Cognitive Training for Post-Acute Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Harry Hallock, Daniel Collins, Amit Lampit, Kiran Deol, Jennifer Fleming, Michael Valenzuela, Harry Hallock, Daniel Collins, Amit Lampit, Kiran Deol, Jennifer Fleming, Michael Valenzuela

Abstract

Objective: To quantitatively aggregate effects of cognitive training (CT) on cognitive and functional outcome measures in patients with traumatic brain injury (TBI) more than 12-months post-injury. Design: We systematically searched six databases for non-randomized and randomized controlled trials of CT in TBI patients at least 12-months post-injury reporting cognitive and/or functional outcomes. Main Measures: Efficacy was measured as standardized mean difference (Hedges' g) of post-training change. We investigated heterogeneity across studies using subgroup analyses and meta-regressions. Results: Fourteen studies encompassing 575 patients were included. The effect of CT on overall cognition was small and statistically significant (g = 0.22, 95%CI 0.05 to 0.38; p = 0.01), with low heterogeneity (I2 = 11.71%) and no evidence of publication bias. A moderate effect size was found for overall functional outcomes (g = 0.32, 95%CI 0.08 to 0.57, p = 0.01) with low heterogeneity (I2 = 14.27%) and possible publication bias. Statistically significant effects were also found only for executive function (g = 0.20, 95%CI 0.02 to 0.39, p = 0.03) and verbal memory (g = 0.32, 95%CI 0.14 to 0.50, p < 0.01). Conclusion: Despite limited studies in this field, this meta-analysis indicates that CT is modestly effective in improving cognitive and functional outcomes in patients with post-acute TBI and should therefore play a more significant role in TBI rehabilitation.

Keywords: TBI; closed head injury; cognitive outcome; cognitive training; neuropsychological outcome; rehabilitation; traumatic brain injury.

Figures

FIGURE 1
FIGURE 1
Flowchart of trial identification and selection. Note that a single study could be excluded on more than one criterion, but appears only once in the chart.
FIGURE 2
FIGURE 2
Efficacy of cognitive training (CT) on (A) overall cognitive outcomes; (B) executive function; and (C) verbal memory. Effect estimates are based on a random-effects model.
FIGURE 3
FIGURE 3
Funnel plots.
FIGURE 4
FIGURE 4
Efficacy of CT on (A) working memory; (B) attention; and (C) processing speed. Effect estimates are based on a random-effects model.
FIGURE 5
FIGURE 5
Efficacy of CT on (A) non-verbal memory; (B) visuospatial; and (C) language. Effect estimates are based on a random-effects model.
FIGURE 6
FIGURE 6
Efficacy of CT on (A) overall functional outcomes; (B) instrumental activities of daily living (IADL); and (C) dysexecutive functions. Effect estimates are based on a random-effects model.
FIGURE 7
FIGURE 7
Subgroup analysis of moderators for (A) overall cognitive outcomes, and (B) overall functional outcomes.
FIGURE 8
FIGURE 8
Matrix of training content against effect size of each cognitive outcome from the individual studies. Gray cells indicate the study trained in the domain. EF = executive functions; WM = working memory. ∗∗p < 0.05

