Group Intervention Studies in the Cognitive Rehabilitation of Individuals with Traumatic Brain Injury: Challenges Faced by Researchers

Kennedy, Mary; Turkstra, Lyn S.

doi:10.1007/s11065-006-9012-8

Cited by 29 publications

(22 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…(f) Evidence-based medicine is rooted in the belief that the strongest evidence is based on RCTs, which control for biases better than other methodologies. Nevertheless, Kennedy and Turkstra (2006) noted that even though the RCT framework has been adopted by behavioral therapists it was originally designed for clinical drug trials, many features of which are not appropriate, practical, or relevant in behavioral intervention research. Moreover, RCTs were initially designed to measure change by using a restricted number of primary outcome measures.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, RCTs were initially designed to measure change by using a restricted number of primary outcome measures. Thus, due to the wide individual variability among clinical features following an ABI (with the consequent need to include multiple outcome measures) Kennedy and Turkstra (2006) concluded that a singlecase rather than an RCT approach might be useful to gather evidence for effective interventions. In fact, behavioral treatments applied during individually tailored interventions should provide the best available advice, especially in an inpatient/residential rehabilitation environment.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Rehabilitation Treatments for Adults with Behavioral and Psychosocial Disorders Following Acquired Brain Injury: A Systematic Review

2010

View full text Add to dashboard Cite

This review was aimed at systematically investigating the treatment efficacy and clinical effectiveness of neurobehavioral rehabilitation programs for adults with acquired brain injury and making evidence-based recommendations for the adoption of these rehabilitation trainings. Using a variety of search procedures, 63 studies were identified and reviewed using a set of questions about research methods, treatments, results and outcomes for the 1,094 participants. The 63 studies included treatments falling into three general categories: approaches based on applied behavior analysis, interventions based on cognitive-behavior therapy (CBT), and comprehensive-holistic rehabilitation programs (CHRPs). Considerable heterogeneity exists in the reviewed literature among treatment methods and within reported sample subjects. Despite the variety of methodological concerns, results indicate that the greatest overall improvement in psychosocial functioning is achieved by CHRP that can be considered a treatment standard for adults with behavioral and psychosocial disorders following acquired brain injury. Both approaches based on applied behavior analysis and CBT can be said to be evidence-based treatment options. However, findings raise questions about the role of uncontrolled factors in determining treatment effects and suggest the need for rigorous inclusion/exclusion criteria, with greater specification of theoretical basis, design, and contents of treatments for both interdisciplinary-comprehensive approaches and single-case methodologies.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rehabilitation Treatments for Adults with Behavioral and Psychosocial Disorders Following Acquired Brain Injury: A Systematic Review

2010

View full text Add to dashboard Cite

show abstract

“…In order for this to best happen, future research needs to carefully consider choices regarding the use of control groups, measurement strategies, and treatment modalities (Kennedy and Turkstra 2006). In the area of addiction treatment, additional questions include how cognitive rehabilitation, compensation, or retraining approaches are best integrated into current AUD treatments for which there is already empirical support for efficacy, how improvements in specific cognitive domains are conceptualized mechanistically with respect to other hypothesized active elements of treatment, whether cognitive enhancement should be offered universally or only to those with some threshold level of cognitive impairment, and whether benefits of cognitive intervention are moderated by other person and environmental characteristics of the client.…”

Section: Facilitating Recovery and Relations To Treatment Outcomesmentioning

confidence: 99%

A Role for Cognitive Rehabilitation in Increasing the Effectiveness of Treatment for Alcohol Use Disorders

