Cognitive enhancement and rehabilitation for the elder population: application of the Feuerstein Instrumental Enrichment Program for the Elderly.

Published in: Life Span and Disability XV, 2 (2012), 21-33 By: Reuven Feuerstein, Louis H. Falik, Rephael S. Feuerstein, Anat Cagan, Lea Yosef, Shmuel Rosen, Zvika Volk

Abstract: The rapidly expanding proportion of elderly individuals in the population demands systematic efforts to maintain quality of life, prevent mental deterioration, and restore lost or declining mental functions. The Feuerstein Instrumental Enrichment (FIE) Program for the Elderly is proposed as an effective way of meeting these needs. The program is described and suggestions made for designing research and intervention protocols. Preliminary results of program participant responses from early implementation projects are presented. Benefits for the elder client, the caretakers, and care providing settings are discussed. Implications for the care providing settings and caretakers are also identified.

Feuerstein’s Program for the Facilitation of Cognitive Development in Young Children.

Published in: Journal of Cognitive Education and Psychology, 10 (3), pp. 224-237, 2011 By: Meir Ben Hur and Refael S. Feuerstein

Abstract: The authors make the case for the inclusion of cognitive enrichment programs in early mainstream education that should be designed to eliminate the early discrepancies in children’s cognitive abilities and prevent later learning disabilities and achievement gaps. Following a review of the literature on existing early cognitive enrichment programs and their effects with cognitive impaired children and children with special needs, the authors present the theoretical and programmatic features of Feuerstein’s 3-year basic program, along with a brief description of its different modules. The authors also provide a summary of all the available evidence of the program’s effectiveness, including the results of 3 evaluation studies of pilot projects in the United States. The article culminates in an appeal for rigorous research on the feasibility and effects of programs in mainstream education for early cognitive enrichment and prevention of learning problems, including research on the effects of Feuerstein’s Instrumental Enrichment–Basic (FIE-B) program.

Helping minority students to succeed in a technological college: a ‘round trip’ from cognitive functions to curriculum and back.

Published in: International Journal of Inclusive Education, 15:4, 421-432, 2011 By: Roman Gouzmanand Alex Kozulin

Abstract: The present study investigated the effectiveness of a cognitive enrichment programme as a tool for enhancing the chances of immigrant and minority students to be admitted to a technological college. Students received two weekly sessions (four hours) of Instrumental Enrichment (IE) during the second semester of the college preparatory programme. The cognitive principles of IE were ‘bridged’ to mathematics and science curricular material. The mathematics and science tasks were analysed to show the students the underlying cognitive principles essential for their solution. Graduates of the programme were much more successful in being admitted to technological college than students in previous years who received no cognitive enrichment.

Cognitive modifiability of children with
developmental disabilities: A multicenter study using Feuerstein’s
Instrumental Enrichment –Basic program.

Published in: Research in Developmental Disabilities, 31:551-559, 2010. By: A. Kozulin, J. Lebeer, A. Madella-Noja, F. Gonzalez, I. Jeffrey, N. Rosenthal and M. Koslowsky

Abstract: The study aimed at exploring the effectiveness of cognitive intervention with the new ‘‘Instrumental Enrichment Basic’’ program (IE-basic), based on Feuerstein’s theory of structural cognitive modifiability that contends that a child’s cognitive functioning can be significantlymodified through mediated learning intervention. The IE-basic program is aimed at enhancing domain-general cognitive functioning in a number of areas (systematic perception, self-regulation abilities, conceptual vocabulary, planning, decoding emotions and social relations) as well as transferring learnt principles to daily life domains. Participants were children with DCD, CP, and intellectual impairment of genetic origin, autistic spectrum disorder, ADHD or other learningdisorders, with a mental age of 5–7 years, from Canada, Chile, Belgium, Italy and Israel. Children in the experimental groups (N = 104) received 27–90 h of the program during 30–45 weeks; the comparison groups (N = 72) received general occupational and sensory–motor therapy. Analysis of the pre- to post-test gain scores demonstrated significant (p < 0.05) advantage of experimental over comparison groups in three WISC-R subtests (‘‘Similarities’’, ‘‘Picture Completion’’, ‘‘Picture Arrangement’’) and Raven Coloured Matrices. Effect sizes ranged from 0.3 to 0.52. Results suggest that it is possible to improve cognitive functioning of children with developmental disability. No advantage was found for children with specific etiology. Greater cognitive gains were demonstrated by children who received the program in an educational context where all teachers were committed to the principles of mediated learning.

