Selective and Integrated Rehabilitation Programs for Disturbances of Visual/Spatial Attention and Executive Function After Brain Damage: A Neuropsychological Evidence-Based Review

European Journal of Physical and Rehabilitation Medicine

Zoccolotti, P., Cantagallo, A., et al. (2011).

European Journal of Physical and Rehabilitation Medicine, 47(1), 123-147.

This systematic review investigates the effect of rehabilitation programs on visual-spatial attentional dysfunction and executive function disorders in adults with non-degenerative brain lesions included nontraumatic and traumatic brain injury (TBI).

Not stated

Up to 2007

Published experimental studies; reviews; meta-analyses

12 studies (part I); 15 studies (part II); 17 studies (part III); 9 studies (part IV)

Evidence supported the use of visuo-spatial orientation training in rehabilitation of neglect disorders. Training consisted of exercises targeting orientation to and exploration of the left space (e.g., visual scanning, copying figures, naming/describing figures, barrage, reading, or external cues to direct attention to neglected space). Exercises generally increased in difficulty during training, and "most effective studies" (p. 129) used several exercises with varied materials and tasks. Evidence on generalization of training to everyday tasks was controversial.

Convergent evidence from four Level 1+ studies indicated effectiveness of rehabilitative training for attentional disorders in TBI. Evidence supported both direct training (e.g. drill and practice) and strategy training.

Evidence for executive function rehabilitation overall was variable. Studies supported the following:<br /> <ul> <li><span style="color: #333333;">the treatment of planning deficits in individuals with TBI (two Level 1+ studies). </span></li> <li><span style="color: #333333;">interventions such as problem solving treatment, social skills training, and time organization training (seven Level 2+ to 2++ studies);</span></li> <li><span style="color: #333333;">treatments such as goal planning, specific training on tasks such as note-taking or using the internet, and categorization (i.e., abstract thinking; seven Level 3 studies). </span></li> </ul> <span style="color: #333333;">Limitations included small number of patients investigated, lack of convergent evidence, and lack of evidence on generalization or retained treatment effects.</span>

A number of rehabilitation treatments were included in the review such as direct cognitive training, compensatory strategy training, psychotherapeutic and cognitive-behavioral interventions. Given the heterogeneity of studies included, the various treatments included and the variability of evaluation tools used to assess the outcomes of treatment, the efficacy of neuropsychological rehabilitation treatments specific to individuals with mild traumatic brain injury could not be determined. The authors conclude that the "quantity and quality of the research is still too scarce ... [to] draw sound conclusions" (p. 139).

Evidence for executive function rehabilitation overall was variable, but one Level 1++ study supported the use of an electronic planner system which paged patients with reminders. Improvements in executive functioning skills, which were noted in daily life activities, remained two months later at follow-up.