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: 4.69). 08/2006; 18(7):1212-22. DOI: 10.1162/jocn.2006.18.7.1212
Source: PubMed

ABSTRACT 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.

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Available from: Keith D Cicerone, Jul 30, 2015
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    • "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). "
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    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
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    • "Therefore, a comprehensive approach to neurorehabilitation that integrates the treatment of both foundational and supervisory skills through a combination of bottom-up and top-down interventions (see Figure 1) is needed in order to provide patients with the maximum opportunity to benefit from treatment . This pyramidal structure is based partially on a hierarchical model of independent but interactive brain operations proposed by Stuss and Benson (1986), and supports an integrative approach to treatment that is based on clinical and empirical evidence ((Ben-Yishay et al., 1985; Cicerone et al., 2004; Gordon et al., 2006a; Malec, 2001). As seen in Figure 1, at the base of the hierarchy lie the foundational skills of arousal, attention , and drive or motivation. "
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    ABSTRACT: Deficits in attention, processing speed and executive functioning are among the most commonly reported and functionally limiting cognitive impairments among individuals with TBI. Changes in mood can exacerbate cognitive deficits and reduce life quality. Contemporary hierarchical models of cognitive functioning suggest that attention/arousal processes underlie and support higher-order functions. Building on decades of clinical research, a synergistic, integrative approach to neurorehabilitation is described, which combines bottom-up and top-town cognitive interventions in addition to psychotherapeutic interventions for mood. This approach is intended to address directly impairments in both foundational (i.e., attention) and higher-order (i.e., executive functions) processes. Executive dysfunction is addressed in a top-down fashion through the application of a series of problem-solving and emotional regulation modules that teach and integrate strategies that can be generalised across situations with practice. Attention, arousal and information processing are necessary prerequisites of successful higher-order thinking, attention skills, and are addressed in a bottom-up fashion through intensive individualised attention and processing training tasks. Combining top-down and bottom-up approaches within a comprehensive day-treatment programme can effect a synergistic improvement of overall functioning.
    05/2013; 14(01). DOI:10.1017/BrImp.2013.9
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    • "A patient with metacognitive deficits (i.e., empathy) may require self-talk and strategies to improve awareness (Cicerone et al., 2006; Levine, Turner & Stuss, 2008). Finally, a patient with executive dysfunction is likely to respond more to goal management training, small group therapy and memory training (Cicerone et al., 2006; Levine, Turner & Stuss, 2008). Adopting a theory such as this one, assists clinicians in characterizing the breadth of domains affected by the injury (Zappala, de Schotten, & Eslinger, 2012), as well as in aiding the development of targeted intervention (Stuss, 2011b). "
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    ABSTRACT: Coping has been suggested as the final common pathway related to outcome after traumatic brain injury (TBI). Different types of coping have been related to either positive or negative psychosocial outcomes. As a result, a small set of studies have attempted to remediate coping through intervention, but the effectiveness of these studies has been modest. We propose that three primary factors are limiting our ability to effectively remediate coping following TBI through intervention TBI: 1) limited understanding of inter-patient variability following TBI; 2) limited understanding of the mechanisms underlying coping following TBI; and 3) reliance on self-report measures of coping. We discuss these obstacles in the context of a model of frontal lobe function, and in light of recent behavioural work on coping.
    Neurorehabilitation 01/2013; 32(4):721-8. DOI:10.3233/NRE-130897 · 1.74 Impact Factor
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