Cognitive modifiability of new immigrant adults.

Published in: Mind, Culture, and Activity, 16:117-129, 2009. By: Alex Kozulin

Abstract: The first research question of this study concerns the plasticity of cognitive processes of adult learners confronted with the task of adapting to a new language and an unfamiliar system of formal education. The second question inquires into the relative contribution of two different forms of cognitive intervention—the Learning Potential Assessment Device (LPAD) procedure and the cognitive education program—to the cognitive modifiability of immigrant adults. Both forms of intervention were studied in the past but never in comparison. It seemed, therefore, important to compare the performance of immigrant adult students who received only the LPAD procedure with that of the students who received both LPAD and a prolonged cognitive intervention. The results indicate that the cognitive processes of adult immigrants are modifiable, often no less than those of school-age children and that the participation in cognitive education program has an added value for students with relatively high preprogram performance as compared to LPAD alone.

Dynamic assessment of receptive language in children with Down syndrome.

Published in: Advances in Speech-Language Pathology, 9:323-331, 2007 By: S. Alony and A. Kozulin

Abstract: The goal of the present study was to explore the dynamic aspects of receptive language development of young children with Down syndrome (DS). By its very nature typical dynamic assessment (DA) of cognitive functions focuses on ‘‘fluid’’ intelligence that is more amenable to change, than verbal knowledge that is ‘‘crystallized’’. We believe, however, that any situation of assessment, even aimed at crystallized knowledge includes many cognitive strategies obscured under conditions of static testing that can be revealed via DA. Thirty children with DS (3 to 7-years-old) participated in the study. The Peabody Picture Vocabulary Test (PPVT-R) was used in static and dynamic assessment modality. The results indicate that even a minimal mediation in the form of‘‘focusing’’ improves the receptive language performance of children with DS. Cross-sectional analysis of the developmental trends indicated that the developmental trend of children with DS generated by the DA procedure is closer to the normative trend than the trend generated by thestatic test data. The effect size of the DA procedure is discussed as well as the relationship between the modifiability in the language area as compared to other cognitive areas.

Integration of culturally different students in mainstream classes.

Published in: Transylvania Journal of Psychology: Special Issue on Inclusive and Cognitive Education, 2: 99-105, 2006. By: Alex Kozulin

Abstract: Today culturally different students constitute the largest group in need of special attention to their integration in mainstream classes. The lack of congruence between their previous learning experience and the demands of the new educational system places many immigrant children at risk of school failure. A new CoReL (Concentrated Reinforcement Lessons) model aimed at solving the learning problems of new immigrant children at risk has been developed at the ICELP. The CoReL is a limited-time intervention model based on integration of the “Instrumental Enrichment” program with intensive language arts and math lessons infused with the principles of mediated learning. An evaluation study conducted with four groups of new immigrant students from Ethiopia demonstrated a statistically significant change in cognitive performance as well as reading comprehension and problem solving in mathematics.

Mediated Learning Experience Intervention Increases Hope of Family Members Coping with a Relative with Severe Mental Illness.

Published in: Community Mental Health Journal, 46(4): 409-15, 2010. By: Dorit Redlich, Naomi Hadas-Lidor, Penina Weiss and Israel Amirav

Abstract: Hope is central in the recovery of the mentally ill, and family attitudes play an important role. Hope may be mediated by cognitive and communication processes. The “Keshet” program is aimed at enhancing communication of family members with the use of cognitive pathways. The present pilot study examines whether the program effectively increases hope in family members in regard to themselves versus their hope for their ill relative. Methods: Forty-nine family members who participated in the “Keshet” program for 6 months comprised the experimental group. The control group comprised of 22 family members who underwent no structural intervention. Hope was measured at baseline and after 6 months using the Hope Scale developed by Snyder. No difference in self-perception was detected in Hope Scores between groups. However, the experimental group displayed a significant increase in their hope toward the ill relative with a concomitant decrease in the gap between the hope of family members in relation to themselves versus their hope toward the ill person. “Keshet” significantly increased the hope of families concerning the ill person, while decreasing the gap between the hope of family members regarding themselves and the affected person. Thus, the program may contribute to the increase the families’ hope in the recovery journey of mentally ill family members. 

