Computerized training of working memory in a group of patients suffering from acquired brain injury. Theory driven rehabilitation of executive functioning: improving planning skills in people with traumatic brain injury through the use of an autobiographical episodic memory cueing procedure. A randomized clinical trial study on the effectiveness of a tele-analogy-based problem-solving programme for people with acquired brain injury (ABI). Remediating deficits of switching attention in patients with acquired brain injury. Escitalopram and enhancement of cognitive recovery following stroke. Rehabilitation of executive functioning: an experimental-clinical validation of goal management training. Treatment to improve self-awareness in persons with acquired brain injury. Effects of an explicit problem-solving skills training program using a metacomponential approach for outpatients with acquired brain injury. Comparison of remedial and compensatory interventions for adults with acquired brain injuries. Management of impaired self-awareness in persons with traumatic brain injury. Computerized working memory training after stroke--a pilot study. Cognitive rehabilitation for traumatic brain injury: A randomized trial. Defense and Veterans Head Injury Program (DVHIP) Study Group. Effects of a multifaceted treatment program for executive dysfunction after acquired brain injury on indications of executive functioning in daily life. A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury.
Study short- and long-term transfer effects of a computerized working memory (WM) training programme for patients suffering from working memory deficits after acquired brain injury.
                A controlled experimental study with a cross-over design.
                A consecutive sample of 21 subjects. Mean age 43.2 years, time since injury/illness onset 37 months (median). The subjects were randomly selected into two groups where one group served as controls. All subjects trained daily for 5 weeks in a computer WM task program. They were followed-up at 4 and 20 weeks after the training.
                A significant improvement in the trained WM tasks, significant improvements in neuropsychological WM-test results at 4 and 20 weeks after training compared to baseline. Improvement in the subjects' rated occupational performance and satisfaction with performance in pre-defined occupational problems. Rated quality-of-life did not change. However, rated overall health increased 20 weeks after training.
                Structured and intense computerized WM training improves subjects' cognitive functioning as measured by neuropsychological WM-demanding tests, rated occupational performance, satisfaction with performance and rated overall health. The training probably has an impact on the rehabilitation outcome, returning to work, as well as on daily activities for individuals with verified WM impairments. Traumatic brain injury (TBI) frequently leads to the development of a 'dysexecutive syndrome'. The associated difficulties with problem solving (including specific impairments in planning, initiation/plan-implementation and self-monitoring) represent a major challenge to functional recovery and adaptation following brain injury and serve as an important target for rehabilitation. Previous research suggests that one reason people with TBI are poor at everyday planning is that they fail to spontaneously use specific autobiographical memories to support planning in unstructured situations. In this study, we examined whether a self-instructional technique involving self-cueing to recall specific autobiographical experiences would improve performance on a planning task. Two groups of 15 participants who had suffered a closed traumatic brain injury carried out the Everyday Descriptions Task (Dritschel, B. (1991). The role of autobiographical memory in describing how to perform everyday activities. In Paper presented at the European Cognitive Society Conference.), in which they were asked to describe how they would plan eight common unstructured activities, i.e. activities that could be solved in a variety of ways. Group 1 was then asked to describe how to plan a second set of eight unstructured activities. Prior to completing their second set of eight activities, Group 2 underwent training in a procedure aimed at prompting the retrieval of specific memories to support planning. The results suggested that the intervention was effective at increasing the number of specific memories recalled, with a corresponding increase in the effectiveness of the plan and number of relevant steps in the plan. Potential applications of the technique are discussed. The present study reports the results of 103 persons with acquired brain injury who were randomly assigned to one of three 20-session analogy problem-solving skill training groups, namely: online training (through computer video conferencing with interactive software); computer-assisted training (through interactive patient-directed software); therapist administered training (face-to-face therapist guided training activities); and a "no-treatment" control group.
                Pre- and post-test quasi-experimental design.
                Individuals' problem-solving skills and self-efficacy in all four groups were assessed over a four-week period. Overall, the training methods were found to be effective in improving problem solving skills regardless of the modes of delivery (except in the case of the control group). The continuous "human touch" characteristics of the therapist-administered group showed significant better improvements in self-efficacy in problem-solving.
