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Table 6.33 The Effect of Cognitive Rehabilitation Strategies on General Cognitive Function Post ABI

Author Year

Country

Research Design

PEDro

Sample Size

Methods Outcome

Linton & Kim (2018)

United States

RCT

PEDro=5

N=8

Population: Mean age=36.5yr; Gender: Male=4, Female=4.

Intervention: Participants were either assigned to the 3-month, in home, Trabajadora de Salud group or the control group. The control group received the same intervention only via telephone.

Outcomes: Neurobehavioral Functioning Inventory, Physical FIM, Cognitive FIM.

1.       Both the experimental and control groups saw a decrease in their depressive symptoms on the Neurobehavioral Functioning Inventory.

2.       Both groups saw an increase in physical FIM scores, although the experimental groups was slightly higher.

3.       Only the experimental group saw an increase in Cognitive FIM scores.

4.       No between-subjects’ analyses were performed.

Schmidt et al. (2013)

Australia

RCT

PEDro=8

N=54

Population: Video Feedback (N=18): Mean age=42.7yr; Gender: Male=14, Female=4; Mean time post-injury=1.5yr; Mean GCS=8.1. Verbal Feedback (N=18): Mean age=41.6yr; Gender: Male=14, Female=4; Mean time post-injury=4.7yr; Mean GCS=7.1. Experimental Feedback (N=18): Mean age=37.5yr; Gender: Male=18; Mean time post-injury=5.8yr; Mean GCS=7.0.

Intervention: Participants received instructions for meal preparation on 4 occasions in one of three formats. The video feedback group watched their recorded meal preparation sessions, the verbal feedback group received feedback on task completion without the video, and the experimental group received no therapist feedback on task completion.

Outcomes: Error rate, Awareness Questionnaire (AQ), Depression Anxiety Stress Scales (DASS-21), Self-perceptions in Rehabilitation Questionnaire (SPIRQ).

1.       There were significant differences between groups at baseline on measures of functional independence (p<0.01), and logical memory (p<0.05).

2.       The video feedback group significantly improved online awareness more than either of the other two groups (p<0.001), and also had significantly fewer errors than either group (p<0.05).

3.       The video feedback group had significantly higher intellectual awareness on the AQ (p<0.05).

4.       There were no significant differences between groups on the DASS-21 or the SPIRQ.

Goverover et al. (2007)

United States

RCT

PEDro=6

N=20

Population: Experimental Group (N=10): Mean age=39.5yr; Gender: Male=8, Female=2; Mean time post-injury=12.9mo; Mean GCS=4.6. Control Group (N=10): Mean age=39.2yr; Gender: Male=8, Female=2; Mean time post-injury=8.6mo; Mean GCS=3.6.

Intervention: Six individualized cognitive treatment task sessions were administered over three weeks, with one session per day 2-3 days a week. Tasks included everyday activities such as making lunch, or a telephone call.

Outcomes: Assessment of awareness of disability (AAD), Assessment of Motor and Process Skills (AMPS), Activities of Daily Living (ADL), Relf-Regulation Skills Interview (SRSI), Satisfaction with quality of care, Awareness Questionnaire (AQ), Community Integration Questionnaire (CIQ).

1.       Groups were not statistically different at baseline.

2.       There were no significant differences between groups following treatment on AAD.

3.       There was a significant improvement in the experimental group on SRSI scores compared to the control group (p<0.05).

4.       There was a significant improvement in AMPS and ADLs for the experimental group, compared to the control group (p<0.05, p<0.05), only on measures of processing and cognition. There were no significant differences on measures of motor AMPS or motor ADLs.

5.       There were no significant differences between groups on AQ or CIQ.

 

Neistadt et al. (1992)

USA

RCT

PEDro=6

N=45

   

Population: TBI: Mean Age=33.2 yr; Gender=Male; Time since injury=7.9 yr.

Intervention: Participants were randomly assigned to an adaptive (n=23) or a remedial (n=22) approaches for their occupational therapy.

Outcome Measure: The Parquetry Block test; Block design subtest of the Wechsler Adult Intelligence Scale-Revised (WAIS-R).

1.       After treatment, the remedial group improved significantly more than the adaptive group on the Parquetry Block test (p=0.019), but there were no significant differences on the WAIS-R Block Design subtest.

2.       There was a non-significant tendency in the expected direction to support that the adaptive group would perform better than the remedial group on the RKE-R after treatment.

Combs et al. (2018)

United States

Pre-Post

N=19

Population: Mean age=32.8yr; Gender: Male=89.5%, Female=10.5%; TBI injury severity: mild=15.8%, severe=63.2%, Other=21.1%.

Intervention: All individuals experienced weekly group meetings around topics in mindfulness-based stress reduction. Each group session lasted 60 mins and group sessions were completed over the course of 32 weeks.

Outcomes: Participants were asked dichotomous questions, or on a Likert-scale about their psychological wellbeing, cognitive functioning, and physical health and their beliefs of the efficacy of the intervention related to those topics.

1.       Overall, the majority of participants reported a significant improvement in their overall health (p<0.001) in relation to the number of sessions they attended.

2.       Participants also reported their beliefs in the ability of the number of sessions to improve physical health symptoms (p<0.05), focus and attention (p<0.05), self-awareness (p<0.05), and mood and anxiety (p<0.001).

3.       No similar significant relationship was found for measures on sleep benefits, or pain.

Rasquin et al. (2010)

Netherlands

Cohort

N=52

Population: Mean Age: 49.5 yr; Gender: male=14, female=13; Mean Time Post-Injury:1.9 yr; Condition: CVA=9, TBI=5, Other ABI=13. Controls who were relatives of the patients=25.

Intervention: Participants were asked to formulate individual strategies to address specific cognitive issues (attention memory or problem solving) and to develop methods to ask for help with problems resulting from the head injury. Caregivers were asked to attend sessions. Sessions lasted approximately 2.5 hours and ran for approximately 15 weeks. Assessment was conducted at baseline, 21 weeks after treatment, 6 months after treatment.

Outcome Measure: Goal Attainment Scaling; Stroke Adapted Impact Scale; Cognitive Failure Questionnaire

1.       Results from the Goal Attainment Scaling, the Stroke Adapted Impact Scale and the Cognitive Failure Questionnaire all indicate there was significant improvement from baseline (T0) to immediately after treatment (T1) (p<0.05).

2.       Patients improved on significantly on individual goals (p<0.05) between T0 to T1.

3.       No further changes were noted on the primary outcomes 6 months post intervention (T2).

Laatsch et al. (1999)

USA

Case series

N=5

   

Population: TBI; Age Range=18-65yr; Time Post-Injury=2-48 months;

Intervention: Cognitive rehabilitation therapy (CRT) programme in a longitudinal protocol involving a resting SPECT and neuropsychological evaluation are pre-treatment, post-treatment and post non-treatment intervals.

Outcome Measure:  Neuropsychological measures.

1.       NP measures: WAIS-R, WMS-R, CVLT, RCFT, SCWT, WCST or ACT, SPECT image.

2.       SPECT data revealed significant increases in cerebral blood flow during the treatment period (p<0.05).

3.       CRT was found to be effective in improving both NP and everyday functioning. All patients were able to be more productive in their lives following treatment.

PEDro = Physiotherapy Evidence Database rating scale score (Moseley et al., 2002a)