Evidence-Based Review of Moderate to Severe Acquired Brain Injury
Retrieved September 18
ERABI Group. (2023).
Retrieved September 18, 2023 from https://www.erabi.ca/.
<div>The updated systematic review investigates the effects of rehabilitation for adults and children with moderate to severe acquired brain injury (ABI), including stroke and/or a traumatic brain injury (TBI). This current edition provides a comprehensive review of the research on acquired brain injury rehabilitation in the acute and post-acute phase of recovery. Conclusions pertaining to dysphagia, cognitive-communication, and vestibular treatment are included.</div>
Ontario Neurotrauma Foundation (Canada); Ministry of Health (Canada)
This systematic review is periodically updated by chapter (module), rather than as a whole document. At the time of writing, we consulted the most current version for each module. We have included this information with each recommendation for your convenience. To check for content published since the time of our writing, please view the authors' <a href="https://erabi.ca/" title="https://erabi.ca/" class="ApplyClass">website</a>.
1980-2017
<div>Prospective study designs; retrospective study designs; experimental study designs; nonexperimental study designs</div>
1000+
<div>For individuals with ABI, the evidence indicates:</div>
<ul>
<li>Increasing inpatient rehabilitation intensity may reduce hospital length of stay compared to conventional therapy (Level 3 Evidence; 2022 Module 3).</li>
<li>High-level involvement in neurorehabilitation goal setting may result in a greater number of goals being maintained at 2-month follow-up (Level 2 Evidence; 2022 Module 3).</li>
<li>Inpatient rehabilitation within 35 days following ABI is associated with better outcomes (Level 2 Evidence; 2022 Module 3).</li>
<li>There can still be benefit from inpatient rehabilitation initiated more than 12 months after sustaining an ABI (Level 2 Evidence; 2022 Module 3).</li>
<li>Earlier initiation of outpatient and community-based rehabilitation is associated with better functional outcomes (Level 2 Evidence; 2022 Module 3).</li>
<li>More intensive outpatient rehabilitation programs are associated with better functional outcomes (Level 2 Evidence; 2022 Module 3).</li>
<li>Those treated at an outpatient clinic may be less dependent on support, display fewer inappropriate social behaviors, and have less difficulty with motor speech compared to those treated in the community (Level 2 Evidence; 2022 Module 3).</li>
</ul>
<div>For individuals with TBI, the evidence indicates:</div>
<ul>
<li>Outpatient care provided at a residential treatment center may improve cognitive function to a greater extent than when care is provided at a nursing facility or at home (Level 3 Evidence; 2022 Module 3).</li>
<li>A formalized early intervention program may improve cognitive levels at discharge, reduce length of stay, and increase the percentage of discharges to home, compared to extended care facilities. These programs may also reduce coma duration in individuals with disorders of conciousness (Level 3 Evidence; 2022 Module 3).</li>
<li>More intensive inpatient rehabilitation may improve Glasgow Outcome Scale scores compared to conventional treatment at 2 months, but not necessarily at 3 months and beyond (Level 1b Evidence; 2022 Module 3).</li>
</ul>
<div>For individuals with severe TBI, Particle Repositioning Maneuver may lead to improvements in positional nystagmus (Level 4 Evidence; 2023 Module 4).</div>
<div>For individuals with memory impairments secondary to moderate to severe ABI, evidence suggests that:</div>
<ul>
<li>Virtual reality telerehabilitation program is feasible and safe for cognitive therapy in individuals with TBI (Level 4 Evidence; 2022 Module 18).</li>
<li>Both computer-administered and therapist-administered memory training may be more effective than no treatment for improving memory (Level 2 Evidence; 2022 Module 18).</li>
<li>Virtual reality (VR) training may improve learning performance (Level 4 Evidence; 2022 Module 18).</li>
<li>Virtual reality training combined with exercise may be promising for improving memory outcomes and has a positive impact on visual and verbal learning (Level 2 Evidence; 2022 Module 18).</li>
<li>Virtual reality training may be superior to reading skills training at improving immediate and general components of memory (Level 2 Evidence; 2022 Module 18).</li>
