NEUROPSYCHOLOGY AND COGNITIVE REHABILITATION:

 A Brain-Centered Perspective

From the insights of Monique J. Tremaine, PhD (Interview 1/22/2026)

Neuropsychology sits at the intersection of brain science, behavior, cognition, and lived human experience. Through more than two decades of clinical practice, teaching, and program leadership, Dr. Monique J. Tremaine has developed a perspective that challenges long-standing silos between “mental health” and “cognitive function.” From her vantage point, these are not parallel domains—they are expressions of the same integrated brain system, shaped by biology, environment, personality, and context. Her work in neuropsychological assessment, cognitive rehabilitation, and emerging technologies offers a clinically grounded vision of how the brain adapts, recovers, and evolves across injury, illness, and life transitions.

 

What Is Neuropsychology?

Neuropsychology is the discipline devoted to understanding how brain structure and function translate into thinking, emotion, behavior, and performance. Unlike approaches that isolate symptoms, neuropsychology examines patterns—how attention, processing speed, memory, executive function, language, and emotional regulation interact in real life. Dr. Tremaine emphasizes that cognition and mental health cannot be separated without losing clinical meaning. The regulatory relationship between the frontal lobes and the limbic system, for example, lies at the core of both mood disorders and many cognitive syndromes. When regulation falters—whether due to trauma, disease, or stress—the entire system is affected.

From this perspective, neuropsychology is not merely diagnostic. It is interpretive. It asks not only what is impaired, but how that impairment alters a person’s ability to function within their family, profession, and environment. This holistic lens is foundational to effective rehabilitation.

Neuroplasticity: Capacity, Variability, and Context

A central theme in Dr. Tremaine’s work is neuroplasticity—the brain’s capacity to reorganize and adapt. While the concept is widely invoked, her clinical experience underscores its complexity. Two individuals with identical brain pathology may show dramatically different symptoms and recovery trajectories. One may be conversational and oriented despite extensive imaging findings; another may be profoundly disrupted with minimal visible injury.

This variability, she explains, reflects the interplay of biological resilience, demographic factors such as age, environmental support, personality structure, access to resources, and goal demands. Plasticity is not automatic rewiring. Natural recovery occurs as the brain heals, but directed activity within a supportive environment is what creates meaningful change. Cognitive rehabilitation, when properly designed and individually tailored, becomes a mechanism for guiding plasticity rather than passively waiting for it.

Cognitive Rehabilitation as an Integrated Process

Cognitive rehabilitation, as practiced under Dr. Tremaine’s leadership, is not a single therapy but a coordinated system. Neuropsychological assessment serves as the engine—carefully selected tests identify specific deficits rather than offering generic profiles. Test selection and interpretation is both an art and a science, tailored to the individual’s etiology, background, and environmental demands.

From there, rehabilitation unfolds within an interdisciplinary framework. Occupational therapy, physical therapy, speech-language pathology, psychology, and vocational rehabilitation are not siloed services but aligned contributors to shared goals. Each discipline addresses cognitive functions through its own lens, while neuropsychology maintains a metacognitive and integrative role—linking cognition, emotion, insight, and strategy use.

Importantly, Dr. Tremaine advocates for expanding assessment beyond pathology to include personality structure: openness to change, flexibility, locus of control, and adaptability. Brain injury affects the whole person and their family system; rehabilitation must reflect that reality.

Technology, Judgment, and the Human Clinician

Dr. Tremaine’s consultation work in virtual reality (VR) and artificial intelligence (AI) places her at the forefront of rehabilitation innovation. She traces AI’s conceptual roots to neuropsychology itself—pattern recognition, learning models, and language processing were first mapped through brain science. Yet she remains clear-eyed about its limits.

AI and VR, in her view, excel at data collection, performance tracking, and simulated environments that clinics cannot replicate. They can predict next steps based on prior performance and create immersive, adaptive challenges. What they cannot replace is clinical judgment. Ethics, contextual understanding, and the nuanced interpretation of human behavior remain clinician-driven responsibilities.

Rather than fearing displacement, Dr. Tremaine envisions clinicians as stewards of technology—shaping tools with guardrails, ensuring they serve patients rather than dictate care. Neuropsychology, with its deep ethical training and systems-level understanding, is positioned to lead that stewardship.

Evidence, Innovation, and Clinical Caution

Her stance on adjunctive brain technologies reflects a balance of openness and rigor. Neurofeedback, QEEG, and neuromodulation approaches are theoretically compelling, yet she emphasizes the need for robust, evidence-based validation—particularly in brain injury populations. Treatments may hold promise, but adoption without sufficient data risks overdiagnosis, misapplication, or false assurance.

Transcranial magnetic stimulation (TMS), while FDA-approved for depression, illustrates another challenge: access and regulation. Even effective tools may remain out of reach for many patients, reinforcing the need for equitable, evidence-guided integration rather than hype-driven enthusiasm.

