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Enhancing SLD Diagnoses Through the Identification of Psychological Processing Deficits. ACTA ACUST UNITED AC 2020. [DOI: 10.1017/edp.2013.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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2
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Memory Rehabilitation in Patients with Epilepsy: a Systematic Review. Neuropsychol Rev 2018; 28:88-110. [PMID: 29450813 DOI: 10.1007/s11065-018-9367-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
Memory failure is a common clinical concern of patients with epilepsy and is associated with significant functional impairments. Thus, memory rehabilitation is of critical clinical importance. In this article, we aimed to systematically evaluate the efficacy of memory rehabilitation in patients with epilepsy. The Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to guide searches, extraction and reporting of data in this review. PsycINFO, Medline and PsychBITE searches yielded 95 studies. Twelve papers met inclusion criteria, reporting outcomes of cognitive or behavioural interventions that specifically targeted the rehabilitation of memory in patients with epilepsy. Methodological rigour was rated using the Single-Case Experimental Design (SCED) scale for single-case studies and a modified version of the Downs and Black checklist for group studies. Twelve prospective studies, nine group (six pre-post design, one waitlist crossover, two randomised controlled trials) and three single-case studies were identified. Eleven of the studies included adults, eight of which involved adults with temporal lobe epilepsy (TLE). One paediatric study was identified. The quality of group studies ranged from 36% (poor) to 72% (good), using the modified Downs and Black checklist. Single-case studies were assessed using the SCED scale and assessed to range in quality from four to seven out to 11. Overall, memory rehabilitation was associated with improved memory function in all studies. Verbal memory outcomes were most commonly examined and associated with improvements. This review found that the level of evidence available to support rehabilitation of memory in patients with epilepsy was generally weak and inconsistent. Nevertheless, studies conducted to date, albeit of limited methodological quality, offer preliminary evidence that memory rehabilitation is associated with improvements in verbal memory in patients with temporal lobe epilepsy. Little is known about the efficacy of memory rehabilitation in patients with non-TLE, children, and other aspects of memory difficulties. Guidelines for future research are proposed.
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Abstract
The past 50 years have been a period of exciting progress in neuropsychological research on traumatic brain injury (TBI). Neuropsychologists and neuropsychological testing have played a critical role in these advances. This study looks back at three major scientific advances in research on TBI that have been critical in pushing the field forward over the past several decades: The advent of modern neuroimaging; the recognition of the importance of non-injury factors in determining recovery from TBI; and the growth of cognitive rehabilitation. Thanks to these advances, we now have a better understanding of the pathophysiology of TBI and how recovery from the injury is also shaped by pre-injury, comorbid, and contextual factors, and we also have increasing evidence that active interventions, including cognitive rehabilitation, can help to promote better outcomes. The study also peers ahead to discern two important directions that seem destined to influence research on TBI over the next 50 years: the development of large, multi-site observational studies and randomized controlled trials, bolstered by international research consortia and the adoption of common data elements; and attempts to translate research into health care and health policy by the application of rigorous methods drawn from implementation science. Future research shaped by these trends should provide critical evidence regarding the outcomes of TBI and its treatment, and should help to disseminate and implement the knowledge gained from research to the betterment of the quality of life of persons with TBI. (JINS, 2017, 23, 806-817).
