EBP Compendium: Summary of Systematic Review

Ontario Neurotrauma Foundation
Cognitive Interventions Post Acquired Brain Injury
Rees, L., Marshall, S., et al. (2007).
Brain Injury, 21(2), 161-200.

Indicators of Review Quality:

Description: This is a review of the published literature investigating the effectiveness of cognitive treatments for individuals with moderate to severe acquired brain injury (ABI). The majority of ABIs were the result of a traumatic brain injury. Treatments targeting learning and memory, attention/concentration, executive functioning and general cognitive approaches were included and evaluated based on the PEDro and Downs and Black evidence scoring system.

Question(s) Addressed:

Question not specifically stated.

Population: Participants with moderate to severe traumatic brain injury

Intervention/Assessment: Cognitive rehabilitation

Number of Studies Included: Approximately 62

Years Included: 1980 - 2006

Findings:

Conclusions:

• Treatment
  • Cognitive-Communication
    • General Findings
      • Limited evidence suggests that “general cognitive therapy following brain injury is effective for improving cognition” (p. 184).
      • While cognitive rehabilitation programs have variable protocols and strategies, the authors state that “all comprehensive interventions appear to have benefit” (p. 184).
      • The authors found “limited evidence that demonstrated the short term effectiveness of group-based interventions for the treatment of executive dysfunction” (p. 180).
    • Computer-Assisted Treatments - Limited evidence from three non-randomized trials suggests that “computer-assisted training is not an effective adjunct to the rehabilitation program following a brain injury” (p. 184).
    • Compensatory Memory Treatments
      • “There is strong evidence that internal strategies appear to be an effective aid in improving recall performance following relatively mild impairment” (p. 180). However, the authors conclude that the long term effect of treatment is unknown.
      • Strong evidence suggests that the use of internal strategies is not effective for those with severe impairments.
    • Drill & Practice Attention Training - Moderate evidence suggests that drill and practice treatments “are not effective for improving attention following moderate to severe brain injury” (p. 165).
    • Drill & Practice Memory Training
      • Limited evidence based on one randomized controlled trial suggests that “memory retraining programs are not effective for functional recovery” (p. 180).
      • However the authors state that “memory retraining may be of benefit to those with mild impairment compared to severely impaired individuals at least in functional day-to-day memory” (p. 180).
    • Dual-Task Cognitive Training - Moderate evidence suggests that “dual-task training on speed of processing is an effective intervention for patients with brain injury” (p. 165).
    • Metacognitive Training - Moderate evidence suggests that “goal management training was effective for improving paper and pencil daily activities and preparation skills” (p. 184). 
• Service Delivery
  • Format
    • The authors found “limited evidence that demonstrated the short term effectiveness of group-based interventions for the treatment of executive dysfunction” (p. 180).
      

Keywords: Brain Injury, Cognitive Rehabilitation, Computer-Based Treatment, Attention

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Added to Compendium: December 2011