The Study of Cognitive Rehabilitation Effectiveness The SCORE clinical trial is a randomized controlled treatment trial evaluating the effectiveness of cognitive rehabilitation in post-deployment military service members who sustained a concussion. While there is less evidence that cognitive rehabilitation may be beneficial when implemented many years after injury, a review of randomized controlled trials reported that implementation of an exercise program has global positive cognitive benefits, even in individuals with chronic TBI (Vanderbeken and Kerckhofs, 2017). These dichotomies include modular versus comprehensive, restorative versus compensatory, and contextualized versus decontextualized treatments. Cognitive rehabilitation has rapidly expanded in the last decades. Moreover, TMS measures can inform us about the functionality of specific neurophysiological circuits implicated in memory functions and may be indicative of how well an individual will profit from a given pharmacological intervention. To enhance recovery of brain injury survivors, clinicians and researchers saw the need to provide cognitive as well as physical rehabilitation. Learn more about cognitive problems that people with cancer and cancer survivors can experience. Retraining exercises appear intuitive and are thought to stimulate dendritic sprouting of neurons in associated areas in the brain, but evidence for its effectiveness at this level is very limited. A relatively new method that is particularly of interest in spatial cognition is the use of virtual reality. This view of cognitive rehabilitation is focused on teaching patients alternative behaviors to compensate for impaired functions. FIGURE 4-2 Model for multi-modal/comprehensive CRT. Patients who experience brain damage, such as stroke or traumatic brain injury, are currently provided detailed guidance to optimize their recovery and, most importantly, to aid that person in obtaining or maintaining physical, psychological, social, and vocational well-being. And finally, this group notes that rather than expecting a rehabilitation method to be a panacea, given findings in the literature to date, it is more realistic to expect domain-specific effects, and a lack of generalizable improvement is not evidence for failure of treatment. File:AFNI screenshot.png. “And it’s important that patients receive the physical aspects of rehabilitation care, as well as cognitive rehabilitation care, to ensure their health and wellbeing is being addressed comprehensively.” Restorative treatments are aimed directly at improving, strengthening, or normalizing specific impaired cognitive functions. One form of treatment for TBI is cognitive rehabilitation therapy (CRT), a patient-specific, goal-oriented approach to help patients increase their ability to process and interpret information. The assumption behind this approach is to remediate or retrain deficits in cognitive functioning. A history of cognitive rehabilitation. Also, you can type in a page number and press Enter to go directly to that page in the book. Adamovich, B. Focal brain injuries, such as stroke or brain tumors, may result in one or a small number of cognitive impairments and largely spare other cognitive processes. Heterogeneity of TBI further complicates studies of CRT impact and may mask benefit in subgroups that the study cannot detect due to small sample size or other limitations in study design. Every change that enhances the treatment of the patient, facilitates their participation in self-care and improves the quality of life is of great value. Patients with TBI often have multiple identifiable cognitive impairments, coupled with mood or other behavioral disturbances, a reduced awareness of their own cognitive and behavioral limitations, and reductions in social competence. In the past, cognitive rehabilitation was provided primarily through center-based computer training of rote memory tasks. Compensatory treatments, in contrast, seek to provide alternative strategies for carrying out important activities of daily living despite residual cognitive impairment. Specific adaptations of CRT for patients with TBI reflect the domains most commonly impaired, notably attention, memory, social communication, and executive function. 2011. performance of a specific activity, or generalizing to multiple activities” (Katz et al. Differences across definitions of CRT are based on theoretical differences regarding the underlying cognitive mechanisms that result in behavioral changes. (accessed May 26, 2011). Within the past 10 years, the scope of cognitive rehabilitation has grown tremendously. In contrast, contextualized attention training would be an approach to finding out what activities are most disrupted by inattention from the individual patient, how to simplify those activities during training, and how to assess progress. Esther van den Berg, Carla Ruis, in Neuropsychology of Space, 2017. For example, if attention capacity can truly be restored, then all of the activities suffering from inattention would likely improve. Notably, studies up to date have relied on TMS measures from the motor cortex. For example, individuals may benefit from intensive practice of memory encoding strategies (modular, decontextualized, compensatory) to bolster remembering new information, while also practicing applying these strategies to various types of material and in various contexts (modular, contextualized, compensatory). Cognitive rehabilitation of EFs is crucial, since this cognitive domain significantly affects everyday life and social functioning. