Cognitive Rehabilitation For People Research Articles

Dynamic Changes in Brain Perfusion after Cognitive Rehabilitation in Patients with Type 1 and Type 2 Diabetes Mellitus

INTRODUCTION: The results of numerous studies indicate a high prevalence of cognitive impairment among patients with diabetes mellitus (DM).
 AIM: To evaluate the effectiveness of computerized training in cognitive rehabilitation in individuals with type 1 and type 2 DM, taking into account the dynamics of brain perfusion.
 MATERIALS AND METHODS: A randomized controlled study. The study group consisted of 25 patients with type 1 DM and 30 patients with type 2 DM aged 23 to 67 years. The comparison group included 20 patients with type 1 DM (mean age 28.4 years) and 20 patients with type 2 DM (mean age 56.0 years). Before and after the rehabilitation course, the patients of the study group underwent a general clinical examination, a blood test for carbohydrate metabolism, cognitive function testing using the Montreal Scale (MoCA test), contrast-free perfusion magnetic resonance imaging (MRI) of the brain. Active rehabilitation lasted 6 month; it was based on a computerized training, including exercises on verbal and nonverbal intelligence.
 RESULTS: On the initial examination, all the subjects did not have the achieved target level of glycated hemoglobin. After completion of the training program, a decrease in the parameter in both groups was noted, as well as a decrease in the mean level of fasting glycemia in people with type 1 DM. The result of neuropsychological testing in all patients at the initial stage corresponded to the diagnosis of ‘cognitive dysfunction’. The control test revealed an improvement in cognitive status according to the overall score, the abstraction scale, speech, memory and visual-constructive skills. Correlation analysis in the group with type 1 DM showed that the result of exercises on visual attention and auditory perception was influenced by memory function. In individuals with type 2 DM, increased glycated hemoglobin was associated with a decrease in cognitive functions according to the overall score of the MoCA test, as well as in tasks for speech, memory, visual-constructive skills. Dynamic analysis of changes in the MRI picture revealed hypoperfusion in the area of the right and left thalamus in patients with type 1 and type 2 DM, respectively, as well as increased perfusion of the white matter of the right parietal lobe in the group with type 1 DM, and in the putamen area on the left in the group with type 2 DM.
 CONCLUSION: In patients with type 1 and type 2 DM, as well as with cognitive deficit, who underwent a course of cognitive rehabilitation using computerized training, an improvement in cognitive status was noted, which was confirmed by the results of contrast-free perfusion MRI. to evaluate the effectiveness of computerized training in cognitive rehabilitation in people with type 1 and type 2 diabetes mellitus, taking into account the dynamics of brain perfusion.

Aerobic physical exercise versus dual-task cognitive walking in cognitive rehabilitation of people with stroke: a randomized clinical trial.

Stroke is a neurological deficit caused by an acute focal injury to the central nervous system due to vascular injury that can result in loss of neurological function, lasting brain damage, long-term disability and, in some cases, death. The literature reports that aerobic physical exercise, as well as dual-task cognitive walking, are used for the cognitive recovery of people with stroke. We aimed to assess whether aerobic physical exercise influences post-stroke cognitive recovery, namely performance on selective and sustained attention. We tested the hypothesis that post-stroke aerobic physical exercise leads to more significant gains than post-stroke dual-task cognitive walking. We used a Randomized Clinical Trial, single-blind, parallel group, to verify the existence of differences between two groups. A total of 34 patients with subacute to chronic stroke were divided into two groups to train three times a week for 12 weeks: the aerobic physical exercise (PE) group engaged in 20 min on a treadmill, 20 min on a stationary bicycle and 5 min on a desk bike pedal exerciser per session; the dual-task (DT) gait exercise group walked for 45 min while simultaneously performing cognitive tasks per session. All participants were assessed on cognitive functioning with the Mini-Mental State Examination (MMSE) and d2 Test of Attention before acute interventions and post interventions. We have also applied a Visual Analog Scale to monitor the participants' perceived difficulty, pre-, post-acute, and post-chronic interventions. Participants also responded to a Borg Scale of perceived exertion following the acute and the final session of chronic training. A mixed model ANOVA revealed a significant interaction effect with a large effect size for most of the cognitive variables under study. The variables associated with the d2 Test of Attention showed significant differences between the groups, mainly from T0 to T2. Also for MMSE, an ANOVA revealed a significant interaction effect with significant improvements from T0 to T2. Our results strongly suggest that aerobic physical exercise is more beneficial than dual-task cognitive-gait exercise since in the PE group, cognitive attention scores increase, and cognitive impairment and perception of exertion decrease, compared to the DT group. These findings support that PE provides more significant benefits for patients post-stroke when compared to DT.