                The statistically significantly improvement in problem solving skills in the online-group suggests that this approach could effectively improve cognitive functions of person with ABI and yield training outcomes comparable to other modes of delivery such as the face-to-face training. The conceptualization and applicability of tele-cognitive rehabilitation, its implications for persons with ABI, and future studies in this research area are also discussed. This study was designed to evaluate the remediating effects of two types of aid on a test of switching attention administered to patients with acquired brain injury (ABI). Based on the separation of cognitive functions suggested by a neural network model, it was hypothesized that external inhibition of obsolete rules, and increased salience of stimuli, would differentially improve the WCST performance of participants with ABI.
                The Wisconsin Card Sorting Test (WCST) performance of 24 patients with ABI assigned to three treatment groups (no treatment, external inhibition, increased stimulus salience) was compared to normal controls.
                External inhibition of learned rules reduced perseverative errors, while increased stimuli salience reduced random errors, committed by patients with ABI.
                The pattern of results supports the separation of functions in switching attention suggested by a neural network model, and establishes minimal aids necessary for remediating deficits associated with ABI. Adjunctive restorative therapies administered during the first few months after stroke, the period with the greatest degree of spontaneous recovery, reduce the number of stroke patients with significant disability.
                To examine the effect of escitalopram on cognitive outcome. We hypothesized that patients who received escitalopram would show improved performance in neuropsychological tests assessing memory and executive functions than patients who received placebo or underwent Problem Solving Therapy.
                Randomized trial.
                Stroke center.
                One hundred twenty-nine patients were treated within 3 months following stroke. The 12-month trial included 3 arms: a double-blind placebo-controlled comparison of escitalopram (n = 43) with placebo (n = 45), and a nonblinded arm of Problem Solving Therapy (n = 41).
                Change in scores from baseline to the end of treatment for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Trail-Making, Controlled Oral Word Association, Wechsler Adult Intelligence Scale-III Similarities, and Stroop tests.
                We found a difference among the 3 treatment groups in change in RBANS total score (P < .01) and RBANS delayed memory score (P < .01). After adjusting for possible confounders, there was a significant effect of escitalopram treatment on the change in RBANS total score (P < .01, adjusted mean change in score: escitalopram group, 10.0; nonescitalopram group, 3.1) and the change in RBANS delayed memory score (P < .01, adjusted mean change in score: escitalopram group, 11.3; nonescitalopram group, 2.5). We did not observe treatment effects in other neuropsychological measures.
                When compared with patients who received placebo or underwent Problem Solving Therapy, stroke patients who received escitalopram showed improvement in global cognitive functioning, specifically in verbal and visual memory functions. This beneficial effect of escitalopram was independent of its effect on depression. The utility of antidepressants in the process of poststroke recovery should be further investigated. Trial Registration clinicaltrials.gov Identifier: NCT00071643. Two studies assessed the effects of a training procedure (Goal Management Training, GMT), derived from Duncan's theory of goal neglect, on disorganized behavior following TBI. In Study 1, patients with traumatic brain injury (TBI) were randomly assigned to brief trials of GMT or motor skills training. GMT, but not motor skills training, was associated with significant gains on everyday paper-and-pencil tasks designed to mimic tasks that are problematic for patients with goal neglect. In Study 2, GMT was applied in a postencephalitic patient seeking to improve her meal-preparation abilities. Both naturalistic observation and self-report measures revealed improved meal preparation performance following GMT. These studies provide both experimental and clinical support for the efficacy of GMT toward the treatment of executive functioning deficits that compromise independence in patients with brain damage. To examine the effects of an awareness training protocol embedded within the practice of instrumental activities of daily living (IADLs) in participants with acquired brain injury on levels of self-awareness and functional performance.
                This study used a randomized control trial design: 10 participants with moderate-to-severe brain injury received six sessions of the self-awareness training while they performed IADLs (experimental group) and 10 participants performed the same IADLs but received conventional therapeutic practice (control group). In the experimental group, participants were asked to predict their performance before each task performance and to estimate their performance level after the performance.
                Pre- and post-intervention outcome measures taken from the two groups were compared. Instruments were standardized measures of 'general' self-awareness with collateral reports by informants (e.g. Awareness Questionnaire); 'task-specific' self-awareness (e.g. Assessment of Awareness of Disability) and Self-Regulation Skills Inventory (SRSI). Performance on IADLs was assessed using the Assessment of Motor and Process Skills (AMPS).
                Compared to the control group, the intervention significantly improved IADL performances and self-regulation. No significant treatment effect was observed for task-specific self-awareness, general self-awareness or community integration.
