Neuropsychological Interventions: Clinical Practice and Research

Archives of Clinical Neuropsychology 19 (2004) 149–151 Book review Neuropsychological Interventions: Clinical Practice and Research By Paul J. Eslinger. New York: The Guilford Press, 2002, 359 pages Brain dysfunction-based disorders, related to acquired brain injury and neurological diseases, represent a leading cause of disability worldwide. In this text, Paul J. Eslinger brings together an impressive list of experts in their fields to identify and discuss the scientific ideas, theoretical models, and research findings that are, or should be, the foundations for interventions to reduce the impact of neuropsychological impairments. The overriding goal of neuropsychological rehabilitation is to promote maximal adaptive functioning in the disabled individual’s activities of daily living after brain injury or in the midst of a progressing neurological disorder. As Eslinger notes, this is accomplished through procedures that address impairments, disabilities, and handicaps in multiple areas, including behavioral, cognitive, and social-emotional spheres. While some of the chapter authors provide very specific suggestions for interventions, this is not a “how to” book. The authors are clearly focused in their presentations on discussing theory, models, and related research relevant to neuropsychological interventions. The good news is that there are neurobiological, neurobehavioral, and rehabilitation outcome data to support rehabilitation interventions. I especially liked Barrett and Gonzalez-Rothi’s discussion in Chapter 2 (from Part I of the book) regarding “why treat cognitive disorders resulting from neurological disease or injury” and the neurobiological rationale they present for providing treatment. Bergquest and Malec provide a good discussion of issues related to neuropsychological assessment in Chapter 3. They point out that identification of deficits or the detection of impairment are not sufficient. Assessment also needs to include an evaluation of the impact that the deficits will have on one’s ability to engage in his/her normal activities of daily living. They also emphasize the need for neuropsychological assessments to evaluate awareness, motivation, mood, personality, and other psychological factors with the hope of increasing the ecological validity of the assessment process. The possibilities of using direct physiological interventions through medications were discussed by Whyte in Chapter 4. Whyte provides a good discussion of methodological issues and design approaches to evaluate the efficacy of pharmacological treatments of cognitive dysfunction. Cognitive remediation and neuropsychological rehabilitation have been criticized, based on negative outcome studies, as producing no benefit by some health insurance companies. In fact, while there is a CPT Code for cognitive rehabilitation, interventions using this code 0887-6177/$ – see front matter © 2003 National Academy of Neuropsychology. doi:10.1016/j.acn.2003.08.003 150 Book review / Archives of Clinical Neuropsychology 19 (2004) 149–151 are routinely rejected by some major carriers. Because of this, and as clearly stated by Levine and Downey-Lamb in Chapter 5, rigorously designed and conducted empirical research is critical for and fundamental to advances in neurorehabilitation. These authors provide a balanced presentation regarding basic issues in the design of successful rehabilitation studies along with possible confounding factors. It is too early in its development for neurorehabilitation research to limit itself to large-scale, randomized control trials, and the authors present alternative research paradigms including quasi-experimental designs, single-case designs, the rehabilitation probe, and meta-analytic review to evaluate the outcome of neuropsychological interventions. The chapters in Part II of the book are organized around the theme “Models of Intervention for Neuropsychological Impairments.” Different chapters discuss different cognitive, emotional, or behavioral domains. Separate chapters discuss the following topics: attention, learning and memory, visuoperceptual skills, language, praxis, executive function, social behavior, and emotion-related processing. As a group, the authors provide very good reviews of the history of research on the topic, neurobehavioral models related to the area, assessment issues, intervention issues, outcome data when available, and thoughts on future research directions. Most authors move easily from theory to real world applications. Dr. Eslinger should be commended for the cohesiveness of the chapters and the even writing style across the many authors. There were not significant discrepancies in the level of discourse from chapter to chapter. Chapter 9 by Jacqueline Hinckley (Models of Language Rehabilitation) stood out for its historical perspective, excellent organization, comprehensiveness, discussion of models and intervention approaches, and description of future research needs. While “The Rehabilitation of Attention” was a good chapter overall, I was surprised and dismayed that Manly, Ward, and Robertson did not review or even mention all of the excellent work, which is theoretically based, on attention process training by Sohlberg and Mateer. It represents some of the best work done in the field of neurorehabilitation. In Chapter 3, Bergquist and Malec emphasized the importance of neuropsychological testing moving beyond the boundaries of evaluating basic cognitive skills. The last two chapters of Part II return to and reemphasize this theme by discussing the “Rehabilitation of Neurologically Based Social Disturbances” (Grattan & Grahramanlou) and “Emotion-Related Processing Impairments” (Flaherty-Craig, Barrett, & Eslinger), respectively. Much of Cicerone’s chapter on “The Enigma of Executive Functioning” is devoted to this topic as well. Impairments in social and emotional processing, awareness, and responding must be addressed in any comprehensive neurorehabilitation program. Such disorders can at times be a greater barrier to successful community reintegration than cognitive impairments. Certainly, such behavior issues, compounded by possible impairments in awareness, can at times be more difficult to compensate for or adapt to than some cognitive disabilities. These chapters not only provide a thoughtful discussion of these issues, but also suggest some intervention strategies. This book is an important contribution to our general knowledge base regarding neuropsychological rehabilitation. Neuropsychological rehabilitation needs more models that are empirically validated upon which to base practical interventions. This text also reinforces Book review / Archives of Clinical Neuropsychology 19 (2004) 149–151 151 the idea that neuropsychological testing and interventions must go beyond simply focusing on basic cognitive skills. Successful interventions will have to incorporate not only cognitive aspects but also emotional, mot (...truncated)