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Evidence-Based Practice for the Use of Internal Strategies as a Memory Compensation Technique After Brain Injury: A Systematic Review. J Head Trauma Rehabil 2016; 31:E1-E11. [DOI: 10.1097/htr.0000000000000181] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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5
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Cognitive and physical rehabilitation of intensive care unit survivors: results of the RETURN randomized controlled pilot investigation. Crit Care Med 2012; 40:1088-97. [PMID: 22080631 DOI: 10.1097/ccm.0b013e3182373115] [Citation(s) in RCA: 193] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Millions of patients who survive medical and surgical general intensive care unit care every year experience newly acquired long-term cognitive impairment and profound physical and functional disabilities. To overcome the current reality in which patients receive inadequate rehabilitation, we devised a multifaceted, in-home, telerehabilitation program implemented using social workers and psychology technicians with the goal of improving cognitive and functional outcomes. METHODS This was a single-site, feasibility, pilot, randomized trial of 21 general medical/surgical intensive care unit survivors (8 controls and 13 intervention patients) with either cognitive or functional impairment at hospital discharge. After discharge, study controls received usual care (sporadic rehabilitation), whereas intervention patients received a combination of in-home cognitive, physical, and functional rehabilitation over a 3-month period via a social worker or master's level psychology technician utilizing telemedicine to allow specialized multidisciplinary treatment. Interventions over 12 wks included six in-person visits for cognitive rehabilitation and six televisits for physical/functional rehabilitation. Outcomes were measured at the completion of the rehabilitation program (i.e., at 3 months), with cognitive functioning as the primary outcome. Analyses were conducted using linear regression to examine differences in 3-month outcomes between treatment groups while adjusting for baseline scores. RESULTS Patients tolerated the program with only one adverse event reported. At baseline both groups were well-matched. At 3-month follow-up, intervention group patients demonstrated significantly improved cognitive executive functioning on the widely used and well-normed Tower test (for planning and strategic thinking) vs. controls (median [interquartile range], 13.0 [11.5-14.0] vs. 7.5 [4.0-8.5]; adjusted p < .01). Intervention group patients also reported better performance (i.e., lower score) on one of the most frequently used measures of functional status (Functional Activities Questionnaire at 3 months vs. controls, 1.0 [0.0 -3.0] vs. 8.0 [6.0-11.8], adjusted p = .04). CONCLUSIONS A multicomponent rehabilitation program for intensive care unit survivors combining cognitive, physical, and functional training appears feasible and possibly effective in improving cognitive performance and functional outcomes in just 3 months. Future investigations with a larger sample size should be conducted to build on this pilot feasibility program and to confirm these results, as well as to elucidate the elements of rehabilitation contributing most to improved outcomes.
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Ho J, Epps A, Parry L, Poole M, Lah S. Rehabilitation of everyday memory deficits in paediatric brain injury: Self-instruction and diary training. Neuropsychol Rehabil 2011; 21:183-207. [DOI: 10.1080/09602011.2010.547345] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Seter C, Giovannetti T, Kessler RK, Worth S. Everyday action planning in schizophrenia. Neuropsychol Rehabil 2011; 21:224-49. [DOI: 10.1080/09602011.2010.544519] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mitchel T, Cusick A. Evaluation of a client-centred paediatric rehabilitation programme using goal attainment scaling. Aust Occup Ther J 2010. [DOI: 10.1111/j.1440-1630.1998.tb00777.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Müller SV, George S, Hildebrandt H, Münte TF, Reuther P, Schoof-Tams K, Wallesch CW. Leitlinie zur Diagnostik und Therapie von exekutiven Dysfunktionen. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2010. [DOI: 10.1024/1016-264x/a000017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Sabine George
- Deutscher Verband der Ergotherapeuten e. V., Karlsbad
| | - Helmut Hildebrandt
- Klinikum Bremen-Ost, Zentrum für Neurologie, Bremen und Universität Oldenburg, Institut für Psychologie, Oldenburg
| | - Thomas F. Münte
- Universitätsklinikum Schleswig-Holstein, Klinik für Neurologie, Lübeck
| | - Paul Reuther
- Ambulantes Neurologisches Rehabilitationscenter Ahrweiler, Bad Neuenahr-Ahrweiler
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Abstract
OBJECTIVE The aims of this review were to: (i) briefly outline common sequelae following childhood traumatic brain injury (TBI); (ii) provide a summary of models and research in the area of intervention; (iii) discuss issues and obstacles in the evaluation of research in the area of intervention; (vi) discuss integrative and translational aspects of research in this area; (v) provide an example of intervention studies being conducted in the laboratory; and (vii) highlight the need for continued and collaborative work in the paediatric intervention field. CONCLUSIONS When reviewing the literature, it is clear that while challenging, the development and evaluation of intervention programs for children post traumatic brain injury, must be encourage and pursued. This in turn will lead to improved quality of life for these children and their families.
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Affiliation(s)
- Cathy Catroppa
- Australian Centre for Child Neuropsychology Studies, Melbourne, Australia.
