Neuropsychological rehabilitation in intellectual disability: strengths, weaknesses and theoretical contribution to treatment definition in complex rehabilitation interventions

This paper describes and evaluates a program of neuropsychological rehabilitationwhich aims to improve three sub-components of money use by the acquisition of re-organization strategies Our program has three steps: cognitive rehabilitation(graduated exercises subdivided into three sub-programs each corresponding to a sub-component) which enables the patient to acquire the three specific strategies; and an ecological rehabilitation, including analyses of scenarios andsimulations of real-life situations, which aims to transfer the strategies learnedto everyday life. It was applied to a group of 11 DI with mild to moderate intellectual disability and limited money knowledge and use. Multiple baseline tests were used to measure the effectiveness of the rehabilitation. The program proved to be effective for all components; a generalization of its effects to everyday life was observed, and the effects were undiminished three months later. Rehabilitation research is challenged to improve its evidence base, whichrequires more precise and more consistent conceptualisation and measurement of treatment ingredients. This paper presents the steps in defining and specifyingtreatments towards the construction of a therapy manual for experimentalinterventions, or a coding system for observational treatment research. Specifyingthe active ingredients, identifying the behavioural operations that are aligned with each, and developing procedural details and materials arediscussed and illustrated using two on-going trials for treatment of traumaticbrain injury. The process of assessing treatment fidelity, that is, the extent towhich interventions are delivered, received and used as intended, is also discussed.