Cognitive Rehabilitation in an Information-Processing Perspective

The aims of treatment of chronic psychiatric patients with or without brain dysfunction have undergone a considerable change in the last decade. The ambitions of the therapists have in general decreased and the expectations of the patients and their families have become more realistic. This process has been operationalized in terms of various concepts and theories. Instead of eliminating or improving the cause of illness and repeatedly attempting to bring chronic psychiatric patients back into society, more attention is now being paid to the actual state of functioning of the patients and to the attempt to improve the quality of their life in the most suitable setting they need. A relevant model was looked for that could enable the elaboration of an appropriate approach to this population and bring about observable change in behaviour and level of functioning within the limits given by the psychotic defect and/or brain dysfunction. We find the competency model as presented by Townes, Martin, Nelson, Prosser, Pepping, Maxwell, Peel, and Preston (1985) a useful starting point The essence of this approach is to indicate the actual level of cognitive functioning of the individual patient in terms of an individualized skills profile derived from test results assessing various cognitive functions. The basis of this model is the brain-behaviour frame of reference. The operationalization of this approach has been realized in the form of neuropsychological screening with the Halstead-Reitan Neuropsychological Test Battery (NTB) as well as specific neuropsychological tests of different cognitive functions. Our theoretical model is based on the conceptual model of behavioural correlates of brain function introduced by Reitan and Wolfson (1985, 1988). The results of the neuropsychological diagnostic process form the basis for elaboration of cognitive training procedures. Cognitive rehabilitation (retraining, training, revalidation) has become increasingly popular in the eighties. There have been many attempts to create training techniques to improve the cognitive functioning of the chronic psychiatric patients. Hereby the neuropsychological model has frequently been applied with the implicit hypothesis that cognitive dysfunctions or defects in chronic schizophrenics were to a great extent similar to those in patients with brain dysfunctions based on observable or hypothesized brain damage. This hypothesis has received support in the literature (e.g., Klonoff, Fibiger, Hutton, 1970). So far, however, we cannot consider this hypothesis as satisfactorily confirmed.