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Long-term compensatory treatment of organizational deficits in a patient with bilateral frontal lobe damage. J Int Neuropsychol Soc 2008; 14:154-63. [PMID: 18078543 DOI: 10.1017/s1355617708080120] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 07/18/2007] [Accepted: 07/18/2007] [Indexed: 11/06/2022]
Abstract
Evans et al. (1998) described compensatory strategy use in R.P., a patient with executive dysfunction following bilateral frontal lobe damage who had difficulty acting upon her intentions. A pager was used to remind R.P. of regularly scheduled activities, along with a checklist that aimed to moderate a perseverative routine. Although successful, 10 years after the original intervention, the strategies were no longer used, and considerable everyday problems were evident. In the current study, we conducted a follow-up assessment to examine potential reasons for this deterioration. No change in neuropsychological functioning was evident. Whereas the previous study introduced the two strategies together, and examined effects upon separate goals, in the current study we reintroduced the two strategies separately, and examined effects on three common goals. In addition to prompting specific activities, we aimed to support completion of more general goals (those that could be enacted within a wider window of time). The paging intervention had a dramatic effect on all three measured behaviors, at a much more consistent level than the checklist. We suggest that, in addition to direct reminders, the pager can cue a process of goal monitoring that bridges the gap between intention and action.
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Troyer AK, Graves RE, Cullum CM. Executive functioning as a mediator of the relationship between age and episodic memory in healthy aging. AGING NEUROPSYCHOLOGY AND COGNITION 2007. [DOI: 10.1080/09289919408251449] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Laatsch L, Harrington D, Hotz G, Marcantuono J, Mozzoni MP, Walsh V, Hersey KP. An Evidence-based Review of Cognitive and Behavioral Rehabilitation Treatment Studies in Children With Acquired Brain Injury. J Head Trauma Rehabil 2007; 22:248-56. [PMID: 17667068 DOI: 10.1097/01.htr.0000281841.92720.0a] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to complete a systematic evidence-based review of published cognitive and behavioral treatment studies with pediatric subjects who have a history of an acquired brain injury (ABI). DATA SOURCES We utilized PubMed and EMBASE to search peer-reviewed journals from 1980 to 2006. DATA SELECTION Terms such as cognitive rehabilitation, speech therapy, language therapy, and behavior therapy were employed in the search and 28 studies met established criteria. DATA EXTRACTION The data extracted from each study included specific details about the cognitive or behavioral treatment, subjects, study design, outcome measurements, and treatment effectiveness. DATA SYNTHESIS The studies, involving 366 children and youth with ABI, were classified as 1 Class I study, 5 Class II studies, 6 Class III studies, and 16 Class IV studies. CONCLUSIONS Despite a limited number of studies, 2 treatment recommendations and 1 option were developed from this systematic literature search.
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Affiliation(s)
- Linda Laatsch
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago 60612, and Children's Specialized Hospital, Mountainside, NJ, USA.
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Anderson V, Catroppa C. Advances in Postacute Rehabilitation After Childhood-Acquired Brain Injury. Am J Phys Med Rehabil 2006; 85:767-78. [PMID: 16924189 DOI: 10.1097/01.phm.0000233176.08480.22] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite traditional views, children do not necessarily recover well from brain injury. Residual functional impairments are commonly documented in physical, cognitive, educational, behavioral, and social domains and result in a significant, ongoing social and economic burden for the child's family and for the broader community. More recent acknowledgment of the serious, and often permanent, consequences of acquired brain injury in childhood has been paralleled by rapid advances in evidence-based, acute medical care and diagnostic technology. In contrast, child-based postacute rehabilitation and long-term interventions are less well developed. To date, child services have borrowed substantially from adult models, combining both direct therapies and interdisciplinary approaches. Despite their proliferation, and strong clinical support, such services are rarely the subject of rigorous evaluation and have given little acknowledgment to the important developmental factors that need to be considered when working with children. Using a developmental framework, this review aims to consider the nature of functional impairments that result from childhood traumatic brain injury, the recovery process postinjury, and the scope and role of child-based rehabilitation. In addition, the relatively scarce body of literature describing the evaluation of child rehabilitation models are reviewed with an emphasis on identifying approaches that provide evidence of enhanced function in the child's everyday life and, in particular, in the home and school contexts.