References

    1. Ardila A. (2013). There are two different dysexecutive syndromes. J. Neurol. Disord. 1 1–4. 10.4172/2329-6895.1000114
    1. Bahar-Fuchs A., Clare L., Woods B. (2013). Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer’s disease and vascular dementia. Cochrane Database Syst. Rev. 6 CD003260. 10.1002/14651858.CD003260.pub2
    1. Baribeau J., Ethier M., Braun C. (1989). A neurophysiological assessment of selective attention before and after cognitive remediation in patients with severe closed head injury. J. Neurol. Rehabil. 3 71–92.
    1. Barnett S. M., Ceci S. J. (2002). When and where do we apply what we learn? A taxonomy for far transfer. Psychol. Bull. 128 612–637. 10.1037/0033-2909.128.4.612
    1. Bayley M. T., Tate R., Douglas J. M., Turkstra L. S., Ponsford J., Stergiou-Kita M., et al. (2014). Incog guidelines for cognitive rehabilitation following traumatic brain injury: methods and overview. J. Head Trauma Rehabil. 29 290–306. 10.1097/HTR.0000000000000070
    1. Borenstein M., Hedges L., Higgins J. P., Rothstein H. R. (2009). Introduction to Meta-Analysis. Chichester: Wiley.
    1. Buschert V., Bokde A. L., Hampel H. (2010). Cognitive intervention in Alzheimer disease. Nat. Rev. Neurol. 6 508–517. 10.1038/nrneurol.2010.113
    1. Cantor J., Ashman T., Dams-O’connor K., Dijkers M. P., Gordon W., Spielman L., et al. (2014). Evaluation of the short-term executive plus intervention for executive dysfunction after traumatic brain injury: a randomized controlled trial with minimization. Arch. Phys. Med. Rehabil. 95 1e–9.e. 10.1016/j.apmr.2013.08.005
    1. Cicerone K. D., Dahlberg C., Malec J. F., Langenbahn D. M., Felicetti T., Kneipp S., et al. (2005). Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. Arch. Phys. Med. Rehabil. 86 1681–1692. 10.1016/j.apmr.2005.03.024
    1. Cicerone K. D., Langenbahn D. M., Braden C., Malec J. F., Kalmar K., Fraas M., et al. (2011). Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch. Phys. Med. Rehabil. 92 519–530. 10.1016/j.apmr.2010.11.015
    1. Clare L., Woods R. T., Moniz Cook E. D., Orrell M., Spector A. (2003). Cognitive rehabilitation and cognitive training for early-stage Alzheimer’s disease and vascular dementia. Cochrane Database Syst. Rev. 4:CD003260.
    1. Colantonio A., Ratcliff G., Chase S., Kelsey S., Escobar M., Vernich L. (2004). Long-term outcomes after moderate to severe traumatic brain injury. Disabil. Rehabil. 26 253–261. 10.1080/09638280310001639722
    1. Dawson D. R., Binns M. A., Hunt A., Lemsky C., Polatajko H. J. (2013). Occupation-based strategy training for adults with traumatic brain injury: a pilot study. Arch. Phys. Med. Rehabil. 94 1959–1963. 10.1016/j.apmr.2013.05.021
    1. Dikmen S. S., Corrigan J. D., Levin H. S., Machamer J., Stiers W., Weisskopf M. G. (2009). Cognitive outcome following traumatic brain injury. J. Head Trauma Rehabil. 24 430–438. 10.1097/HTR.0b013e3181c133e9
    1. Duval S., Tweedie R. (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56 455–463. 10.1111/j.0006-341X.2000.00455.x
    1. Edwards J., Wadley V., Myers R., Roenker D. L., Cissell G., Ball K. (2002). Transfer of a speed of processing intervention to near and far cognitive functions. Gerontology 48 329–340. 10.1159/000065259
    1. Egger M., Davey Smith G., Schneider M., Minder C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629 10.1136/bmj.315.7109.629
    1. Gates N., Valenzuela M. J. (2010). Cognitive exercise and its role in cogitive function in older adults. Curr. Psychiatry Rep. 12 20–27. 10.1007/s11920-009-0085-y