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL:, URL:, URL:, URL:, URL:, URL:, URL:, URL:, URL:, URL:, Stephanie A. Kolakowsky-hayner, Jeffrey S. Kreutzer, in, Cognitive Rehabilitation in Patients with BTRE, Marta Maschio MD, Loredana Dinapoli PhD, in, Encyclopedia of the Neurological Sciences, A Comprehensive Guide to Geriatric Rehabilitation (Third Edition), Anna-katharine Brem, ... Alvaro Pascual-leone, in, Davies and Maloney, 1976; Coyle et al., 1983, Cognitive Rehabilitation for Mild Traumatic Brain Injury (mTBI), Neurosensory Disorders in Mild Traumatic Brain Injury, Archives of Physical Medicine and Rehabilitation, Annals of Physical and Rehabilitation Medicine. Annals of the New York Academy of Sciences 931:359–375. Cognitive rehabilitation following TBI has a long history with early evidence for rehabilitation ameliorating disabilities secondary to cognitive impairment in the areas of attention, memory, and executive dysfunction (Raskin and Mateer, 1999; Mateer and Sira, 2006; Sohlberg and Mateer, 2017). B. CRT interventions also differ in the degree to which they take place in the real world or use materials and tasks from the patient’s everyday life. (accessed May 26, 2011). McLean, VA: Brain Injury Association of America. If you have symptoms of depression, be sure to talk to your doctor about getting treatment. For a person with paralysis, rehabilitation might examine whether the individual’s strength could be improved through exercise, whether the tendons of nonparalyzed muscles could be surgically transferred to a mechanically. The overall goal may be restoring function in a cognitive domain or set of domains or teaching compensatory strategies to overcome domain specific problems, improving. Alternatively, a modular treatment may not have substantial impact on activities and participation in a patient with multiple impairments unless other coexisting cognitive and emotional factors are concurrently addressed, as in a comprehensive program. For example, in individuals with moderate TBI, on average of 16 months postinjury, there is evidence that cognitive training in attention is associated with improved performance on attentional measures during follow-up testing, in addition to altered activation of attention networks, commonly disrupted following injury. The authors conduct cognitive rehabilitation research at Kessler Foundation, home to the Rocco Ortenzio Neuroimaging Center, a research-dedicated facility, and collaborate with researchers in … Paper and pencil may be sufficient for a grocery list, but taking notes may need to be supplemented by audio recordings of the lecture. Experience suggests that the most effective therapy occurs when cognitive training is conducted in real-life situations and has high interest to the individual. For example, a comprehensive program for patients with moderate or severe TBI might begin with a comprehensive neuropsychological assessment, along with a patient and family interview of current difficulties in activities, social behavior, and mood. “The Cognitive Rehabilitation Manual is a landmark volume translating decades of research into clearly described procedures indispensable for working clinicians. Short-latency intracortical inhibition (SICI) and the cortical silent period (cSP) are thought to reflect the excitability of inhibitory γ-aminobutyric acid (GABA)ergic circuits (Hallett, 2000) and were also found to be abnormal in patients with AD. Levine and collaborators (2000) assessed the effectiveness of GMT in brain-injured patients. Such treatments, when delivered alone, might be expected to enhance activities and participation most effectively in patients with a single or predominant impairment (i.e., patients with a more focal impairment). For patients with multifocal or diffuse injuries, evaluation of the effectiveness of CRT in terms of real clinical impact faces a particular challenge. Recently, there has been a shift to real-world community-based programming with a more holistic approach. SAI is a TMS measure that is indicative of cholinergic circuits in the motor cortex (Di Lazzaro et al., 2000) and is altered in patients with AD (for a review see Freitas et al., 2011a). 4 Could enhanced sensory stimulation (posterior column or muscle spindle input) promote recovery from motor incapacity by cerebellar as well as by cerebral mechanisms? Traumatic brain injury (TBI) may affect 10 million people worldwide. This description allows for comprehensive, interdisciplinary rehabilitation programs with interventions to restore or reorganize function, compensate, TABLE 4-1 Definitions of Cognitive Rehabilitation Therapy by Organization. Thus there may be ways of improving cognition even after the acute and subacute stages of recovery, and this places greater emphasis on conceptualizing the long-term consequences for TBI and the need for understanding developmental periods postinjury that extend into senescence. “Cognitive rehabilitation is a systematically applied set of medical and therapeutic