Learning from Failures in Perceptual Cognitive Retraining in Stroke

Abstract

Interventions for perceptual/cognitive problems have been responses to therapeutic failures in rehabilitation. Failure, for the program we are about to describe, thus has been the beginning rather than the end of inquiry. In this chapter we propose to elucidate this point by describing a sequence of controlled experiments and case studies which helped in developing tools and strategies to overcome failure. Our understanding of the problems associated with the perceptual difficulties of the right brain-damaged person and strategies for the management of these problems have been evolving over the past decades and include a series of studies over the past two decades which has taken the following paths: (1) observations of failures during teaching/ learning in rehabilitation; (2) relating naturalistic phenomena to test-based observations; (3) development of a therapeutic strategy based on test-based observations; (4) development of a hierarchy of interventions for disturbances in visual information processing; (5) further extensions of treatments for different aspects of information processing; and (6) case studies indicating that treatment involves a continuous attempt to overcome obstacles of failures. While the bulk of the work has been conducted with right hemi- spheric-damaged hemiplegics in a medical rehabilitation setting suffering from different degrees of visuospatial neglect, in the past five years the work has been applied to individuals with perceptual problems, due to bilateral brain damage, and to people with etiology other than stroke.