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Response to: Can We Successfully Improve Attentional Impairments After Brain Injury With Computer-Based Interventions? Letter to the Editor on “Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014”

      We appreciate the opportunity to clarify our recommendations for evidence-based rehabilitation of attention deficits after traumatic brain injury and stoke. In our 2011 article,
      • Cicerone KD
      • Langenbahn DM
      • Braden C
      • et al.
      Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008.
      we recommended a Practice Standard for incorporating both direct-attention training and metacognitive strategy training to promote compensatory strategies and generalization to real-life tasks. We also recommended a general Practice Option for the use of computer-based interventions as an adjunct to clinician-guided treatment. In our 2019 article,
      • Cicerone KD
      • Goldin Y
      • Ganci K
      • et al.
      Evidence-based cognitive rehabilitation: systematic review of the literature from 2009 through 2014.
      we retained our recommended Practice Standard. We also noted 2 articles by Vallet-Azouvi et al
      • Vallat-Azouvi C
      • Prada-Diehl P
      • Azouvi P.
      Rehabilitation of the central executive of working memory after severe traumatic brain injury: two single-case studies.
      ,
      • Vallat-Azoivi C
      • Pradat-Diehl P
      • Azouvi P.
      Modularity in rehabilitation of working memory: a single case study.
      that reported efficacy of direct-attention training for specific components of working memory. These interventions did not rely on computer-based interventions. However, we noted a class I study
      • Lundqvist A
      • Grundstro K
      • Samuelsson K
      • Rothberg J.
      Computerized training of working memory in a group of patients suffering from acquired brain injury.
      that relied on computer-based interventions to increase performance on working memory tasks and self-reported cognitive difficulties. Based primarily on these 3 studies, we made a stronger but more precise recommendation for the use of direct attention training, including the use of computer-based tasks, for specific, modular impairments of working memory. We considered this Practice Guideline to be a refinement of our previous, more general practice option. We continue to consider the use of computer-based tasks as an adjunct to clinician-guided treatment; in fact, our 2019 article explicitly continued to “emphasize the importance of therapist involvement and intervention . . . over the stand-alone use of computer-based tasks.”
      • Cicerone KD
      • Goldin Y
      • Ganci K
      • et al.
      Evidence-based cognitive rehabilitation: systematic review of the literature from 2009 through 2014.
      (p1518)
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      References

        • Cicerone KD
        • Langenbahn DM
        • Braden C
        • et al.
        Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008.
        Arch Phys Med Rehabil. 2011; 92: 519-530
        • Cicerone KD
        • Goldin Y
        • Ganci K
        • et al.
        Evidence-based cognitive rehabilitation: systematic review of the literature from 2009 through 2014.
        Arch Phys Med Rehabil. 2019; 100: 1515-1533
        • Vallat-Azouvi C
        • Prada-Diehl P
        • Azouvi P.
        Rehabilitation of the central executive of working memory after severe traumatic brain injury: two single-case studies.
        Brain Inj. 2009; 23: 585-594
        • Vallat-Azoivi C
        • Pradat-Diehl P
        • Azouvi P.
        Modularity in rehabilitation of working memory: a single case study.
        Neuropsychol Rehabil. 2014; 24: 220-237
        • Lundqvist A
        • Grundstro K
        • Samuelsson K
        • Rothberg J.
        Computerized training of working memory in a group of patients suffering from acquired brain injury.
        Brain Inj. 2010; 24: 1173-1183

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