Webster J S, Scott R R
Veterans Administration Medical Center, Long Beach, CA.
Prog Behav Modif. 1988;22:48-87.
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.
从关于代偿性训练的文献中可以清楚地看出，脑损伤患者能够学会执行他们在脑损伤后不久无法完成的任务。目前，由于几个原因，关于认知再训练的疗效几乎没有更多可说的。首先，我们的大部分研究无法预测现实生活中的恢复情况，因为它们专注于心理测量测试或实验程序的改进，而这些测试或程序几乎没有社会效度。其次，大多数研究未能评估患者自我启动所获得技能的能力，即使评估了，也很少有研究表明患者能够有效地运用这些技能自行解决问题。第三，大多数研究只使用了少数受试者，无法评估特定技术对特定神经心理学问题的效力。在使用多个单病例的研究中，许多研究人员通常不得不根据受试者独特的心理和神经心理学优势与劣势来修改技术。因此，即使一开始非常相似的程序，在治疗过程中往往也会发生根本性的改变，以至于在训练结束时，不同受试者之间几乎没有共同特征。最后，对认知再训练的未来最重要的是研究与开发的持续进行。尽管认知再训练努力的初步结果令人鼓舞，但临床再训练技术可能比现有治疗结果数据所证明的更受欢迎。向公众承诺一种尚未充分开发的技术必然会给患者和愿意资助此类治疗的机构带来负面影响。