    1. Gleser L. J., Olkin I. (2009). “Stochastically dependent effect sizes,” in The Handbook of Research Synthesis and Meta-Analysis, 2nd Edn, eds Cooper H., Hedges L., Valentine J. (New York, NY: Russell Sage Foundation; ).
    1. Goranson T. E., Graves R. E., Allison D., La Freniere R. (2003). Community integration following multidisciplinary rehabilitation for traumatic brain injury. Brain Injury 17 759–774. 10.1080/0269905031000088513
    1. Gordon W. A., Zafonte R., Cicerone K., Cantor J., Brown M., Lombard L., et al. (2006). Traumatic brain injury rehabilitation: state of the science. Am. J. Phys. Med. Rehabil. 85 343–382. 10.1097/01.phm.0000202106.01654.61
    1. Higgins J., Green S. (eds) (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0: The Cochrane Collaboration. Available at: [accessed Nov 14, 2011]
    1. Higgins J. P., Thompson S. G., Deeks J. J., Altman D. G. (2003). Measuring inconsistency in meta-analyses. BMJ 327:557 10.1136/bmj.327.7414.557
    1. Lampit A., Hallock H., Valenzuela M. (2014). Computerized cognitive training in cognitively healthy older adults: a systematic review and meta-analysis of effect modifiers. PLoS Med. 11:e1001756 10.1371/journal.pmed.1001756
    1. Leung I. H. K., Walton C. C., Hallock H., Lewis S. J. G., Valenzuela M., Lampit A. (2015). Cognitive training in Parkinson disease: a systematic review and meta-analysis. Neurology 85 1843–1851. 10.1212/WNL.0000000000002145
    1. Liberati A., Altman D. G., Tetzlaff J., Mulrow C., Gotzsche P. C., Ioannidis J. P., et al. (2009). The Prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700 10.1136/bmj.b2700
    1. Lu J., Gary K. W., Neimeier J. P., Ward J., Lapane K. L. (2012). Randomized controlled trials in adult traumatic brain injury. Brain Inj. 26 1523–1548. 10.3109/02699052.2012.722257
    1. Maher C. G., Sherrington C., Herbert R. D., Moseley A. M., Elkins M. (2003). Reliability of the Pedro scale for rating quality of randomized controlled trials. Phys. Ther. 83 713–721.
    1. Marshall G. A., Rentz D. M., Frey M. T., Locascio J. J., Johnson K. A., Sperling R. A. (2011). Executive function and instrumental activities of daily living in MCI and AD. Alzheimers Dement. 7 300–308. 10.1016/j.jalz.2010.04.005
    1. Nelson L. A., Macdonald M., Stall C., Pazdan R. (2013). Effects of interactive metronome therapy on cognitive functioning after blast-related brain injury: a randomized controlled pilot trial. Neuropsychology 27 666–679. 10.1037/a0034117
    1. O’Neil-Pirozzi T. M., Strangman G. E., Goldstein R., Katz D. I., Savage C. R., Kelkar K., et al. (2010). A controlled treatment study of internal memory strategies (I-Mems) following traumatic brain injury. J. Head Trauma Rehabil. 25 43–51. 10.1097/HTR.0b013e3181bf24b1
    1. Pa J., Boxer A., Chao L. L., Gazzaley A., Freeman K., Kramer J., et al. (2009). Clinical-neuroimaging characteristics of dysexecutive mild cognitive impairment. Ann. Neurol. 65 414–423. 10.1002/ana.21591
    1. Potvin M. J., Rouleau I., Senechal G., Giguere J. F. (2011). Prospective memory rehabilitation based on visual imagery techniques. Neuropsychol. Rehabil. 21 899–924. 10.1080/09602011.2011.630882
    1. Povlishock J. T., Katz D. I. (2005). Update of neuropathology and neurological recovery after traumatic brain injury. J. Head Trauma Rehabil. 20 76–94. 10.1097/00001199-200501000-00008
    1. Rao V., Lyketsos C. (2000). Neuropsychiatric sequelae of traumatic brain injury. Psychosomatics 41 95–103. 10.1176/appi.psy.41.2.95
    1. Rattok J., Ross B., Ben-Yishay Y., Ezrachi O., Silver S., Lakin P., et al. (1992). Outcome of different treatment mixes in a multidimensional neuropsychological rehabilitation program. Neuropsychology 6 395–415. 10.1037/0894-4105.6.4.395
