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Clinical Neuropsychology of Intervention Clinical Neuropsychology of Intervention CLINICAL NEUROPSYCHOLOGY OF INTERVENTION CLINICAL NEUROPSYCHOLOGY OF INTERVENTION EDITED BY BARBARA P. UZZELL Hospital of the University ofPennsylvania YIGALGROSS Bar-Ban University MARTINUS NIJHOFF PUBLISHING A MEMBER OF THE KLUWER ACADEMIC PUBLISHERS GROUP BOSTON DORDRECHT LANCASTER © 1986 by Martinus Nijhoff Publishing.Publishing, Boston. All rights reserved. No part of this publication may be reproduced,reproduced. stored in a retrieval system,system. or tr.lnsmittedtrdlnsmitted in any form or by any means,means. mechanical.mechanical, photocopying,photocopying. recording,recording. or other­ wise,wise. without the prior written permission of the publishers.publishers, Martinus Nijhoff Publishing,Publishing. 190 Old Derby])erby Street.Street, Hingham,Hingham. MA 02043, USA. PRINTEDPRI:t\rTED IN THE UNITED STATES. DISTRIBUTORS for the United States and Canada: Kluwer Academic Publishers, 190 Old Derby Street.Street, Hingham,Hingham. MA.MA, 02043, USA for the UK and Ireland: Kluwer Academic Publishers.Publishers, MTP Press Limited,Limited. Falcon House,House. Queen Square, Lancaster LAlLA1 1lRN,RN, UK for anal]l other countries: Kluwer Academic Publishers Group.Group, Distribution Centre, P.O. Box 322, 3300 AH Dordrecht.Dordrecht, The Netherlands LibraryLibr~lry of Congress Cataloging-in-Publication Data Main entry under title: Clinical neuropsychology of intervention. Includes bibliographies and index. 1. Brain damage. 2. Brain damage-Patients­ Rehabilitation. 3. Neuropsychological tests. I. U2:Zell.U2;zell, Barbara P. II. Gross.Gross, Yigal. [DNLM: 1. Brain Injuries-rehabilitation. 2. Neuropsychology­ methods. WL 354 C6413jC6413] RC387.5.C56 1985 616.8 85-15498 ISBN-13:ISBN 0-89838-756-6978-1-4612-9412-2 e-ISBN-13: 978-1-4613-2291-7 DOl: 10.007/978-1-4613-2291-7 CONTENTS Contributing Authors Vll Foreword by Edith Kaplan xii Preface xv I. ORIGINS OF INTERVENTION 1 1. Pathophysiology and Behavioral Recovery 3 Barbara P. Uzzell D. ASSESSMENT FOR INTERVENTION 19 2. The Ecological Validity ofNeuropsychological Assessment and Remediation 21 Tessa Hart and Mary Ellen Hayden 3. Qualitative Neuropsychological Assessment: Kurt Goldstein Revisited 51 Herbert Kohn 4. Cognitive Assessment in the Neuropsychological Rehabilitation of Head-Injured Adults 59 Keith D. Cicerone and David E. Tupper 5. Relationships Between Test Scores and Everyday Life Functioning 85 Mary Bryant Acker 6. Competency Assessment in Clinical Populations: An Introduction to the Cognitive Competency Test 119 Paul L. Wang and Karen E. Ennis v vi 7. Cognitive, Personality and Psychosocial Factors in Neuropsychological Adjustment ofBrain-Injured Patients 135 George P. Prigatano, Mary Pepping, and Pamela Klonoff III. INTERVENTION TECHNIQUES AND STRATEGIES 167 8. Applying Luria's Theory to the Rehabilitation Process of Brain Damage 169 Anne-Lise Christensen 9. Intervention Models in Neuropsychology 179 Yigal Gross and Larry E. Schutz to. Skills, Routines, and Activity Patterns ofDaily Living: A Functional Nested Approach 205 Nathaniel H. Mayer, Daniel]. Keating, and Dorrie Rapp 11. Management of Persisting Communication Deficits in Patients with Traumatic Brain Injury 223 Sandra B. Milton and Robert T. Wertz 12. Memory Remediation: Restoration, Alleviation and the Acquisition of Domain-Specific Knowledge 257 Daniel L. Schacter and Elizabeth L. Glisky 13. Learning from Failures in Perceptual Cognitive Retraining in Stroke Leonard Diller and Joseph Weinberg 283 Index 294 CONTRIBUTING AUTHORS Mary Bryant Acker, Ph.D. Hospital Psychology Services Program Manager Santa Clara Valley Medical Center San Jose, California, 95128, U.S.A. Anne-Lise Christensen. C. Psychol. Director ofRehabilitation Center for Rehabilitation ofBrain Damage University ofCopenhagen, Amager Nialsgade 88 2300 Copenhagen S., Denmark Keith D. Cicerone, Ph.D. Clinical Director ofthe Cognitive Rehabilitation Department LiFEstyle Institute 2050 Oak Tree Road Edison, NewJersey, 08820, U.S.A. Leonard Diller, Ph.D. Director ofPsychology in Behavioral Sciences Rusk Institute ofRehabilitation Medicine Professor ofClinical Rehabilitation Medicine New York University Medical Center vii viii 400 East 34th Street New York, New York, 10016, U.S.A. Karen E. Ennis, Ph.D. Psychology Staff Mount Sinai Hospital Department ofPsychology 600 University Avenue Toronto, Ontario, Canada M5G lX5 Elizabeth L. Glisky, Ph. D. Research Fellow Unit for Memory Disorders Department ofPsychology University ofToronto Toronto, Ontario, Canada M5S 2)5 Yigal Gross, Ph.D. Senior Lecturer Department ofPsychology Bar-Han University Ramat-Gan; Director ofDevelopment and Training The Neuropsychological Unit for Treatment and Rehabilitation Givatayim, Israel Tessa Hart, Ph.D. Director ofResearch