 

Life Stages, Hormones, and Cognitive Change

Dr. Tremaine also highlights underexplored domains such as menopause and other hormonally driven life transitions. Cognitive changes—slower processing speed, word-finding difficulty, attention disruption—mirror patterns seen in concussion and post-viral syndromes. Yet cognitive rehabilitation remains largely reactive, authorized only after injury rather than as preventative care.

She argues that the techniques already used in rehabilitation could be applied earlier, reframing cognitive care as maintenance rather than repair. Longitudinal neuropsychological baselines, taken across adulthood, could allow individuals to be compared to themselves rather than population norms—an underutilized but powerful concept.

Post-COVID Brain Fog and Functional Cognition

Post-COVID cognitive sequelae further illustrate her core principle: intellect often remains intact, while the foundational drivers of intellect—attention, processing speed, working memory—are compromised. When these systems falter, people feel “less sharp,” even though reasoning ability persists.

Cognitive rehabilitation addresses this through strategy training, environmental modification, repetitive practice, and mindfulness-based attentional control. The goal is not to “restore intelligence,” but to optimize the systems that allow intelligence to function.

Looking Ahead: Measurement, Ethics, and Evolution

When asked about the future of neuropsychology, Dr. Tremaine looks beyond symptom tracking toward real-time measurement of brain change—perhaps even at cellular or network levels. Wearables and neural interfaces hint at what may be possible, but she stresses caution. Scientific advancement without ethical oversight invites harm. Her vision places clinicians at the center of innovation, balancing curiosity with responsibility. As brain-based technologies grow more immersive and influential, neuropsychology’s role expands—not only as a diagnostic specialty, but as a guiding conscience for how society engages with the brain.

A Unifying View of the Brain

Through her work, Dr. Tremaine offers a unifying framework: cognition, emotion, personality, and environment are inseparable expressions of brain function. Neuropsychology, when practiced with depth and humility, becomes both a science and a translation—turning complex neural data into meaningful human recovery. Cognitive rehabilitation, in turn, becomes not just treatment, but a guided partnership with the brain’s capacity to adapt, heal, and evolve.

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PART 2 —

Functional Cognition, Cognitive Rehabilitation, and Neuroplasticity: A Collaborative Perspective

Written by: Robert L. Bard, MD, DABR, FAIUM, FASLMS

Functional cognition does not exist in isolation. It is the outward expression of an integrated biological system—neuronal signaling, vascular integrity, autonomic regulation, metabolic balance, and lived experience converging in real time. As diagnostic imaging specialists, we are trained to look beneath symptoms, to identify physiological contributors that shape how cognition performs, adapts, and recovers. This is precisely where collaboration with neuropsychology, as exemplified by the work of Monique J. Tremaine, PhD, becomes not only valuable but essential.

Cognitive rehabilitation is most effective when it is grounded in measurable biology. Neuroplasticity—the brain’s capacity to adapt through targeted experience—is not an abstract concept; it is influenced by blood flow dynamics, neural connectivity, autonomic tone, and regional metabolic demand. When neuropsychological assessment identifies deficits in attention, processing speed, executive function, or emotional regulation, advanced imaging can help contextualize why those deficits are occurring and how they may evolve with intervention.

Over the past two decades, my work has focused on noninvasive imaging approaches that complement cognitive science. Transcranial Doppler ultrasound allows us to evaluate cerebral blood flow velocity and vascular responsiveness—critical factors in cognitive stamina, processing speed, and recovery potential. Functional blood flow imaging offers insight into perfusion asymmetries that may correlate with attentional bias, fatigue, or executive inefficiency. Optical scanning technologies extend this analysis by examining microvascular and tissue-level dynamics that traditional structural imaging may overlook.

Equally important is the autonomic nervous system, particularly the vagus nerve, which plays a central role in cognitive-emotional regulation, stress response, and neuroinflammatory balance. Vagus nerve scanning provides objective data on parasympathetic integrity—data that aligns closely with neuropsychological observations of mood regulation, adaptability, and resilience. When cognitive rehabilitation targets attention, emotional modulation, or stress tolerance, autonomic metrics help validate and refine those efforts.

What makes this collaboration powerful is not redundancy, but complementarity. Neuropsychology defines functional impact, adaptive capacity, and behavioral strategy. Advanced imaging defines physiological context and constraint. Together, they transform cognitive rehabilitation from a compensatory model into a precision-guided process—one that respects individual variability rather than forcing standardized expectations.

Dr. Tremaine’s emphasis on individualized assessment, environmental context, and personality structure aligns directly with what imaging has long demonstrated: two patients with similar pathology rarely behave—or recover—the same way. Imaging confirms variability; neuropsychology translates it into meaningful care.

The future of brain health will not belong to any single discipline. It will be built through collaboration between cognitive science, diagnostic imaging, rehabilitation medicine, and ethical clinical leadership. When neuropsychologists and imaging specialists work together, neuroplasticity becomes measurable, functional cognition becomes explainable, and recovery becomes both scientifically grounded and human-centered.

This is not parallel work—it is shared science.