<li>Cognitive Pragmatic Treatment, Cogmed, Cogmed QM, and RehaCom software may improve memory and cognitive function (Level 4 Evidence; 2022 Module 18).</li>
<li>There is conflicting evidence regarding the effectiveness of Parrot software at improving memory and learning (Level 4 Evidence; 2022 Module 18).</li>
<li>The format of route learning (either real or virtual reality based) does not significantly impact any improvements in memory as a result of route learning strategies (Level 2 Evidence; 2022 Module 18).</li>
<li>Computer assisted cognitive rehabilitation shows no significant differences in memory when compared to traditional therapy methods (Level 4 Evidence; 2022 Module 18).</li>
<li>N-back training compared to virtual search training is not effective for improving memory (Level 2 Evidence; 2022 Module 18).</li>
<li>BrainHQ is not an effective program for improving memory (Level 2 Evidence; 2022 Module 18).</li>
<li>Non-specific computer-based memory retraining, self-paced or otherwise, may not be effective at improving memory (Level 2 Evidence; 2022 Module 18).</li>
</ul>
<div>For individuals with memory impairments secondary to moderate to severe ABI, evidence suggests that:</div>
<ul>
<li>Self-imagination as an effective strategy to improve memory compared to standard rehearsal (Level 1b Evidence; 2022 Module 18).</li>
<li>Spaced retrieval training is an effective memory strategy when compared to massed retrieval or rehearsal (Level 2 Evidence; 2022 Module 18).</li>
<li>Strategies that utilize methods of multiple encoding, compared to strategies which only use singular methods, are more superior for improving memory (Level 2 Evidence; 2022 Module 18).</li>
<li>Errorless learning is more effective than errorful learning when it comes to improving memory (Level 4 Evidence; 2022 Module 18).</li>
</ul>
<div>For individuals with cognitive deficits post moderate to severe ABI, evidence suggests that:</div>
<ul>
<li>Corrective video feedback is more effective for improving generalized cognitive functioning and self awareness compared to verbal feedback only (Level 1b Evidence; 2022 Module 19).</li>
<li>Cognitive therapies compared to standard therapy are more effective than no therapy for improving generalized cognitive functioning, as well as self-awareness (Level 1b Evidence; 2022 Module 19).</li>
<li>A low intensity outpatient cognitive rehabilitation program may improve goal attainment and cognitive impairment (Level 4 Evidence; 2022 Module 19).</li>
<li>The Parrot computer-based cognitive retraining program may enhance general cognitive functioning (Level 4 Evidence; 2022 Module 19).</li>
</ul>
<div>For individuals with cognitive deficits post moderate to severe TBI, evidence suggests that:</div>
<ul>
<li>Executive and compensatory memory retraining may be effective for general cognition (Level 2 Evidence; 2022 Module 19).</li>
<li>The use of quasi-contextualized treatment may improve cognitive outcomes (Level 4 Evidence; 2022 Module 19).</li>
<li>An intensive rehabilitation program may enhance cognitive reserve in individuals with severe TBI (Level 4 Evidence; 2022 Module 19).</li>
</ul>
<div>For individuals with TBI:</div>
<ul>
<li>Cognitive rehabilitation may reduce depressive symptoms (Level 1b Evidence; 2022 Module 8).</li>
<li>Comprehensive rehabilitation may be more effective than social or cognitive rehabilitation alone for emotional disorders (Level 2 Evidence; 2022 Module 8).</li>
<li>Community-based rehabilitation alone may not improve depression (Level 4 Evidence; 2022 Module 8).</li>
<li>Participation in rehabilitation programs may prevent the development of conditions such as anxiety (Level 2 Evidence; 2022 Module 8).</li>
<li>A program addressing recognition of facial emotions may not improve irritability and aggression (Level 1b Evidence; 2022 Module 8).</li>
<li>A social skills training programs may improve social behavior (Level 1b and Level 4 Evidence; 2022 Module 8).</li>
</ul>
<div>For individuals with ABI:</div>
<ul>
<li>A neurorehabilitation program focused on orientation, cognitive training, relaxation and physical activities may improve depression post ABI (Level 2 Evidence; 2022 Module 8).</li>
</ul>
<div>Psychometrics for screening and assessment measures of consciousness and cognition were as follows (2022 Module 17):</div>
<ul>
