Evidence-based cognitive rehabilitation

Recommendations for clinical practice

Keith D. Cicerone, Cynthia Dahlberg, Kathleen Kalmar, Donna M. Langenbahn, James F. Malec, Thomas F. Bergquist, Thomas Felicetti, Joseph T. Giacino, J. Preston Harley, Douglas E. Harrington, Jean Herzog, Sally Kneipp, Linda Laatsch, Philip A. Morse

Research output: Contribution to journalArticle

777 Citations (Scopus)

Abstract

Objective: To establish evidence-based recommendations for the clinical practice of cognitive rehabilitation, derived from a methodical review of the scientific literature concerning the effectiveness of cognitive rehabilitation for persons with traumatic brain injury (TBI) or stroke. Data Sources: A MEDLINE literature search using combinations of these key words as search terms: attention, awareness, cognition, communication, executive, language, memory, perception, problem solving, reasoning, rehabilitation, remediation, and training. Reference lists from identified articles also were reviewed; a total bibliography of 655 published articles was compiled. Study Selection: Studies were initially reviewed according to the following exclusion criteria: nonintervention studies; theoretical, descriptive, or review papers; papers without adequate specification of interventions; subjects other than persons with TBI or stroke; pediatric subjects; pharmacologic interventions; and non-English language papers. After screening, 232 articles were eligible for inclusion. After detailed review, 61 of these were excluded as single case reports without data, subjects other than TBI and stroke, and nontreatment studies. This screening yielded 171 articles to be evaluated. Data Extraction: Articles were assigned to 1 of 7 categories according to their primary area of intervention: attention, visual perception and constructional abilities, language and communication, memory, problem solving and executive functioning, multi-modal interventions, and comprehensive-holistic cognitive rehabilitation. All articles were independently reviewed by at least 2 committee members and abstracted according to specified criteria. The 171 studies that passed initial review were classified according to the strength of their methods. Class I studies were defined as prospective, randomized controlled trials. Class II studies were defined as prospective cohort studies, retrospective case-control studies, or clinical series with well-designed controls. Class III studies were defined as clinical series without concurrent controls, or studies with appropriate single-subject methodology. Data Synthesis: Of the 171 studies evaluated, 29 were rated as Class I, 35 as Class II, and 107 as Class III. The overall evidence within each predefined area of intervention was then synthesized and recommendations were derived based on consideration of the relative strengths of the evidence. The resulting practice parameters were organized into 3 types of recommendations: Practice Standards, Practice Guidelines, and Practice Options. Conclusions: Overall, support exists for the effectiveness of several forms of cognitive rehabilitation for persons with stroke and TBI. Specific recommendations can be made for remediation of language and perception after left and right hemisphere stroke, respectively, and for the remediation of attention, memory, functional communication, and executive functioning after TBI. These recommendations may help to establish parameters of effective treatment, which should be of assistance to practicing clinicians. (C) 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

Original languageEnglish (US)
Pages (from-to)1596-1615
Number of pages20
JournalArchives of Physical Medicine and Rehabilitation
Volume81
Issue number12
DOIs
StatePublished - 2000
Externally publishedYes

Fingerprint

Rehabilitation
Stroke
Language
Communication
Committee Membership
Visual Perception
Aptitude
Information Storage and Retrieval
Bibliography
Practice Guidelines
MEDLINE
Cognition
Case-Control Studies
Cohort Studies
Randomized Controlled Trials
Traumatic Brain Injury
Prospective Studies
Pediatrics
Practice (Psychology)
Therapeutics

Keywords

  • Brain injuries
  • Cerebrovascular accident
  • Cognitive disorders
  • Practice guidelines
  • Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation

Cite this

Cicerone, K. D., Dahlberg, C., Kalmar, K., Langenbahn, D. M., Malec, J. F., Bergquist, T. F., ... Morse, P. A. (2000). Evidence-based cognitive rehabilitation: Recommendations for clinical practice. Archives of Physical Medicine and Rehabilitation, 81(12), 1596-1615. https://doi.org/10.1053/apmr.2000.19240

Evidence-based cognitive rehabilitation : Recommendations for clinical practice. / Cicerone, Keith D.; Dahlberg, Cynthia; Kalmar, Kathleen; Langenbahn, Donna M.; Malec, James F.; Bergquist, Thomas F.; Felicetti, Thomas; Giacino, Joseph T.; Harley, J. Preston; Harrington, Douglas E.; Herzog, Jean; Kneipp, Sally; Laatsch, Linda; Morse, Philip A.

In: Archives of Physical Medicine and Rehabilitation, Vol. 81, No. 12, 2000, p. 1596-1615.

Research output: Contribution to journalArticle

Cicerone, KD, Dahlberg, C, Kalmar, K, Langenbahn, DM, Malec, JF, Bergquist, TF, Felicetti, T, Giacino, JT, Harley, JP, Harrington, DE, Herzog, J, Kneipp, S, Laatsch, L & Morse, PA 2000, 'Evidence-based cognitive rehabilitation: Recommendations for clinical practice', Archives of Physical Medicine and Rehabilitation, vol. 81, no. 12, pp. 1596-1615. https://doi.org/10.1053/apmr.2000.19240
Cicerone, Keith D. ; Dahlberg, Cynthia ; Kalmar, Kathleen ; Langenbahn, Donna M. ; Malec, James F. ; Bergquist, Thomas F. ; Felicetti, Thomas ; Giacino, Joseph T. ; Harley, J. Preston ; Harrington, Douglas E. ; Herzog, Jean ; Kneipp, Sally ; Laatsch, Linda ; Morse, Philip A. / Evidence-based cognitive rehabilitation : Recommendations for clinical practice. In: Archives of Physical Medicine and Rehabilitation. 2000 ; Vol. 81, No. 12. pp. 1596-1615.
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