services designed to improve cognitive functioning and participation in activities that may be affected by difficulties in one or more cognitive domains…. Patients may learn to use computerized navigation in their car or on their smartphones (see Box 10.4). Show this book's table of contents, where you can jump to any chapter by name. However, real-world settings are highly variable and often unpredictable, challenging the effectiveness of therapy. Code of Ethics (revised). The assumption behind this approach is to remediate or retrain deficits in cognitive functioning. Often times, if skills can taught to help a patient compensate for their loss. Occupational therapy practitioners are experts at addressing the effects of cognitive deficits on daily life. It is part of the process of neuropsychological rehabilitation.. Do you want to take a quick tour of the OpenBook's features? It is conceivable that patients with a behavioral syndrome from cerebellar lesions may also benefit from such approaches, but one first has to recognize that this syndrome exists before being able to treat it. Contextualized therapy addresses cognitive impairments as they disrupt activities and skills in various milieus (American Speech-Language-Hearing Association 2003a; Hartley 1995; Ylvisaker and Feeney 1998). After an accident, cognitive rehabilitation therapy is an important part of stroke and traumatic brain injury rehabilitation. Jump up to the previous page or down to the next one. To date, cognitive rehabilitation has aimed at improving specific EF abilities, such as planning, inhibition, or updating, rather than the entire EF domain. This group cites several pitfalls with cognitive rehabilitation research to date, such as the need for well explained, standardized rehabilitation treatments. A chart explaining the different types of Cognitive Rehabilitation Therapies. The study found no evidence to suggest one type of cognitive rehabilitation was better than the other in improving return to work or the ability to live independently. Contextualized treatments also are more difficult to evaluate, standardize, and disseminate because doing so requires the therapist to have the skills necessary to design and execute them, and generally requires more availability/effort from the patient. Cognitive therapy approaches such as using video games, virtual reality techniques, and computer-generated rehabilitation therapy are currently being studied as ways to improve cognitive function after a stroke. The ability to translate a treatment task to real-world applications is largely dependent on the circumstances of the individual with cognitive deficits. From this assessment, certain patient-specific modules might be selected. Consider a female patient who frequently becomes stalled in complex tasks and often forgets appointments and commitments. Share a link to this book page on your preferred social network or via email. Three different types of cognitive rehabilitation methods are generally distinguished (for an overview see eg, Wilson, 1997). Rehabilitation accepts the complex correspondence between disease and the ability to function: a disease may be eradicated while disability remains; disability can be reduced in the face of permanent injury or chronic disease. 2010 Oct;16(5):298-307. doi: 10.1111/j.1755-5949.2009.00110.x. NeuroRehabilitation 2(3):62–67. These findings suggest that cognitive training can result in distributed networks that maintain improved cognitive functioning, though the longevity of these effects is less clear (Kim et al., 2009). As with physical rehabilitation, cognitive rehabilitation may include interventions that aim to lessen impairments, or interventions that aim to lessen the disabling impact of those impairments. It focuses not only on the specific cognitive deficits of the individual with brain injury, but also on their impact on social, communication, behavior, and academic/vocational performance. Not a MyNAP member yet? Harley, J. P., C. Allen, T. L. Braciszewski, K. D. Cicerone, C. Dahlberg, S. Evans, M. Foto, W. A. Gordon, D. Harrington, W. Levin, J. F. Malec, S. Millis, J. Morris, C. Muir, J. Richert, E. Salazar, D. A. Schiavone, and J. S. Smigelski. Cognitive Rehabilitation: The Evidence, Funding, and Case for Advocacy in Brain Injury. While a person may develop considerable skill in the trained task, there is no convincing evidence that the cognitive processes that underlie this skill improve and, furthermore, one may question whether a person can find his way better in day-to-day life. TBI can cause an array of physical and mental health concerns and is a growing problem, particularly among soldiers and veterans because of repeated exposure to violent environments. 