EFNS guidelines on cognitive rehabilitation: report of an EFNS task force

Abstract

Disorders of language, spatial perception, attention, memory, calculation and praxis are a frequent consequence of acquired brain damage [in particular, stroke and traumatic brain injury (TBI)] and a major determinant of disability. The rehabilitation of aphasia and, more recently, of other cognitive disorders is an important area of neurological rehabilitation. We report here a review of the available evidence about effectiveness of cognitive rehabilitation. Given the limited number and generally low quality of randomized clinical trials (RCTs) in this area of therapeutic intervention, the Task Force considered, besides the available Cochrane reviews, evidence of lower classes which was critically analysed until a consensus was reached. In particular, we considered evidence from small group or single cases studies including an appropriate statistical evaluation of effect sizes. The general conclusion is that there is evidence to award a grade A, B or C recommendation to some forms of cognitive rehabilitation in patients with neuropsychological deficits in the post-acute stage after a focal brain lesion (stroke, TBI). These include aphasia therapy, rehabilitation of unilateral spatial neglect (ULN), attentional training in the post-acute stage after TBI, the use of electronic memory aids in memory disorders, and the treatment of apraxia with compensatory strategies. There is clearly a need for adequately designed studies in this area, which should take into account specific problems such as patient heterogeneity and treatment standardization.

Recovery after brain damage: Is there any indication for generalization between different cognitive functions?

“…On the other hand, Redick et al (2013) and Dunning, Holmes, and Gathercole (2013), found no transfer effects of working memory training on tests of other cognitive functions. Treatment of attention deficits in order to increase memory performance after organic brain damage has been investigated, partly with positive (Cappa et al, 2005;Malia et al, 2004;Gauggel & Niemann, 1996), and partly with negative results (Hildebrandt, BussmannMork, & Schwendemann, 2006;Spahn et al, 2010). The results of this study are in line with studies reporting negative findings.…”

“…The search for generalization effects of cognitive improvement traditionally relies on interventional studies, treating, for instance, attention in order to also induce improvement in memory (Cappa et al, 2005;Gauggel & Niemann, 1996;Malia et al, 2004;Spahn et al, 2010). Other methods to look for factors implicated in recovery are regression analyses and/or other multivariate statistical tests.…”

“…There is some evidence that working memory plays such a role (review in: Klingberg, 2010) as it may be a fundamental resource to work with memory, reasoning abilities, and so on. Attentional skills are also often regarded as the underlying basis of all other cognitive skills (Cappa et al, 2005;Malia et al, 2004). Robertson, Ridgeway, Greenfield, and Parr (1997) demonstrated that performance in sustained attention 2 months after stroke was a good predictor for improvement in motor recovery and functional status in brain-damaged patients.…”

Feasibility of a Mobile Cognitive Intervention in Childhood Absence Epilepsy

“…Cognitive rehabilitation focuses on restoring impaired function via repeated skills practice and facilitating compensation for deficits through instruction in cognitive strategies (Kesler et al, 2011). Cognitive rehabilitation has been well-studied as an intervention following traumatic brain injury or stroke, with sufficient evidence to support its use as a therapeutic too (Cicerone et al, 2000; Cappa et al, 2005). However, the study of cognitive rehabilitation in epilepsy has been limited, especially in children, and clinically only 23% of children with CAE receive any kind of intervention to help with their school struggles (Caplan et al, 2008).…”

Outcomes after Cognitive Perceptual Motor Retraining (CPM) of Patients with Acquired Brain Injury (ABI)

“…Therapeutic activities include those similarly used in cognitive rehabilitation (Cappa et al, 2005;Helmick, 2010), such as process, strategy and functional training activities, errorless learning, and awareness training (Golisz, 2009;Malia et al, 2004;Ueno et al, 2009). Other goals include increasing tactile sensitivity and other visual-spatial, tactilekinesthetic, and fine motor skills.…”