2013

View full text Add to dashboard Cite

Neurocognitive impairments are prevalent in persons seeking treatment for alcohol use disorders (AUDs). These impairments and their physical, social, psychological and occupational consequences vary in severity across persons, much like those resulting from traumatic brain injury; however, due to their slower course of onset, alcohol-related cognitive impairments are often overlooked both within and outside of the treatment setting. Evidence suggests that cognitive impairments can impede treatment goals through their effects on treatment processes. Although some recovery of alcohol-related cognitive impairments often occurs after cessation of drinking (time-dependent recovery), the rate and extent of recovery is variable across cognitive domains and individuals. Following a long hiatus in scientific interest, a new generation of research aims to facilitate treatment process and improve AUD treatment outcomes by directly promoting cognitive recovery (experience-dependent recovery). This review updates knowledge about the nature and course of cognitive and brain impairments associated with AUD, including cognitive effects of adolescent AUD. We summarize current evidence for indirect and moderating relationships of cognitive impairment to treatment outcome, and discuss how advances in conceptual frameworks of brain-behavior relationships are fueling the development of novel AUD interventions that include techniques for cognitive remediation. Emerging evidence suggests that such interventions can be effective in promoting cognitive recovery in persons with AUD and other substance use disorders, and potentially increasing the efficacy of AUD treatments. Finally, translational approaches based on cognitive science, neurophysiology, and neuroscience research are considered as promising future directions for effective treatment development that includes cognitive rehabilitation.

show abstract

“…Mykhalovsky and Weir [38] caution against the standardization of clinical judgment and clinical care. Kennedy and Turkstra [28] further analyze a number of the limitations of relying on high levels of evidence, particularly the RCT. First, with large sample sizes, group heterogeneity may mask individual treatment benefits.…”

Section: Limitations Of the Rct In The Context Of Abi Rehabilitationmentioning

confidence: 99%

“…expertise in ABI), available time and funding and compliance, in addition to the varying cognitive and communication demands of home, work, or school [9,32,63]. While in earlier studies, severity of injury was used to equate experimental samples, it is now recognized that consideration of the cognitive, communication and behavioural profiles is necessary when comparing subjects [28,32]. To rely solely on a diagnosis of moderate-severe ABI is erroneous, as there can be many different presentations and needs that accompany this complex designation [66].…”

Section: Limitations Of the Rct In The Context Of Abi Rehabilitationmentioning

confidence: 99%

Perspectives on evidence based practice in ABI rehabilitation. “Relevant Research”: Who decides?

Wiseman-Hakes

MacDonald²,

Keightley

2010

NRE

View full text Add to dashboard Cite

Growing evidence suggests that acquired brain injury (ABI) rehabilitation and research should be guided by a philosophy that focuses on: restoration, compensation, function and participation in all aspects of daily life. Such a broad, more pluralistic approach influences ABI rehabilitation research at a number of levels, including both the generation of evidence, and in searching for, critiquing and applying the evidence to practice. The objective of evidence based medicine/practice (EBM/EBP) is to apply and integrate clinical expertise with evidence gained through systematic research and scientific inquiry to medical/clinical practice. While there is abundant literature debating the practical and sociological implications of EBP, there has been limited examination of EBP within the inherently complex nature of ABI rehabilitation and rehabilitation research. This paper provides a framework for clinical decision making regarding evidence based practice in the context of ABI rehab including: 1. A discussion of the purpose of evidence based practice, 2. Levels of evidence relevant to ABI rehabilitation research, and 3. A rationale for incorporating a broader, more pluralistic concept of evidence or "person-centred EBP". We conclude with a series of key questions for the evaluation and application of systematic reviews of the evidence in the context of ABI rehabilitation.

show abstract

Group Intervention Studies in the Cognitive Rehabilitation of Individuals with Traumatic Brain Injury: Challenges Faced by Researchers

Cited by 29 publications

References 24 publications

Rehabilitation Treatments for Adults with Behavioral and Psychosocial Disorders Following Acquired Brain Injury: A Systematic Review

Rehabilitation Treatments for Adults with Behavioral and Psychosocial Disorders Following Acquired Brain Injury: A Systematic Review

A Role for Cognitive Rehabilitation in Increasing the Effectiveness of Treatment for Alcohol Use Disorders

Perspectives on evidence based practice in ABI rehabilitation. “Relevant Research”: Who decides?

Contact Info

Product

Resources

About