Person-Centered Goal Setting is Feasible in People With Parkinson's Disease Who Have Subjective Cognitive Decline

<h3>Research Objectives</h3> Evaluate the feasibility of person-centered goal setting in cognitive rehabilitation for people with Parkinson's disease (PD) and explore the characteristics of the formulated goals. <h3>Design</h3> Secondary analysis. <h3>Setting</h3> Community. <h3>Participants</h3> Thirty adults with PD who have subjective cognitive decline completed person-centered goal setting prior to participating in a cognitive intervention. <h3>Interventions</h3> Person-centered goal setting was delivered by occupational therapists as a part of two studies investigating a cognitive intervention. <h3>Main Outcome Measures</h3> The total mean number of formulated goals per participant, the importance level of each goal using a 10-point scale (1: not important – 10: very important), and goal domains and categories coded using a goal coding system developed based on the literature and Occupational Therapy Practice Framework (OTPF). Using the coding system, two researchers independently coded all goals. Discrepancies were resolved by consensus or in consultation with a senior researcher. <h3>Results</h3> Participants formulated a total of 166 goals. The mean number of formulated goals per participant was 5.53 (SD = 2.19, range = 3 – 10). The mean importance level of all formulated goals was 8.31 (SD = 1.5, range = 4 – 10). Eighty-seven percent of all formulated goals were scored 7 or higher importance level. At the individual level, twenty-eight participants developed at least three goals with a 7 or higher importance level, whereas the remaining two formulated only two goals with a 7 or higher importance level. Goals included diverse domains and categories as per the OTPF. The most common domains were occupations (45%) and client factors (22%). The most common categories were symptom and condition management (12%), higher-level cognitive (11%), and time management (11%). <h3>Conclusions</h3> Person-centered goal setting can guide people with PD who have subjective cognitive decline to formulate personally meaningful goals. Diverse domains and categories of goals highlight clients' multifaceted needs and potential priority areas for cognitive rehabilitation. Future studies can optimize the current goal setting approach to enhance personally meaningful goal formulation and evaluate its effectiveness to improve cognitive rehabilitation outcomes. <h3>Author(s) Disclosures</h3> No conflict of interest.

Limitations of the new ISO standard for health and wellness apps

Limitations of the new ISO standard for health and wellness apps

Memory rehabilitation for people with multiple sclerosis.

