Abstract
Objectives
To conduct an updated, systematic review of the clinical literature, classify studies
based on the strength of research design, and derive consensual, evidence-based clinical
recommendations for cognitive rehabilitation of people with traumatic brain injury
(TBI) or stroke.
Data Sources
Online PubMed and print journal searches identified citations for 250 articles published
from 2009 through 2014.
Study Selection
Selected for inclusion were 186 articles after initial screening. Fifty articles were
initially excluded (24 focusing on patients without neurologic diagnoses, pediatric
patients, or other patients with neurologic diagnoses, 10 noncognitive interventions,
13 descriptive protocols or studies, 3 nontreatment studies). Fifteen articles were
excluded after complete review (1 other neurologic diagnosis, 2 nontreatment studies,
1 qualitative study, 4 descriptive articles, 7 secondary analyses). 121 studies were
fully reviewed.
Data Extraction
Articles were reviewed by the Cognitive Rehabilitation Task Force (CRTF) members according
to specific criteria for study design and quality, and classified as providing class
I, class II, or class III evidence. Articles were assigned to 1 of 6 possible categories
(based on interventions for attention, vision and neglect, language and communication
skills, memory, executive function, or comprehensive-integrated interventions).
Data Synthesis
Of 121 studies, 41 were rated as class I, 3 as class Ia, 14 as class II, and 63 as
class III. Recommendations were derived by CRTF consensus from the relative strengths
of the evidence, based on the decision rules applied in prior reviews.
Conclusions
CRTF has now evaluated 491 articles (109 class I or Ia, 68 class II, and 314 class
III) and makes 29 recommendations for evidence-based practice of cognitive rehabilitation
(9 Practice Standards, 9 Practice Guidelines, 11 Practice Options). Evidence supports
Practice Standards for (1) attention deficits after TBI or stroke; (2) visual scanning
for neglect after right-hemisphere stroke; (3) compensatory strategies for mild memory
deficits; (4) language deficits after left-hemisphere stroke; (5) social-communication
deficits after TBI; (6) metacognitive strategy training for deficits in executive
functioning; and (7) comprehensive-holistic neuropsychological rehabilitation to reduce
cognitive and functional disability after TBI or stroke.
Keywords
List of abbreviations:
APT (Attention Process Training), CogSMART (Cognitive Symptom Management and Rehabilitation Therapy), CO-OP (Cognitive Orientation to Occupational Performance), CRTF (Cognitive Rehabilitation Task Force), CVA (cerebrovascular accident), GMT (Goal Management Training), MST (Metacognitive Strategy Training), NFT (Neurofunctional Training), PCS (postconcussion symptoms), PM (prospective memory), PST (problem-solving therapy), PTSD (posttraumatic stress disorder), RCT (randomized controlled trial), SOT (standard occupational therapy), TBI (traumatic brain injury), TPM (time pressure management), VR (virtual reality), WM (working memory)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 26, 2019
Footnotes
Disclosures: none.
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© 2019 by the American Congress of Rehabilitation Medicine
