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  1. The Editors of JHTR

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2021 WITNESSED the passing of 2 pioneers in the neuropsychological assessment and rehabilitation of individuals with brain injuries: Dr Yehuda Ben-Yishay and Dr Muriel Lezak. Both introduced new and effective clinical methods during the infancy of brain injury rehabilitation. Both have left a lasting legacy, as their methods were widely adopted and continue to evolve. Both inspire their successors worldwide, not only with their clinical insights but also with their strength of character and commitment to the service of people with brain injuries and their families.

 

Early in his career, Dr Yehuda Ben-Yishay developed methods to rehabilitate Israeli soldiers with brain injuries. After moving to the United States, he continued to establish these methods with Dr Leonard Diller at the NYU Medical Center. His approach was holistic, addressing the needs of the whole person in the context of their social environment. The goal of rehabilitation for Dr Ben-Yishay was no less than helping the patient restore a secure, positive sense of self. He was adamant about the importance of family involvement in rehabilitation. Dr Ben-Yishay recognized that often patients with brain injuries could not reliably recall a problematic behavior long enough to address it with the appropriate rehabilitation specialty. Consequently, his approach was transdisciplinary, that is, each rehabilitation team member was sufficiently versed in the recommended interventions of other disciplines to be able to assume each other's roles during teachable moments. He also recognized the limitations on transfer of training caused by brain injury and introduced work trials in which patients explored vocational options in real-life situations with the support of the rehabilitation team. His methods were adopted and further developed by Dr George Prigatano. These seminal programs became the basis for scores of brain injury rehabilitation programs worldwide. Continuing clinical research seeks to identify active ingredients in Ben-Yishay's approach, leading to more streamlined programs. Nonetheless, his holistic, transdisciplinary orientation remains fundamental to contemporary brain injury rehabilitation.

 

Dr Muriel Lezak is best known for her comprehensive text, Neuropsychological Assessment, first published in 1976 with the 6th edition scheduled for publication in 2023, which will carry her name in the title. One or more editions of this volume no doubt reside on the bookshelf of virtually every practicing clinical neuropsychologist. She too developed her early interest in traumatic brain injury (TBI) from working with veterans at the Portland VA and was one of the first to call attention to risk of TBI in sports, particularly for youth. In her own practice, she selected tests from the array of measures described in her book that were best suited to the specific individual. This flexible approach to neuropsychological testing allowed the evaluating neuropsychologist to hone in on the often idiosyncratic cognitive deficits resulting from brain injury and disease. Dr Lezak was also keenly aware that TBI often resulted in behavioral and interpersonal deficits that were not captured on neuropsychological tests. She developed the Portland Adaptability Inventory, which evolved into the Mayo-Portland Adaptability Inventory, to capture these limitations through behavioral observation, testing, and family interviews. She recognized the importance of family, not only in understanding but also as a valuable treatment ally in rehabilitation and a source of ongoing support.

 

While we miss the engaging presence of these guiding lights at meetings and symposia, their creative spirits and unflagging devotion continue to inspire and guide us.

 

The Editors of JHTR