<li>For the Galveston Orientation and Amnesia Test, reliability was adequate to excellent but rigor was poor. Validity was excellent, but rigor was only adequate.</li>
<li>The Glasgow Coma Scale had adequate reliability but poor rigor, while it had adequate validity and adequate rigor for this property. The Glasgow Outcome Scale/Extended similarly had adequate reliability but poor rigor. However, it had excellent validity and adequate rigor for this property.</li>
<li>The Mini Mental State Examination had adequate to excellent reliability with excellent rigor. It had adequate validity with excellent rigor.</li>
<li>The Neurobehavioral Functioning Inventory was found to have excellent reliability with poor rigor and poor validity with poor rigor.</li>
<li>The Rancho Los Amigos Level of Cognitive Functioning Scale had excellent reliability and validity with poor rigor.</li>
</ul>
<div>The following assessments of Quality of Life were investigated (2022 Module 17):</div>
<ul>
<li>The Satisfaction with Life Scale has adequate to excellent reliability with excellent rigor. It has excellent validity with adequate rigor.</li>
<li>The Quality of Life after Traumatic Brain Injury had excellent reliability and rigor. It had adequate validity and excellent rigor.</li>
</ul>
<div>Peer-group training of pragmatic language skills might improve communication in children post ABI (Level 4 Evidence; 2022 Module 14). Interventions directed at improving social interactions might be beneficial in children post TBI (Level 4 Evidence; 2022 Module 14).</div>
<div>Text-to-speech technology improved reading rates in individuals with communication impairments secondary to moderate to severe ABI, but had no impact on reading comprehension (Level 4 Evidence; 2022 Module 20).</div>
<div>Evidence suggests that augmentative and alternative communication interventions are beneficial in improving communication, particularly for those with severe ABI (Ungraded; 2022 Module 20).</div>
<div>For individuals with cognitive deficits post moderate to severe TBI, evidence suggests that:</div>
<ul>
<li>Dual-task training may not improve executive functioning (Level 2 Evidence; 2022 Module 19).</li>
<li>Cognitive pragmatic treatments may improve communicative-pragmatic abilities, including executive function, in individuals with severe TBI (Level 4 Evidence; 2022 Module 19).</li>
<li>Categorization training may improve executive function (Level 1b Evidence; 2022 Module 19).</li>
<li>Attention Process Training likely improves performance in executive functioning (Level 1b Evidence; 2022 Module 19).</li>
<li>Computer assisted cognitive rehabilitation and computer software programs, such as BrainHQ and ProSolv, may not be effective at improving executive function (Level 2 Evidence; 2022 Module 19).</li>
<li>Virtual-reality training is not superior to conventional cognitive training at improving executive function outcomes (Level 1b Evidence; 2022 Module 19).</li>
<li>A Cognitive Application for Life Management (CALM) intervention (i.e., a combined treatment of Goal Management Training and a mobel device for cueing and attention training) may not be effective in treating executive dysfunction (Level 1b Evidence; 2022 Module 19).</li>
<li>Emotional regulation interventions are effective at improving executive function (Level 1b Evidence; 2022 Module 19).</li>
<li>Cognitive retraining program focused on repetitive practice and drills may improve processing speed, working memory and executive function (Level 4 Evidence; 2022 Module 19).</li>
</ul>
<div>For individuals with cognitive deficits post moderate to severe ABI, evidence suggests that:</div>
<ul>
<li>A comprehensive cognitive strategy that addresses problems of daily living may improve executive functioning in daily life (Level 1b Evidence; 2022 Module 19).</li>
<li>The Intensive NeuroRehabilitation programme, compared to no treatment, does not improve executive functioning (Level 2 Evidence; 2022 Module 19).</li>
<li>Goal Management Training may improve executive function; however, this intervention may not be effective when combined with mobile technology (Level 1b Evidence; 2022 Module 19).</li>
<li>Goal-directed attentional self-regulation training may improve executive function (Level 2 Evidence; 2022 Module 19).</li>
<li>The SMART program may be effective for improving executive functioning (Level 1b Evidence; 2022 Module 19).</li>
