Generalization Issues

Generalization can be characterized into three distinct levels. Level 1 involves basic learning over trials, in which performance improves as training continues. The client should demonstrate the ability to transfer learning from one task to another similar task. The second level involves the transfer of learning to performance on psychometric tests measuring similar functional areas. For example, a client is trained to use maintenance rehearsal techniques (simple repetition of information) for memory and then incorporates similar behaviors while completing a verbal memory test. Lastly, level 3 includes transferring learning to general activities of daily living. For example, the client taught to use maintenance rehearsal techniques calls directory assistance for the phone number of a pizza place. He proceeds to repeat the number until he finishes dialing.

Cognitive rehabilitation has been shown to provide adequate training such that clients are able to transfer previously learned material to similar contexts. However, the most controversial issue regarding the efficacy of cognitive rehabilitation is level 3 generalization, the ability to apply previously learned material to a variety of novel contexts. For example, outcome studies often use paper-and-pencil tests to measure the benefits of cognitive rehabilitation, and it has been difficult to determine whether such test results translate into meaningful functional abilities. Furthermore, difficulty arises when trying to measure real-life contexts. Vocational rehabilitation settings provide potential real-world assessment arenas; however, obtaining a truly randomized and controlled sample would be nearly impossible.

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