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Affiliation(s)
- Vicki Anderson
- Australian Centre for Child Neuropsychology Studies, Murdoch Children's Research Institute, Melbourne, Australia
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Schoof-Tams K. Stellungnahme der Gesellschaft für Neuropsychologie e. V. (GNP) zum Fragenkatalog “Ambulante Neuropsychologie” des gBA (Gemeinsamen Bundesausschuss). ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2006. [DOI: 10.1024/1016-264x.17.1.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Cicerone KD, Dahlberg C, Malec JF, Langenbahn DM, Felicetti T, Kneipp S, Ellmo W, Kalmar K, Giacino JT, Harley JP, Laatsch L, Morse PA, Catanese J. Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. Arch Phys Med Rehabil 2005; 86:1681-92. [PMID: 16084827 DOI: 10.1016/j.apmr.2005.03.024] [Citation(s) in RCA: 611] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To update the previous evidence-based recommendations of the Brain Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 1998 through 2002. DATA SOURCES PubMed and Infotrieve literature searches were conducted using the terms attention, awareness, cognition, communication, executive, language, memory, perception, problem solving, and reasoning combined with each of the terms rehabilitation, remediation, and training. Reference lists from identified articles were reviewed and a bibliography listing 312 articles was compiled. STUDY SELECTION One hundred eighteen articles were initially selected for inclusion. Thirty-one studies were excluded after detailed review. Excluded articles included 14 studies without data, 6 duplicate publications or follow-up studies, 5 nontreatment studies, 4 reviews, and 2 case studies involving diagnoses other than TBI or stroke. DATA EXTRACTION Articles were assigned to 1 of 7 categories reflecting the primary area of intervention: attention; visual perception; apraxia; language and communication; memory; executive functioning, problem solving and awareness; and comprehensive-holistic cognitive rehabilitation. Articles were abstracted and levels of evidence determined using specific criteria. DATA SYNTHESIS Of the 87 studies evaluated, 17 were rated as class I, 8 as class II, and 62 as class III. Evidence within each area of intervention was synthesized and recommendations for practice standards, practice guidelines, and practice options were made. CONCLUSIONS There is substantial evidence to support cognitive-linguistic therapies for people with language deficits after left hemisphere stroke. New evidence supports training for apraxia after left hemisphere stroke. The evidence supports visuospatial rehabilitation for deficits associated with visual neglect after right hemisphere stroke. There is substantial evidence to support cognitive rehabilitation for people with TBI, including strategy training for mild memory impairment, strategy training for postacute attention deficits, and interventions for functional communication deficits. The overall analysis of 47 treatment comparisons, based on class I studies included in the current and previous review, reveals a differential benefit in favor of cognitive rehabilitation in 37 of 47 (78.7%) comparisons, with no comparison demonstrating a benefit in favor of the alternative treatment condition. Future research should move beyond the simple question of whether cognitive rehabilitation is effective, and examine the therapy factors and patient characteristics that optimize the clinical outcomes of cognitive rehabilitation.
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Abstract
BACKGROUND The need to address acquired cognitive impairments is increasing in child populations seen across a range of settings. However, current clinical practice following brain injury in children does not necessarily incorporate the use of cognitive rehabilitation models or techniques. The aim of this paper is to review the literature in this area. METHODS All published interventions targeting the cognitive domains of attention, memory and/or executive function that could be identified were reviewed. Different cognitive rehabilitation techniques are briefly described and the clinical and research implications of the findings are discussed. RESULTS Eleven papers, involving 54 children and adolescents receiving intervention, were identified. This literature describes generalised cognitive rehabilitation programmes as well as more specific strategies targeting focal deficits. CONCLUSIONS There is an absence of randomised controlled trials and a very limited number of studies using other methodological approaches, providing at this time no conclusive evidence for the efficacy of cognitive rehabilitation for children with acquired brain injury, but a clear need to address a range of methodological difficulties in this field of enquiry.
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Affiliation(s)
- Jenny Limond
- Paediatric Psychology, Southampton General Hospital, Southampton, UK
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Strangman G, O'Neil-Pirozzi TM, Burke D, Cristina D, Goldstein R, Rauch SL, Savage CR, Glenn MB. Functional neuroimaging and cognitive rehabilitation for people with traumatic brain injury. Am J Phys Med Rehabil 2005; 84:62-75. [PMID: 15632490 DOI: 10.1097/01.phm.0000150787.26860.12] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cognitive deficits are a common consequence of traumatic brain injury. Although such deficits are amenable to rehabilitation, methods for individualizing cognitive interventions are still unrefined. Functional neuroimaging methods such as positron emission tomography and functional magnetic resonance imaging are emerging as possible technologies for measuring and monitoring the cerebral consequences of plasticity associated with brain injury and for evaluating the effectiveness of rehabilitation interventions. Functional neuroimaging may even enable more customized and efficient selection, design, or adaptation of individual cognitive rehabilitation programs. We review the current literature on functional neuroimaging after traumatic brain injury, relating these findings to cognitive rehabilitation. Overall, functional neuroimaging after traumatic brain injury has shown reliable differences in brain activity within several regions of frontal cortex, partly but not uniformly consistent with neuropsychological and structural findings in traumatic brain injury. We also outline a number of promising research opportunities for applying functional neuroimaging in traumatic brain injury settings, along with associated challenges.
