This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is cognitive rehabilitation.
Background: There is a paucity of literature on the rationale, design, and content of successful cognitive rehabilitation programmes. In the current paper, we describe in detail a cognitive rehabilitation programme that has previously proven effective in a randomized controlled trial in patients with primary brain tumours. The programme’s content may be of practical interest to those working with populations of cognitively impaired patients.
Programme: The programme consists of six weekly, individual, 2-hour sessions plus homework, and incorporates both strategy training and attention retraining. The elements were taken from two of the few programmes that are evidence-based. It's design consists of psycho-education, teaching of strategies to compensate for problems in attention, memory and executive functioning in daily life. The retraining was based on the assumption that a target process can be improved by frequently practising exercises. It is focused on attention as intact attention may also be necessary for adequate functioning of other cognitive domains. The hierarchically organized exercises, embedded in a game-like computer program, were tailored to the needs of the individual patient.
Evaluation: Mean total training time was estimated to be 35 hours in seven weeks. Adherence to the programme was high. The majority of the participants found the programme to be (very) useful. However, older participants found the programme more burdensome than younger patients.
Discussion: Splitting up and spreading out sessions may increase the feasibility and usefulness of the programme for older participants. Further suggestions for improvements and future studies on this programme are also provided.
Cicerone KD,Dahlberg C,Malec JF, et al.Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002.Arch Phys Med Rehabil. 2005;86:1681-1692
2.
Sohlberg MM,McLaughlin KA,Pavese A,Heidrich A,Posner MI.Evaluation of attention process training and brain injury education in persons with acquired brain injury.J Clin Exp Neuropsychol. 2000;22:656-676
3.
Fasotti L,Kovacs F,Eling PATM,Brouwer WH.Time pressure management as a compensatory strategy training after closed head injury.Neuropsychol Rehabil. 2000;10:47-65
4.
Winkens I,Van Heugten CM,Wade DT,Habets EJ,Fasotti L.Efficacy of time pressure management in stroke patients with slowed information processing: a randomized controlled trial.Arch Phys Med Rehabil. 2009;90:1672-1679
5.
Kaschel R,Della Sala S,Fahlböck A,Laaksonen R,Kazen M.Imagery mnemonics for the rehabilitation of memory: a randomised group controlled trial.Neuropsychol Rehabil. 2002;12:127-153
6.
Levine B,Robertson IH,Clare L, et al.Rehabilitation of executive functioning: an experimental-clinical validation of goal management training.J Int Neuropsychol Soc. 2000;6:299-312
7.
Winkens I,Van Heugten CM,Wade DT,Fasotti L.Training patients in Time Pressure Management, a cognitive strategy for mental slowness.Clin Rehabil. 2009;23:79-90
8.
Gehring K,Sitskoorn MM,Gundy CM, et al.Cognitive rehabilitation in patients with gliomas: a randomized, controlled trial.J Clin Oncol. 2009;27:3712-3722
9.
Anderson SW,Damasio H,Tranel D.Neuropsychological impairments associated with lesions caused by tumor or stroke.Arch Neurol. 1990;47:397-405
10.
Klein M,Heimans JJ,Aaronson NK, et al.Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study.Lancet. 2002;360:1361-1368
11.
Tucha O,Smely C,Preier M,Lange KW.Cognitive deficits before treatment among patients with brain tumors.Neurosurgery. 2000;47:324-333
12.
Meyers CA,Brown PD.Role and relevance of neurocognitive assessment in clinical trials of patients with CNS tumors.J Clin Oncol. 2006;24:1305-1309
13.
Laack NN,Brown PD,Ivnik RJ, et al.Cognitive function after radiotherapy for supratentorial low-grade glioma: a North Central Cancer Treatment Group prospective study.Int J Radiat Oncol Biol Phys. 2005;63:1175-1183
14.
Robertson IH,Murre JM.Rehabilitation of brain damage: brain plasticity and principles of guided recovery.Psychol Bull. 1999;125:544-575
15.
van Zomeren AH,Brouwer WHClinical neuropsychology of attention. New York: Oxford University Press; 1994:
16.
Luria ARRestoration of function after brain injury. Oxford: Pergamon Press; 1963:
Duncan J.Disorganisation of behaviour after frontal lobe damage.Cogn Neuropsychol. 1986;3:271-290
19.
Clare L and Wilson, BA. Geheugen kun je helpen. Hulpmiddelen en strategieën om een verminderd geheugen het hoofd te bieden [Coping with memory problems. A practical guide for people with memory impairments, their relatives, friends and carers.]. Lisse: Zwets & Zeitlinger, 1998.
20.
Clare L and Wilson BA. Coping with memory problems. A practical guide for people with memory impairments, their relatives, friends and carers. Suffolk: Thames Valley Test Company, 1997.
21.
Allewijn M and Vink M. Het vernuftig geheugen. Beter leren onthouden. [Ingenious memory. Learning to remember better.] Teleac NOT, ed. Woerden: Uitgeverij Rheynboek, 1997.
22.
Blokhorst M, Slot L and Winter F. Het brein de baas… het zelf behandelen van geheugenproblemen. [Master the brain… Self-help for memory problems.] Soest: Ruitenberg Boek, 1994.
