Keith D Cicerone1, Yelena Goldin2, Keith Ganci3, Amy Rosenbaum4, Jennifer V Wethe5, Donna M Langenbahn6, James F Malec7, Thomas F Bergquist5, Kristine Kingsley6, Drew Nagele8, Lance Trexler9, Michael Fraas10, Yelena Bogdanova11, J Preston Harley12. 1. Cognitive Rehabilitation Department, John F. Kennedy Johnson Rehabilitation Institute, Hackensack Meridian Health System, Edison, New Jersey, the United States; Department of Physical Medicine and Rehabilitation, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, the United States. 2. Cognitive Rehabilitation Department, John F. Kennedy Johnson Rehabilitation Institute, Hackensack Meridian Health System, Edison, New Jersey, the United States; Department of Physical Medicine and Rehabilitation, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, the United States. Electronic address: Yelena.Goldin@hackensackmeridian.org. 3. Charlotte Center for Neuropsychological Services, Charlotte, North Carolina, the United States. 4. Traumatic Brain Injury Program, Park Terrace Care Center, Rego Park, New York, the United States. 5. Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota and Phoenix, Arizona, the United States. 6. Rusk Rehabilitation New York University Langone Health, New York City, New York, the United States; New York University School of Medicine, New York City, New York, the United States. 7. Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota and Phoenix, Arizona, the United States; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, the United States. 8. Beechwood NeuroRehab, Langhorne, Pennsylvania, the United States; Department of Rehabilitation Neuropsychology, Rehabilitation Hospital of Indiana, Indianapolis, Indianna, the United States. 9. Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, the United States; A. Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, the United States. 10. Department of Communication Sciences and Disorders, Western Washington University; Bellingham, Washington, the United States. 11. Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, the United States; Veterans Affairs Boston Healthcare System, Jamaica Plain Division, Boston, Massachusetts, the United States. 12. Advocate Christ Medical Center, Oak Lawn, Illinois, the United States.
Abstract
OBJECTIVES: To conduct an updated, systematic review of the clinical literature, classify studies based on the strength of research design, and derive consensual, evidence-based clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) or stroke. DATA SOURCES: Online PubMed and print journal searches identified citations for 250 articles published from 2009 through 2014. STUDY SELECTION: Selected for inclusion were 186 articles after initial screening. Fifty articles were initially excluded (24 focusing on patients without neurologic diagnoses, pediatric patients, or other patients with neurologic diagnoses, 10 noncognitive interventions, 13 descriptive protocols or studies, 3 nontreatment studies). Fifteen articles were excluded after complete review (1 other neurologic diagnosis, 2 nontreatment studies, 1 qualitative study, 4 descriptive articles, 7 secondary analyses). 121 studies were fully reviewed. DATA EXTRACTION: Articles were reviewed by the Cognitive Rehabilitation Task Force (CRTF) members according to specific criteria for study design and quality, and classified as providing class I, class II, or class III evidence. Articles were assigned to 1 of 6 possible categories (based on interventions for attention, vision and neglect, language and communication skills, memory, executive function, or comprehensive-integrated interventions). DATA SYNTHESIS: Of 121 studies, 41 were rated as class I, 3 as class Ia, 14 as class II, and 63 as class III. Recommendations were derived by CRTF consensus from the relative strengths of the evidence, based on the decision rules applied in prior reviews. CONCLUSIONS: CRTF has now evaluated 491 articles (109 class I or Ia, 68 class II, and 314 class III) and makes 29 recommendations for evidence-based practice of cognitive rehabilitation (9 Practice Standards, 9 Practice Guidelines, 11 Practice Options). Evidence supports Practice Standards for (1) attention deficits after TBI or stroke; (2) visual scanning for neglect after right-hemisphere stroke; (3) compensatory strategies for mild memory deficits; (4) language deficits after left-hemisphere stroke; (5) social-communication deficits after TBI; (6) metacognitive strategy training for deficits in executive functioning; and (7) comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability after TBI or stroke.
OBJECTIVES: To conduct an updated, systematic review of the clinical literature, classify studies based on the strength of research design, and derive consensual, evidence-based clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) or stroke. DATA SOURCES: Online PubMed and print journal searches identified citations for 250 articles published from 2009 through 2014. STUDY SELECTION: Selected for inclusion were 186 articles after initial screening. Fifty articles were initially excluded (24 focusing on patients without neurologic diagnoses, pediatric patients, or other patients with neurologic diagnoses, 10 noncognitive interventions, 13 descriptive protocols or studies, 3 nontreatment studies). Fifteen articles were excluded after complete review (1 other neurologic diagnosis, 2 nontreatment studies, 1 qualitative study, 4 descriptive articles, 7 secondary analyses). 121 studies were fully reviewed. DATA EXTRACTION: Articles were reviewed by the Cognitive Rehabilitation Task Force (CRTF) members according to specific criteria for study design and quality, and classified as providing class I, class II, or class III evidence. Articles were assigned to 1 of 6 possible categories (based on interventions for attention, vision and neglect, language and communication skills, memory, executive function, or comprehensive-integrated interventions). DATA SYNTHESIS: Of 121 studies, 41 were rated as class I, 3 as class Ia, 14 as class II, and 63 as class III. Recommendations were derived by CRTF consensus from the relative strengths of the evidence, based on the decision rules applied in prior reviews. CONCLUSIONS: CRTF has now evaluated 491 articles (109 class I or Ia, 68 class II, and 314 class III) and makes 29 recommendations for evidence-based practice of cognitive rehabilitation (9 Practice Standards, 9 Practice Guidelines, 11 Practice Options). Evidence supports Practice Standards for (1) attention deficits after TBI or stroke; (2) visual scanning for neglect after right-hemisphere stroke; (3) compensatory strategies for mild memory deficits; (4) language deficits after left-hemisphere stroke; (5) social-communication deficits after TBI; (6) metacognitive strategy training for deficits in executive functioning; and (7) comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability after TBI or stroke.
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