Development of Rehabilitation of Eclectic Cognitive Functioning Post-Traumatic Brain Injury to Retrain and Restore Attention, Concentration, Memory and Executive Functions (RETRACE)

Abstract

BackgroundTraumatic brain injury (TBI) incapacitates nearly 3.5 million Indians and can result in a host of physical, cognitive, social, emotional and behavioural problems. Neuropsychological rehabilitation (NR) aids in amelioration of these deficits. As people with low literacy levels represent a significant proportion of the world, specific cognitive rehabilitation modules for such populations are indispensable. A standardised, economical NR intervention may assist in faster recovery.MethodsThe study was initiated after obtaining institute ethics approval and the Clinical Trials Registry – India clearance. A 6-week indigenised literacy-free NR intervention Rehabilitation of Eclectic Cognitive Functioning post Traumatic Brain Injury to Retrain and Restore Attention, Concentration, Memory and Executive Functions (RETRACE) was developed. This intervention targeted areas of memory, attention and concentration, executive functioning, and response inhibition. It was standardised on 50 healthy controls and 18 patients. Prior to recruitment, a written informed consent was obtained from each patient, their primary caregiver and the healthy controls.ResultsIndividuals were divided into four groups based on their education levels: illiterates; 1–9 years, 10–14 years; and >15 years. All the outcomes for each of the four cognitive domains in the intervention did not have any significant difference for errors committed among the healthy controls with respect to different levels of education. The performance of patients with the healthy controls on all the four cognitive domains revealed a significant difference in each.ConclusionsRETRACE covers major areas of cognitive impairment that affects an individual’s social, vocational and personal quality of life after brain injury. This intervention is feasible to administer and may help alleviating cognitive complaints after brain injury in low literate or mixed cultural populations. RETRACE is simple to score and can be done easily at the patient’s home under the supervision of the patient’s caregiver. Further study of its efficacy in a randomised trial is already underway.