Re-assessing the current assessment practice of children with special education needs in Europe.

Published in: School Psychology International, 33(1) 69-92, 2011. By: Jo Lebeer, Noemi Birta-Szekely, Karmen Demeter, Krisztina Bohacs, Adelina Araujo Candeias, Gunvor Sonnesyn, Petri Partanen and Lorna Dawson

Abstract: This article reports the results of the European ‘DAFFODIL’’ (Dynamic Assessment of Functioning and Oriented at Development and Inclusive Learning) Project on the question of how functional and learning assessment systems facilitate or inhibit participation of children with developmental difficulties in inclusive education. Questionnaires were sent to medical, psychological, educational professionals, and parents in Sweden, Portugal, Hungary, Belgium, Romania, Norway, and the Virgin Islands. Interviews and focus groups were organized. Results (95%) showed that static standardized psychometric tests of intellectual, behavioural, and language functioning were mainly used, with the WISC-III being the most frequent test applied. Less than 5% of the 166 professionals in our sample used formative assessment and contextual observation to reveal learning or developmental potential in a process-oriented way. Experts were generally not satisfied with current assessment practices. Reported weaknesses included lack of time, human resources, materials, cooperation, and follow-up. Assessment practice was mainly used to determine whether a child should be placed in a special needs programme, a special school, or an institutional setting, depending on whether a country has inclusive education practice or not. Parents were satisfied with static functional assessment when its purpose was to obtain disability benefits (financial, special education resources, recognition), but were unhappy with the negative outlook of reports. The main complaint of teachers and parents was about the poverty of recommendations on how to work with the child. Our conclusion is that the current practice of standardized psychometric testing seems to contribute to barriers to learning if it is used in a deterministic or predictive way. In this regard, dynamic and functional assessment methods that are qualitatively oriented seem promising in addressing the issues of learning and development in a different way. The methods also contribute to an understanding of the child’s needs in learning and development. However, interpretation and communication of assessment results in a way that emphasizes a more adequate and challenging educational intervention for the child seems to be central.

Learning Potential in high IQ children: The contribution of dynamic assessment to the identification of gifted children.

Published in: Learning and Individual Differences, 21, 176-181, 2011. By: M. Dolores Calero, M. Garcia-Martin, M. Belen and Auxiliadora Robles

Abstract: In recent years, models of giftedness have incorporated personal and social variables which influence IQ, rather than taking IQ into account exclusively. Among the various options presented in this context, authors have proposed dynamic assessment techniques as a method for revealing the potential capacity in different groups, independently of the IQ they present. The aim of the present study was to investigate, in two samples of Spanish children from the urban middle class previously identified as gifted and of normal intelligence, three basic assumptions common to studies in this line of research: (1) that there are significant differences in Learning Potential between gifted children and children with average IQ; (2) that the differences are apparent in diverse tasks, and (3) that Learning Potential significantly predicts the high/average status of the subjects. 127 children from 6 to 11 years old (64 high-IQs and 63 average-IQs) were evaluated using different dynamic tests. Significant intergroup differences were obtained and the tests were shown to have high predictive power.

Estimation of Cognitive Plasticity in Old Adults Using Dynamic Assessment Techniques.

Published in: Journal of Cognitive Education and Psychology, 8(1) pp.38-51, 2009. By: Elena Navarro and Maria Dolores Calero

Abstract: In recent years, research has provided extensive data concerning the use, utility, and appropriateness of dynamic assessment techniques as a way of determining cognitive plasticity in old adults. Current research in this area is focused on three principle lines of investigation: (a) determining neurological correlates of cognitive plasticity evaluated through dynamic assessment techniques; (b) establishing the diagnostic utility of such procedures; and (c) analyzing age-related limits with regard to quantity and domains of plasticity. In this context, the present study was undertaken using a sample of 274 older adults, who were evaluated through two dynamic assessment techniques and one cognitive functioning screening test over a period of 3 consecutive years. Results show differences in plasticity related to both age and cognitive status. The study also demonstrates the capacity of plasticity to predict maintenance and decline in a follow-up period of 3 years.