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Affiliation(s)
- Gary Strangman
- Neural Systems Group, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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Kennedy MRT, Yorkston KM. The effects of frontal injury on “on-line” self-monitoring during verbal learning by adults with diffuse brain injury. Neuropsychol Rehabil 2004. [DOI: 10.1080/09602010443000038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- Jack Avery
- Department of Communication Disorders, University of Minnesota, Minneapolis
| | - Mary R. T. Kennedy
- Department of Communication Disorders, University of Minnesota, Minneapolis
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Affiliation(s)
- McKay Moore Sohlberg
- Department of Communication Disorders and Sciences, University of Oregon, Eugene
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22
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Cicerone KD, Dahlberg C, Kalmar K, Langenbahn DM, Malec JF, Bergquist TF, Felicetti T, Giacino JT, Harley JP, Harrington DE, Herzog J, Kneipp S, Laatsch L, Morse PA. Evidence-based cognitive rehabilitation: recommendations for clinical practice. Arch Phys Med Rehabil 2000; 81:1596-615. [PMID: 11128897 DOI: 10.1053/apmr.2000.19240] [Citation(s) in RCA: 638] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To establish evidence-based recommendations for the clinical practice of cognitive rehabilitation, derived from a methodical review of the scientific literature concerning the effectiveness of cognitive rehabilitation for persons with traumatic brain injury (TBI) or stroke. DATA SOURCES A MEDLINE literature search using combinations of these key words as search terms: attention, awareness, cognition, communication, executive, language, memory, perception, problem solving, reasoning, rehabilitation, remediation, and training. Reference lists from identified articles also were reviewed; a total bibliography of 655 published articles was compiled. STUDY SELECTION Studies were initially reviewed according to the following exclusion criteria: nonintervention studies; theoretical, descriptive, or review papers; papers without adequate specification of interventions; subjects other than persons with TBI or stroke; pediatric subjects; pharmacologic interventions; and non-English language papers. After screening, 232 articles were eligible for inclusion. After detailed review, 61 of these were excluded as single case reports without data, subjects other than TBI and stroke, and nontreatment studies. This screening yielded 171 articles to be evaluated. DATA EXTRACTION Articles were assigned to 1 of 7 categories according to their primary area of intervention: attention, visual perception and constructional abilities, language and communication, memory, problem solving and executive functioning, multi-modal interventions, and comprehensive-holistic cognitive rehabilitation. All articles were independently reviewed by at least 2 committee members and abstracted according to specified criteria. The 171 studies that passed initial review were classified according to the strength of their methods. Class I studies were defined as prospective, randomized controlled trials. Class II studies were defined as prospective cohort studies, retrospective case-control studies, or clinical series with well-designed controls. Class III studies were defined as clinical series without concurrent controls, or studies with appropriate single-subject methodology. DATA SYNTHESIS Of the 171 studies evaluated, 29 were rated as Class I, 35 as Class II, and 107 as Class III. The overall evidence within each predefined area of intervention was then synthesized and recommendations were derived based on consideration of the relative strengths of the evidence. The resulting practice parameters were organized into 3 types of recommendations: Practice Standards, Practice Guidelines, and Practice Options. CONCLUSIONS Overall, support exists for the effectiveness of several forms of cognitive rehabilitation for persons with stroke and TBI. Specific recommendations can be made for remediation of language and perception after left and right hemisphere stroke, respectively, and for the remediation of attention, memory, functional communication, and executive functioning after TBI. These recommendations may help to establish parameters of effective treatment, which should be of assistance to practicing clinicians.
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Affiliation(s)
- K D Cicerone
- JFK-Johnson Rehabilitation Institute, Edison, NJ 08820, USA.
