| O’Neill et al. (2017)
UK
RCT
PEDro=7
NInitial=27, NFinal=24 |
Population: TBI=16, Subarachnoid hemorrhage=3, Other=5; Mean Age=45.14 yr; Gender: Male=22, Female=2; Mean Time Post Injury=5.53 yr; Severity: severe.
Intervention: Participants were randomly assigned to the experimental (n=10) or control group (n=14), and assessed before (baseline), during, and after intervention (return to baseline). Experimental group participants received Guide, an audio-verbal interactive micro-prompting software designed to emulate the verbal prompts and questions provided by carers or support workers. Control group participants received rehabilitation as usual.
Outcome Measures: Morning Checklist (number of support worker prompts, number of safety critical and general errors, deviations from and repetitions of the necessary sequence), Satisfaction score (5-point scale). |
1. Compared to baseline, there was a significantly greater reduction in the intervention group than the control group during (p<0.010) and after (p<0.010) the intervention for the number of prompts needed.
1. There were no significant differences between groups across the three phases in terms of number of errors, sequence errors, or satisfaction scores. |
| Gracey et al. (2017)
UK
RCT
PEDro=6
NInitial=74, NFinal=59 |
Population: CVA=23, Infection=3, TBI=33, Tumor=10, Missing=1. Control First (n=34): Mean Age=50.18 yr; Gender: Male=23, Female=11; Mean Time Post Injury=8.62 yr. Assisted Intention Monitoring (AIM, n=36): Mean Age=46.36 yr; Gender: males=23, females=13; Mean Time Post Injury=4.89 yr.
Intervention: Participants were randomized to receive AIM or control first. In the AIM-first group, participants received goal management training followed by text messages for improving achievement of everyday intentions. Control-first group received brain injury information, Tetris game, and non-informational text messages. After 3 wk, participants were crossed over with AIM-first group receiving usual care and control-first group receiving AIM.
Outcome Measures: Mean daily proportion of intentions achieved, Achievement of all goals excluding the phone call task, Profile of Mood States total mood disturbance (POMS MD), Hotel Task, Verbal Fluency. |
1. Participants achieved a greater proportion of intentions during the AIM intervention relative to control (p=0.040).
2. Participants achieved a greater proportion of goal attainment (without the phone call task) during the AIM intervention relative to control (p=0.033).
3. No significant Group x Time interaction effect was found for the POMS MD or Hotel Test.
2. When only comparing group differences at post-intervention phase 1, intention to treat analysis showed no significant difference between groups for proportion of intentions achieved or achievement of goals excluding the phone task. |
| Shum et al. (2011)
Australia
RCT
PEDro=7
N=45
|
Population: TBI patients: Age Range=19-57 yr; Gender: male=37, female=8; Mean Glasgow Coma Score: 6.25, Mean time since injury=273 day.
Intervention: Participants were randomized to one of four treatment groups: self-awareness training, active control for self-awareness with training, compensatory prospective memory (PM) training, and active control for compensatory PM training. All interventions involved 8 weekly attendances (1.5 hr each). Participants were assessed at baseline and after intervention.
Outcome Measure: Cambridge Prospective Memory Test (CAMPROMPT); number of valid diary entries; Comprehensive Assessment of Prospective Memory (CAPM); Sydney Psychosocial Reintegration Scale (SPRS). |
1. All 4 groups showed no significant differences on the CAMPROMPT during the pre-intervention phase.
2. Following intervention, those with a self-awareness training component were not significantly different from those without on the change scores.
3. Groups with a compensatory training component were found to have a significantly larger change score than those without (p=0.007).
4. There was a significant increase in the number of participants who took notes (p=0.008).
5. Post intervention the groups with a compensatory training component were found to have larger change scores than those without (p<0.017).
6. Scores on the CAPM and SPRS were not significantly different among the 4 groups pre- or post-intervention. |
| Dahlberg et al. (2007)
USA
RCT
PEDro=6
N=52 |
Population: TBI; Mean Age=41.17 yr; Gender: Male=44, Female=8; Mean Time Post Injury=9.67 yr; Severity: Severe=40, Moderate to mild=12.
