Clinical Psychology

to“treat”the patient’s deficits. Golden et al. (1992,

pp. 214–215) offer the following general guidelines

for formulating this type of rehabilitation task:

1. It should include the impaired skill that one is
   trying to reformulate. All other skill require-
   ments in the task should be in areas with which
   the subject has little or no trouble.


2. The therapist should be able to vary the task in
   difficulty from a level that would be simple for
   the patient to a level representing normal
   performance.


3. The task should be quantifiable, so that prog-
   ress can be objectively stated.


4. The task should provide immediate feedback to
   the patient.


5. The number of errors made by the patient
   should be controlled.
   Golden and colleagues (1992) give examples of
   rehabilitation programs for various cognitive and
   behavioral deficits. For example, verbal memory
   impairment might be treated by administering sim-
   ple memory problems (those involving one unit of
   information) to the patient and then, later, more
   complex tasks (e.g., a problem requiring the mem-
   orization of six or seven units of information). The
   complexity of the task can be varied further by, for

example, using unrelated words or decreasing the

time of exposure to the stimulus words.

More recently, Wilson (2008) has argued that

rehabilitation programs should incorporate several

components to increase the likelihood of success.

First, in collaboration with the patient goal setting

at the beginning and periodic evaluation of goals

throughout the rehabilitation program should be

conducted. Second, the link between cognitive,

emotional, and physical deficits due to brain injury

must be explored and incorporated into more

“holistic” approaches to rehabilitation. Finally,

rehabilitation psychologists should take advantage

of recent advances in technology, including the

use of electronic diaries and pagers that can prompt

individuals to use cognitive skills as well as the use

of virtual reality to simulate real-life experience for

both assessment and treatment.

CONCLUDING REMARKS

Training

Without doubt, neuropsychology as a specialty area

within clinical psychology is dynamic and exciting.

At the same time, however, the procedures in this

subfield have become so sophisticated that specialty

training is necessary (Boake, 2008).

BOX18-5 Focus on Professional Issues: Cross-cultural Neuropsychology

Neuropsychologists are becoming increasingly sensitive

to the possibility that normative data for traditional

neuropsychological tests may not apply to individuals

from different ethnic or cultural backgrounds. The field

of cross-cultural neuropsychology seeks to identify dif-

ferences in neuropsychological performance that may be

at least partially due to differences in ethnic or cultural

backgrounds. Neuropsychological tests may have tasks or

items that are at least partially influenced by culturally

learned abilities, and these tests have typically been

standardized using individuals who are native English

speakers and Caucasian, for example. Given the increas-

ing diversity in the United States and other countries,

the field of neuropsychology is being faced with the

challenge of demonstrating that the interpretation of

neuropsychological test scores is appropriate for indi-

viduals from diverse language and cultural backgrounds.

But how do we know if test results are“biased”

against certain cultural groups? Pedrazza and Mungus

(2008) remind us that simply showing mean differences

in scores on tests is not, in and of itself, sufficient to

demonstrate bias. Rather, evidence for bias is obtained

if a test score has a significantly different meaning for

one cultural group versus another. This can be assessed

in different ways including making sure the similar

cognitive abilities are being assessed in different cul-

tural groups using the same tests, as well as ensuring

that test scores predict relevant outcomes (e.g., diag-

nosis of brain injury) with equal strength regardless of

an individual’s cultural background. In the absence of

such evidence, it is necessary to adapt or modify tests

to accommodate cultural and language diversity so

that persons from all backgrounds can profit from

clinical neuropsychological services (Boake, 2008).

532 CHAPTER 18