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Ownsworth TL, Mcfarland K. Memory remediation in long-term acquired brain injury: two approaches in diary training. Brain Inj 1999; 13:605-26. [PMID: 10901689 DOI: 10.1080/026990599121340] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This study investigated the remediation and assessment of everyday memory impairment in a sample of long-term acquired brain injury (ABI) subjects. The Rivermead Behavioural Memory Test (RBMT) and subtests of the Wechsler Memory Scale-Revised (WMS-R) were selected to measure global memory performance. A memory questionnaire and a daily memory checklist were developed from a review of existing self-report questionnaires. The interrelationships among self-report measures and standardized psychometric tests of memory were examined and the findings suggest that self-report measures may be used to obtain relatively accurate information about everyday memory performance. A baseline across groups' design evaluated the relative effectiveness of two different approaches in training subjects to use a diary to compensate for memory problems. There was a Diary Only (DO) approach, which emphasized compensation based upon task specific learning, and a Diary and Self-Instructional Training (DSIT) approach, which taught compensation using higher cognitive skills of self-awareness and self-regulation. The results obtained show that, during the treatment phase, the DSIT group more consistently made diary entries, reported less memory problems, and made more positive ratings associated with treatment efficacy. The implications arising from the current study are that: (1) the choice of memory assessment procedures need to be guided by the patients' real daily living needs; and (2) an approach based upon self-instructional training has greater ecological validity than an approach that focuses on task specific learning. In general, successful assessment and rehabilitation of memory deficits requires a well-established theoretical basis and sound ecological validity.
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Affiliation(s)
- T L Ownsworth
- School of Psychology, University of Queensland, Brisbane, Australia.
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Abstract
PURPOSE Traumatic brain injury (TBI) stands as a major public health problem and one of the most important challenges for neurological rehabilitation. This review discusses advances that have occurred in the past 10 years in rehabilitation after severe TBI in adults. METHOD First, theoretical concepts, goals of rehabilitation and organization of resources are reviewed. Then specific questions that arise in the rehabilitation of severe TBI patients are considered. RESULTS Three phases are distinguished in post-traumatic evolution. Acute rehabilitation takes place during coma and arousal states. Specific aims are to prevent orthopaedic and visceral complications, and to provide sensory stimulations with the hope of accelerating arousal. Secondly subacute (generally inpatient) rehabilitation is designed to facilitate and accelerate recovery of impairments, and to compensate for disabilities. Motility, cognition, behaviour, personality and affect should be simultaneously addressed in an holistic approach. Physical as well as psychological independence and self-awareness are the major goals to emphasize. A third, post-acute rehabilitation phase includes outpatient therapy for achieving physical, domestic and social independence, reduction of handicaps and re-entry into the community. CONCLUSIONS Problems with returning home, obtaining financial independence, driving, returning to work, participating in social relationships and leisure activities, and the importance of psychosocial adjustment and self-acceptance, are outlined. Questions about economic aspects and rehabilitation in the future are addressed.
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Affiliation(s)
- J M Mazaux
- Centre Hospitalier Universitaire de Bordeaux, France
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Abstract
We present descriptive data for alternate forms of clustered and unclustered word list recall in 102 healthy elderly adults and test results for 11 patients with Parkinson's disease. The word list test provided a relatively stable measure of verbal memory. Alternate forms were equivalent except for a tendency of the unclustered list of Form 1 to be easier than those of the other three forms. Verbal intelligence, total word recall, and the ability to cluster related words at recall were related significantly. There were modest effects of education on word recall; female subjects tended to recall more words than males.
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Affiliation(s)
- R P Hart
- Medical College of Virginia/Virginia Commonwealth University, Richmond 23298
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Sohlberg MM, White O, Evans E, Mateer C. Background and initial case studies into the effects of prospective memory training. Brain Inj 1992; 6:129-38. [PMID: 1571717 DOI: 10.3109/02699059209029651] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Two preliminary case studies are presented introducing the technique of Prospective Memory Training (PMT) as a potential means to manage severe memory impairments. PMT involves repetitive administration of prospective memory tasks in which the patient is asked to initiate a specific action at a future designated time. Background information relevant to the concept of prospective memory is presented. Possible theoretical foundations for PMT are also discussed.
