In 1983, Lezak described executive functioning as the ability to engage in independent, purposeful, self-directive and self-serving behaviour. Self initiation, problem-solving and self-monitoring or regulation of behaviour are important components of executive functioning. This paper presents the results of efforts to improve executive functioning in three areas: problem solving, self-initiation and self-regulation.
To deal with the problem of stealing, an overcorrection procedure was designed in which the thief was required to give his victim an item identical to the stolen one in addition to returning the stolen item. This procedure was compared with the more commonly used simple correction procedure (restitution) in which the thief is required to return the stolen item. Under the simple correction procedure, an average of 20 thefts per day had been occurring among 34 retarded residents of an institution. The overcorrection procedure reduced the thefts by 50% on the first day, by 75% on the second day, and eliminated thefts by the fourth day, after which no further stealing occurred. The overcorrection procedure was a rapid and effective method of eliminating stealing, it provided special consideration for the victim, and it should be applicable to the nonretarded.
Six traumatically brain-injured clients were trained in four memory improvement strategies. These were written rehearsal, verbal rehearsal, acronym formation, and memory notebook logging. This study showed that only memory notebook logging was effective in increasing recall of classroom material.
Three brain-injured clients failed to respond significantly to consequence management programmes designed to increase attendance, use of a cane, and to reduce unauthorized breaks. When antecedent stimulus control procedures were applied, attendance and use of a cane increased and unauthorized breaks decreased. The study shows that antecedent control may be the treatment of choice when treating brain-injured clients with memory loss.
In its first decade cognitive rehabilitation has emerged from infancy with the energy and much of the turmoil of youth. It has become an established speciality in brain-injury rehabilitation and has inspired many neuropsychologists to broaden their expertise beyond diagnosis and address their efforts to intervention. Restoration, although controversial, is an important and valid goal at the outset of cognitive rehabilitation, whereas the substitution of other means of goal achievement and environmental redesign are significant components of a comprehensive neuro-rehabilitative treatment programme. Efficacy is being demonstrated in many ways, ranging from increased patterns of use to controlled empirical studies. Few continue to raise the naive issue of whether there is any scientific basis for this neuropsychological speciality; instead, questions have become more focused on understanding the process of change to best serve human needs. In the next decade the refinement of current approaches can be anticipated, as well as the breaking of new ground. Neuropsychologists specializing in cognitive rehabilitation are likely to be turning their attention to underserved populations, such as those emerging from protracted coma, individuals suffering from 'progressive' neurological conditions, and persons whose brains were injured early in development. Scientific (theoretical, methodological and empirical) developments in cognitive psychology will help to delve more precisely into the underlying basic processes, including the sensory substrate. We will be challenged to address specific applications, such as advising people with known or suspected cognitive deficits who wish to drive.
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