When we think of treatments, we tend to assume that they will translate into improved daily functioning and overall quality of life to at least a certain extent. However, reality can be more complex, especially in cases of brain injury. Neuropsychological treatments have evolved significantly over the years, offering various strategies to help individuals manage specific cognitive impairments. But how effective are these treatments in real-life settings?
Choosing the appropriate treatment strategy begins with assessing which cognitive domains need improvement. This often includes cognitive tests and self-reports from patients. If patients cannot complete the assessments themselves, reports are provided by partners or primary caregivers instead, which are called ‘’proxy reports’’. Different approaches exist to help deal with challenges of mental difficulties such as memory, attention, and language. The effectiveness of these strategies in improving cognitive functioning and patient participation in daily life depends on both personal and environmental factors. A highly motivated patient might be more likely to engage in and benefit from memory exercises. On the other hand, a patient dealing with mood problems might need additional support to participate fully in cognitive training. Environmental factors such as the patient's living situation, social support network, and availability of resources could also determine how effective these strategies could be.
One of these strategies is computerized training, which is used for people with working memory problems. Patients can be asked to play games or engage in computerized tasks where they have to remember a sequence of numbers or shapes, helping them maintain and use information better. Reading comprehension training for post traumatic brain injury and stroke patients is also a common strategy, where patients read passages and answer questions to see how well they have understood what they read. For patients with executive functioning problems, metacognitive strategy training is used as a strategy, which aims to teach people to set their own goals by breaking tasks into smaller steps, checking their progress regularly and monitoring their performance when needed.
Unfortunately, there aren’t many measurement instruments out there that focus on participation in daily life as the most important outcome. The results of assessments often cannot be reflected in real-life situations because the tests are usually conducted in laboratory environments. These environments do not account for the strategies that people use in their daily lives that could help them out with their challenges. Tools that evaluate cognitive functioning in observational settings are particularly valuable because they offer ecological validity, i.e. how well the results of assessment tools could predict the functioning in real-world settings. Imagine you're testing how well someone can remember a list of words. If you do this test in a laboratory, it might not be the same as doing it in a grocery store, where people usually make lists to help them. Ecological validity is about making sure that the way we test things is as close as possible to how they happen in everyday life. This helps researchers understand how their findings will actually apply to real world conditions.
Neuropsychological treatments used today offer strategies that can significantly benefit individuals with cognitive impairments. However, their success often depends on personalized approaches and real-life applicability. Research and advancements in assessment tools will continue to improve these treatments' effectiveness, ultimately helping patients lead more independent and fulfilling lives. Validating comprehensive measurement instruments that account for daily functioning, therefore enhancing the ecological validity of these evaluations seem to be the way forward in psychological assessment.
Author: Ege Su Gülseven
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