Summary of the Systematic Review

Article Citation

Knowledge Translation in ABI Rehabilitation: A Model for Consolidating and Applying the Evidence for Cognitive-Communication Interventions

MacDonald, S., & Wiseman-Hakes, C. (2010).
Brain Injury, 24(3), 486-508.
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Sponsoring Body

Canadian Institutes of Health Research; Toronto Rehabilitation Institute; Ministry of Health and Long-Term Care in Ontario (Canada)

Article Quality Ratings

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Indicators of Review Quality

  • No The review states a clearly focused question/aim.
  • Yes Criteria for inclusion of studies are provided.
  • Yes Search strategy described in sufficient detail for replication.
  • No Included studies are assessed for study quality.
  • No Quality assessments are reproducible.
  • Yes Characteristics of the included studies are provided.

Article Details

Description

This is an umbrella review of predominantly systematic reviews and meta-analyses from the peer-reviewed and non-peer-reviewed literature examining the use of cognitive-communication interventions in adults and children with acquired brain injury (ABI) resulting from occurrences such as stroke or a traumatic brain injury.

Questions/Aims Addressed

The aim was to "consolidate the existing evidence for cognitive and communication interventions available in systematic reviews and meta-analyses for the purpose of translation to clinical practice in cognitive-communication interventions" (p. 488).

Population

Children and Adults with ABI

Intervention/Assessment

Any cognitive-communication intervention as defined by the Cognitive-Communication Intervention Review Framework. These interventions include

  • social communication;
  • verbal expression;
  • auditory or listening comprehension;
  • reading comprehension;
  • attention;
  • memory;
  • organization, reasoning, problem solving, executive function/meta-cognition & self-regulation;
  • community & family communication;
  • academic & school supports; and
  • vocational communication.

Number of Studies Included

20 systematic reviews

Years Included

1997-2007


Conclusions from This Systematic Review

What are Conclusions?

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Treatment

"There is an established body of evidence for language interventions for adults with aphasia or language deficits due to stroke. Converging evidence in the aphasia and ABI literature suggests that 'active ingredients' in language interventions include individualized goal setting, context-sensitive intervention, opportunities for practice in daily communications, and communication partner training" (p. 499).

Keywords: Stroke, Conversation Partner Training, Aphasia, Language, Conversation Partner Training

Overall there is general support for interventions targeting verbal expression or language formulation for adults with acquired brain injury. Further research is needed to determine the most effective treatment treatment approach for improving verbal communication given the wide array of language formulation and word retrieval techniques available.

Keywords: Language, Language Treatment (Not Otherwise Specified)

No systematic reviews were found investigating interventions for written expression. In the absence of evidence for individuals with ABI, the authors suggest the review of evidence from similar populations.

Keywords: Writing Treatments

Findings from two systematic reviews examining reading comprehension treatments in adults with acquired brain injury found broad support for the use of reading interventions. However the authors conclude that further research is warranted, including "reading interventions for primary school students, reading interventions for the college curriculum and reading assistance for vocational purposes" (p. 500).

Keywords: Reading Treaments, Language

No systematic reviews were identified examining auditory comprehension interventions for individuals with ABI. The authors conclude that auditory comprehension is an area of intervention that is under-represented with further research recommended.

Keywords: Language, Receptive/Expressive Language, Language Treatment (Not Otherwise Specified), Brain Injury

Community involvement has been shown to be a beneficial adjunct to therapy (p. 503).

Keywords: Setting (e.g. Acute/Outpatient), Language Treatment (Not Otherwise Specified)

There were mixed findings regarding the involvement of family members in communication interventions in individuals with acquired brain injury (p. 503).

Keywords: Conversation Partner Training

"The combined evidence presented in these systematic reviews for memory interventions point to a number of best practices including: use of external memory aids, clear delineation of intervention targets, errorless learning, provision of sufficient distributed practice, multiple exemplars, strategy training and ecologically valid targets" for individuals with acquired brain injury (p. 502).

Keywords: Cognition, External Strategies (e.g. Planner/Memory Book/PDAs), Instructional Techniques (e.g. Errorless Learning/Vanishing Cues)

"Overall the evidence supports the use of social communication interventions; however, it indicates that more evidence is required to recommend specific forms of social communication intervention" (p. 499).  Evidence to date suggests that social communication interventions are most likely to be effective when they are individualized, contextualized, involve practice in real world communications, focus on self-regulation or meta-cognitive approaches and incorporate provision of natural feedback, videotaping self-monitoring" for adults and children with acquired brain injury (p. 499).

