The Power of Consistent Therapy Sessions for Ongoing Progress

At Neuroplastic Rehab we believe that meaningful, sustained recovery after a neurological event such as a traumatic brain injury (TBI) requires more than occasional visits. That is why our protocol of seeing clients twice weekly in two-hour sessions is designed to allow the time and space to address a broad range of goals: activities of daily living (ADL), instrumental ADL (IADL), executive functioning/cognition, strength/mobility/cardiovascular endurance, community integration, and organization/planning. This frequency and duration allow us to engage deeply across cognitive, physical, and emotional domains.

Why consistency matters

Research supports the idea that timing and intensity of neurorehabilitation affect outcomes. A systematic review of moderate-to-severe TBI found that early commencement of rehabilitation and more intensive programs produced significantly better functional outcomes compared with usual care (effect size for early onset d = 1.02; for intensive programs d = .67) (Rosenbaum et al., 2018). This suggests that regular, frequent engagement in therapy contributes to recovery.

Moreover, one clinical study of cognitive recovery after severe TBI reported that functions such as planning required an average of 69 training sessions and that “training cannot be given all at once, although it should be consistent and progressive” (Lundqvist et al., 2011). These findings underline why our model of twice‐weekly, two-hour blocks is appropriate: it allows adequate repetition, consolidation, and cross‐domain work without excessively long or infrequent sessions that might stall progress.

Addressing the TBI-specific challenges

For individuals with TBI, staying focused, getting all the thoughts out, and managing emotions are common obstacles. Fatigue, distractibility, impaired initiation, slowed processing, and emotional dysregulation often hamper progress in therapy and daily life. In sessions we intentionally build in strategies to manage these issues so that they do not derail goal-directed work.

• Attention and thought organization: Because clients may find it difficult to stay focused on a task or to articulate their thoughts clearly, we begin sessions by acknowledging these potential barriers. We practice cueing strategies (for example, “Let’s take a moment to note what is distracting you right now” or “Let’s pause and write down what you want to accomplish together today”). This helps reduce frustration or wandering thoughts and brings attention back to the agreed therapy goals.

• Emotional regulation and self-monitoring: The emotional impact of TBI such as anger, frustration, reduced self-awareness, mood fluctuations, can quickly redirect a therapy session from where it needs to go. We integrate emotional self-monitoring (“Are you feeling overwhelmed or frustrated? Why is this?”) and apply evidence-informed interventions such as cognitive behavioral techniques (e.g., normalizing the challenge, reframing unhelpful thoughts). We express that we are here to understand and emphasize, not simply sympathize.

• Goal‐cueing and redirection: When distractions or emotional obstacles arise, our role is to gently bring the client back to the therapy agenda: “We acknowledge the interruption; now let’s re-center on the action plan for this session so we can move your goals forward.” This approach ensures the session retains structure while still validating the client’s experience.

• Integration of physical, cognitive and emotional work: Rather than treating physical (mobility/strength/cardiovascular) and cognitive (executive function, planning, organization) and emotional domains as isolated, we combine them in meaningful tasks. For example: planning a community outing (IADL) requiring organization and sequencing (cognition), getting out of the home and navigating terrain (mobility/cardio) and managing emotional responses in the social environment (emotional regulation). This integrated approach is supported in the occupational therapy literature about addressing cognition and functional performance after TBI.

  
  

Why two‐hour sessions twice a week?

• Time to dive into multiple domains: In a single session we have sufficient time to address more than one goal area (for example, ADL/IADL work, cognitive strategy training, strength/mobility, and emotional check-in). Shorter sessions may force us to pick only one domain, potentially fragmenting the work.

• Opportunity for reflection and consolidation: Repetition and consolidation are key in neurorehabilitation. As noted in the Lundqvist et al. study, recovery of cognitive functions involves consolidation over time, not just intensive bursts. The two‐hour block allows time for practice, metacognitive reflection (“What worked? What did we notice about your attention or emotions today?”), and planning for carry-over into the week.

• Sufficient frequency for momentum: Twice weekly ensures momentum is maintained while still allowing time between sessions for clients to implement home exercise programs (HEPs), integrate strategies into daily life, and rest. The literature suggests that higher intensity is associated with better outcomes (Rosenbaum et al., 2018).

• Balance between challenge and sustainability: Sessions that are too long or too frequent may lead to fatigue, especially in the TBI population. Two hours provides a robust window without overwhelming the client. Twice weekly strikes a balance between progress and sustainability.

  
  

Promoting hope and independence

We emphasize a hopeful message throughout therapy. Rather than emphasizing deficits, we frame each session as an opportunity for growth, rewiring, and greater independence. Clients are encouraged to view themselves as active participants in their recovery, not simply recipients of therapy. The narrative is: “We are here for you physically, cognitively and emotionally. We will listen. We will understand. We will guide you. And we will remind you of your strengths and possibilities.”

As clients engage consistently, the gains accumulate. Over time, those twice-weekly sessions build into improved independence in ADL/IADL, stronger cognitive-executive skills, improved mobility, better community engagement, and greater emotional self-regulation. As the literature shows, neurorehabilitation is not about passive rest; it is about active, structured, repeated engagement.

Practical tips for clients

• View each session as a building block rather than a one‐off.

• Between sessions follow your HEP consistently. The skills we practice together then translate into daily life only through regular implementation.

• Acknowledge emotional or cognitive distractions as they are part of the process. By naming them, you reduce their power and help us redirect back to the goal.

• Use built-in reflection: At the end of each session we’ll ask: “What went well? What was challenging? What will you try before next session?” This helps cement the metacognitive link between therapy and real‐world application.

• Embrace the idea that progress may be non‐linear. Some weeks you may feel incremental, others more dramatic. That is normal in TBI recovery.

Conclusion

Consistent therapy sessions—twice per week for two hours each—provide the ideal structure for comprehensive neurological rehabilitation in adults with TBI. At Neuroplastic Rehab we combine attention to the physical, cognitive, emotional, and community domains. We listen. We understand. We emphasize. You are not simply attending therapy. You are rebuilding your life. With consistency, structure, and a hopeful mindset, meaningful progress is possible.

References

1. Lundqvist, A., et al. (2011). Recovery of cognitive function during comprehensive rehabilitation after severe traumatic brain injury. Journal of Rehabilitation Medicine, 43(6), 492–497.

2. Rosenbaum, B., et al. (2018). Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome After Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 99(4), 698-715.

3. American Occupational Therapy Association. (n.d.). Interventions: Psychosocial Interventions for Adult TBI.

4. McCormick, L., Otte, M., et al. (2022). Effectiveness of Functional Cognition Intervention for Adults with Traumatic Brain Injuries. American Journal of Occupational Therapy, 76(Suppl 2), 7613393180.

5. American Occupational Therapy Association. (n.d.). Interventions: Addressing Cognition for Adults with Traumatic Brain Injury.