Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence
Institute of Medicine. (2011).
Washington, D.C.: The National Academies Press, Available from https://doi.org/10.17226/13220.
This review investigates the effects of cognitive rehabilitation therapy during acute, subacute, and chronic phases of recovery on a variety of outcomes (e.g., attention, executive function, language and social communication, memory) in adults, 18 years and older, with mild, moderate, or moderate-to-severe traumatic brain injury (TBI).
National Academy of Sciences; U.S. Department of Defense
Through April 2011
All study designs including single-subject experimental designs (excludes any studies that lacked a comparison group and any uncontrolled case reports or case series)
90
<div>The authors "found evidence that was not informative that memory intervention restores memory functioning in patients with moderate-severe TBI" (Not Informative Evidence; p. 194).</div>
<div>The use of internal memory strategies may improve everyday memory in individuals with moderate-severe TBI (Limited Evidence). The majority of treatment effects were maintained 1-month post treatment. Additionally when compared to no treatment or non-cognitive rehabilitation treatment, use of internal strategies may improve performance on standard memory tests for individuals with moderate-severe TBI (Modest Evidence).</div>
<div>External memory aids (e.g., notebooks, alerting devices) may be effective to "reduce everyday memory failures" and "compensate for poor memory" for individuals with moderate-severe TBI (Modest Evidence; pp. 197-198).</div>
<div>No studies were found examining cognitive rehabilitation therapy to improve executive functioning in mild TBI.</div>
<div>Two randomized controlled trials and two single-subject studies addressed the effects of cognitive rehabilitation therapy to improve awareness deficits in patients with chronic, moderate-severe TBI. "Treatment effects show benefit for immediate/short-term outcomes, such as improvement in self-regulatory skills. The evidence provides no support for long-term treatment effect" (p. 153).</div>
<div>The use of internal memory strategies (e.g., visual imagery and other encoding strategies) may improve recall of new information for individuals with chronic, mild TBI and may benefit memory long term (Limited Evidence). However, no evidence was found demonstrating the "benefits of using internal memory strategies for improving everyday memory given the absence of patient-centered outcomes" (p. 193).</div>
<div>Cognitive rehabilitation therapy may improve social communication skills in adults with chronic, moderate-severe TBI (Modest Evidence). Additionally, research shows that there may be sustained effects of cognitive rehabilitation therapy on language and social communication for individuals with chronic, moderate-severe TBI (Limited Evidence). "These studies found that beneficial effects on social communication skills or emotional perception were maintained" (p. 171).</div>
<div>No evidence was found investigating the benefits of external memory aids for individuals with mild TBI.</div>
<div>Limited evidence suggests that divided attention training improves patient-centered outcomes or improves divided attention beyond the tasks being trained.</div>
<div>Treatment focused on goal management training, goal setting, completion of familiar tasks, and time pressure management training were considered uninformative for improvement in patient-centered outcomes (quality of life, functional status) and maintenance of treatment effect.</div>
<div>Findings specific to goal management training, goal setting and time management training for individuals with chronic, moderate-severe TBI were uninformative. Goal management training did not reveal beneficial "improvements beyond the training session for individuals with chronic, moderate-severe TBI" (p. 159).</div>
<div>Limited evidence suggests that the use of a holistic, comprehensive cognitive rehabilitation approach improves patient-centered outcomes (e.g., quality of life, functional status) and domain-specific outcomes (e.g., cognitive measures) for individuals with chronic, mild TBI. Additionally, limited evidence suggests the maintenance of treatment effects at three months post treatment.</div>
<div>No studies were found examining cognitive rehabilitation therapy to improve executive functioning in individuals with subacute, moderate-severe TBI.</div>
<div>The evidence was uninformative for the use of a holistic, comprehensive cognitive rehabilitation approach to improve patient-centered outcomes (e.g., quality of life, functional status) and domain-specific outcomes (e.g., cognitive measures) for individuals with chronic, moderate-severe TBI. The maintenance of treatment effects was also considered uninformative.</div>
<div>"Overall evidence is insufficient to clearly establish whether telehealth technology delivery modes are more or less effective or more or less safe than other means of delivering [cognitive rehabilitation therapy] CRT" (p. 247).</div>
<div>Considering subacute and chronic studies together, limited evidence suggests that "intensive practice of hierarchical attention-demanding tasks had a positive impact on psychometric measures of attention in the immediate post treatment period and/or at follow-up" (Modest Evidence; p. 135).</div>