Department ofNeuropsychology Medical Center Del Oro Hospital 8081 Greenbriar Dr. Houston, Texas, 77054, U.S.A. Mary Ellen Hayden, Ph.D. Director Department ofNeuropsychology Medical Center Del Oro Hospital 8081 Greenbriar Dr. Houston, Texas, 77054, U.S.A. Edith Kaplan, Ph. D. Director of Clinical Neuropsychological Services Boston Veterans Administration Medical Center; Associate Professor ofNeurology (Neuropsychology) Boston University Medical Center Boston, Massachusetts 02118 ix Daniel J. Keating, Ph. D. Unit Director Intermediate Living Skills Program Drucker Brain Injury Center Moss Rehabilitation Hospital 12th Street and Tabor Road Philadelphia, Pennsylvania, 19141, U.S.A. Pamela Klonoff, Ph.D. Postdoctoral Fellow Section ofNeuropsychology Department ofNeurosurgery Presbyterian Hospital University of Oklahoma Health Science Center Oklahoma, Oklahoma, 73104, U.S.A. Herbert Kohn, Ph.D. Associate Professor ofPsychiatry Department ofPsychiatry UMDNJ-Rutgers Medical School Piscataway, NewJersey, 08854, U.S.A. Nathaniel H. Mayer, M.D. Professor, Rehabilitation Medicine Temple University Health Sciences Center Director, Drucker Brain Injury Center Moss Rehabilitation Hospital 12th Street and Tabor Road Philadelphia, Pennsylvania, 19141, U.S.A. Sandra B. Milton, M.A., c.c.c.-Sp. Director Head Injury Rehabilitation Consulting Services 6317 Wilshire Boulevard, Suite 402 Los Angeles, California, 90048, U.S.A. Mary Pepping, Ph.D. Director, Section ofNeuropsychology Department ofNeurosurgery Presbyterian Hospital University of Oklahoma Health Science Center Oklahoma, Oklahoma, 73104, U.S.A. George P. Prigatano, Ph.D. Chairman ofDepartment of Neuropsychology Clinical Director ofNeurological Rehabilitation x Barrow Neurological Institute 350 West Thomas Road Phoenix, Arizona, 85013, U.S.A. Dorrie: Rapp, Ph.D. Clinical Assistant Professor Department ofMental Health Sciences Hahnemann University Clinical Neuropsychologist 7906 Chandler Road Laverock, Pennsylvania, 19118, U.S. A. Daniel L. Schacter, Ph.D. Assistant Professor Unit for Memory Disorders Department ofPsychology University ofToronto Toronto, Ontario, Canada M5S 2J5 Larry E. Schutz, Ph. D. Clinical Director Head Injury Center at Manatee Springs 5627 9th Street East Bradenton, Florida, 33507, U.S.A. David E. Tupper, Ph.D. Staff Psychologist Cognitive Rehabilitation Department LIFEstyle Institute 2050 Oak Tree Road Edison, NewJersey, 08820, U.S.A. Barbara P. Uzzell, Ph.D. Clinical Neuropsychologist Research Assistant Professor Division ofNeurosurgery Hospital ofthe University ofPennsylvania 3400 Spruce Street Philadelphia, Pennsylvania, 19104, U.S.A. Paul L. Wang, Ph. D. Director ofNeuropsychology Mount Sinai Hospital Department ofPsychology 600 University Avenue Toronto, Ontario, Canada M5G 1X5 xi Joseph Weinberg, M.A. Senior Psychologist Rusk Institute ofRehabilitation Medicine New York University Medical Center 400 East 34th Street New York, New York, 10016, U.S.A. Robert T. Wertz, Ph.D. Chief, Audiology and Speech Pathology VA Medical Center 150 Muir Road Martinez, California, 94553, U.S.A. FORI~WORD It is estimated that 400,000 to 500,000 individuals who have sustained a trau­ matic head injury are admitted to hospitals every year. Of these, 40,000 to 50,000 have moderate to severe head injury causing significant enduring dis­ abilities. Another 70,000 to 90,000 have minor head injuries with persistent sequelae such as memory and/or behavioral problems that preclude imme­ diate return to the workplace. Contributing further to the problem is the fact that the largest number of head injury victims are below the age of 30 and have a considerable life expectancy. It is, therefore, not surprising that there has been a recent proliferation of cognitive rehabilitation centers. In 1980, when the National Head Injury Foundation was established, there were only 22 idlentified cognitive rehabilitation centers. In 1985, the resource guide of the National Head Injury Foundation lists 350 cognitive rehabilitation centers dedicated to address the overwhelming needs of the head injured and their familites. Concomitant with this rapidly growing increase in the number of facilities, there have been remarkable developments in clinical imaging tech­ nology that have expanded our knowledge of the affected neural substrate and the behavioral consequences. In conjunction with these advances, pro­ fessionals in the rapidly evolving field of clinical neuropsychology have be­ come cognizant of the need to expand their role as clinicians to meet the increasing demands for treatment of the brain injured. As a result, there has been a move in the direction of assessment of processes or strategies that a patient employs (whether they be adaptive or maladaptive), rather than the xii. xiii more traditional psychometric focus on
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