Intervention for executive functions after traumatic brain injury: A systematic review, meta-analysis and clinical recommendations

Abstract

A systematic review of studies that focused on the executive functions of problem solving, planning, organising and multitasking by adults with traumatic brain injury (TBI) was performed through 2004. Qualitative and quantitative methods were used to evaluate the 15 studies that met inclusion criteria. Demographic variables, design and intervention features, and impairment and activity/participation outcomes (ICF) (World Health Organization, 2001) were documented. Five randomised control treatment (RCT) studies used step-by-step, metacognitive strategy instruction (MSI) and outcomes were evaluated in a meta-analysis. Effect sizes (ESs) from immediate impairment outcomes after MSI and "control" intervention were similar to each other, and both were significantly larger than chance. ESs from immediate activity/participation outcomes after MSI were significantly larger than the ESs from control intervention, and both were significantly larger than chance. These results, along with positive outcomes from the other group, single-subject design and single case studies, provided sufficient evidence to make the clinical recommendation that MSI should be used with young to middle-aged adults with TBI, when improvement in everyday, functional problems is the goal (Level A) (American Academy of Neurology, 2004). Although maintenance effects were generally positive, there was insufficient data quantitatively to evaluate this. Furthermore, there was insufficient evidence to make clinical recommendations for children or older adults. Intervention that trained verbal reasoning and multi-tasking was promising, although the evidence is insufficient to make clinical recommendations at this time. Additional research needs were highlighted.

A Voxel-Based Analysis of FDG-PET in Traumatic Brain Injury: Regional Metabolism and Relationship between the Thalamus and Cortical Areas

“…To date, several studies have demonstrated the importance of preserving frontal metabolism in patients who have suffered a TBI. [13][14] Damage to the frontal lobe and its connections are particularly detrimental and compromise long-term outcome by interfering with the restoration of normal personality, occupational function and community reintegration. Given the recognized importance of the fronto-thalamic connectivity, it was not surprising that the hypometabolism detected in this system appeared to be the most relevant dysfunction of our sample, with the expected resultant clinical implications.…”

“…[32] In the case of the frontal cortex, the differences found between the healthy controls and the patients who had recovered from PTA again highlight the importance of the normal functioning of the frontal cortex in the final outcome after TBI. [13][14] The different evolution of the metabolism of these two cortical structures could also be due to differences in the distribution of lesions detected by structural imaging or to the classification criteria used in this study. It is possible that a classification based on more specific criteria, which are directly related to the functionality of these areas, would have yielded different results.…”

“…Characteristically, damage to these regions has been linked to deficits in complex neurocognitive functioning and behavioral changes that lead to a reduced functional recovery after a TBI. [13][14] In this paper, we extend our analysis to other structures of the cerebral cortex, including the frontal cortex, temporal cortex and precuneus. Our aim was to study the integrity of the connections between these cortical structures and the connections that are established between these cortical structures and deep brain structures such as the thalamus.…”

Rehabilitation of Executive Functions in Patients with Chronic Acquired Brain Injury with Goal Management Training, External Cuing, and Emotional Regulation: A Randomized Controlled Trial

“…Although the effectiveness of cognitive rehabilitation is documented within some domains following ABI, there is still a paucity of empirical evidence for the efficacy of interventions for rehabilitation of EF (Cicerone et al, 2011;Rees, Marshall, Hartridge, Mackie & Weiser, 2007; Wilson, 2008). Reviews recommend metacognitive strategy training including self-monitoring and self-regulation as practice standard following ED due to traumatic brain injury (TBI) (Cicerone et al, 2011;Kennedy et al, 2008). Promising results have been reported for (Coull, 1995;Smith & Nutt, 1996).…”

Treating reading comprehension deficits in sub-acute brain injury rehabilitation: Identifying clinical practice and management

“…In other populations (including education, learning difficulties and adult literacy) [60][61][62][63][64][65] reading strategies are well researched and have a strong evidence base. Within ABI cognitive rehabilitation, strategy use is a common intervention 91,92 , with strong evidence for metacognitive strategy instruction 93 . It should therefore not be surprising to see clinicians utilising strategies as common practice in the rehabilitation of CCRC deficits.…”