Keywords: Social Communication Treatments, Social Communication

No reviews examined the effect of attention interventions of communication in individuals with acquired brain injury. Five systematic reviews examined the effect of attention interventions on attention outcomes or cognitive outcomes on adults with acquired brain injury. The findings from two reviews found there was "no strong evidence for attention training through repetitive drill exercises" (p. 500) and some support for specific skill/functional attention training on functional tasks. An additional review concluded that "direct attention training is best provided in an individualized manner in conjunction with meta-cognitive training (feedback, self-monitoring, strategy training, self-reflective logs and anticipation/prediction activities)" (p. 501).

Keywords: Cognition, Attention Treatments (e.g. Dual Task/Attention Process Training)

"Increasingly the evidence points to the benefits of strategy training within natural contexts. A beneficial next step in evidence-based research would be a [systematic review (SR)] that analyses the effectiveness of cognitive-communication strategy training within the academic context" (p. 503).

Keywords: Cognition, Cognitive Treatment (Not Otherwise Specified)

"Evidence reviews of comprehensive therapies following ABI have provided strong evidence of benefit from formal intervention and strong evidence of more intensive programmes" (p. 503).

Keywords: Dosage (e.g. Frequency/Intensity), Language Treatment (Not Otherwise Specified)

"Overall these reviews indicate that cognitive interventions, including interventions for organization, reasoning, executive functioning and self-regulation, are beneficial whether offered in group or individual format" (p. 502).

Keywords: Cognition, Format (e.g. Group/Telepractice), Cognitive Treatment (Not Otherwise Specified)

Service Delivery

Community involvement has been shown to be a beneficial adjunct to therapy (p. 503).

Keywords: Setting (e.g. Acute/Outpatient), Language Treatment (Not Otherwise Specified)

"Evidence reviews of comprehensive therapies following ABI have provided strong evidence of benefit from formal intervention and strong evidence of more intensive programmes" (p. 503).

Keywords: Dosage (e.g. Frequency/Intensity), Language Treatment (Not Otherwise Specified)

"Overall these reviews indicate that cognitive interventions, including interventions for organization, reasoning, executive functioning and self-regulation, are beneficial whether offered in group or individual format" (p. 502).

Keywords: Cognition, Format (e.g. Group/Telepractice), Cognitive Treatment (Not Otherwise Specified)

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Treatment

"There is an established body of evidence for language interventions for adults with aphasia or language deficits due to stroke. Converging evidence in the aphasia and ABI literature suggests that 'active ingredients' in language interventions include individualized goal setting, context-sensitive intervention, opportunities for practice in daily communications, and communication partner training" (p. 499).

Keywords: Stroke, Conversation Partner Training, Aphasia, Language, Conversation Partner Training

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Treatment

The authors conclude that there was insufficient evidence regarding the use of cognitive interventions to improve executive functioning in children with ABI (p. 502). Further research is warranted.

Keywords: Acquired Brain Injury (Not Specified), Cognitive Treatments (Not Specified)

"Overall the evidence supports the use of social communication interventions; however, ... more evidence is required to recommend specific forms of social communication intervention. Evidence to date suggests that social communication interventions are most likely to be effective when they are individualized, contextualized, involve practice in real world communications, focus on self-regulation or meta-cognitive approaches, and incorporate provision of natural feedback, videotaping self-monitoring" for adults and children with ABI (p. 499).

Keywords: Acquired Brain Injury (Not Specified), Brain Injury, Technology/Video-based Instruction, Metacognitive Treatments, Social Communication Treatments (e.g. Social Skills Training)

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Treatment

"Overall the evidence supports the use of social communication interventions; however, ... more evidence is required to recommend specific forms of social communication intervention. Evidence to date suggests that social communication interventions are most likely to be effective when they are individualized, contextualized, involve practice in real world communications, focus on self-regulation or meta-cognitive approaches, and incorporate provision of natural feedback, videotaping self-monitoring" for adults and children with ABI (p. 499).

Keywords: Acquired Brain Injury (Not Specified), Brain Injury, Technology/Video-based Instruction, Metacognitive Treatments, Social Communication Treatments (e.g. Social Skills Training)

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Treatment

No systematic reviews were identified examining auditory comprehension interventions for individuals with ABI. The authors conclude that auditory comprehension is an area of intervention that is under-represented with further research recommended.

Keywords: Language, Receptive/Expressive Language, Language Treatment (Not Otherwise Specified), Brain Injury

Go to Map

Treatment

"There is an established body of evidence for language interventions for adults with aphasia or language deficits due to stroke. Converging evidence in the aphasia and ABI literature suggests that 'active ingredients' in language interventions include individualized goal setting, context-sensitive intervention, opportunities for practice in daily communications, and communication partner training" (p. 499).

Keywords: Stroke, Conversation Partner Training, Aphasia, Language, Conversation Partner Training

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