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The Clincal Neuropsychologist's Dilemma
Keynote Address - Symposium on Neuropsychological Rehabilitation, Uluru, Australia. Published in Brain Impairment, 5(1), 105
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This paper suggests that problems faced by therapists, patients and their families involved in cognitive rehabilitation are so diverse and complicated that claims that cognitive rehabilitation itself can be rendered effective by following directions indicated by and emanating from research in the basic cognitive neurosciences cannot be justified. Although Robertson's (2003) elegant and well researched paper entitled 'Cognitive neuroscience and Brain Rehabilitation: A Promise Kept' suggests the contrary, drawing support from studies in plasticity, unilateral neglect in stroke patients, the reduction of attentional deficits in people with brain injury and others, it is the contention of this paper that such research on its own cannot provide sufficient guidelines or a strong enough framework to cope with the scale and complexity of concerns faced by the parties involved in the process of cognitive rehabilitation. A typical scenario is presented with a number of problems, for example, memory, attention, planning and organisational difficulties. He has emotional difficulties such as anxiety, depression and mood swings; he has behavioural problems including poor self control and verbal aggression. His family needs help, and the young main himself wants to return to work. Most of these problems are not the focus of research in the neurosciences. Obviously, we can call upon research from the neurosciences to help in reducing specific difficulties. We might be able to arrange a PET scan or functional MRI to help obtain guidance as to whether to use a restitution or compensatory strategy. However, such contributions are at best limited in the face of the multiplicity of concerns that face the participants in cognitive rehabilitation. It is suggested that a much broader theoretical framework is needed, which should include models of cognition, emotion, behaviour, recovery, together with empathy and clinical skills.