Problems with cognition, particularly memory, are common in people with multiple sclerosis (MS) and can affect their ability to complete daily activities and can negatively affect quality of life. Over the last few years, there has been considerable growth in the number of randomised controlled trials (RCTs) of memory rehabilitation in MS. To guide clinicians and researchers, this review provides an overview of the effectiveness of memory rehabilitation for people with MS. To determine whether people with MS who received memory rehabilitation compared to those who received no treatment, or an active control showed better immediate, intermediate, or longer-term outcomes in their: 1. memory functions, 2. other cognitive abilities, and 3. functional abilities, in terms of activities of daily living, mood, and quality of life. We searched CENTRAL which includes Clinicaltrials.gov, World Health Organization (The Whoqol) International Clinical Trials Registry Portal,Embase andPubMed (MEDLINE), and the following electronic databases (6 September 2020): CINAHL, LILACS, the NIHR Clinical Research Network Portfolio database, The Allied and Complementary Medicine Database, PsycINFO, and CAB Abstracts. We selected RCTs or quasi-RCTs of memory rehabilitation or cognitive rehabilitation for people with MS in which a memory rehabilitation treatment group was compared with a control group. Selection was conducted independently first and then confirmed through group discussion. We excluded studies that included participants whose memory deficits were the result of conditions other than MS, unless we could identify a subgroup of participants with MS with separate results. Eight review authors were involved in this update in terms of study selection, quality assessment, data extraction and manuscript review. We contacted investigators of primary studies for further information where required. We conducted data analysis and synthesis in accordance with Cochrane methods. We performed a 'best evidence' synthesis based on the methodological quality of the primary studies included. Outcomes were considered separately for 'immediate' (within the first month after completion of intervention), 'intermediate' (one to six months), and 'longer-term' (more than six months) time points. We added 29 studies during this update, bringing the total to 44 studies, involving 2714 participants. The interventions involved various memory retraining techniques, such as computerised programmes and training on using internal and external memory aids. Control groups varied in format from assessment-only groups, discussion and games, non-specific cognitive retraining, and attention or visuospatial training. The risk of bias amongst the included studies was generally low, but we found eight studies to have high risk of bias related to certain aspects of their methodology. In this abstract, we are only reporting outcomes at the intermediate timepoint (i.e., between one and six months). We found a slight difference between groups for subjective memory (SMD 0.23, 95% CI 0.11 to 0.35; 11 studies; 1045 participants; high-quality evidence) and quality of life (SMD 0.30, 95% CI 0.02 to 0.58; 6 studies; 683 participants; high-quality evidence) favoring the memory rehabilitation group. There was a small difference between groups for verbal memory (SMD 0.25, 95% CI 0.11 to 0.40; 6 studies; 753 participants; low-quality evidence) and information processing (SMD 0.27, 95% CI 0.00 to 0.54; 8 studies; 933 participants; low-quality evidence), favoring the memory rehabilitation group. We found little to no difference between groups for visual memory (SMD 0.20, 95% CI -0.11 to 0.50; 6 studies; 751 participants; moderate-quality evidence), working memory (SMD 0.16, 95% CI -0.09 to 0.40; 8 studies; 821 participants; moderate-quality evidence), or activities of daily living (SMD 0.06, 95% CI -0.36 to 0.24; 4 studies; 400 participants; high-quality evidence). AUTHORS' CONCLUSIONS: There is evidence to support the effectiveness of memory rehabilitation on some outcomes assessed in this review at intermediate follow-up. The evidence suggests that memory rehabilitation results in between-group differences favoring the memory rehabilitation group at the intermediate time point for subjective memory, verbal memory, information processing, and quality of life outcomes, suggesting that memory rehabilitation is beneficial and meaningful to people with MS. There are differential effects of memory rehabilitation based on the quality of the trials, with studies of high risk of bias inflating (positive) outcomes. Further robust, large-scale, multi-centre RCTs, with better quality reporting, using ecologically valid outcome assessments (including health economic outcomes) assessed at longer-term time points are still needed to be certain about the effectiveness of memory rehabilitation in people with MS.

Evidence-Based Cognitive Rehabilitation for People With Multiple Sclerosis: A Systematic Review

Abstract Date Presented 04/22/21 Computer-based programs, conventional cognitive rehabilitation, neurologic music therapy, and noninvasive brain stimulation are effective in improving memory and learning, processing speed, language, executive function, or general cognitive skills. However, the retention of treatment effects and the generalizability of the cognitive improvement to the daily occupations are not clear. Including a predetermined single outcome, functional and long-term outcomes are needed in future studies. Primary Author and Speaker: Yu-Chih Chen Contributing Authors: Nicole Gerhardt, Christina Calhoun Thielen, Winnie Dunn, and Mary Jane Mulcahey

Менеджмент когнітивних симптомів та реабілітаційна терапія (CogSMART) при черепно-мозковій травмі. Посібник для фахівців (україномовна версія). 3 частина: сесії 9-12