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Freeman MR, Mittenberg W, Dicowden M, Bat-Ami M. Executive and compensatory memory retraining in traumatic brain injury. Brain Inj 1992; 6:65-70. [PMID: 1739854 DOI: 10.3109/02699059209008124] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A controlled treatment outcome study was conducted comparing the efficacy of memory remediation treatment with no treatment on traumatic brain-injury patients. The memory remediation treatment consisted of both compensatory and executive training skills and was delivered 6 hours weekly over a 2 1/2-week period. Six subjects in the treatment group and 6 subjects in the control group were matched on WAIS-R FSIQ scores, pre-test memory scores and age. Pre- and post-test measures were obtained for both groups on a paragraph memory task. A significant difference was demonstrated between the treatment and control post-test memory scores. The experimental group significantly improved memory scores beyond that of the control group, suggesting that memory remediation is effective for head-injury patients with memory deficits. Discussion of findings and suggestions for further investigation are presented.
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Affiliation(s)
- M R Freeman
- Nova University School of Psychology, Ft. Lauderdale, Florida
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Abstract
The benefits of new knowledge on the psychobiology and neuropsychology of serious mental illnesses have been slow to impact on psychiatric rehabilitation technology. A literature review reveals that, at least in the case of schizophrenia, enough is known about neurobiological deficits and their impact on neurocognitive functioning to justify a more informed approach to psychiatric rehabilitation. Essential elements for a program of research are presented and preliminary data are reported examining the prevalence of executive deficits, correlations between neuropsychological deficits and social adjustment, and the nature of socially stigmatizing neuromotor deficits and their reliable assessment. In addition, early experience with the remediation of executive deficits is described and suggestions are made for future developments in this area. The authors conclude that barriers to the integration of knowledge from biological psychiatry and psychiatric rehabilitation have been largely related to academic "cultural" isolation, and that active cross fertilization of ideas is clearly justified by the present state of knowledge.
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Affiliation(s)
- J Jaeger
- Department of Psychiatric Rehabilitation, Hillside Hospital/Long Island Jewish Medical Center, Glen Oaks, N.Y. 11004
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29
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Marsh NV, Knight RG. Behavioral assessment of social competence following severe head injury. J Clin Exp Neuropsychol 1991; 13:729-40. [PMID: 1955528 DOI: 10.1080/01688639108401086] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Eighteen community-dwelling adults who had suffered a very severe closed-head injury more than 18 months previously and required long-term rehabilitative support were compared with a closely matched control group on a number of behavioral measures of skill during social interaction. Results showed that during social interactions the head-injured patients exhibited impaired communication skills. They appeared disinterested, and their speech was characterized as lacking in fluency and clarity due to their difficulty in finding appropriate words, use of inappropriate expressions and inability to express ideas clearly. Attempts to find a relationship between the patients' cognitive deficits and their impaired communication skills were unsuccessful. It is suggested that the often reported poor social adjustment of some head-injured patients is in part related to their inappropriate behavior during social interactions. This is particularly manifest in their poor language skills and speech delivery style.
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Affiliation(s)
- N V Marsh
- Department of Psychology, University of Waikato, Hamilton, New Zealand
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30
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Franzen MD, Haut MW. The psychological treatment of memory impairment: a review of empirical studies. Neuropsychol Rev 1991; 2:29-63. [PMID: 1844703 DOI: 10.1007/bf01108846] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Memory impairment is a frequent effect of many different forms of brain dysfunction. Memory impairment is also a frequent focus of treatment interventions, and there have been many different treatment methods suggested. The suggested methods include direct retraining, the use of spared skills in compensating for the impairment (alternate functional systems), and the use of behavioral strategies to circumvent the manifest memory dysfunction (behavioral prosthetics). Unfortunately, there are very few studies comparing the various suggested treatment methods. The present paper evaluates the empirical evidence related to the treatment of memory dysfunction and suggests directions for future investigations. Although the evidence is not conclusive, it appears that some forms of treatment may be helpful in remediating certain types of memory impairment. An approach likely to be productive would include some consideration of the impaired neurological and psychological mechanisms responsible for the manifest memory deficit as well as a consideration of the etiology of the injury thought to be causally related to the memory deficit. As yet, there have been no rigorous empirical evaluations of these considerations.
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Affiliation(s)
- M D Franzen
- Department of Behavioral Medicine and Psychiatry, Virginia University Health Sciences Center, Morgantown 26506
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