Single Case Studies as Seeds: Brain Models That Matter

Background Of Case Study Exposure

Single case studies and connectionist modelling can give uncommon insight into human behaviour and rehabilitation after neurological insult. In this article a strong focus is given to the art of reading as it serves as a pivotal focus for observing dysfunction and rehabilitative potential Naish (2000) states “Reading employs symbols of symbols and the processing required to link the written word with the original concept has been considered by some to be so complex that if we could understand fully how it took place we would effectively understand the whole of human cognition” Excerpts by Cohen, Johnston and Plunkett (2000) and Parkin (1996) refer to reading and cognition issues associated with the use of single studies to generate theories and relate they have had immense exploratory value.

A single case study may reveal patterns that generate an insight. When this pattern is compared to similar conditions research strategies can emerge. As single case studies are combined with similar case studies, double disassociations, cognitive modelling and neuron imaging the resulting data sets can produce a robust model. The increase of computer based communication makes it possible for scientists to collaborate internationally on single case studies, evolving case series or computer based data that represents models of human behaviour during neurodegenerative insult.

Greenhalgh (1997) refers to single case studies as the quick and dirty method for extracting research information and lists their inclusion at the bottom of the research hierarchy in regards to evidence. She later qualifies this statement, stating that when single case studies are well done they can yield superior detail generally lost in larger studies (Greenhalgh, 1997).

Single case studies are crucial when an observation requires rapid attention even though methodological links are weak. For example three children at school go out to play before reading class and one child dares the other two to eat ‘mushrooms’ on the playground, they are poisonous but taste fine and the two children continue to play but later show a loss of balance, hallucinations and inability to read in class. Knowledge based on a single case study on mushroom poisoning could result in recognizing the progression of circumstances and taking appropriate action to save the children’s lives. Large randomized double blind studies could determine correlation factors and average rate of poison over time; however the available single case study information is appropriate for immediate intervention.

Rather than focusing solely on the value of single case studies or that of connectionist models they will be seen as seeds of research. How this seed is tended determines its core qualities and its capacity to reproduce in the field of research. It is good to bear in mind that without an initial ‘seed’ the likelihood of a major double blind clinical trial is slim. Likewise, undue emphasis on finding disassociations and grouping deficits into convenient “syndromes” can mask individual differences and invoke dichotomies.

The value of single case studies hinge on circumstances surrounding reports, the skill with which they are presented and ways they are integrated with other research. Using dysfunctional models to illuminate normal function is risky in that the dysfunctional component can influence the working areas surrounding it and so confound the model (Cohen, 2000). Case studies may be thought to lack credibility as they are not sufficient to determine the development of generalizable results. Although this work uses the case studies as a teaching tool there are more rigorous forms of single case study methods developed within this field that have greatly added to the scientific method and contain the potential for validating the areas of interest for more detailed scientific exploration (Crawford, 2011) There is an excellent resource for adopting case studies into clinical practice at http://homepages.abdn.ac.uk/j.crawford/pages/dept/SingleCaseMethodology.htm.