CogSMART is a cognitive training program for people with traumatic brain injury (TBI). It aims to improve the skills of perspective memory, attention, executive functions (problem solving, planning, cognitive flexibility) in order to more successfully perform daily activities and achieve personal, work and study goals. CogSMART is based not on a large number of trainings and tasks, but on a compensatory cognitive training — improving cognitive skills by using certain adaptation strategies and removing obstacles. The use of CogSMART has already shown good results in the cognitive rehabilitation of people with traumatic brain injury in the United States. The translation of the manual was performed by specialists of the Kyiv City Clinical Hospital for War Veterans with further scientific editing of the text by professors of the Department of Medical Psychology, Psychosomatic Medicine and Psychotherapy at Bogomolets National Medical University. With the permission of Dr. Elizabeth Twamley, the author of the original program, the Ukrainian version of the manual is published in the journal and is available for Ukrainian-speaking audience. The program contains 12 sessions. Sessions 1-4 can be found in the first part of the translated manual via this link. Sessions 5-8 can be found in the second part of the translated manual via this link. This part of the Ukrainian version of the manual presents sessions 9-12 of the CogSMART program. The 9th session is dedicated to learning and memory, is a logical continuation of the 8th session. Participants can learn about new memorization strategies and practice them during group tasks. Session 10 is dedicated to problem solving and cognitive flexibility. Participants will be able to get acquainted with brainstorming strategies and a six-step method of solving problems. The 11th session is a logical continuation of the 10th session and is also dedicated to problem solving and cognitive flexibility. Participants will have the opportunity to learn verbal strategies, hypothesis testing and other skills that will be helpful during planning activities. The 12th session is the final one, during which the results of the CogSMART sessions are summed up and further perspectives and ways of development are discussed.

Менеджмент когнітивних симптомів та реабілітаційна терапія (CogSMART) при черепно-мозковій травмі. Посібник для фахівців (україномовна версія). 2 частина: сесії 5-8

CogSMART is a cognitive training program for people with traumatic brain injury (TBI). It aims to improve the skills of perspective memory, attention, executive functions (problem solving, planning, cognitive flexibility) in order to more successfully perform daily activities and achieve personal, work and study goals. CogSMART is based not on a large number of trainings and tasks, but on a compensatory cognitive training — improving cognitive skills by using certain adaptation strategies and removing obstacles. The use of CogSMART has already shown good results in the cognitive rehabilitation of people with traumatic brain injury in the United States. The translation of the manual was performed by specialists of the Kyiv City Clinical Hospital for War Veterans with further scientific editing of the text by professors of the Department of Medical Psychology, Psychosomatic Medicine and Psychotherapy at Bogomolets National Medical University. With the permission of Dr. Elizabeth Twamley, the author of the original program, the Ukrainian version of the manual is published in the journal and is available for Ukrainian-speaking audience. The program contains 12 sessions. This part of the Ukrainian version of the manual presents the sessions 5 – 8 of CogSMART. Sessions 1 - 4 can be found in the first part of the translated manual via this link. This part of the Ukrainian version of the manual presents sessions 5 - 8 of the CogSMART program. The 5th session is dedicated to the training of perspective memory, and is a logical continuation of the 4th session. Participants can learn how to effectively use the calendar and link tasks, as well as train making to-do lists and other short-term memory strategies. Session 6 focuses on attention and concentration. In this session, participants can learn about concentration difficulties after traumatic brain injury and practice strategies to improve attention skills. Session 7 continues the analysis of attention. In this session, participants can master the skills of vigilance during a conversation and discuss how strategies for focusing can help with long-term goals. Session 8 is dedicated to learning and memory. It aims to introduce the concepts of memory, to train new strategies for memorizing information. This material can be useful for clinical psychologists, occupational therapists, psychotherapists and specialists in related fields who help people with traumatic brain injury and conduct a cognitive rehabilitation or cognitive training.

Methodological Designs Applied in the Development of Computer-Based Training Programs for the Cognitive Rehabilitation in People with Mild Cognitive Impairment (MCI) and Mild Dementia. Systematic Review.

In recent years, different computer-based cognitive training (CT) programs for people with dementia (PwD) have been developed following a psychosocial approach. Aim: This systematic review aims to identify the methodological designs applied in the development of computer-based training (CCT) programs for the rehabilitation of cognitive functioning in people with mild cognitive impairment (MCI) or mild dementia. Methods: A systematic review was conducted using the databases PubMed and PsycINFO. The search period was between 2000–2019. The study selection and data extraction processes were carried out by two independent reviewers. The protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42020159027. Results: Thirteen studies met the inclusion criteria. The most frequently used methodological design in the development of CCT programs for people with MCI or mild dementia was the user-centered design (UCD). This design involves an interactive system characterized by the inclusion of end users from the initial stages of its development, throughout the establishment of functional requirements, and in the evaluation of the program’s usability and user-experience (UX). Conclusion: UCD was the most used methodological design for the development of CCT programs although there was quite some variation in how this design was applied. Recommendations for future studies about the development of CCT programs for people with MCI and mild dementia are given. Central focus should be the inclusion and active participation of end users from the initial stages of development.