Treatment: Patients were randomly assigned to either the experimental (n=26) group or the control group (n=26). Individuals receiving the training focused on listening to others, communicating needs, and regulating their emotions during social interactions. There were 12 sessions each lasting 1.5 hr. The control group waited 3 mo before undergoing treatment. Patients were assessed 5 times: baseline (wk 0), end of treatment (wk 12), at wk 24, 36 and 48.
Outcome Measure: Profile of Functional Impairment in Communication (PFIC), Social Communication Skills Questionnaire-Adapted (SCSQ-A), Goal Attainment Scale (GAS). |
1. Results of the PFIC rating scale showed significantly greater improvements on 7 of the subscales included on the PFIC: general participation (p=0.001), quantity (p=0.024), internal relation (p=0.009), external relation (p=0.005), clarity of experience (p=0.024), social style (p<0.001) and aesthetics (p=0.014).
2. The SCSQ-A showed significant improvement (p=0.005) for the treatment group compared to the control, pre- and post-intervention.
3. Over time significant improvement were noted between baseline scores and post-treatment scores for all participants receiving training on the PFIC (21 of the 30 subscales: p<0.001). Significant improvement was noted on the SCSQ-A (p<0.001) as well.
4. Significant improvements were made on the GAS from baseline to all post-treatment evaluations (p<0.001). |
| Goverover et al. (2007)
USA
RCT
PEDro=6
N=20
|
Population: ABI; Gender: Male=16, Female=4. Treatment Group (n=10): Mean Age=39.5yr; Mean Time Post Injury=12.9mo; Mean GCS=4.6. Control Group (n=10): Mean Age=39.2yr; Mean Time Post Injury=8.6mo; Mean GCS=3.6.
Intervention: The experimental group received 6 sessions of self-awareness training while they performed various instrumental activities of daily living. The control group received conventional therapeutic intervention.
Outcome Measures: Assessment of Awareness of Disability (AAD), Awareness Questionnaire (AQ), Self-Regulation Skills Inventory (SRSI), Assessment of Motor and Process Skills (AMPS), Community Integration Questionnaire (CIQ). |
3. The treatment group showed improvement (+2.1) in task-specific AAD while the control group worsened (-1.8), although the difference between groups was not significant (p=0.12).
4. SRSI and AMPS scores improved more in the treatment group than in the control group (p<0.001 and p<0.01, respectively).
5. No treatment effect was shown for AQ or CIQ. |
| Evald et al. (2015)
Denmark
Pre-Post
N=13 |
Population: TBI; Mean Age=41.5 yr; Gender: Male=11, Female=2; Mean Time Post Injury=11 yr; Mean GCS=6.6.
Intervention: Participants underwent memory training using smartphones (1 individual and 5 group sessions, 1.5 hr/session, 1 session/wk, for 6 weeks). In the individual session participants were instructed on smartphone setup. During the group sessions participants were instructed on compensatory memory strategies using appointment, tasks and contacts applications. Each group session was completed in 4 steps; 1) introduction to the memory strategy, 2) demonstration of the application, 3) exercises with examples and 4) homework instructions.
Outcome Measure: Self-reported measures of overview, memory, stress and fatigue. |
1. 5 of the 13 participants reported memory improvements following smartphone use, while the remaining reported no change.
2. 3 of the 13 participants reported stress improvements following smartphone use while the remaining reported no change.
3. 1 of the 13 participants reported fatigue improvements following smartphone use while the remaining reported no change.
4. 9 of the 13 participants reported a positive overview of smartphone use while the remaining reported no change.
1. There were no negative events reported. |
| Schoenberg et al. (2008)
US
Case Control
N=39 |
Population: TBI; Teletherapy (TELE) Group (n=19): Mean Age=27.4yr; Gender: Male=18, Female=1; Mean Time Post Injury=58.7mo; Severity: Moderate-to-severe=19; Face-to-Face (FTF) Reference Group (n=20): Mean Age=33.1yr; Gender: Male=15, Female=5; Mean Time Post Injury=29.4mo; Severity: Moderate-to-Severe=20
Intervention: Participants in the TELE group received computer-based cognitive rehabilitation program via computers connected to the Internet at their home. The teletherapy program included individual exercises
ranging from simple attention and executive tasks to complex visuospatial memory tasks, as well as complex problem-solving and decision-making exercises. Participants in the FTF group received a minimum of six sessions of face-to-face outpatient cognitive and speech–language rehabilitation therapy
Outcome Measures: Independent living status, independent driving, return to work or school, total cost of the treatment and a measure of service costs per hour, hours of therapy. |
1. Self-reported hours of therapy ranged from 10 to 243 hours for the TELE group and 6 to 114 hours for the FTF group.
2. There were no participants in the TELE group or the FTF group who were working or attending school, living independently, or driving at the start of the study
3. Within-groups analysis of change from baseline to post-intervention revealed that the proportion of participants living independently, driving, and working significantly improved for both groups (p<.01).
