Rehabilitation of Neuropsychological Disorders by Brick Johnstone & Henry H. Stonnington

Author:Brick Johnstone & Henry H. Stonnington [Brick Johnstone and Henry H. Stonnington]
Language: eng
Format: epub
Publisher: Psychology Press

PRACTICAL TREATMENT STRATEGIES FOR VISUAL-SPATIAL IMPAIRMENTS

General Treatment Strategies for Visual-Spatial Impairments

The goal of remediating visual-spatial deficits is to improve the patient’s awareness of deficits and their impact on daily functioning and to apply appropriate compensatory strategies to maximize functioning. The literature is replete with warnings that individuals suffering from brain dysfunction do not generalize training well from one setting or task to others; therefore, treatment should be as ecologically valid as possible. Training should ideally be provided in each functional domain, as well as in the patient’s home and workplace. As with most neuropsychological impairments, it is important for individuals with deficits in visual-spatial abilities to practice skills across different settings, as improvements may only result in the targeted task or setting. Family education regarding modifications to activities and potential activity restrictions will be extremely important, as they will likely need to assist in restructuring the environment or providing regular and consistent cues. Furthermore, the operation of power tools or motorized vehicles may be prohibitively risky, and individuals with impairments in various visual-spatial skills should always be professionally evaluated before they resume using potentially dangerous tools or machinery.

There are numerous commercially available computer-based visual-spatial rehabilitation software programs; however, their effectiveness has not been well documented. Computer versus recreational rehabilitation training has been found to be equally effective (Robertson, Gray, Pentland, & Waite, 1990), although the overall efficacy of the rehabilitation of visual-spatial and other cognitive deficits is often questioned. It has been argued that individuals with cognitive impairments will eventually achieve the same functional status whether or not they have received rehabilitation services, although rehabilitation may shorten the length of recovery. Diller and Weinberg (1977) found that in their study evaluating the efficacy of visual-spatial interventions, many of the controls’ hemi-inattention deficits became worse, possibly because they developed poor gazing habits. At a 1-year follow-up, those in the treatment group improved following treatment with a slight fallback; the control group remained at the level they achieved at the time of their discharge. The greatest gain of any control group participant was well below the median of the treatment group gains.

The mechanism of recovery of visual-spatial skills is not well understood. For neglect, there are intrahemispheric and interhemispheric theories. It has been argued that the injured hemisphere recovers and readapts, or that the undamaged (typically left) hemisphere may be able to compensate by processing information ipsilaterally through collosal connections (Heilman, Bowers, Valenstein, & Watson, 1987).

Repetition is the principle most applied to remediation of visual-spatial deficits. Often, creativity is the critical factor for involving the patient in rehabilitation and maintaining his or her interest and motivation. It is not adequate to rely upon incidental practice for remediation of deficits, especially given that motivation problems are often present with brain dysfunction. Practice needs to be focused on the area of deficit, as it is typical and natural for the patient to rely more heavily on relatively preserved areas of function. During treatment, the natural tendency to compensate for deficits using intact, relatively stronger abilities can be detrimental to the effective remediation of impairments.

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