Computer-based cognitive rehabilitation program GRADIOR for mild dementia and mild cognitive impairment: new features

BackgroundThe growing number of older people and, with it, the increase of neurological impairments such as dementia has led to the implementation of the use of computer programs for cognitive rehabilitation in people with dementia. For 20 years, we have been developing the GRADIOR cognitive rehabilitation program and conducted several studies associated with its usability and effectiveness. This paper describes the development of the latest version of the GRADIOR computer-based cognitive rehabilitation program for people with different neurological etiologies, especially mild cognitive impairment and mild dementia.ResultsGRADIOR is a program that allows cognitive evaluation and rehabilitation of people affected by cognitive impairment. The new version of GRADIOR is characterized by a structure that is dynamic and flexible for both user and therapist, consisting of: Clinical Manager, Clinical History Manager, Treatment Manager and Report Manager. As a structure based on specific requirements, GRADIOR includes a series of modalities and sub-modalities, each modality comprising a series of exercises with different difficulty levels.DiscussionPrevious studies associated with earlier versions of GRADIOR have allowed the development of a new version of GRADIOR. Taking into account aspects associated with user experience, usability and effectiveness. Aspects that have made it possible to achieve a program that can meet the needs of older people with dementia.

Neuropsychological management of multiple sclerosis: evaluation of a supervised and customized cognitive rehabilitation program for self-used at home (SEPIA): protocol for a randomized controlled trial

BackgroundCognitive and mood disorders negatively impact daily life in patients with multiple sclerosis (MS). Pharmacological treatments did not demonstrate any effect on cognition compared with cognitive rehabilitation (CR). However, if CR programs offer promising results on cognition, they are less consistent concerning mood and quality of life (QoL). In this context, we designed a randomized controlled trial to evaluate the efficacy of an innovative computerized CR program, conducted at home, on QoL. Secondary objectives will estimate the improvement, or the stabilization over time, of patients’ cognitive performances and their emotional affects.MethodsForty MS patients (relapsing-remitting or secondary progressive forms) who have cognitive impairment will be recruited for the trial (called SEPIA-NCT03471338) and randomly assigned to either the experimental group or the control group. Patients randomly assigned in the experimental group will perform a home-based CR program with psychological support during eight consecutive weeks. CR will be based on computerized cognitive exercises from the PRESCO® software developed by HAPPYneuron©. Training sessions (three sessions of 45 min per week) will consist of short exercises evaluating a broad range of cognitive domains and will be personalized for each patient (tracking tool and supervised guidance). The control group, designed to control for non-specific elements of the intervention, will receive only psychological support consisting of various issues related to MS, such as everyday cognitive-related difficulties or management of emotions. QoL, assessed by the MUSIQOL (Multiple Sclerosis International Quality Of Life) questionnaire, will be evaluated three times (at baseline and after 1 week and 25 weeks after home-based intervention) as well as secondary outcomes measuring self-esteem, cognition, depression, anxiety, metacognition, fatigue, and sleep quality. Given the expected MUSIQOL variation, the inclusion of 20 patients per group (alpha risk 5% and power 80%) will be required.DiscussionEvidence suggests that computerized programs may be a practice option for CR for people with MS, but there is a paucity of studies evaluating QoL. We hope that this innovative program will highlight such benefits over time in patients’ daily life. In the future, such programs will allow a wider range of available therapeutic options for MS patients with cognitive impairment and for practitioners in charge of their care.Trial registrationClinicalTrials.gov identifier: NCT03471338. Retrospectively registered on 25 April 2018. https://clinicaltrials.gov/ct2/show/NCT03471338?term=NCT03471338&cond=Multiple+Sclerosis&draw=2&rank=1.

Cognitive rehabilitation for people with mild to moderate dementia

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effects of cognitive rehabilitation on everyday functioning and other outcomes for people with mild to moderate dementia, and on outcomes for caregivers To identify and explore factors that may be associated with the efficacy of cognitive rehabilitation.

Functional Connectivity with the Default Mode Network Predicts Efficacy of Cognitive Rehabilitation in People with Multiple Sclerosis (P5.2-043)

Functional Connectivity with the Default Mode Network Predicts Efficacy of Cognitive Rehabilitation in People with Multiple Sclerosis (P5.2-043)

Virtual Reality and Cognitive Rehabilitation in People With Stroke: An Overview.

