Cognitive rehabilitation: A neuropsychological speciality comes of age

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Abstract
In its first decade cognitive rehabilitation has emerged from infancy with the energy and much of the turmoil of youth. It has become an established speciality in brain-injury rehabilitation and has inspired many neuropsychologists to broaden their expertise beyond diagnosis and address their efforts to intervention. Restoration, although controversial, is an important and valid goal at the outset of cognitive rehabilitation, whereas the substitution of other means of goal achievement and environmental redesign are significant components of a comprehensive neuro-rehabilitative treatment programme. Efficacy is being demonstrated in many ways, ranging from increased patterns of use to controlled empirical studies. Few continue to raise the naive issue of whether there is any scientific basis for this neuropsychological speciality; instead, questions have become more focused on understanding the processes of change to best serve human needs. In the next decade the refinement of current approaches can be anticipated, as well as the breaking of new ground. Neuropsychologists specializing in cognitive rehabilitation are likely to be turning their attention to underserved populations, such as those emerging from protracted coma, individuals suffering from 'progressive' neurological conditions, and persons whose brains were injured early in development. Scientific (theoretical, methodological and empirical) developments in cognitive psychology will help to delve more precisely into the underlying basic processes, including the sensory substrate. We will be challenged to address specific applications, such as advising people with known or suspected cognitive deficits who wish to drive. Assessment of non-compliance has been discussed. This included exploration of reinforcement contingencies, age appropriateness, cultural background and social background. Several perspectives on this have been addressed. Memory deficits are also critical when assessing non-compliance. Specifically, when the TBI person has severe memory deficits. Consequence management and antecedent control techniques have shown to be highly effective in promoting participation. Additionally, non-compliance should not necessarily be viewed as non-desirable, in fact, the client may be communicating preferred and non-preferred interests. It is important to recognize individual talents, interests and preferences. This is a signicant point when you consider that TBI survivors had pre-injury lifestyles, i.e. full-time employment, a working social network, and preferred interests and activities.

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