<li>The ProSolv mobile application may not improve executive function (Level 2 Evidence; 2022 Module 19).</li>
<li>Combining a brief goal-directed rehabilitation with SMS text message alerts may not improve executive function (Level 1b Evidence; 2022 Module 19).</li>
</ul>
<div>For individuals with moderate to severe ABI, there is evidence that:</div>
<ul>
<li>Self-awareness training may not improve social integration compared to conventional therapy (Level 1b Evidence 2021; Module 13).</li>
<li>Group-based therapy may improve independent living and social integration (2022 Module 13).</li>
<li>Certain cognitive rehabilitation interventions may improve independence, community, and social integration (2022 Module 13).</li>
<li>Multimodal interventions have inconsistent impacts on independence and social integration, but may improve employability (2022 Module 13).</li>
<li>Multi-faceted rehabilitation, coping skills training, and support-based interventions may improve self-efficacy and/or perceived quality of life (2022 Module 13).</li>
<li>Virtual reality training may not be more effective than conventional psychoeducation in improving employment outcomes (Level 2 Evidence; 2022 Module 13).</li>
<li>Cognitive rehabilitation therapy may not be effective for improving employment rates (2022 Module 13).</li>
<li>Simulated educational experiences may be helpful for predicting an individual’s readiness to return to school (Level 4 Evidence; 2022 Module 13).</li>
<li>Care partner training and education may improve certain outcomes in care partners (2022 Module 13).</li>
</ul>
<div>For individuals with moderate to severe ABI at the acute phase of recovery:</div>
<ul>
<li>Multisensory stimulation may be more effective than standard care at improving consciousness and cognitive function (Level 1a Evidence; 2022 Module 15).</li>
<li>Sensory stimulation may be most effective when it is specific, directed, and regulated (Level 2 Evidence; 2022 Module 15).</li>
<li>Sensory stimulation may be most effective when stimuli are familiar or delivered by a familiar individual (Level 1b Evidence; 2022 Module 15).</li>
<li>Structured auditory sensory stimulation improves Sensory Stimulation Assessment Measure and Disability Rating Scale, but not Glasgow Outcome Scale scores compared to controls (Level 2 Evidence; 2022 Module 15).</li>
<li>Multisensory stimulation delivered five times per day rather than twice per day may be more effective at improving consciousness and cognitive function (Level 1b Evidence; 2022 Module 15).</li>
<li>Multimodal stimulation may be superior to standard care at reducing coma duration (Level 2 Evidence; 2022 Module 15).</li>
<li>Multimodal stimulation is superior to unimodal stimulation at increasing behaviors corresponding with arousal (Level 4 Evidence; 2022 Module 15).</li>
<li>Multi-sensory stimulation has no effect on emergence from coma, Glasgow Outcome Scale scores, or recovery compared to controls (Level 3 Evidence; 2022 Module 15).</li>
</ul>
<div>For individuals with moderate to severe TBI, there is evidence that a coordinated, multidisciplinary team approach to inpatient rehabilitation may result in functional improvements that are sustained for a longer period compared to a single-discipline approach (Level 2 Evidence; 2022 Module 3). <span style="color: #333333;">Individuals with ABI may have greater functional gains from an integrated network of inpatient, outpatient, and community services compared to standard inpatient rehabilitation</span> (Level 2 Evidence; 2022 Module 3).</div>
<div>Studies investigating the effects of executive function interventions for children post ABI indicate that:</div>
<ul>
<li>Therapist-assisted metacognitive treatment programs for pre-adolescents likely improve executive function and increase the use of metacognitive learning strategies (Level 2 Evidence; 2022 Module 14).</li>
<li>Web-based teen problem solving intervention programs are effective in reducing parental depression, anxiety, and distress compared to an internet resource comparison group (Level 1a Evidence; 2022 Module 14).</li>
<li>An online problem-solving program with therapist assistance may be superior to an internet resource comparison group at improving treatment compliance and self-management (Level 1a Evidence; 2022 Module 14).</li>
</ul>
<div>Studies investigating the effects of cognitive interventions for children post ABI indicate that:</div>
