Computer-Based Cognitive Rehabilitation Interventions for Traumatic Brain Injury: A Critical Review of the Literature

Abstract

Background Computer-based interventions have been developed to improve cognitive performance after mild traumatic brain injury, however, a thorough evaluation of this body of research has not been addressed in the literature. Objectives To provide a synthesis and critical review of current research studies that have tested the efficacy of computer-based interventions on cognitive performance after mild traumatic brain injury. Methods A critical review was conducted by identifying relevant studies in the electronic databases PubMed/Medline, PsycInfo and CINAHL from 2011 to the present. Due to the limited number of publications focused exclusively on mild traumatic brain injury, research studies that assessed the impact of computer-based interventions on cognitive outcomes in populations with acquired brain injury were included. Results Of the 58 studies identified, only 10 publications included participants with mild traumatic brain injury. Overall, the identified studies did not use a standard method for assessing the severity of traumatic brain injury, many studies included participants with a wide variety of etiologies for acquired brain injury and used multiple measures of cognitive performance, which made comparisons difficult across studies. In addition to small sample sizes, the study samples were heterogeneous in regard to the number of prior traumatic brain injuries, time elapsed since injury, as well as age and gender distributions. Pre-injury comorbidities that may affect cognitive performance, such as depression, anxiety or learning disabilities, were often not assessed. Discussion There is weak evidence that computer-based interventions can improve working memory and cognitive function in individuals following mild traumatic brain injury. Due to the low-quality evidence, seminal questions remain regarding the optimal format, dosage, timing and duration of computer-based intervention for improving cognitive performance. Future studies should focus on using a strong research design, such as a prospective longitudinal, repeated measures study, with an adequate number of participants that meet mild traumatic brain injury criteria. Pre-injury comorbidities, cognitive reserve, time since injury, age and gender, should be addressed in the design as there may be differences in recovery time and mechanisms of cognitive plasticity among populations. Conclusions Overall, computer-based interventions appear promising as an approach to improve working memory in individuals with acquired brain injury. There is no evidence that currently available interventions are specific to mild traumatic brain injury. Well-designed research studies with adequate sample sizes are needed to assess the effect of computer-based interventions on cognitive performance after mild traumatic brain injury.

Cognitive Training in Young Patients With Traumatic Brain Injury: A Fixel-Based Analysis

“…Previous research has established the effectiveness of restorative cognitive training interventions in patients with acquired brain injury (ABI). 7,10,30 A detailed description of this training program and preliminary efficacy results are reported elsewhere. 26 In short, BrainGames is an iPad application that consists of 8 games designed to train different aspects of cognitive functioning, including sustained, selective, and divided attention, inhibitory control, cognitive flexibility, verbal and visuospatial working memory, updating, and processing speed.…”

“…Numerous recent studies and reviews highlighted that rehabilitative cognitive training programs are a promising approach for improving cognitive functioning in brain injury. [7][8][9][10] In addition, the biological mechanisms that underlie cognitive improvements are recently being mapped utilizing magnetic resonance imaging (MRI) techniques. Functional MRI (fMRI) studies have shown functional changes in brain regions after cognitive training (i.e.…”

Computer-based cognitive interventions in acquired brain injury: A systematic review and meta-analysis of randomized controlled trials

“…These findings are in line with previous works in ABI population. Fetta, Starkweather & Jill [13] conducted a systematic review on computer-based cognitive intervention in mild traumatic brain injury population. The authors concluded that there is weak evidence of improvement in working memory after intervention.…”

“…Although the trials included in these studies had methodological problems that could be improved, they showed a general positive small effect on cognition. Previous systematic reviews in mild traumatic brain injury [13], stroke [14] and ABI [15] population suggest that computer-based cognitive interventions might be effective, although the current available evidence is weak and methodologically flawed. To date, no meta-analysis has been performed on computer-based cognitive interventions for ABI.…”

Virtual Reality as a Vehicle to Empower Motor-Cognitive Neurorehabilitation

“…Despite the existence of several reviews and meta-analyses on VR for stroke ( Lohse et al, 2014 ; Gibbons et al, 2016 ; Laver et al, 2017 ), Parkinson disease ( Dockx et al, 2016 ), multiple sclerosis ( Massetti et al, 2016 ) and multiple neurological conditions ( Cano Porras et al, 2018 ), results about the effectiveness of VR-mediated training are yet inconclusive. One main reason for this is that many studies include small sample sizes as compared to the great variability of the tested clinical populations, which makes extremely difficult to control for other variables such lesion location and size, severity of impairments, phase of recovery and, importantly for cognitive functions, no separation between age or level of education ( Fetta et al, 2017 ). Another key factor is the choice (or lack) of the control group to compare the effect with: for instance, for home rehabilitation, if the effectiveness of a VR-mediated training (with the therapist remotely shaping and monitoring the training program) is compared to that of 1-to-1 therapy sessions of the same intensity and duration with a highly trained clinician, the non-inferiority of the VR-mediated training should be actually considered as a positive outcome, independently of other socio-economic advantages such as reduced costs.…”