    1. Rees L., Marshall S., Hartridge C., Mackie D., Weiser M. (2007). Cognitive interventions post acquired brain injury. Brain Inj. 21 161–200. 10.1080/02699050701201813
    1. Rice-Oxley M., Turner-Stokes L. (1999). Effectiveness of brain injury rehabilitation. Clin. Rehabil. 13(Suppl. 1), 7–24. 10.1191/026921599668051623
    1. Rohling M. L., Faust M. E., Beverly B., Demakis G. (2009). Effectiveness of cognitive rehabilitation following acquired brain injury: a meta-analytic re-examination of Cicerone et al.’s (2000, 2005) systematic reviews. Neuropsychology 23 20–39. 10.1037/a0013659
    1. Ruff R. M., Baser C. A., Johnston J. W., Marshall L. F., Klauber S. K., Klauber M. R., et al. (1989). Neuropsychological rehabilitation: an experimental study with head-injured patients. J. Head Trauma Rehabil. 4 20–36. 10.1097/00001199-198909000-00006
    1. Ryan T. V., Ruff R. M. (1988). The efficacy of structured memory retraining in a group comparison of head trauma patients. Arch. Clin. Neuropsychol. 3 165–179. 10.1016/0887-6177(88)90061-3
    1. Skandsen T., Finnanger T. G., Andersson S., Lydersen S., Brunner J. F., Vik A. (2010). Cognitive impairment 3 months after moderate, and severe traumatic brain injury: a prospective follow-up study. Arch. Phys. Med. Rehabil. 91 1904–1913. 10.1016/j.apmr.2010.08.021
    1. Sohlberg M. M., Mateer C. A. (2001). Cognitive Rehabilitation: An Integrative Neuropsychological Approach. New York, NY: The Guilford Press.
    1. Sterne J. A., Sutton A. J., Ioannidis J. P., Terrin N., Jones D. R., Lau J., et al. (2011). Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 343:d4002 10.1136/bmj.d4002
    1. Strauss S., Sherman E., Spreen O. (2006). A compendium of Neuropsychological Tests: Administration, Norms and Commentary. Oxford: Oxford University Press.
    1. Thomas-Stonell N., Johnson P., Schuller R., Jutai J. (1994). Evaluation of a computer-based program for remediation of cognitive-communication skills. J. Head Trauma Rehabil. 9 25–37. 10.1097/00001199-199412000-00005
    1. Tiersky L. A., Anselmi V., Johnston M. V., Kurtyka J., Roosen E., Schwartz T., et al. (2005). A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury. Arch. Phys. Med. Rehabil. 86 1565–1574. 10.1016/j.apmr.2005.03.013
    1. Toril P., Reales J. M., Ballesteros S. (2014). Video game training enhances cognition of older adults: a meta-analytic study. Psychol. Aging 29 706–716. 10.1037/a0037507
    1. Twamley E. W., Jak A. J., Delis D. C., Bondi M. W., Lohr J. B. (2014). Cognitive symptom management and rehabilitation therapy (cogSMART) for veterans with traumatic brain injury: pilot randomized controlled trial. J. Rehabil. Res. Dev. 51 59–70. 10.1682/JRRD.2013.01.0020
    1. Vas A. K., Chapman S. B., Cook L. G., Elliott A. C., Keebler M. (2011). Higher-order reasoning training years after traumatic brain injury in adults. J. Head Trauma Rehabil. 26 224–239. 10.1097/HTR.0b013e318218dd3d
    1. Wai-Kwong Man D., Soong W. Y. L., Tam S. F., Hui-Chan C. W. Y. (2006). Development and evaluation of a pictorial-based analogical problem-solving programme for people with traumatic brain injury. Brain Inj. 20 981–990. 10.1080/13561820600909852
    1. Wilson M., Zolfaghari P., Griffin C., Lockey D., Tolias C., Verma V. (2014). The future of traumatic brain injury research. Scand. J. Trauma Resusc. Emerg. Med. 22(Suppl. 1):A7 10.1186/1757-7241-22-S1-A7
    1. Wykes T., Huddy V., Cellard C., Mcgurk S. R., Czobor P. (2011). A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am. J. Psychiatry 168 472–485. 10.1176/appi.ajp.2010.10060855

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren