( Cavanaugh & Green, 1990). Current students of theories of intellect argue that cognitive processes can be divided into two systems. One is biological and provides the basic architecture system for cognition, such as memory span, speed of encoding, and decoding information. The second is learned and provides the executive system that guides problem solving and metacognition ( Campione & Brown, 1978). Although neuropsychologists would reframe the distinction between biological and environmental, the notion of two systems operating in cognition may be a useful guide to students of cognitive remediation.
The right treatment for the right patient? Important steps have been taken to develop more precise replies to this question. First there is a more careful sorting out of patients at both ends of the spectrum of severity: the most severe and the least severe. These steps involve neurological and behavioral measures. Second, there have been advances in various therapeutic modalities, including innovative therapies delivered in groups, family coaches, supportive employment, and assistive technology. These modalities point toward helping people function at an optimal level in specific contexts. Third, there has been an outpouring of studies on cognitive remediation, but the field does not rest on a firm footing because most studies have dealt with impairments so that gains are difficult to translate into practical benefits. In addition, there is a lack of replicated experimental studies. However, there is also a sense of using cognitive remediation as a step linked to functional outcomes by tying the remediation to functional activities. Fourth, there has been interest in psychological constructs, which serve as moderator variables. Constructs such as awareness and self-efficacy also reflect larger trends in general psychology.
Finding the right treatment for the right patient at this time involves guesswork. With the rapid growth in documenting treatments and descriptions of TBI, we are narrowing the guesses.
This chapter was supported in part by the U.S. Department of Education, National Institute on Disability and Rehabilitation Research, Research and Training Center on Head Trauma and Stroke, Grant No. H133B80028.