Application of IE-Basic Program to Promote Cognitive and Affective Development in Preschoolers: A Chilean Study.

Published in: Journal of Cognitive Education and Psychology, 9 (3), 2010. By: Natalia Salas, Cecilia Assael, David Huepe, Teresa Pérez, Fernando González, Alejandra Morales, Rita Arévalo, Chetty Espinoza and Grimaldina Araya

Abstract: This study explores the effectiveness of the Instrumental Enrichment Basic program (IE-B) in enhancing cognitive and affective functions of young children. The IE-B is a cognitive intervention program based on Feuerstein’s theories of structural cognitive modifiability (SCM) and mediated learning experience (MLE). Thirty 3- to 4-year-old children were assigned to experimental and control groups. The experimental
group received the IE-B program for seven months (for a total of 48 hours) and was compared to the control group before and after intervention on tests of knowledge acquisition and vocabulary.Cognitive change was evaluated using a Chilean assessment battery that measured children’s language, cognition, and knowledge. The fi ndings indicate that children in the experimental group improved their performance more than children in the control group. Results indicate thatIE-B can be used with socially disadvantaged children as young as 3–4 and that it leads to improvement in their performance.

Exploring the impact of Feuerstein’s
Instrumental Enrichment Programme on the cognitive development of
prospective mathematics educators.

Published in: The Journal of Transdisciplinary Research in Southern Africa, 6(2), pp. 359-378, 2010. By: M. Kloppers and M. M. Grosser

Abstract: In this article the researchers report on the findings obtained from a sequential explanatory mixed method study through testing and narratives in order to determine the extent to which 24 prospective Mathematics educators at a South African university enrolled for a BEd-degree possess cognitive skills, and to establish the potential of the Feuerstein Instrumental Enrichment programme (FIE) to develop and improve the cognitive skills of the said prospective educators. Results indicated that there is a need for improving the cognitive skills of the prospective Mathematics educators and that the FIE programme possesses the latent potential to improve and develop cognitive skills.The significance of this research lies in the contribution it makes in particular to equip lecturers involved in educator training with knowledge regarding the merits of the Feuerstein FIE programme for improving cognitive performance.

Effects of mediated intervention on cognitive functions: A pilot study with Grade 5 learners at a remedial school.

Published in: Australian Journal of Learning Difficulties, 14(2), pp. 185-198, 2009. By: Joseph Seabi and Zaytoon Amod

Abstract: The present study explored the effects of a mediated intervention programme on a sample of Grade 5 learners, in a remedial school. The participants (n = 20) were systematically sampled and they constituted two groups; namely, Individual Mediation (n = 10) and Group Mediation (n = 10). It was hypothesised that participants exposed to this programme would yield a significant improvement in cognitive functioning as measured by the Raven’s Coloured Progressive Matrices. It was further proposed that participants within the Individual Mediation group would perform significantly better than those within Group Mediation. Set Variations B-8 to B-12 from Feuerstein’s Learning Potential Assessment Device served as a vehicle for mediating cognitive deficiencies. Results revealed a significant improvement in scores only within the Individual Mediation group. Despite the statistically significant improvement yielded within the Individual Mediation group, no statistically significant difference was found between the Individual Mediation and the Group Mediation sample. These findings are discussed in light of existing literature and future recommendations are suggested. 

Clinical Applications of the Modifiability Model: Feuerstein’s Mediated Learning Experience and the Instrumental Enrichment Program.

Dissertation by Krisztina Bohács. Ph.D. Thesis. 2014. Graduate School of Educational Sciences, University of Szeged, Hungary.

