Neuropsychology of Everyday Functioning

Abstract

Many individuals with disabilities and chronic illnesses experience challenges with neuropsychological functioning. In order to assist people with disabilities to cope with barriers to functioning, it is important for rehabilitation professionals to be aware of neuropsychological deficits and their impact on everyday functioning. Drs Marcotte and Grant in their book, Neuropsychology of Everyday Functioning, present recent research findings that can support the efforts of rehabilitation professionals to develop psychoso-cial interventions for individuals with neuropsychiatric disorders. The book is structured into two parts. The first part, 'Assessment Concepts and Methods', is further divided into two sections: 'Approaches to Assessing the Relationship Between Cognition and Everyday Functioning'; and, 'Assessment of Specific Functional Abilities and Assessment Considerations'. The chapters in Section A of Part I focus on addressing neuropsychological assessments and their ability to predict everyday func-tioning, as well as the relationship between cognition and functioning. The first two chapters, 'Neuropsychology and the Prediction of Everyday Functioning' and 'Understanding the Relevance of Human Factors/Ergonomics to Neuropsychology Practice and the Assessment of Everyday Functioning', specifically address how the assess-ment of everyday functioning (i.e., ADLs, driving) can be determined by the use of neuropsychological assessments. The authors provide different assessment measures that can be used to compare outcomes, validate assessments and provide suggestions for future research directions. The third, and final, chapter in this section views this process from an occupational therapy (OT) approach, looking at cognitive theoretical models, func-tional skill training, the evaluation process and recent intervention studies in the OT field. This section could benefit by adding a chapter from the rehabilitation field, specif-ically in the area of rehabilitation psychology or rehabilitation counselling and their approach to assessment and concept of the relationship between cognition and everyday functioning. The chapters in Section B of Part I focus on assessing specific functional abilities including: IADLs, vocational functioning, medication management, driving and cross-cultural issues. This section in particular provides an array of tables and figures including pictures, diagrams and graphs that assist in conceptualising the information. All chapters include innovative assessments designed to gauge functional abilities, comparison with clinical evaluations and directions for future research. However, the chapters in this section were rather inconsistent in their format and address of issues. For example, Chapter 7 (driving) appears to be the most comprehensive, covering: a concep-tual framework; sensation and perception; executive functions and driver behaviour (i.e., decision-making, impulse control/response inhibition, attention and working memory, emotions); emotions and personality; arousal, alertness and fatigue; drug effects; assess-ment of driving performance (road tests, state records, driving simulators, instrumented vehicles, naturalistic driving, countermeasures); and practical assessment and public policy. Yet, only Chapter 4 (IADLs) addressed how to minimise errors in clinical judg-ment, an area that should be addressed in all functional assessments. It is our opinion that Chapter 8 (cross-cultural issues) is seriously lacking many areas of culture that can affect the assessment process by only focusing on linguistic appropri-ateness, namely language and translation. Other factors that may contribute to cultural inappropriateness or irrelevance (i.e., age, SES, family, occupation, religion) are ignored. The second part of the book, 'Everyday Impact of Normal Aging and Neuropsychiatric Disorders' examines how ageing and neurological disorders can impact everyday functioning. The authors incorporated chapters on the association between neurocognitive deficits and everyday functioning for the following groups: cognitive impairment, normal ageing, vascular dementia, traumatic brain injury, sports-related mild traumatic brain injury, multiple sclerosis, HIV-associated neurocognitive disorders, depression and schizophrenia. In each chapter of Part II, the authors typically provided a general overview and cognitive profile on each group. In addition, the chapters included empirical evidence for associations between neuropsychological assessment performance and everyday func-tioning. More specifically, the chapter authors generally disseminated research findings on neuropsychological predictors of ADLs (i.e., grooming), IADLs (i.e., driving), voca-tional functioning and quality of life. These findings are of particular interest to rehabil-itation professionals as the goal of rehabilitation for individuals with disabilities is to enhance overall functioning. The book concluded with recommendations for future directions in the assessment of everyday functioning. Limitations to the book may include a lack of information provided on functioning in recreation and leisure activities. Moreover, the chapters included inadequate information on psychosocial interventions. For example, most chapters did not include information on therapy methods. Improvements could be made by addressing these factors in future editions. It is our opinion that rehabilitation professionals should utilise the empirical literature reported in this book to design rehabilitation interventions that will augment everyday functioning for individuals with neuropsychological disorders. By enhancing everyday functioning, individuals with disabilities may increase community participation and may eventually achieve higher quality of life and psychosocial adjustment to disability. Overall, this book would prove beneficial to rehabilitation professionals including, but not limited to: rehabilitation psychologists, neuropsychologists, rehabilitation educa-tors, rehabilitation counselors, vocational counselors, case managers, nurses, clinical social workers and special education teachers.