4. There were no significant differences between groups in the proportion of participants living independently, driving, or returning to school or work at the conclusion of intervention (p>.05). |
|
Gentry et al. (2008)
Canada
Pre-Post
N=23 |
Population: TBI patients: Age Range 18-66 yr; Gender: Male=16, Female=7; Time Post-Injury=1-34 yr.
Intervention: Participants were each given a PDA and trained on how to use it by an occupational therapist (OT).
Outcome Measures: Craig Handicap Assessment and Rating Technique Revised (CHART); Canadian Occupational Performance Measure (COPM). |
1. On the COPM, improvements were noted when looking at post training performance and post training satisfaction (p<0.001).
2. Scores on the CHART-R self-assessment rating scale showed improvement as well post-training (p<0.001).
3. Significant improvement was seen on the scores of the cognitive independence, mobility, and occupation subsections of the test (p<0.001). |
| Cicerone et al. (2004)
USA
PCT
N=56 |
Population: TBI; Gender: Male=40, Female=16; Severity: Mild=11.1%, Moderate-to-Severe=88.9%. Treatment Group (n=27): Mean Age=37.8yr; Mean Time Post Injury=33.9 mo. Control Group (n=29): Mean Age=37.1yr, Mean Time Post Injury=4.8 mo.
Intervention: Participants were assigned to an Intensive Cognitive Rehabilitation Program (ICRP, treatment group) or Standard Neurorehabilitation Program (SRP, control group) for 4 mo. ICRP focused on executive and metacognitive functioning, interpersonal group processes, therapeutic work trials and placement to facilitate educational or vocational readiness.
Outcome Measures: Community Integration Questionnaire (CIQ), Quality of Community Integration Questionnaire, Trail-Making Test Parts A (TMT-A) and B (TMT-B), California Verbal Learning Test (CVLT), Rey Complex Figure (RCF). |
1. Both groups showed significant improvements on the CIQ following treatment (p<0.001); although the treatment group was more than twice as likely to show clinical benefit on the CIQ compared to the control group.
2. The treatment group showed significant improvements on overall neuropsychological functioning following treatment (p<0.001), with significant improvements on the TMT-A (p=0.002), CVLT (p=0.007), and RCF (p=0.002).
3. Improvements on overall neuropsychological functioning were associated with improvements on total CIQ raw scores (p=0.03).
4. Within the treatment group, participants who showed a clinically significant improvement on the CIQ showed a greater improvement in overall neuropsychological functioning (p=0.045) and attention (TMT-B; p=0.001). |
| Giles et al. (1997)
USA
Case Series
N=4 |
Population: TBI=3, Stroke=1; Mean Age=26.75yr; Gender: Male=3, Female=1; Mean Time Post Injury=14mo.
Intervention: Participants received a behavioural retraining program targeting washing and dressing, which involved a written component to aid learning and a behavioral observation task.
Outcome Measure: Adaptive Behavioral Scale (ABS). |
1. Marked improvements were seen on the ABS for 3 participants, and 2 participants reached maximum independence on all subscales by 3 mo.
2. As treatment progressed, all 4 participants were capable of stating the order in which activities of daily living were to be performed. |
| Carnevale (1996)
USA
Case Series
N=11 |
Population: ABI; Mean Age=30.5yr; Gender: Male=7, Female=4.
Intervention: Participants received a mobile Natural-Setting Behaviour Management Program for 1yr, which consisted of education, intervention, and phase-out components.
Outcome Measure: Attainment of target behaviours. |
1. By the phase-out period, there was an 82% improvement in target behaviours.
2. The greatest change (51%) occurred early on in the training program during the education component.
3. An additional 27% improvement was attained during the intervention period. |