4 Defining Cognitive Rehabilitation Therapy. Irene Cristofori, ... Jordan Grafman, in Handbook of Clinical Neurology, 2019. What types of tests and measures do physical therapists use? The findings revealed better performance on the primary outcome measure, but little generalization to other measures in the treatment group (Evans et al., 2009). With regard to hemispatial neglect promising results are observed following prism adaptation (see chapter X). Practitioners and researchers acknowledge that the ultimate goal of treatment should be functionally meaningful improvements in the patient (i.e., activities, participation, or quality of life), and there may be many approaches to reaching this goal (Sohlberg and Mateer 2001). Pp. Both center-based and community-based programs have advantages and disadvantages. Sign up for email notifications and we'll let you know about new publications in your areas of interest when they're released. Patients can learn to make use of landmarks in their day-to-day surroundings or memorize verbal descriptions of well-known routes (“go left at the third crossing”). Functional changes are achieved through various intervention methods targeting restitution, compensation, and adaptation (Cicerone et al., 2000). A recent randomized controlled trial found evidence for improved learning and memory through the implementation of a protocol administering the modified Story Memory Technique over the course of 5 weeks (Chiaravalloti et al., 2016). Guidelines for cognitive rehabilitation. Ready to take your reading offline? American Physical Therapy Association. Katz, D. I., M. Ashley, G. J. O’Shanick, and S. H. Connors. It is important to distinguish between the two. The aim of this training is to monitor and adjust goals during ongoing behavior (Levine et al., 2000). Prigatano, G. P. 2005. She might also receive individual psychotherapy to address depression, along with periodic joint sessions with her husband to help him understand the sources of her unreliability as well as address his own sense of the loss of his familiar partner. COVID-19 rehabilitation focuses on helping people regain their physical and cognitive abilities after the illness. The GMT consists of five steps: (1) orient awareness toward the actual state of the situation; (2) define the goal of the task; (3) list subgoals; (4) learn the subgoals; and (5) check if the result of an action corresponds to the stated goal. Participants were randomly assigned to GMT or motor skills training. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Benedict, S. M., H. G. Belanger, S. D. Ceperich, D. X. Cifu, M. Cornis-Pop, H. L. Lew, and K. Meyer. The goal of cognitive rehabilitation therapy (CRT) is to help an individual with a brain injury enhance his or … For example, Toglia et al. These attributes also affect the experimental designs that are most applicable and feasible for advancing the science of CRT. Modular treatments, for example, can be aimed at either restoration or compensation. American Physical Therapy Association. Furthermore, such treatment programs are expensive to provide without clinical revenue, which would preclude intentionally designing an ineffective comparison treatment. Specific routes can be trained in real life to ensure better recovery from memory. 2006). Attributes of CRT are not mutually exclusive options, and various attributes can be combined in a multitude of ways. This chapter focuses on the results of cognitive rehabilitation in either BT patients or patients with epilepsy in order to draw implications for future research on BTRE in this area. SAI may even be useful to differentiate dementia subtypes (Di Lazzaro et al., 2006, 2008) and may be used as an indicator of who will profit from AChE inhibitors. 2003a. In The Effectiveness of Rehabilitation for Cognitive Deficits. determine if restoration of a cognitive process is possible. Stephanie A. Kolakowsky-hayner, Jeffrey S. Kreutzer, in Encyclopedia of the Human Brain, 2002. Intentional definitions can limit the interpretation of CRT evidence since treatment efficacy and effectiveness depend more on the contents and processes of treatment than the intention of the clinician providing it. Do you enjoy reading reports from the Academies online for free? Hartley, L. L. 1995. For one thing, it works best with people who have mild dementia or mild cognitive impairment rather than deficits that are farther along. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website. This approach is based on a theory of sustained attention (Robertson and Garavan, 2000), which claims that the right fronto-thalamic-parietal network provides the neural support for ongoing activation of attention, which allows for the maintenance of higher-order goals in working memory. professionals often use a variety of therapy approaches, providing interventions that target activities and participation while systematically addressing the underlying cognitive impairment(s). (2005, 2006) report several examples of behavioral improvement through cognitive training (e.g., Medd and Tate, 2000). For everyone else, therapy is a crucial part of the recovery process. A study evaluating comprehensive treatment programs ideally will include a manual specifying the rules that link assessment to selection of specific treatment elements, and how those elements will be advanced or tailored to individual performance. ASHA Supplement 23:13–15. FIGURE 4-1 Model for modular CRT. When the NCD deficits are progressive, the stage to which it has progressed affects the intervention. Goal Management Training (GMT) is a well-established rehabilitation technique focused on goal-directed behaviors. The treatment interventions used in physical rehabilitation include traditional drug and surgical treatments, as well as physical exercise, technology (e.g., braces, wheelchairs), skill training (e.g., learning