                The self-awareness intervention significantly but selectively improved self-awareness during IADL task performance as well as functional performance. The need for a larger study with more treatment sessions is discussed. We investigated the effects of an explicit problem-solving skills training program using a metacomponential approach with 33 outpatients with moderate acquired brain injury, in the Hong Kong context.
                We compared an experimental training intervention with this explicit problem-solving approach, which taught metacomponential strategies, with a conventional cognitive training approach that did not have this explicit metacognitive training.
                We found significant advantages for the experimental group on the Metacomponential Interview measure in association with the explicit metacomponential training, but transfer to the real-life problem-solving measures was not evidenced in statistically significant findings. Small sample size, limited time of intervention, and some limitations with these tools may have been contributing factors to these results.
                The training program was demonstrated to have a significantly greater effect than the conventional training approach on metacomponential functioning and the component of problem representation. However, these benefits were not transferable to real-life situations. To examine the effects of a compensatory intervention versus a remedial intervention for deficits in visual processing of adults with acquired brain injuries (ABI).
                A cognitive rehabilitation program at a large comprehensive rehabilitation hospital in the New York City metropolitan area.
                Thirty adults with ABI were matched according to severity of injury, gender, age, and time post-injury, and randomly assigned to the remedial or compensatory group.
                The remedial intervention consisted of four 45-minute sessions (once weekly) of participation in computer tasks without instruction in compensatory strategies. The compensatory intervention consisted of four 45-minute sessions of instruction in the use of three internal compensatory strategies, including verbalization, chunking, and pacing.
                Pretest/posttest measures included three functional computer tasks. Weekly measures included a computerized version of the Paced Auditory Serial Addition Task (PASAT) and two computerized matching tasks.
                Both groups exhibited statistically significant improvement of comparable degree on posttests and weekly measures. Further analysis revealed that 80% of both groups used compensatory strategies, regardless of intervention method. Those who used strategies demonstrated better performance than those who did not.
                The ability to use internal compensatory strategies may be a significant confound in research examining the effects of the various cognitive rehabilitation intervention methods. To develop and evaluate a systematic intervention programme for the management of impaired self-awareness (ISD) in people with traumatic brain injury.
                This study adopted a pre-test-post-test control group design. Twenty-one patients with traumatic brain injury were randomly assigned to an experimental group and a control group according to their admission sequence. The groups joined a newly developed Awareness Intervention Programme (AIP) and a conventional rehabilitation programme respectively for 4 weeks. Pre- and post-intervention outcome measures taken from the two groups were compared. Wilcoxon Signed-Ranks Tests were conducted to compare the within-group changes of the outcome measures of the Self-Awareness of Deficits Interview (SADI), the Functional Independence Measure (FIM) and the Lawton Instrumental Activities of Daily Living Score (Lawton IADL) in the control and experimental groups. Mann Whitney U-tests were conducted to compare the across-group differences of improvements of outcome measures between the participants in the two groups.
                After AIP training, the participants in the experimental group demonstrated significant improvement in their level of awareness as compared to the control group. However, the functional outcomes of the participants in experimental group did not show significant differences.
                The AIP can promote improvement in the level of self-awareness of people with traumatic brain injury. This new programme can be further developed to extend a better carryover treatment effect to functional improvement in daily activities. To examine the effects of working memory (WM) training in adult patients with stroke.
                A randomized pilot study with a treatment group and a passive control group; 18 participants (12 males) in a vocational age group (mean age 54 years) were randomized to either the treatment or the control condition. The intervention consisted of computerized training on various WM tasks for five weeks. A neuropsychological test battery and self-rating on cognitive functioning in daily life (the CFQ) were administered both before and after the treatment.
                Statistically significant training effects were found on the non-trained tests for WM and attention, i.e., tests that measure related cognitive functions but are not identical to tasks in the training programme (Span board p < 0.05; PASAT p < 0.001; Ruff 2&7 p < 0.005). There was a significant decrease in symptoms of cognitive problems as measured by the CFQ (p < 0.005). Conclusion: More than one year after a stroke, systematic WM training can significantly improve WM and attention. Traumatic brain injury (TBI) is a principal cause of death and disability in young adults. Rehabilitation for TBI has not received the same level of scientific scrutiny for efficacy and cost-efficiency that is expected in other medical fields.
                To evaluate the efficacy of inpatient cognitive rehabilitation for patients with TBI.
                Single-center, parallel-group, randomized trial conducted from January 1992 through February 1997 at a US military medical referral center.
