Barreca et al. (2003)

Canada

RCT

PEDro=6

N=13

Population: ABI; Mean Age: 41.3 yr; Gender: Male= 10, Female= 3; Mean Time Post Injury=33 mo; Mean GCS=4.8.

Treatment: Patients were assigned to an ABAB (n=7) or BABA (n=6) treatment sequence. Group A received an enriched stimulus environment, collaborative multi-disciplinary intervention, and additional yes/no response training (30 min, 3x/wk). Group B received standard intervention within a hospital environment. This took place over 8 wk, each interval being 2 wk.

Outcome Measure: Western Aphasia Battery.

1.       No order effect (AB vs BA; F=0.29; p=0.06) but a treatment trend was found for the effectiveness of group A over group B (A vs B; F=3.84; p=0.07).

2.       No significant differences in Western Aphasia Battery scores between treatments at admission or 6 mo later (p>0.05).

Sumowski et al. (2014)

USA

Pre-Post

N=10

Population: Severe TBI=10; Mean Age=42.8 yr; Gender: Male=6, Female=4; Mean Time Post Injury=8.4 yr.

Intervention: Participants studied 48 verbal paired associates (VPAs) divided into 3 learning conditions: massed restudy (MR), spaced restudy (SR), and retrieval practice (RP). MR is similar to cramming, whereas SR is distributed learning. RP was similar to SR; however, re-exposure trials were framed as cued recall tests. Recall of VPAs was done at 30 min post intervention, and at 1 wk. Participants performed all 3 methods of learning.

Outcome Measure: Recall of VPAs.

1.       Participants recalled 46.3% of VPAs learned through RP compared with 12.5% through MR (p<0.0001), and 15% through SR (p=0.002).

2.       SR did not result in better memory than MR (p=0.0555).

3.       At 1wk, participants recalled 11.3% in the RP group compared to 0.0% in the MR (p=0.004), and 1.3% in SR (p=0.011). Again, SR and MR did not differ from each other (p=0.343).

Harvey et al. (2013)

USA

Pre-Post

N=9

Population: Severe TBI=9; Mean Age=35.78 yr; Gender: Male=8, Female=1; Mean Time Post Injury=10.89 yr.

Intervention: Participants read 24 passages in two different scenarios, once without any training and once after receiving 6 sessions of computerized text-to-speech training.

Outcome Measure: Reading rate, comprehension accuracy.

1.       Reading rates were significantly faster after receiving training (p=0.036).

2.       No significant difference between text-to-speech and no text-to-speech conditions were noted for comprehension accuracy (p=0.950).

Brownell et al. (2013)

USA

Pre-Post

N=8

Population: TBI=8; Mean Age=43 yr; Gender: Male=5, Female=3; Mean Time Post Injury=8.5 yr; Severity: Moderate to severe.

Intervention: Therapy targeting difficulties interpreting figurative language. Participants were assessed at baseline and then performed metaphor interpretation probes and untrained line orientation tasks during the three study phases: (1) baseline phase (10 session, 2x/wk); (2) training phase with word tasks ranging in difficulty (2x/wk); and (3) post training phase (10 sessions, 2x/wk). The exact number of sessions varied (total 23 to 34). Follow-up conducted at 3 to 4 mo post training.

Outcome Measure: Oral Metaphor interpretation, Benton Line Orientation-Judgment Task Short Form Q.

1.       As a whole, the group significantly improved on the Oral Metaphor Interpretation following treatment compared to baseline (Mean difference score=5.9, p<0.001).

2.       Scores on the Benton line Orientation task did not improve significantly (Mean difference score=-0.2, p=0.585) from pre to post training.

3.       6 of 8 participants improved significantly on metaphor interpretation following training, 3 of which maintained these improvements at follow-up.

O’Neil-Pirozzi et al. (2010b)

USA

Prospective Control Trial

N=94

Population: TBI; Experimental Group: Mean Age=47.3 yr; Mean Time Post-Injury=11.8 yr; Control Group: Mean Age=47.0 yr; Mean Time Post-Injury=13.4 yr

Treatment: In a non-randomized pre-post study group comparison, participants in the experimental group were trained to use Internal Memory Strategies (I-MEMS; n=54); the intervention consisted of 12 90-min sessions, held 2x/wk for 6 wk. It included memory education and emphasized internal strategy acquisition to improve memory function from encoding, storage and retrieval perspectives; the control group (n=40) consisted of a convenience sample. Outcome Measure: Hopkins Verbal Learning Test-Revised (HVLT-R), Rivermead Behavioural Memory Test II (RBMT II). Patients were assessed on Week 1 (pretest), Week 7 (post-test 1), and Week 11 (post-test 2).

1.       Pretesting revealed a significant difference between experimental and control groups on the HVLT-R only (p=0.02).

2.       Individuals who had had a severe TBI performed more poorly on the HVLT-R than those with moderate injuries.

3.       Although those with a severe injury did not improve as much as those with a mild or moderate injury, they did improve more than those in the control group at both post-test 1 (p=0.0002) and post-test 2 (p<0.0001).

4.       Similar to what was found with HVLT-R assessments, severe injury predicted worse RMBT II scores than moderate injury.

5.       RBMT II scores in the I-MEMS groups revealed significant improvements at both post-test 1 (p=0.045) and post-test 2 (p=0.0013) relative to control.

6.       Overall memory performance was improved for all those in the experimental group compared to the control group.