Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014
Archives of Physical Medicine & Rehabilitation
Cicerone, K. D., Goldin, Y., et al. (2019).
Archives of Physical Medicine & Rehabilitation, 100(8), 1515-1533.
This is a guideline providing recommendations for the cognitive rehabilitation of individuals with traumatic brain injury (TBI) or stroke. This is an update of the previous guideline by Cicerone et al. (2011). For more information, please see the Notes on this Article section.
Cognitive Rehabilitation Task Force, Brain Injury Special Interest Group, American Congress of Rehabilitative Medicine
<p>This article is updated from:</p><ul><li>Cicerone, K. D., Langenbahn, D. M., et al. (2011). Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature from 2003 through 2008. <em>Archives of Physical Medicine and Rehabilitation, 92</em>(4), 519-530.</li></ul>
Specific interventions targeting functional communication impairments, including pragmatic conversational skills and recognition of emotions from facial expressions, are recommended for improving social communication skills after TBI (Practice Standard).
Memory strategy training is recommended for the improvement of recall in the performance of everyday tasks in individuals with mild memory impairments after TBI, including the use of internalized strategies, such as visual imagery and association techniques, and external memory compensations, such as notebooks (Practice Standard).
During acute rehabilitation, specific gestural or strategy training is recommended for apraxia following left hemisphere stroke (Practice Standard).
Group-based interventions may be considered during post-acute rehabilitation after traumatic brain injury to remediate mild-moderate executive-functioning impairments to improve awareness, problem solving, goal management, and emotional self-regulation (Practice Option).
Group-based interventions may be considered for rehabilitation of language impairments after left hemisphere stroke and for social-communication impairments after TBI (Practice Option).
For individuals with severe memory impairments following TBI, errorless learning techniques may be effective for learning specific skills or knowledge, with limited transfer to new tasks or reduction in overall functional memory issues (Practice Option).
"Direct attention training for specific 'modular' impairments in working memory, including the use of computer-based interventions, should be considered to enhance both cognitive and functional outcomes during post-acute rehabilitation for acquired brain injury" (Practice Guideline; Table 2).
Visuospatial rehabilitation including visual scanning training is recommended to treat left neglect following right hemisphere stroke (Practice Standard). However; the use of isolated microcomputer exercises to treat left neglect after stroke does not appear to be effective and is not recommended (Practice Guideline).
Computer-based interventions as a supplement to clinician-guided treatment may be considered in the rehabilitation of cognitive-linguistic impairments after left hemisphere stroke or TBI. However, sole reliance on computer-based tasks without some involvement and intervention by a clinician in not recommended (Practice Option).
During post-acute rehabilitation, metacognitive strategy training (i.e., self-monitoring, self-regulation) is recommended for the treatment of mild to moderate executive functioning impairments, including emotional self-regulation, after TBI. During the post-acute stage, metacognitive strategy training include formal protocols for problem solving, goal management, and application to everyday situations and functional activities (Practice Standard; Table 6). For individuals with impaired self-awareness after TBI, explicit (verbal-and-video) performance feedback should be considered as a formal component of metacognitive strategy training (Practice Option).
Cognitive-linguistic treatment is recommended during acute and post-acute rehabilitation for language impairments following left hemisphere stroke (Practice Standard).
Following right hemisphere stroke, electronic technologies for visual scanning training may be included to treat neglect (Practice Option). As a part of acute rehabilitation, systemic training of visuospatial deficits and visual organization skills may be considered for individuals with visual perceptual deficits, without visual neglect, following right hemisphere stroke (Practice Option).
Following left hemisphere stroke or TBI, cognitive interventions for specific language impairments such as reading comprehension and language formulation are recommended (Practice Guideline).
Memory strategy training is recommended to improve prospective memory in people with mild memory impairments following TBI or stroke. Memory strategy training includes internalized strategies, such as visual imagery and association techniques, and external memory aids, such as notebooks and electronic technologies (Practice Standard).
Group-based interventions may be considered for treatment of mild to moderate memory impairments, including the improvement of prospective memory and recall of information used in everyday tasks, after TBI or stroke (Practice Option).
During the post-acute stages of recovery, treatment of impaired attention should include both direct attention training and metacognitive strategy training to increase task performance and facilitate generalization to daily functioning after TBI and stroke (Practice Standard).
"Treatment intensity should be considered a key factor in the rehabilitation of language skills after left hemisphere stroke" (Practice Guideline; Table 5).
For individuals with severe memory impairments following TBI or stroke, the use of external compensatory aids with direct application to functional activities is recommended (Practice Guideline).