how to use a wheelchair), and social policies and services (e.g., accessible transportation). These approaches to CRT evolved somewhat differently, from different philosophical perspectives and for different purposes, such as treating focal versus diffuse injuries, although considerable overlap exists. Types of cognitive stimulation activities and techniques. Current definitions of CRT focus on the intention to improve or accommodate one or more impaired cognitive functions, rather than on the contents or active ingredients of treatment. RCTs involving comprehensive treatments are more difficult to design and execute, because of the need to distill a multifaceted treatment, often individually tailored, into standard form. Specifically, modular restorative treatments are relatively amenable to randomized controlled trials (RCTs). However, the strategy-training group improved more from pre- to posttraining. Because there is no “window into the brain,” it is difficult to. In this approach rehabilitation of deficits in spatial cognition can also be focused on fear of losing one’s way or the impact of dependence on others or external aid on a person’s feeling of self-worth. Dealing With Navigation Problems (Case XX). International Classification of Functioning, Disability and Health (ICF), resolution WHA 54.21. Classic cognitive rehabilitation comprises of “drill and practise” exercises. Secondary outcome measures involved performing either two motor tasks or two cognitive tasks. Rachel A. Bernier, Frank G. Hillary, in Handbook of Clinical Neurology, 2019. Compensatory modular treatments, however, such as training in memory strategies, are often applied to the real-world activities the patient faces. Should this impairment lead to inability to successfully manage his job or social activities, then this would be considered impairment at the level of participation. The Brain Injury Association of America, the largest U.S. advocacy organization for individuals with brain injury, summarizes this issue: “Theoretical models of cognitive rehabilitation vary along several different dimensions. A 2017 review of studies on rehabilitation therapies in MS found moderate-quality evidence that cognitive-behavioral therapy (CBT), a type of psychotherapy, is beneficial for treating depression and helping patients accept and cope with MS. More research will be required to refine techniques and interventions. Some EF training studies focus on awareness of EFs deficits during treatment. In contrast, patients with multiple impairments (i.e., deficits in attention and memory, along with impulsivity and depression) may receive a comprehensive program also referred to as “holistic,” “multi-modal,” or “neuropsychological rehabilitation.” Comprehensive programs typically contain a mix of modular treatments that target specific cognitive impairments, treatments that address self-awareness of the impact of cognitive deficits, and individual or group therapies that facilitate coping with residual deficits and their social consequences. Since the involvement of family and caregivers is crucial, educating them must be a priority. In case of severe deficits external compensatory strategies can be used. Cognitive rehabilitation consists in assessment-based therapeutic interventions aiming to reduce disability and promote functional recovery. Occupational Therapy’s Role in Adult Cognitive Disorders. Cognitive stimulation refers to the set of techniques, strategies and materials to improve performance and effectiveness of cognitive capabilities and executive functions such as memory, attention, language, reasoning and planning, among others. You might have therapy to strengthen your swallowing. Chapter X already showed some applications with regard to navigation problems. Music Therapy. In October 2011, the Institute of Medicine (IOM) released the report Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence, assessing the published evidence for the effectiveness of using cognitive rehabilitation therapy (CRT) to treat people with traumatic brain injury (TBI). oriented cognitive rehabilitation interventions that aim to (i) draw on retained strengths to support adaptive behaviour; and (ii) achieve optimum levels of wellbeing by targeting performance on personally relevant goals (Clare, 2008). Cognitive rehabilitation attempts to enhance functioning and independence in patients with cognitive impairments as a result of brain damage or disease, most commonly following TBI or stroke. The awareness of a cerebellar role in sensory (Gao et al., 1996), autonomic (Martner, 1975; see chapter by D. E. Haines et al. These skills include intellectual performance, problem solving, attention deficits, memory and language difficulties. M. Abrams, in a multitude of ways result of the body or type of ability affected by stroke... Often considered in regard to spatial cognition is the remedial process of cognitive. And S. H. Connors intentionally designing an ineffective comparison treatment patients with NCD is currently possible rather. Life to ensure better recovery from memory in complex tasks and often unpredictable, challenging the effectiveness of most..., 1997 ) or compensation Ruis, in contrast, diffuse ( i.e., multifocal brain. 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