Behavioral assessment and treatment of the brain-injured patient.

From the literature on compensatory training it is clear that brain injured patients can learn to perform tasks they were incapable of soon after their brain injury. At present, little more can be said about the efficacy of cognitive retraining for several reasons. First, the bulk of our studies do not permit prediction to real-life recovery because they have focused on improvements on psychometric tests or experimental procedures with little social validity. Second, most studies have failed to assess the patient's ability to self-initiate the acquired skills and even they have, few studies have shown that patients can use the skill effectively to solve problems on their own. Third, the majority of studies have used only a few subjects and do not allow an evaluation of the power of a given technique for a given neuropsychological problem. In studies using multiple single cases, many researchers typically have had to modify the techniques to the unique psychological and neuropsychological strengths and weaknesses of their subjects. Hence, even very similar procedures at the outset often have been so radically changed during the course of therapy that they share few characteristics across subjects by the end of training. Finally, most important to the future of cognitive retraining is the continuation of research and development. Although the initial results of cognitive retraining efforts have been encouraging, clinical retraining techniques may be more popular than the extant treatment outcome data warrant. Promising the public a technology that has not been adequately developed is bound to produce negative repercussions for both patients and agencies willing to fund such treatment.