Cognitive Rehabilitation Interventions for Executive Function: Moving from Bench to Bedside in Patients with Traumatic Brain Injury

JFK Johnson Rehabilitation Institute.
Journal of Cognitive Neuroscience (Impact Factor: 4.09). 08/2006; 18(7):1212-22. DOI: 10.1162/jocn.2006.18.7.1212
Source: PubMed


Executive function mediated by prefrontally driven distributed networks is frequently impaired by traumatic brain injury (TBI) as a result of diffuse axonal injury and focal lesions. In addition to executive cognitive functions such as planning and working memory, the effects of TBI impact social cognition and motivation processes. To encourage application of cognitive neuroscience methods to studying recovery from TBI, associated reorganization of function, and development of interventions, this article reviews the pathophysiology of TBI, critiques currently employed methods of assessing executive function, and evaluates promising interventions that reflect advances in cognitive neuroscience. Brain imaging to identify neural mechanisms mediating executive dysfunction and response to interventions following TBI is also discussed.

Download full-text


Available from: Keith D Cicerone,
  • Source
    • "Remediation approaches OTs might adopt for improving EF include using metacognitive strategies, classic neuroscience research—including working memory training, improving EF using intact cognitive abilities, use of the GMT protocol, and adopting virtual reality environments to prepare for community reintegration. For more detail on deficits , assessment, and treatment, please see recent reviews specific to EF (Chung, Pollock, Campbell, Durward, & Hagen, 2013; Cicerone, Levin, Malec, Stuss, & Whyte, 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Nearly 1.7 million Americans sustain a traumatic brain injury (TBI) each year. These injuries can result in physical, emotional, and cognitive consequences. While many individuals receive cognitive rehabilitation from occupational therapists (OTs), the interdisciplinary nature of TBI research makes it difficult to remain up-to-date on relevant findings. We conducted a literature review to identify and summarize interdisciplinary evidence-based practice targeting cognitive rehabilitation for civilian adults with TBI. Our review summarizes TBI background, and our cognitive remediation section focuses on the findings from 37 recent (since 2006) empirical articles directly related to cognitive rehabilitation for individuals (i.e., excluding special populations such as veterans or athletes). This manuscript is offered as a tool for OTs engaged in cognitive rehabilitation and as a means to highlight arenas where more empirical, interdisciplinary research is needed.
    OTJR Occupation Participation Health 02/2015; 35(1):5-22. DOI:10.1177/1539449214561765 · 0.80 Impact Factor
  • Source
    • "Cognitive and behavioral deficits seem to be especially deleterious impacting overall functional outcomes and quality of life of patients and their families [8]–[15]. The extent of these deficits following TBI is broad and includes information processing [16], attention [17], memory [18], executive function [19], computation, and discrimination of probabilities [20]. They can occur singly or in combination, can change in severity over time, and often remain greatly impaired despite rehabilitation [10], [21]–[23]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Rehabilitation can improve cognitive deficits observed in patients with traumatic brain injury (TBI). However, despite rehabilitation, the ability of making a choice often remains impaired. Risk taking is a daily activity involving numerous cognitive processes subserved by a complex neural network. In this work we investigated risk taking using the Balloon Analogue Risk Task (BART) in patients with acute TBI and healthy controls. We hypothesized that individuals with TBI will take less risk at the BART as compared to healthy individuals. We also predicted that within the TBI group factors such as the number of days since the injury, severity of the injury, and sites of the lesion will play a role in risk taking as assessed with the BART. Main findings revealed that participants with TBI displayed abnormally cautious risk taking at the BART as compared to healthy subjects. Moreover, healthy individuals showed increased risk taking throughout the task which is in line with previous work. However, individuals with TBI did not show this increased risk taking during the task. We also investigated the influence of three patients' characteristics on their performance at the BART: Number of days post injury, Severity of the head injury, and Status of the frontal lobe. Results indicate that performance at the BART was influenced by the number of days post injury and the status of the frontal lobe, but not by the severity of the head injury. Reported findings are encouraging for risk taking seems to naturally improve with time postinjury. They support the need of conducting longitudinal prospective studies to ultimately identify impaired and intact cognitive skills that should be trained postinjury.
    PLoS ONE 12/2013; 8(12):e83598. DOI:10.1371/journal.pone.0083598 · 3.23 Impact Factor
  • Source
    • "Executive processes, that is high-level cognitive functions involved in control and direction of action, including planning, monitoring, initiating, and switching, have been described by Lezak as being the heart of all socially useful, personally enhancing, constructive and creative activities [1]. Thus, impairments of executive function can have the most devastating impact on everyday life because of their super ordinate role in behavioural and cognitive processing [2]. Considerable attention has been directed at developing and testing interventions to manage these impairments; in the past six years, four systematic reviews and one meta-analysis related to treatment for executive dysfunction have been published [3]– [6]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We have been investigating an ecologically valid strategy-training approach to enable adults with executive dysfunction to attain everyday life goals. Here, we report the protocol of a randomized controlled trial of the effects of this training compared to conventional therapy in a sample of community-dwelling adults with acquired brain injury and/or stroke.Methods/design: We will recruit 100 community-dwelling survivors at least six months post-acquired brain injury or stroke who report executive dysfunction during a telephone interview, confirmed in pre-training testing. Following pre-training testing, participants will be randomized to the ecologically valid strategy training or conventional therapy and receive two one-hour sessions for eight weeks (maximum of 15 hours of therapy). Post-testing will occur immediately following the training and three months later. The primary outcome is self-reported change in performance on everyday life activities measured using the Canadian Occupational Performance Measure, a standardized, semi-structured interview. Secondary outcomes are objective measurement of performance change from videotapes of treatment session, Performance Quality Rating Scale; executive dysfunction symptoms, Behavioural Rating Inventory of Executive Function -- Adult; participation in everyday life, Mayo-Portland Adaptability Inventory Participation Index; and ability to solve novel problems, Instrumental Activities of Daily Living Profile. This study is of a novel approach to promoting improvements in attainment of everyday life goals through managing executive dysfunction using an ecologically valid strategy training approach, the Cognitive Orientation to daily Occupational Performance. This study compares the efficacy of this approach with that of conventional therapy. The approach has the potential to be a valuable treatment for people with chronic acquired brain injury and/or stroke.Trial registration: Clinical, Trial Identification Number: NCT01414348.
    Trials 09/2013; 14(1):306. DOI:10.1186/1745-6215-14-306 · 1.73 Impact Factor
Show more