This review evaluates the use of virtual reality (VR) tools in cognitive rehabilitation of stroke-affected individuals. Studies performed between 2010 and 2017 that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the terms "VR," "rehabilitation," and "stroke." Stroke patients experienced significant improvement in many cognitive domains (such as executive and visual-spatial abilities and speech, attention, and memory skills) after the use of VR training. Rehabilitation using new VR tools could positively affect stroke patient cognitive outcomes by boosting motivation and participation.

Psychological diagnosis and quantitative electroencephalography analysis in cognitive rehabilitation for people with Down syndrome

U radu se predstavlja mogućnost primjene QEEG-a u psihološkoj obradi osoba s Downovim sindromom. Primijenjeni su testovi Mitsar EEG 202 i SON-R (2.5-7). U ispitivanju je sudjelovalo dvadeset ispitanika s Downovim sindromom. Detaljno su analizirani rezultati osamnaestogodišnje muške osobe. Rezultati su uputili na prenaglašenu ekspresivnost, posebice theta valova (4-6 Hz) registriranih u čeonom i tjemenom režnju. Podaci prikupljeni tijekom psihološke obrade potvrđuju iste rezultate QEEG-a kod pacijenta. Također iznose se pretpostavke neurofeedback-treninga i tipova zadataka koji bi se trebali upotrebljavati u kognitivnoj rehabilitaciji.

An Intelligent Assistive Tool Using Exergaming and Response Surface Methodology for Patients With Brain Disorders

Intelligent assistive technologies represent a concept that refers to products and services that can offset functional limitations, facilitate independent life, improve their quality of life, and enable people with disabilities to reach their own potential. This paper presents a medical recovery exergaming that includes a Microsoft Kinect Motion Sensor, designed for upper limb rehabilitation, especially for old people with brain disorders. The game is 3D and during the game, the user has to pick up the red or green apples according to a level, and different angles of inclination of the neck, hand, shoulder, and so on are measured and then a total score is generated. To know if the patient has progressed in his medical recovery, the final score should be increased. In order to find the score that a subject without a locomotor system disorder can achieve, we have optimized the game with mathematical modeling and canonical analysis by applying response surface methodology and multiple nonlinear regression. The exergaming based on VR active games represents a useful tool in physical and cognitive rehabilitation for people with motor impairments or brain disorders, considering the advantage of home-training.

Reporting interventions in trials evaluating cognitive rehabilitation in people with multiple sclerosis: a systematic review

Objective: To determine the quantity and quality of description of cognitive rehabilitation for cognitive deficits in people with multiple sclerosis, using a variety of published checklists, and suggest ways of improving the reporting of these interventions. Data sources: A total of 10 electronic databases were searched, including MEDLINE, EMBASE, CINAHL and PsycINFO, from inception to May 2017. Grey literature databases, trial registers, reference lists and author citations were also searched. Review methods: Papers were included if participants were people with multiple sclerosis aged 18 years and over and if the effectiveness of cognitive rehabilitation in improving functional ability for memory, attention or executive dysfunction, with or without a control group, was being evaluated. Results: A total of 54 studies were included in this review. The reporting of a number of key aspects of cognitive rehabilitation was poor. This was particularly in relation to content of interventions (reported completely in 26 of the 54 studies), intervention procedures (reported completely in 16 of the 54 studies), delivery mode (reported completely in 24 of the 54 studies) and intervention mechanism of action (reported completely in 21 of the 54 studies). Conclusion: The quality of reporting of cognitive rehabilitation for memory, attention and executive function for multiple sclerosis, across a range of study designs, is poor. Existing reporting checklists do not adequately cover aspects relevant to cognitive rehabilitation, such as the approaches used to address cognitive deficits. Future checklists could consider these aspects we have identified in this review.

Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes.