                One hundred twenty active-duty military personnel who had sustained a moderate-to-severe closed head injury, manifested by a Glasgow Coma Scale score of 13 or less, or posttraumatic amnesia lasting at least 24 hours, or focal cerebral contusion or hemorrhage on computed tomography or magnetic resonance imaging.
                Patients were randomly assigned to an intensive, standardized, 8-week, in-hospital cognitive rehabilitation program (n=67) or a limited home rehabilitation program with weekly telephone support from a psychiatric nurse (n=53).
                Return to gainful employment and fitness for military duty at 1-year follow-up, compared by intervention group.
                At 1-year follow-up, there was no significant difference between patients who had received the intensive in-hospital cognitive rehabilitation program vs the limited home rehabilitation program in return to employment (90% vs 94%, respectively; P=.51; difference, 4% [95% confidence interval ¿CI¿, -5% to 14%]) or fitness for duty (73% vs 66%, respectively; P=. 43; difference, 7% [95% CI, -10% to 24%]). There also were no significant differences in cognitive, behavioral, or quality-of-life measures. In a post-hoc subset analysis of patients who were unconscious for more than 1 hour (n = 75) following TBI, the in-hospital group had a greater return-to-duty rate (80% vs 58%; P=. 05).
                In this study, the overall benefit of in-hospital cognitive rehabilitation for patients with moderate-to-severe TBI was similar to that of home rehabilitation. These findings emphasize the importance of conducting randomized trials to evaluate TBI rehabilitation interventions. JAMA. 2000;283:3075-3081 A multicenter randomized control trial (RCT) was conducted to evaluate the effects of a treatment for dysexecutive problems after acquired brain injury (ABI) on daily life functioning. Seventy-five ABI patients were randomly allocated to either the experimental treatment, multifaceted strategy training for executive dysfunction, or a control treatment, computerized cognitive function training. Assessment took place before, directly after, and 6 months post-treatment. The primary outcome measure, the Role Resumption List (RRL), and two other follow-up measures, the Treatment Goal Attainment (TGA) and the Executive Secretarial Task (EST), were indications of daily life executive functioning. The experimental group improved significantly more over time than the controls on the RRL and attained significantly higher scores on the TGA and EST. We conclude that our treatment has resulted in significant improvements of executive functioning in daily life, lasting at least 6 months post-treatment. Although control patients' satisfaction and subjective well-being were at the same level, the experimental group had better abilities to set and accomplish realistic goals, to plan, initiate, and regulate a series of real-life tasks, and to resume previous roles with respect to work, social relations, leisure activities, and mobility. To evaluate the effectiveness of comprehensive, holistic neuropsychologic (NP) rehabilitation compared with standard, multidisciplinary rehabilitation for people with traumatic brain injury (TBI).
                Randomized practical controlled trial.
                Postacute brain injury rehabilitation center within a suburban rehabilitation hospital.
                Participants with TBI were recruited from clinical referrals and referrals from the community. Sixty-eight participants who met inclusion criteria were randomly allocated to treatment conditions. Most participants (88%) had sustained moderate or severe TBI, and greater than half (57%) were more than 1 year postinjury at the beginning of treatment.
                Treatment was conducted 15 hours per week for 16 weeks. Standard neurorehabilitation consisted primarily of individual, discipline specific therapies (n=34). Intensive cognitive rehabilitation emphasized the integration of cognitive, interpersonal, and functional interventions within a therapeutic environment (n=34).
                Primary outcomes were the Community Integration Questionnaire (CIQ) and Perceived Quality of Life scale (PQOL). Secondary outcomes included NP functioning, perceived self-efficacy, and community-based employment.
                NP functioning improved in both conditions. Intensive cognitive rehabilitation participants showed greater improvements on the CIQ (effect size [ES]=0.59) and PQOL (ES=0.30) as well as improved self-efficacy for the management of symptoms (ES=0.26) compared with standard neurorehabilitation treatment. These gains were maintained at the 6-month follow-up. Standard neurorehabilitation participants showed improved productivity at the 6-month follow-up associated with the need for continued rehabilitation.
                Improvements seen after intensive cognitive rehabilitation may be related to interventions directed at the self-regulation of cognitive and emotional processes and the integrated treatment of cognitive, interpersonal, and functional skills. The results show the effectiveness of comprehensive holistic NP rehabilitation for improving community functioning and quality of life after TBI compared with standard rehabilitation.