Cognitive neuropsychological rehabilitation: The emperor's new clothes?

It has often been claimed that cognitive neuropsychology allows a far better diagnosis and understanding of the nature of a patient's language disorder than classical clinical diagnoses, and that a theoretically-driven therapeutic intervention can only be based on a cognitive diagnosis. In this paper we argue that: (1) Cognitive neuropsychologists have fostered and made explicit knowledge about the nature of aphasia which can be a rational starting point for intervention; however, former aphasia therapy was not atheoretical, but always based on existent theories of aphasia. (2) The new cognitive dyslexia and dysgraphia syndromes are perhaps more homogeneous than the classical diagnoses but no more informative or useful for rehabilitation planning. (3) Due to the modularity assumption, cognitive rehabilitation has sometimes been planned with only the damaged module/s being taken into consideration. We argue that the whole functional structure of the model adopted should be addressed because it can dictate the focus of rehabilitation. We conclude that cognitive neuropsychology allows a more detailed analysis of the functional damage but provides no indication as to how to implement rehabilitation for a given patient-even if it does evidence the lack of rationality of many interventions.