countries.¹⁶ Goldstein’s core ideas provided an alternative to conventional approaches to post-acute neuropsychological management and rehabilitation. They are briefly summarized in the following sections.