Table I.

Classification of therapeutic interventions, according to ‘Transfer Distance’.

1. Global Metacognitive Strategy-Learning:

Therapy aims to improve awareness of the impaired cognitive processes and clients are taught to use ‘higher-order’ compensatory strategies, for instance using internal scripts intended to facilitate problem-solving, decision-making, executive functioning and reasoning. It is assumed that, with sufficient experience/training, clients will be able to generalize the application of these compensatory strategies to novel situations. The central focus of treatment is teaching the strategy and the actual tasks used in training are secondary [30,31].

2. Domain-Specific Strategy-Training:

Domain-specific strategies aim to help the client compensate for a specific perceptual or cognitive dysfunction. The focus is on the strategy, rather than the task itself (e.g. developing a routine for scanning, using an electronic memory aid). The strategy is applied in as many substantially-different settings as possible (e.g. scanning training may be taught in reading and in street crossing).

3. Function-Embedded Cognitive Retraining:

Cognitive retraining is focused on a cognitive deficit, but the strategy is taught within a contextual environment (e.g. driving simulators). Although the training is ‘context specific’, some authors propose that generalization of skills and improved performance in other tasks will occur [32], depending on the degree of overlap in processing operations between the training task and the new task, i.e. ‘near’ or ‘far’ transfer distance (the ‘transfer-appropriate’ processing hypothesis).

4. Specific task-training:

A specific functional behaviour is taught and the therapist attempts to circumvent cognitive deficits that hamper performance by providing a routine [26,33,34]. No assumptions are made in respect to generalization across activities. Skills trained may or may not have secondary effects on other aspects of functioning.

5. Environmental modifications & assistive technology:

Environmental modifications and simplifications are included in most of the approaches described above. Part of the process of intervention is to simplify task demands, so that skills can be practiced and cueing reduced as skills are learned. There are a number of technological aids that have been developed to facilitate task initiation, scheduling and to guide tasks in order to bypass memory impairments, e.g. smart phone applications, Neuropage or similar [35–37]. These cueing systems may be used permanently or as part of therapy and become redundant, as the client internalizes the routine.