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APPENDIX IV
The Clinical Neuropsycholonist 1991, Vol.5, No. 1, pp. 3-19
TASK FORCE REPORT DIVISION 40 - CL1NICAL NEUROPSYCHOLOGY
AMERICAN PSYCHOLOGICAL ASSOCIATION
Guidelines for Computer-Assisted Neuropsychological Rehabilitation and
Cognitive Remediation
Charles G. Matthews
University of Wisconsin School of Medicine, Madison, WI
J. Preston Harley
Consulting Neuropsychologist
Chicago, IL
James F. Malec
Mayo Clinic
Rochester, NY
Early in 1984, the Executive Committee of Division 40 (Clinical Neuropsychology)
of the American Psychological Association, established a task force on
the use of computer technology in evaluation and rehabilitation in Neuropsychology.
Because of the complexity of the topic, the Task Force decided to complete
its work in a two-phase report. Phase I titled Task Force Report on Computer-Assisted
Neuropsychological Evaluation was completed in late 1986 and was published
in The Clinical Neuropsychologist (1987).
The Phase II report, titled Division 40 Task Force Report: Guidelines
for Computer-Assisted Neuropsychological Rehabilitation and Cognitive Remediation,
has been developed by a committee co-chaired by Charles G. Matthews, Ph.D.
and J. Preston Harley, Ph.D. Members of the Phase II Task Force were:
Gregory Brown, Ph.D.
Leonard Diller, Ph.D.
Rosamond Gianutsos, Ph.D.
Ned L. Kirsch, Ph.D.
Robert T. Kurlychek, Ph.D.
William J. Lynch, Ph.D.
John McSweeney, Ph.D.
James F. Malec, Ph.D.
Jeri Morris, Ph.D.
Daniel L. Schachter, Ph.D.
The Task Force met for preliminary discussion at the Mid-Winter Division
40 meeting in Washington, DC in February, 1987, when specific committee
members were assigned responsibility for separate sections of the report.
Some of these preliminary position statements as well as input received
from the audience attending were discussed at a Division 40 Conversation
Hour at the MA convention on August 30, 1987. Since September 1987, the
Task Force has continued to develop and refine these position papers, and
submitted a draft to the Division 40 Executive Committee for its review
correction, and further action at the August, 1989, Division 40 meeting
in New Orleans.
The Phase I document had its format predetermined by the format
used in the Guidelines for Computer-Based Tests and Interpretations developed
by APA s Committee for Professional Standards and Committee of Psychological
Tests and Measurements (1986). This APA statement was judged to be sufficiently
comprehensive, balanced, and rigorous to serve as the basic guideline for
this report. As noted in the introduction to the Phase I report (1987),
the only changes in the APA Guidelines were... in the nature of minor additions
designed to focus the reader s attention upon the specific applicability
of the guidelines to the practice of clinical neuropsychology (p. 161).
The format selected for the Phase II report is illustrated in
an article in the 1987 American Psychologist, titled Resolutions Approved
by the National Conference on Graduate Education in Psychology. This format
presents Issues followed by a series of Resolutions for each issue, and
lends itself to a somewhat more extended presentation of the background
and controversy involved in the relatively new field of computer-assisted
neuropsychological rehabilitation and cognitive remediation than was required
for the Phase I document. The Phase II document has been written to represent
the official policy of Division 40 in the matters addressed, but the document
has not been reviewed by APA for approval.
ISSUE I: DOES COMPUTER-ASSISTED COGNITIVE REHABILITATION HAVE A ROLE IN THE PRACTICE OF CLINICAL NEUROPSYCHOLOGY?
The technological aura and enthusiastic claims of efficacy associated
with the initial use of computer-assisted rehabilitation programs in the
early 1970s have gradually been replaced by a more modest and balanced
consensus: (a) that the computer is not a magical instrument and has no
inherently unique status as a treatment tool; and (b) given that caveat,
a number of potential benefits can be derived from its proper use.
Computer software can provide a medium to capture and engage
the interest of the patient. Because computers are often employed in the
repetitive presentation and recording of increasingly complex tasks, properly
constructed and presented software programs can minimize the patient s
frustration and loss of dignity when working on tasks he or she once could
have accomplished with ease. For some patients, the context of learning
to use the computer itself - regardless of the software package - can provide
the patient with an experience of mastery and a sense of control. Because
the computer can collect and store data representing the patient's performance
over time, the therapist can be freed to focus on treatment rather than
data collection. In fact, the computer can often measure multiple dimensions
of performance (latency, strength, and locus of response) at levels not
possible for the human observer (e.g., milliseconds, grams, and millimeters).
The computer is a particularly efficient medium for tasks that would otherwise
require extensive set-up and/or preparation time, (e.g., rapid change of
font size for reading tasks, rapid modification of graphic materials)
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