Evaluation of cognitive rehabilitation as a treatment paradigm.

PURPOSE The construct of 'cognitive rehabilitation' has not been defined in a consensual manner and the variations in usage have produced misunderstanding and controversy. At one extreme, it refers to a paradigm of complex, sophisticated, integrated interventions and at the other to a poorly conceptualized and largely ineffectual service modality. A number of articles criticizing cognitive rehabilitation make little effort to differentiate between these usages, thus subjecting very different clinical procedures to the same complaints. METHODS This article abstracts five major criticisms from this literature to examine the best-developed, 'holistic' versions. CONCLUSION A treatment selection standard is proposed, specifying the conditions under which a holistic model or the 'contextualized' training alternative is likely to be more viable.