Rehabilitation of the central executive of working memory after severe traumatic brain injury: two single-case studies.

UGECAM-Antenne UEROS, Hôpital Raymond Poincaré, Garches 92380, France.
Brain Injury (Impact Factor: 1.51). 07/2009; 23(6):585-94. DOI: 10.1080/02699050902970711
Source: PubMed

ABSTRACT A deficit of the central executive of working memory is a frequent finding in patients with severe traumatic brain injury (TBI). The objective of the present study was to assess the efficacy of a rehabilitation programme of the central executive after severe TBI.
An experimental single-case design was used in two patients with remote severe TBI suffering from an isolated central executive deficit. Outcome was assessed with specific working memory tests (spans, Brown Peterson, n-back), non-specific cognitive tasks requiring working memory (dual-task, arithmetic solving problem), an ecological questionnaire to assess generalization to everyday life and non-target tasks not requiring working memory, to assess the specificity of the therapy.
Performance was stable on two baseline sessions before therapy. For both patients, an improvement was found for target measures, mainly for central executive tasks, and for the questionnaire on attention failures in everyday life. In opposition, no change was found for non-target measures.
Improvement was not seemingly related to spontaneous recovery, nor to re-test effects. This study suggests that specific cognitive training may improve the central executive of working memory in patients with remote severe TBI.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OPINION STATEMENT: Traumatic brain injury (TBI) is a major public health problem with neurobehavioral sequelae contributing to the long-term disability that is often associated with the moderate to severe levels of injury. Rehabilitation of cognitive skills is central to encouraging the full participation of the individual in home, vocational, and social roles. The review of available evidence points to four major recommendations for the rehabilitation of cognition following brain injury: 1) Access to subacute rehabilitation that is holistic in nature and involves a multidisciplinary or transdisciplinary team to work in an integrated fashion to support physical, cognitive, and social skill retraining is vital to support positive outcome following TBI. The collaborative effort of these individuals allows for continual reinforcement and evaluation of treatment goals and will often involve the family and/or important others in the individual's life to prepare for community re-entry. 2) Trials of medication, especially methylphenidate, to assist individuals with significant attention and memory impairment appear well supported by the available evidence. Though some data suggest that the use of cholinesterase inhibitors may be of use for individuals with memory impairments, there is less support for this practice and there are indications that it may worsen the behavioral sequelae of the injury. 3) Randomized controlled trials demonstrate the utility of specific rehabilitation approaches to attention retraining and retraining of executive functioning skills. Future research is needed on rehabilitation techniques in other domains of cognition. 4) Training in the use of supportive devices (either a memory book or more technologically enhanced compensatory devices) to support the individual's daily activities remains central to the independent function of the individual in the community. Though emerging treatments (eg, virtual reality environments) show relative degrees of promise for inclusion in the rehabilitation of the individual with TBI, these need further evaluation in systematic trials.
    Current Treatment Options in Neurology 09/2010; 12(5):412-23. · 1.94 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Recovery after Traumatic Brain Injury (TBI) is variable, even for patients with similar severity of brain injury. Recent research has highlighted the contribution that genetic predisposition plays in determining TBI outcome. This review considers the potential for genetic polymorphisms to influence recovery of cognitive and social processes following TBI. Limitations and considerations that researchers should make when assessing the potential impact of polymorphisms on TBI outcome are also discussed. Understanding the genetic factors that support neuroplasticity will contribute to an understanding of the variation in outcome following injury and help to identify potential targets for rehabilitation.
    Brain Imaging and Behavior 08/2012; · 2.67 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Traumatic brain injury, due to its diffuse nature and high frequency of injury to frontotemporal and midbrain reticular activating systems, may cause disruption in many aspects of attention: arousal, selective attention, speed of information processing, and strategic control of attention, including sustained attention, shifting and dividing of attention, and working memory. An international team of researchers and clinicians (known as INCOG) convened to develop recommendations for the management of attentional problems.
    The Journal of head trauma rehabilitation. 07/2014; 29(4):321-337.


Available from
May 19, 2014