Biomedical Engineering Reference
In-Depth Information
6.3 Cognitive Therapy With Individuals Having Cognitive Disability
The efficacy of different types of intervention in the cognitivistic frame may be compared
in the treatment of cognitive diseases. The definition of cognitive trouble in the frame of
the wider category of disability has to be articulated and precise considering the further
distinction between cognitive and intellectual diseases (Schalock and Luckasson 2004).
It is also to underscore that the diagnostic assessment and the intervention also
substantially feel the effect of this definition, influencing the attitude of all participants.
In fact, in addition to the categorical diagnosis, in the assessment phase the damage of
the person system is evaluated (functional and dimensional analysis) to determine the
presence/absence of resources necessary for treatment.
The cognitive diseases are generally defined as an alteration of the so-called superior
cognitive functions: intelligence, attention, memory, language, reading and writing capaci-
ties, visiospatial abilities, praxis abilities, and executive functions (judgment ability, plan-
ning, cognitive flexibility, etc.). These diseases are normally the consequences of congenital
or acquired brain damage. The most frequent causes of acquired cognitive disability
in adults are cranial trauma, degenerative illnesses of the central nervous system (as in
dementia and Alzheimer's disease), illnesses of the central nervous system (such as epi-
lepsy and cerebral infections of viral origin), cerebral infarcts (ischemia), brain tumors,
metabolic disorders, and other neurological illnesses.
Cognitive disabilities often result in difficulties in social and work adjustment, and they
are often accompanied by relational and emotional problems (anxiety, insecurity, depres-
sion, etc.). The evaluation is based on anamnesis, on medical and neuropsychological
assessments that investigate the damage in cognitive areas by means of behavioral obser-
vation, and on the use of sets of standardized tests.
The suitable intervention, in addition to the medical one, is cognitive rehabilitation com-
bined with cognitive-behavioral therapy. Although in the past therapeutic interventions
with subjects presenting cognitive disability were considered useless, there is a notable
growing interest in structuring interventions focused and adapted to the presented cogni-
tive deficit (Willner and Hatton 2006). It must be emphasized that psychological correlates
of cognitive impairment are inevitable and cannot be omitted in a bio-psycho-social inte-
grated approach (Arthur 2003).
Whatever is the adopted approach, it is necessary to adapt the therapy to patients with vary-
ing cognitive disabilities by simplifying techniques, language, and tasks while adopting a flex-
ible method characterized by more directivity and at the same time more attachment behavior
(Hurley et al. 1998). Only with these adaptations the therapeutic approaches used with the
“normal” population, both the psychodynamical and the cognitivistic ones, can be effective
with persons with cognitive disabilities. The reference theory determines which adaptations
are more often realized in practice. In the CBT approach, the adaptations are mostly related to
the technical aspects whereas in the psychodynamic approach they are more often tied to the
therapist's attitude and to the countertransference (Whitehouse et al. 2006).
As previously said, the CBT approach is characterized by directivity and teaching to
foster improvement of the damaged capacities and to teach the patient specific strategies
of deficit compensation by means of the remaining abilities (Taylor 2005; Taylor et al. 2008).
Many studies comparing the effectiveness of therapeutic interventions show many lim-
its due to the difficulty of isolating the variables that have produced the change in the
treated patients (Heyvaert et al. 2010). The theories, techniques, and strategies used by the
therapist that determining the nature of his or her approach cannot be disentangled from
 
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