Participants: Participants of our study (N=15) were randomly chosen individuals from all parts of Hungary from all socio-economic backgrounds. They had very different age (from 2;8 to 14;8). They had mild (n=5) to moderate (n=10) intellectual developmental disorder with very different etiology (genetic syndromes, cerebral paresis, perinatal brain injury and/or metabolic diseases) and presented heterogenious comorbid phenomena (e.g. obsessive behaviour, severe ADHD and/or motoric dysfunctioning /dyspraxia, ataxia and hemiphlegia/. Two children were diagnosed with ASD. All of them had problems with speech comprehension and expressive language. Four of them were non-verbal children upon arrival.

Intervention: FIE-Basic and MST (Mediated Self-talk) within the framework of Mediated Learning Experience as for way of interaction. The time of acceleration was 24 months in each cases. The intervention sessions were one-to-one with large intensity (7-15 sessions per week).

Methodology: The first part of the empirical research desribes the development of the individual cases (qualitative method of multiple embedded case studies), and the second part presents aggregated data and test-probes (descriptive statistics and test-statistics).

Main results: Raven Colored Matrices showed an increase in general intelligence of our atypical population by 29,37%p within the two year long intervention period (mean improvement). PPVT has indicated a 3 year 10 month growth in mental years within the two year long intervention time as a mean improvement for 14 cases. Analysis by test-statistics (Paired Samples T-test) has indicated that there were significant changes in the cognitive development of the participants between pre-test and post-test measures on Raven’s Colored Matrices (mean 10,57, SD=6,12, t=6,460, p<0,001;). Results gained by a school screening criterion-oriented test system (DIFER-test) have shown a mean growth of improvement by 39,46%p in domains necessary for school readiness. The very intensive human figure development of the participants – as a generalized “byproduct” of the intervention – prove to be surprising.

Conclusions: The boundaries of human intellect can be enlarged in case of intellectual disability as well. It is possible to improve fluid intelligence of children with cognitive impairments, using a comprehensive program such as MLE, FIE-Basic and MST. If applied systematically with children with intellectual disabilities for a longer period of time (maybe even for 3-4 years) the applied systems are expected to lead to increased learning effectiveness, more effective basic cognitive processes and thinking skills, and to prepare children for school learning and a better adaptation to the challenges of everyday life.

The Impact of Cognitive Education Training on Teachers’ Cognitive Performance

Published in: Journal of Cognitive Education and Psychology, Volume 14, Number 2, 2015 By: Alex Kozulin

Abstract: Cognitive education is usually considered in terms of its impact on students’ problem-solving skills and their acquisition of disciplinary knowledge. Little is known about the impact of cognitive training on the cognitive skills of teachers themselves. In this pilot study, 80 South African high school teachers participated in the cognitive education (Instrumental Enrichment) course and then implemented the principles of cognitive teaching/learning in their classroominstruction. Teachers’ problem-solving skills were evaluated before the start and after 9 months of training and implementation. Significant changes were observed in teachers’ problem-solving performance. Teachers with better mastery of cognitive education program also demonstrated better cognitive task performance on the posttest. Teachers with weaker pre-training cognitive performance made greater relative gains than teachers with stronger initial performance. Recommendations are made regarding the use of Instrumental Enrichment as a tool of cognitive enhancement for teachers.

An Innovative model for the Dynamic Neurocognitive Rehabilitation for individuals with Acquired Brain Injury.

Published in: Transylvanian Journal of Psychology, June 2015 16 (1): 3-30 By: Idit Dorfzaun-Harif, et al.

Abstract: This article presents the work carried out at the Feuerstein Institute in Jerusalem with people who have suffered Acquired Brain Injury (ABI). Over the last decade 105 people suffering from ABI have been treated: 61 people after a traumatic brain injury, 20 people aftercerebrovascular accident, 11 after anoxic brain damage, 9 after brain tumours and 4 suffering from ABI, due to different diseases. The neurocognitive rehabilitation approach is based on Reuven Feuerstein’s theory of Structural Cognitive Modifiability (SCM). The theoretical and practical aspects of working with this population are expounded, and examples of treatment descriptions based on case studies are included. We will explain the special value of working in the dynamic neurocognitive rehabilitation approach with the population of Acquired Brain Injured clients after they have completed the hospitalized rehabilitation phase.