<ul>
<li>Multidisciplinary outpatient programs may improve functional outcomes (Level 4 Evidence; 2022 Module 14).</li>
<li>The Strategic Memory Advanced Reasoning Training (SMART) intervention may improve higher-order cognitive functioning in adolescents (Level 1b Evidence; 2022 Module 14).</li>
<li>The Amsterdam Memory and Training program may improve selective, but not sustained attention (Level 1b Evidence; 2022 Module 14).</li>
</ul>
<div>Speech therapy using electropalatography might improve articulation in children with dysarthria post TBI (Level 4 Evidence; 2022 Module 14).</div>
<div>For individuals with social communication deficits secondary to moderate to severe ABI, there is evidence that cognitive pragmatic treatments improve communicative-pragmatic skills. Specifically, the evidence suggests that:</div>
<ul>
<li>Group social communication intervention programs may improve social communication skills (Level 1b Evidence; 2022 Module 20).</li>
<li>Treatment for Impairments in Social Cognition and Emotion Regulation (T-ScEmo) is effective for the remediation of social communication skills and facial affect, when compared to general cognitive gains treatment (Level 1b Evidence; 2022 Module 20).</li>
<li>Group Interactive Structured Treatment program (GIST) is effective for improving social communication skills (Level 2 Evidence; 2022 Module 20).</li>
<li>Interactive virtual reality touch screen games focused on areas of reasoning, knowledge, cohesion, and action may be effective for improving social skills (Level 4 Evidence; 2022 Module 20).</li>
<li>Facial affect recognition training and emotional inference training may improve emotion recognition (Level 1b Evidence; 2022 Module 20).</li>
<li>A short duration intervention designed to improve the ability to recognize emotional prosody may not be effective (Level 1b Evidence; 2022 Module 20).</li>
<li>Cognitive pragmatic treatment programs are effective in improving communicative-pragmatic abilities (Level 4 Evidence; 2022 Module 20).</li>
</ul>
<div>For individuals with social communication deficits secondary to TBI:</div>
<ul>
<li>A goal-driven, metacognitive strategy intervention may be beneficial (Level 4 Evidence; 2022 Module 20).</li>
<li>Cognitive Pragmatic Treatment may improve communicative-pragmatic abilities (Level 4 Evidence; 2022 Module 20).</li>
<li>Interventions that focus on training communication partners in the community, compared to no training, are effective for improving interactions (Level 1b Evidence; 2022 Module 20).</li>
<li>Providing training to both the communication partner and the individual with a TBI together is more effective than only training the individual with TBI alone or no training at all (Level 1b Evidence; 2022 Module 20).</li>
</ul>
<div>For individuals with ABI:</div>
<ul>
<li>During computer-based training, compensatory strategies may result in better performance in attention tasks (Level 2 Evidence; 2022 Module 6).</li>
<li>THINKable, a computer-based multi-media program, is effective for improving attention (Level 2 Evidence; 2022 Module 6).</li>
<li>Computer-assisted attention retraining programs may be more beneficial than memory training or recreational computing (Level 1b Evidence; 2022 Module 6).</li>
<li>Video game play may not improve sustained attention (Level 1b Evidence; 2022 Module 6).</li>
<li>Rehabilitation interventions using computer programs and software have limited effects on attention (Level 2 Evidence; 2022 Module 6).</li>
<li>Attention performance can be improved through task repetition in virtual reality environments (Level 4 Evidence; 2022 Module 6).</li>
</ul>
<div><span style="color: #333333;">Studies investigating the effects of executive function interventions for children post TBI indicate that:<br></span></div>
<ul>
<li>Self-monitoring training might improve on-task behavior, but not accuracy in completing assignments or task engagement (Level 4 Evidence; 2022 Module 14).</li>
<li>Counsellor-assisted problem-solving and internet resource interventions may be effective at mitigating behavioral problems; however, conflicting evidence exists as to which is superior and who benefits the most (Level 1b Evidence; 2022 Module 14).</li>
<li>Online family problem solving interventions likely improve everyday functioning, specifically in the school and community domains, but not at home, in adolescents (Level 1b Evidence; 2022 Module 14).</li>