Cognitive impairment in people with traumatic brain injury (TBI) could affect multiple facets of their daily functioning. Cognitive rehabilitation brings about clinically significant improvement in certain cognitive skills. However, it is uncertain if these improved cognitive skills lead to betterments in other key aspects of daily living. We evaluated whether cognitive rehabilitation for people with TBI improves return to work, independence in daily activities, community integration and quality of life. To evaluate the effects of cognitive rehabilitation on return to work, independence in daily activities, community integration (occupational outcomes) and quality of life in people with traumatic brain injury, and to determine which cognitive rehabilitation strategy better achieves these outcomes. We searched CENTRAL (the Cochrane Library; 2017, Issue 3), MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), and clinical trials registries up to 30 March 2017. We identified all available randomized controlled trials of cognitive rehabilitation compared with any other non-pharmacological intervention for people with TBI. We included studies that reported at least one outcome related to : return to work, independence in activities of daily living (ADL), community integration and quality of life. Two review authors independently selected trials. We used standard methodological procedures expected by Cochrane. We evaluated heterogeneity among the included studies and performed meta-analysis only when we could include more than one study in a comparison. We used the online computer programme GRADEpro to assess the quality of evidence, and generate 'Summary of findings' tables. We included nine studies with 790 participants. Three trials (160 participants) compared cognitive rehabilitation versus no treatment, four trials (144 participants) compared cognitive rehabilitation versus conventional treatment, one trial (120 participants) compared hospital-based cognitive rehabilitation versus home programme and one trial (366 participants) compared one cognitive strategy versus another. Among the included studies, we judged three to be of low risk of bias.There was no difference between cognitive rehabilitation and no intervention in return to work (risk ratio (RR) 1.80, 95% confidence interval (CI) 0.74 to 4.39, 1 study; very low-quality evidence). There was no difference between biweekly cognitive rehabilitation for eight weeks and no treatment in community integration (Sydney Psychosocial Reintegration Scale): mean difference (MD) -2.90, 95% CI -12.57 to 6.77, 1 study; low-quality evidence). There was no difference in quality of life between cognitive rehabilitation and no intervention immediately following the 12-week intervention(MD 0.30, 95% CI -0.18 to 0.78, 1 study; low-quality evidence). No study reported effects on independence in ADL.There was no difference between cognitive rehabilitation and conventional treatment in return to work status at six months' follow-up in one study (RR 1.43, 95% CI 0.87 to 2.33; low-quality evidence); independence in ADL at three to four weeks' follow-up in two studies (standardized mean difference (SMD) -0.01, 95% CI -0.62 to 0.61; very low-quality evidence); community integration at three weeks' to six months' follow-up in three studies (Community Integration Questionnaire: MD 0.05, 95% CI -1.51 to 1.62; low-quality evidence) and quality of life at six months' follow-up in one study (Perceived Quality of Life scale: MD 6.50, 95% CI -2.57 to 15.57; moderate-quality evidence).For active duty military personnel with moderate-to-severe closed head injury, there was no difference between eight weeks of cognitive rehabilitation administered as a home programme and hospital-based cognitive rehabilitation in achieving return to work at one year' follow-up in one study (RR 0.95, 95% CI 0.85 to 1.05; moderate-quality evidence). The study did not report effects on independence in ADL, community integration or quality of life.There was no difference between one cognitive rehabilitation strategy (cognitive didactic) and another (functional experiential) for adult veterans or active duty military service personnel with moderate-to-severe TBI (one study with 366 participants and one year' follow-up) on return to work (RR 1.10, 95% CI 0.83 to 1.46; moderate-quality evidence), or on independence in ADL (RR 0.90, 95% CI 0.75 to 1.08; low-quality evidence). The study did not report effects on community integration or quality of life.None of the studies reported adverse effects of cognitive rehabilitation. There is insufficient good-quality evidence to support the role of cognitive rehabilitation when compared to no intervention or conventional rehabilitation in improving return to work, independence in ADL, community integration or quality of life in adults with TBI. There is moderate-quality evidence that cognitive rehabilitation provided as a home programme is similar to hospital-based cognitive rehabilitation in improving return to work status among active duty military personnel with moderate-to-severe TBI. Moderate-quality evidence suggests that one cognitive rehabilitation strategy (cognitive didactic) is no better than another (functional experiential) in achieving return to work in veterans or military personnel with TBI.

The Effect of Music Therapy on Cognitive Rehabilitation for People with Dementia: A Systematic Review and Meta-Analysis

The Effect of Music Therapy on Cognitive Rehabilitation for People with Dementia: A Systematic Review and Meta-Analysis

Memory rehabilitation for people with multiple sclerosis.

Memory rehabilitation for people with multiple sclerosis.