Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes

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K Suresh Kumar1, Selvaraj Samuelkamaleshkumar2, Anand Viswanathan3, Ashish S Macaden4

1. London School of Hygiene and Tropical Medicine, Clinical Research Department, London, UK
2. Christian Medical College, Physical Medicine and Rehabilitation, Vellore, Tamilnadu, India
3. Christian Medical College, Cochrane South Asia, Prof. BV Moses Center for Evidence-Informed Health Care and Health Policy, Vellore, Tamil Nadu, India
4. Raigmore Hospital (NHS Highland), Stroke and Rehabilitation Medicine, Inverness, UK

Kumar KS, Samuelkamaleshkumar S, Viswanathan A, Macaden AS. Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD007935. DOI: 10.1002/14651858.CD007935.pub2

Access the full-text article here: DOI: 10.1002/14651858.CD007935.pub2

Cognitive rehabilitation for people with brain injury due to trauma to help them return to work

Background

Traumatic brain injuries (head injuries) are becoming increasingly common, and their impact on people's lives can be devastating. Depending on which part of the brain is injured and to what extent, impairments could be in physical functions such as walking, and use of hands and legs, or in mental functions (also known as 'cognitive functions'). Problems with mental functions can be related to memory, understanding language, using appropriate words to express oneself, analyzing options in a situation and making appropriate decisions . Problems with mental functions could lead to difficulty in 'occupational activities', a term that refers to employment, pursuing education and managing daily routines. Limitations in these activities could lead to a poor quality of life and withdrawal from social life.

'Cognitive rehabilitation' is the term used to refer to the training given to people with brain injury to address and improve the specific mental abilities that are impaired. This is usually done to improve return to work, independence in managing daily routines, and quality of life.

Review question

Does cognitive rehabilitation for people with traumatic brain injury improve their return to work, independence in daily activities, community integration and quality of life?

Study characteristics

We included nine studies with 790 participants. Seven of the studies were conducted in the US, and one each in Australia and China. Follow-up (monitoring) duration in the studies ranged between two weeks and two years.

Key findings

Cognitive rehabilitation compared to no treatment

There was insufficient evidence to conclude that cognitive rehabilitation, as compared to no other treatment, led to better return to work, community integration or quality of life in adults with traumatic brain injury. We judged the quality of this evidence as low or very low because of poor reporting of both the methods used and the results.

Cognitive rehabilitation compared to other conventional rehabilitation

There was inadequate evidence to conclude that adults with traumatic brain injury who received cognitive rehabilitation had better return to work, independence in daily living, community integration or quality of life when compared to adults who received conventional rehabilitation. We judged the quality of evidence for these outcomes to vary between moderate and very-low because of poor reporting of the methods used, different types of 'conventional' treatment and imprecise results.

Home-based cognitive rehabilitation training compared to hospital-based training

In one study on active military personnel, those who received a home programme for cognitive rehabilitation training had similar return to work when compared to those who received cognitive rehabilitation training in a hospital. We judged this evidence to be of moderate quality due to imprecise results.

Different types of cognitive rehabilitation compared against each other

One study compared trial-and-error type cognitive rehabilitation (cognitive didactic) to another type of cognitive rehabilitation that provided cues to avoid errors (functional-experiential) for veterans or active military personnel with traumatic brain injury. 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. We judged the quality of evidence to be of moderate (return to work) and low quality (ability to live independently) because of imprecise results.

None of the studies reported information about harms from cognitive rehabilitation.