认知损伤的评估

Assessment of Cognitive Impairments

该文介绍了作为认知损伤临床评估最优方法的必要条件。评估的一个重要目的是将关于功能区域的优势和劣势的假设公式化，并据此设定适当的康复目标，评价康复的结果，为了达到这一目的，评估应该开始于康复之前，贯穿于康复过程，并持续到康复结束之后。文中比较了两种评估方法：量表法和假设检验法。为了考察认知损伤及其引起的障碍的变化，测验应该具有信度、敏感性和效度。量表法通常不具备这三个必要条件，而假设检验法在这方面更好。该文以一例获得性失语症的词语产出损伤评估为例，介绍了假设检验法的应用。

This paper addresses the requirements for best practice in clinical assessment of people with cognitive deficits. It is proposed that a significant goal for assessment should be to enable formulation of a hypothesis regarding the areas of strength and weakness in functioning， in order to set appropriate aims for rehabilitation， and to evaluate the outcome of the rehabilitation process. Meeting this goal requires appropriate assessment before rehabilitation begins， during the rehabilitation process and after rehabilitation（by the clinician） has ended. Two approaches are contrasted：the “battery” approach and the “hypothesis testing approach”. In order to measure change in both cognitive impairments and the handicaps they cause， testing is required that is reliable， sensitive and valid （measures changes that are of real consequence）. It will be argued that assessment batteries often fail on all three of these requirements， and the hypothesis testing approach is superior in this regard. The paper provides an example of the use of the hypothesis testing approach in the assessment of world production impairments in acquired aphasia.