<li>Counsellor assisted problem-solving programs may be effective in improving executive function in adolescents; especially older adolescents (Level 1a Evidence; 2022 Module 14).</li>
<li>Goal management therapy may reduce parental ratings of their child’s executive dysfunction (Level 4 Evidence; 2022 Module 14).</li>
<li>Injury-related information provided to participants and parents may not have an effect upon deficit self-awareness (Level 1b Evidence; 2022 Module 14).</li>
</ul>
<div>For individuals with memory impairments secondary to moderate to severe ABI, evidence suggests that:</div>
<ul>
<li>Individual memory therapy is no more effective than group memory therapy (Level 1b Evidence; 2022 Module 18).</li>
<li>Programs involving multiple learning strategies (such as modelling, reciting, verbal instruction, and observation) are more effective than singular strategies therapy (Level 2 Evidence; 2022 Module 18).</li>
<li>The Short Memory Technique may not be more effective than standard memory therapy at improving memory (Level 1b Evidence; 2022 Module 18).</li>
<li>The Categorization Program, and Strategic Memory and Reasoning Training (SMART) may be effective for improving memory compared to standard therapy (Level 1a Evidence; 2022 Module 18).</li>
<li>Compensatory memory strategies, self-awareness training, and participation in memory group sessions may be effective for improving memory (Level 1b Evidence; 2022 Module 18).</li>
<li>The Intensive Neurorehabilitation Programme is not effective for improving memory compared to controls therapy (Level 2 Evidence; 2022 Module 18).</li>
<li>Mental addition tasks may improve working memory (Level 4 Evidence; 2022 Module 18).</li>
<li>The Wilson’s Structured Behavioral Memory Program is not effective for improving memory (Level 4 Evidence; 2022 Module 18).</li>
<li>Time pressure management training is no more effective than concentration training at improving memory (Level 2 Evidence; 2022 Module 18).</li>
<li>Participation in a goals training program, followed by an educational program, may be more effective for improving memory compared to receiving the treatment conditions in reverse order (Level 2 Evidence; 2022 Module 18).</li>
<li>Both cognitive remediation and emotional self-regulation may be effective at improving different elements of memory (Level 2 Evidence; 2022 Module 18).</li>
<li>Attention training programs may not be effective for improving memory (Level 1b Evidence; 2022 Module 18).</li>
<li>Attention process training may improve memory measurements compared to education alone (Level 1b Evidence; 2022 Module 18).</li>
</ul>
<div>For individuals with memory impairments secondary to moderate to severe TBI, evidence suggests that:</div>
<ul>
<li>The effectiveness of cognitive pragmatic treatment programs on memory is unclear (Level 4 Evidence; 2022 Module 18).</li>
<li>A cognitive retraining program may improve cognition and memory (Level 4 Evidence; 2022 Module 18).</li>
</ul>
<div>For individuals with communication impairments post moderate to severe ABI, evidence suggests that:</div>
<ul>
<li>Intervention targeting figurative language improves communication skills (Level 4 Evidence; 2022 Module 20).</li>
<li>Metacognitive strategy instruction may not be effective for improving communication (Level 4 Evidence; 2022 Module 20).</li>
<li>Yes/no training does not significantly improve communication responses (Level 1b Evidence; 2022 Module 20).</li>
</ul>
<div>For individuals with memory impairments secondary to moderate to severe ABI, evidence suggests that:</div>
<ul>
<li>Voice organizers may be an effective memory aid (Level 2 Evidence; 2022 Module 18).</li>
<li>Palmtop computers may be an useful memory aid (Level 4 Evidence; 2022 Module 18).</li>
<li>Prospective memory reminders delivered through the television is superior to typical reminder strategies (i.e., paper planners, cell phones, computers) at improving the amount of completed tasks (Level 2 Evidence; 2022 Module 18).</li>
<li>There are conflicting results about the effectiveness of calendars as a tool for improving memory and task completion (2022 Module 18).</li>
<li>The use of a diary may help to improve memory and task completion (Level 2 Evidence; 2022 Module 18).</li>
</ul>