23.
Verhaeghen P, de Mey G, Helsen Z, Assel van A, Vanwijnsberghe L. Omgaan met het geheugen. Handboek voor hulpverleners en cursusbegeleiders. [Managing memory. Handbook for therapists and course supervisors.] Leuven, Belgium/Amersfoort, The Netherlands: Acco, 1992.
24.
Lezak MDNeuropsychological assessment. New York: Oxford University Press; 1995:
25.
Lezak MD,Howieson DB,Loring DW,Hannay HJ,Fischer JSNeuropsychological assessment. New York: Oxford University Press; 2004:
26.
Stuss DT,Winocur G,Robertson IHCognitive neurorehabilitation. Cambridge: Cambridge University Press; 1999:
27.
Stuss DT,Winocur G,Robertson IHCognitive neurorehabilitation. New York: Cambridge University Press; 2005:
28.
Petersen SE,van Mier H,Fiez JA,Raichle ME.The effects of practice on the functional anatomy of task performance.Proc Natl Acad Sci USA. 1998;95:853-860
29.
Kim YH,Yoo WK,Ko MH,Park CH,Kim ST,Na DL.Plasticity of the attentional network after brain injury and cognitive rehabilitation.Neurorehabil Neural Repair. 2009;23:468-477
30.
Sturm W,Longoni F,Weis S, et al.Functional reorganisation in patients with right hemisphere stroke after training of alertness: a longitudinal PET and fMRI study in eight cases.Neuropsychologia. 2004;42:434-450
31.
Kaleita TA,Wellisch DK,Cloughesy TF, et al.Prediction of neurocognitive outcome in adult brain tumor patients.J Neuro-oncol. 2004;67:245-253
32.
Robertson IHCognitive neurorehabilitation. Stuss DTWinocur GRobertson IH, ed. New York: Cambridge University Press; 2005:302-313.
33.
Sohlberg MM,Mateer CA.Improving attention and managing attentional problems. Adapting rehabilitation techniques to adults with ADD.Ann N Y Acad Sci. 2001;931:359-375
34.
Engelberts NH,Klein M,Ader HJ,Heimans JJ,Trenite DG,Van Der Ploeg HM.The effectiveness of cognitive rehabilitation for attention deficits in focal seizures: a randomized controlled study.Epilepsia. 2002;43:587-595
35.
Strache W.Effectiveness of two modes of training to overcome deficits of concentration.Int J Rehabil Res. 1987;10 (suppl 5): 141-145
36.
Ben-Yishay Y,Diller L,Gerstman L,Haas A.The relationship between impersistence, intellectual function and outcome of rehabilitation in patients with left hemiplegia.Neurology. 1968;18:852-861
37.
Robertson IH,Ridgeway V,Greenfield E,Parr A.Motor recovery after stroke depends on intact sustained attention: a 2-year follow-up study.Neuropsychology. 1997;11:290-295
38.
Mateer CACognitive neurorehabilitation. Stuss DTWinocur GRobertson IH, ed. New York: Cambridge University Press; 2005:314-332.
39.
Sturm W,Willmes K,Orgass B,Hartje W.Do specific attention deficits need specific training?.Neuropsychol Rehabil. 1997;7:81-103
40.
Sohlberg MM, Johnson L, Paule L, Raskin SA and Mateer CA. APT-II Attention Process Training: a program to address attentional deficits for persons with mild cognitive dysfunction, second edition. Wake Forest, NC: Lash & Associates, 2001.
41.
Gehring K and Sitskoorn MM. Handleiding C-Car [Manual C-Car], 2004.
42.
Sohlberg MM,Mateer CA.Effectiveness of an attention-training program.J Clin Exp Neuropsychol. 1987;9:117-130
43.
Meichenbaum DTCognitive-behavior modification. New York: Plenum Press; 1977:
Berg IJ. Memory rehabilitation for closed-head injured patients [Dissertation]. State University Groningen, The Netherlands, 1993.
46.
Wilson BA.Long-term prognosis of patients with severe memory disorders.Neuropsychol Rehabil. 1991;1:117-134
47.
Berg IJ,Koning-Haanstra M,Deelman BG.Long-term effects of memory rehabilitation: a controlled study.Neuropsychol Rehabil. 1991;1:97-111
48.
Gray JM,Robertson I,Pentland B,Anderson S.Microcomputer-based attentional retraining after brain damage: a randomised group controlled trial.Neuropsychol Rehabil. 1992;2:97-115
49.
Gehring K, Aaronson NK, Gundy CM, Taphoorn MJB and Sitskoorn MM. Predictors of neuropsychological improvement following cognitive rehabilitation in patients with gliomas. J Int Neuropsychol Soc DOI:10.1017/S1355617710001530, published online by Cambridge University Press 21 December 2010.
50.
Brooks JO,Friedman L,Pearman AM,Gray C,Yesavage JA.Mnemonic training in older adults: Effects of age, length of training, and type of cognitive pretraining.Int Psychogeriatr. 1999;11:75-84
51.
Andersson G.Using the Internet to provide cognitive behaviour therapy.Behav Res Ther. 2009;47:175-180