A cognitive approach applied to teaching.

By: VĚRA POKORNÁ, et al.

Abstract: This article reports the results of educational strategies and methods based on Feuerstein´s Instrumental Enrichment Programme (FIE) in some schools and consultation centresof the Czech Republic. Beginning with the year 2000, when the first workshop in FIE was realized, about 780 psychologists, teachers, special educators and parents were educated in Reuven Feuerstein’s methodology through the ATC (Accredited Training Centre). It is very difficult to say, how many children and adults really benefitted from FIE intervention. The alumni are mostly responsible for a group of children, a class, or at least for a family. Almost each of them becomes an opinion leader in education, so that the number of children who benefit from FIE is about ten times higher than the number of participants. It rises slowly, but continually. The presented contribution is a collection of case studies, using a qualitative research method. The first part of the article compares the present work of a teacher in a small school, who applies the concept of Prof. Feuerstein, with the previous way of teaching. The second deals with pupils´ self-evaluation in individual subjects (math, mother tongue etc.), the third discusses the application of FIE in teaching children with intellectual disability, the fourth is devoted to the use of tables and paradigms in teaching mother tongue and other languages in the seventh grade, the fifth on the application of FIE in teaching physics and the last part (6) on the lesson planning based on the FIE course. Altogether six teachers and 99 pupils were involved.

Refining pedagogy with a humanistic psychology of cognitive mediation.

By: Lorenzo Tebar Belmonte

Abstract: This paper examines the intellectual legacy of Reuven Feuerstein (1921-2014) through an analysis of how his implied theories and practices serve to align pedagogy with mediational teaching. It offers a closer examination of ten psychological and pedagogical aspects of mediationfor the practice of education in the classroom, after outlining twelve characteristics of a mediating pedagogy. The principles of the cognitive map are explained to increase a teacher’s understandingof how to transmit content more effectively and more adaptively. This mediating style gives teachers a sense of professional authenticity. The simple role of transmitter of material is changed into that of the expert, guide, director, neighbourly educator, etc. As a consequence of this transformation, many teachers have begun to feel more enthusiastic for their job. It concludes with a summary of Feuerstein’s influence derived from these formulations.

Fidelity of Peer Mediation and its Role in Improving Students’ Oral English Communication Skills.

By: Betegiorgis Mamo & Abiy Yigzaw Published: Science, Technology and Arts Research Journal, 4(1), 203-214, 2015

Abstract: The purpose of this study was to examine fidelity of peer mediation and its role in improving students’ oral English communication skills at Debre-Berhan University. A Communicative English Skills class was randomly selected as a study group. From this class, high- and medium together with low performing students in oral English communication skills were identified as peer mediators (N=15) and mediatees (N=61), respectively. The mediatees were categorized into medium and low achieving peer groups, each of which comprised five members, including one peer mediator assigned randomly to the group. During a three-week teacher-led session, the peer groups were trained in the peer mediation procedure enhancing such aspects of oral abilities as organization of related bits of information, succession of events and description of individual qualities in personal introduction. The findings revealed that there was an acceptable level of agreement between both the peer mediators and the mediatees on fidelity of the peer mediation as they rated the fidelity checklist. Pre-to post-test oral communication scores significantly improved for low and medium achievers as a result of the peer mediation. Based on the findings, recommendations were made for purposes of examining sustained practicality of peer mediation toward improving students’ learning and performance in oral English communication skills.

Restoring one’s language edifice: A case study of long-term effects of intensive aphasia therapy employing cognitive modifiability strategies.