<div>For individuals with memory impairments secondary to moderate to severe TBI, evidence suggests that:</div>
<ul>
<li>Automated prompting systems and a computerized tracking system can help individuals with TBI remember to complete tasks (2022 Module 18).</li>
<li>Personal digital assistant (PDA) devices are superior to paper-based interventions at improving memory and task completion; specially when introduced using systematic instructions and in combination with occupational therapy. Individuals who have used previous memory aids might benefit from this intervention the most (2022 Module 18).</li>
<li>The NeuroPage system may increase the individual’s ability and efficiency to complete tasks (Level 2 Evidence; 2022 Module 18).</li>
<li>Reminder text messages sent to individuals through their mobile phones, whether alone or in combination with goal management training, improves goal completion (Level 1b Evidence; 2022 Module 18).</li>
</ul>
<div>In individuals with ABI, the evidence indicates:</div>
<ul>
<li>Intense, orofacial tract therapy in swallowing is feasible and may improve swallowing specific parameters (Level 1b Evidence; 2023 Module 5).</li>
<li>Intensive rehabilitation programs for communication and swallowing disorders may be effective in treating in individuals with anoxic brain injury (Level 4 Evidence; 2023 Module 5).</li>
<li>There is evidence that oral care may reduce rates of pneumonia (Level 3 Evidence; 2023 Module 5).</li>
</ul>
<div>In individuals with TBI, the evidence indicates:</div>
<ul>
<li>Evidence-based, bundled care may improve swallowing function (Level 2 Evidence; 2023 Module 5).</li>
<li>Providing oral hygiene education results in a significant reduction of dental plaque (Level 2 Evidence; 2023 Module 5).</li>
</ul>
<div>Studies investigating the effects of cognitive interventions for children with TBI found that:</div>
<ul>
<li>The Attention Improvement and Management (AIM) program may improve sustained, but not selective, attention skills compared to healthy controls (Level 2 Evidence; 2022 Module 14).</li>
<li>Attention-specific neuropsychological training improves cognition, attention and behavioral skills (Level 2 Evidence; 2022 Module 14).</li>
<li>A cognitive computerized training (CCT) program may be feasible (Level 2 Evidence; 2022 Module 14).</li>
<li>Mobile-based supports may help improve memory in adolescents (Level 2 Evidence; 2022 Module 14).</li>
<li>Utilization of a diary in combination with self-instructional training might temporarily improve memory in children (Level 4 Evidence; 2022 Module 14).</li>
<li>Sensory stimulation paired with cognitive neuropsychological rehabilitation may improve intellectual function (Level 2 Evidence; 2022 Module 14).</li>
<li>Biweekly sessions of cognitive rehabilitation may improve memory skills (Level 4 Evidence; 2022 Module 14).</li>
</ul>
<div>For individuals with ABI, the evidence indicates:</div>
<ul>
<li>Drill and practice training may not be effective to remediate attention compared to spontaneous recovery (Level 2 Evidence; 2022 Module 6).</li>
<li>Dual-task training may be effective to improve attention task performance (Level 2 Evidence; 2022 Module 6).</li>
<li>Adaptive training is not more effective than non-adaptive training in remediating attention (Level 2 Evidence; 2022 Module 6).</li>
<li>The Short-Term Executive Plus (STEP) cognitive rehabilitation program is not effective in treating attentional disorders compared to controls (Level 1b Evidence; 2022 Module 6).</li>
<li>External supports may improve attention switching (Level 2 Evidence; 2022 Module 6).</li>
<li>Attention process training may improve attentional function (Level 1a Evidence; 2022 Module 6).</li>
<li>Time pressure management training may improve attention performance and information processing speed (Level 2 Evidence; 2022 Module 6).</li>
<li>Working memory training may remediate attention (Level 4 Evidence; 2022 Module 6).</li>
<li>Pragmatic training may not be effective for improving attention (Level 4 Evidence; 2022 Module 6).</li>
<li>Goal management training may be effective at improving attention as compared to education (Level 2 Evidence; 2022 Module 6).</li>
<li>Goal management training is more effective in remediating task completion times than motor skill training, but is not more effective in treating attention deficits (Level 2 Evidence; 2022 Module 6).</li>
</ul>
