Randomized Controlled Trials in Cognitive Rehabilitation for Adults with Traumatic Brain Injury

Approximately, 5.3 million Americans with traumatic brain injury (TBI) are living with long-term disabilities. Cognitive rehabilitation is a common treatment to restore neurobehavioral and psychosocial function following TBI. We conducted a comprehensive literature review on randomized controlled trials (RCTs) for adult TBI over the past 30 years during the post-acute recovery phase. Our aims were to (1) understand the needs of the heterogeneous TBI population, (2) study trends, commonality and differences among different cognitive rehabilitation interventions and (3) optimize strategies for effective care. Medline, PsycINFO and CINAHL databases were searched, yielding 1176 peer reviewed publications. Of those, 45 RCTs were conducted during the post-acute phase. Twenty-four were cognitive rehabilitation trials, which were classified as comprehensive interdisciplinary models, cognitive or academic exercises and communication skills training, compensatory techniques and computer-assisted training, education, and psychotherapy and behavior modification. The results indicated 22 out of 24 RCTs produced positive treatment effects in various settings. Several trends are worth noting: (1) multidisciplinary inpatient cognitive rehabilitation approaches appeared more effective than the standard programs among moderate and severe TBI samples; (2) higher intensity of rehabilitation treatment was more effective than less intensive methods; and (3) early educational counseling was helpful in reducing TBI-related symptoms with significantly better overall outcomes even with single session treatment. However, the evidence gathered is mostly from small and less representative samples. Moreover, lack of uniformity in data collection, well defined treatment windows and common outcome measurements made the study applications less generalizable and the comparison between these studies difficult.