Traumatic Brain Injury (Adults)
Service Delivery

Setting
(e.g. inpatient, day treatment, home, telerehabilitation)

External Scientific Evidence

Evidence-Based Practice Guidelines

Brain Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine   Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature from 1998 through 2002 Cicerone, K. D., Dahlberg, C., et al. (2005). Archives of Physical Medicine and Rehabilitation, 86(8), 1681-92.

 

Description

This guideline provides recommendations for the cognitive rehabilitation of individuals with traumatic brain injury (TBI) or stroke. This is an update of a previous guideline published by Cicerone et al. in 2000. The target audience of this guideline is healthcare professionals involved in the management of individuals with acquired brain injury. Recommendations are provided and defined as Practice Standards, Practice Guidelines, or Practice Options based on the strength and the quality of the supporting evidence. A recommendation for a Practice Standard is based on at least one well-designed class I study with support from class II or class III evidence that directly addresses treatment effectiveness.  A Practice Guideline recommendation is based on one or more class I studies with methodological limitations or well-designed class II studies that directly address treatment effectiveness.  A recommendation for a Practice Option is based on class II or class III studies that directly address treatment effectiveness.

 

Recommendations

The implementation of comprehensive-holistic cognitive rehabilitation programs are recommended for treating individuals with moderate to severe TBI in the post-acute phase (Practice Guideline).

 

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Evidence-Based Systematic Reviews

Cognitive Rehabilitation Following Traumatic Brain Injury: Assessment to Treatment Tsaousides, T., & Gordon, W. A. (2009). Mount Sinai Journal of Medicine, 76(2), 173-181.

 

Description

This is a review of the state of the evidence for cognitive rehabilitation following traumatic brain injury. The findings are based on class I and class II studies from three previous systematic reviews conducted by a subcommittee of the Brain Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine and one review conducted by the National Institute on Disability and Rehabilitation Research.

 

Conclusions

The evidence supports cognitive rehabilitation using a cognitive holistic day treatment approach. The authors report that cognitive holistic day treatment programs, in addition to improving cognitive functioning, appear to “facilitate skill transfer and generalization and to increase self-awareness, behavioral and affective regulation, psychosocial functioning, and community integration” (p. 178).

 

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Evidence-Based Review of Moderate to Severe Acquired Brain Injury Teasell, R., Marshall, S., et al. (2008). Retrieved from http://www.abiebr.com.

 

Description

This is a review of prospective and retrospective experimental and non-experimental studies that investigated the effectiveness of rehabilitation for adults and children with moderate to severe acquired brain injury (ABI), including stroke and traumatic brain injury (TBI). This review includes the assessment and management of several aspects of rehabilitation including speech and language treatments. The levels of evidence used to summarize the findings are based on the modified Sackett criteria: Level 1 was applied to randomized controlled trials (RCT) with a PEDro score greater than 5.  Level 2 was applied to RCTs with a PEDro score less than 6, non-RCTs, and cohort studies.  Level 3 was applied to case control studies.  Level 4 was applied to pre-post studies, post-studies, case series, and single intervention group studies. Level 5 was applied to observational studies, case studies, and consensus statements.

 

Conclusions

“There is level 2 evidence that rehabilitation, whether hospital-based (outpatient) or community-based, does improve the level of independence for persons with acquired brain injury” (p. 35) with effects maintained one to three years later.

 

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The Efficacy of Acquired Brain Injury Rehabilitation Cullen, N., Chundamala, J., et al. (2007). Brain Injury, 21(2), 113-132.

 

Description

This is a review of research studies pertaining to the rehabilitation of individuals with acquired brain injury, the majority of which resulted from traumatic brain injury. Although the review does not directly address speech-language pathology treatments, it includes cognitive, neurobehavioral and comprehensive interdisciplinary programs and investigates the impact of service delivery (e.g. intensity, setting) on functional outcomes. 

 

Conclusions

There is limited evidence that community-based social and behavioral rehabilitation of at least six months results in "greater independence, higher social activity levels, and less need for care support" (p. 125). 

 

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Community Reintegration Following Acquired Brain Injury McCabe, P., Lippert, C., et al. (2007). Brain Injury, 21(2), 231-257.

 

Description

This is a review of published studies evaluating the effectiveness of any treatment or intervention for individuals with acquired brain injury with outcomes relating to satisfaction and community reintegration. The majority of participants included individuals with traumatic brain injury.

 

Conclusions 

While the review was not specific to speech and language treatment, the authors found  “rehabilitation whether hospital-based or community-based, improves the level of independence for persons with a brain injury” (p. 255) and that “there is also evidence that demonstrated the positive effects of community-based rehabilitation programs using a supported relationship mode of intervention" (p. 255).

 

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