By: Anaki D , Goldenberg R , Devisheim H , Rosenfelder D , Falik L , Harif I . Journal: NeuroRehabilitation

Abstract: NG is an architect who suffered a left occipital-parietal hemorrhage cerebral vascular accident (CVA) in 2000, resulting in aphasia of Wernicke and conduction types. He was characterized with fluent paraphasic speech, decreased repetition, and impaired object naming. Comprehension was relatively preserved but reading and writing were severely compromised, as well as his auditory working memory. Despite a grim prognosis he underwent intensive aphasia therapy, lasting from 2001 to 2010, at the Center for Cognitive Rehabilitation of the Brain Injured at the Feuerstein Institute. The tailored-made interventions, applied in NG’s therapy, were based upon the implementation of the principles of the Structural Mediated Learning Experience (MLE) and the Feuerstein Instrumental Enrichment (FIE) Program, to optimize his rehabilitation. As a result NG improved in most of his impaired linguistic capacities, attested by the results of neuropsychological and linguistic assessments performed throughout the years. More importantly, he was able to manage again his daily functions at a high level, and to resume his occupational role as an architect, a role which he holds to this day.

Significance of the Feuerstein approach in neurocognitive rehabilitation.

By: Lebeer, Jo. Journal: NeuroRehabilitation

Abstract: The theory of Structural Cognitive Modifiability and Mediated Learning Experience of Reuven Feuerstein states that individuals with brain impairment, because of congenital or acquired origin, may substantially and structurally improve their cognitive functioning, by a systematic intervention based on a specific, criteria-based type of interaction (“mediated learning”). Three application systems are based on it: a dynamic interactive assessment of learning capacity and processes of learning, the LPAD (LearningPropensity Assessment Device); a cognitive intervention program called “Instrumental Enrichment Program”, which trains cognitive, metacognitive and executive functions; and a program, which is oriented at working in context, Shaping Modifying Environments. These programs have been applied in widely different target groups: from children and young adults with learning and developmental disabilities, at risk of school failure, or having failed at school, because of socio-economic disadvantage or congenital neurological impairment;disadvantaged youngsters and adults in vocational training, to elderly people at the beginning of a dementia process. Experience with cognitive rehabilitation of children and adults with acquired brain damage, has been relatively recent, first in the Feuerstein Institute’s Brain Injury Unit in Jerusalem, later in other centers in different parts of the world; therefore scientific data are scarce.

The purpose of this paper is to examine how the Feuerstein-approach fits into the goals and proposed approaches of cognitive rehabilitation, and to explore its relevance for assessment and intervention in individuals with congenital or acquired brain damage.

The methodology of the Feuerstein approach consists of four pillars: dynamic assessment, cognitive activation, mediated learning and shaping a modifying environment. The criteria of mediated learning experience are explained with specific reference to people with acquired brain injury. The procedure of learning propensity assessment device uses visuo-spatial and verbal tasks known from neuropsychological assessment (such as Rey’s complex figure drawing), as well as a in a pre-test – brief intervention – post-test format.

Cognitive activation is done in various ways: a paper-and-pencil relatively content-free program called “instrumental enrichment”, with transfer of learned principles into daily life situations, followed by metacognitive feedback. Four case histories of acquired brain damage are analyzed: a 19 year old man with extensive post-astrocytoma frontotemporal brain lesions; a 19 year old man with bilateral frontal and right temporal and parieto-occipital parenchymatous destruction after a traumatic brain injury; a 24 year old man with hemispherectomy for intractable epilepsy because of Sturge-Weber syndrome; and a 30-year old man with left porencephalic cyst after cerebral hemorrhage.

Structural cognitive improvement could be demonstrated in positive change scores in visuo-spatial memory, associative and verbal memory, abstract thinking, and organizing tasks, even more than 10 years post-TBI. In some cases a rise in IQ has been documented. Improvement in daily life functioning and academic skills (re)learning has also been seen.

Though impossible to claim scientific evidence, the case histories nevertheless suggest the importance of interactive assessment in designing intervention programs which have sufficient intensity, frequency, duration and consistency of mediation; furthermore, an essential ingredient is the ecological approach which requires working with the patient and the whole network around; a firm “belief system” or that modifiability is possible even with severe brain damage and many years after the injury; a cognitive, metacognitive and executive approach, and a quality of interaction according to criteria of mediated learning. They suggest that Feuerstein approach may offer interesting perspectives to cognitive rehabilitation. More extensive research is needed to provide a broader scientific evidence base.

Cognitive rehabilitation; Feuerstein’s theory of structural cognitive modifiability; acquired brain damage; dynamic assessment; ecological plasticity; mediated learning experience.