title: Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002.
abstract: OBJECTIVE
  To update the previous evidence-based recommendations of the Brain Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 1998 through 2002.
  
  
  METHODS
  PubMed and Infotrieve literature searches were conducted using the terms attention, awareness, cognition, communication, executive, language, memory, perception, problem solving, and reasoning combined with each of the terms rehabilitation, remediation, and training. Reference lists from identified articles were reviewed and a bibliography listing 312 articles was compiled.
  
  
  METHODS
  One hundred eighteen articles were initially selected for inclusion. Thirty-one studies were excluded after detailed review. Excluded articles included 14 studies without data, 6 duplicate publications or follow-up studies, 5 nontreatment studies, 4 reviews, and 2 case studies involving diagnoses other than TBI or stroke.
  
  
  METHODS
  Articles were assigned to 1 of 7 categories reflecting the primary area of intervention: attention; visual perception; apraxia; language and communication; memory; executive functioning, problem solving and awareness; and comprehensive-holistic cognitive rehabilitation. Articles were abstracted and levels of evidence determined using specific criteria.
  
  
  RESULTS
  Of the 87 studies evaluated, 17 were rated as class I, 8 as class II, and 62 as class III. Evidence within each area of intervention was synthesized and recommendations for practice standards, practice guidelines, and practice options were made.
  
  
  CONCLUSIONS
  There is substantial evidence to support cognitive-linguistic therapies for people with language deficits after left hemisphere stroke. New evidence supports training for apraxia after left hemisphere stroke. The evidence supports visuospatial rehabilitation for deficits associated with visual neglect after right hemisphere stroke. There is substantial evidence to support cognitive rehabilitation for people with TBI, including strategy training for mild memory impairment, strategy training for postacute attention deficits, and interventions for functional communication deficits. The overall analysis of 47 treatment comparisons, based on class I studies included in the current and previous review, reveals a differential benefit in favor of cognitive rehabilitation in 37 of 47 (78.7%) comparisons, with no comparison demonstrating a benefit in favor of the alternative treatment condition. Future research should move beyond the simple question of whether cognitive rehabilitation is effective, and examine the therapy factors and patient characteristics that optimize the clinical outcomes of cognitive rehabilitation.
authors.affiliation: JFK-Johnson Rehabilitation Institute, Edison, NJ 08820, USA. kcicerone@solarishs.org
authors.forename: Keith D
authors.initials: KD
authors.lastname: Cicerone
authors.forename: Cynthia
authors.initials: C
authors.lastname: Dahlberg
authors.forename: James F
authors.initials: JF
authors.lastname: Malec
authors.forename: Donna M
authors.initials: DM
authors.lastname: Langenbahn
authors.forename: Thomas
authors.initials: T
authors.lastname: Felicetti
authors.forename: Sally
authors.initials: S
authors.lastname: Kneipp
authors.forename: Wendy
authors.initials: W
authors.lastname: Ellmo
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kalmar
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Giacino
authors.forename: J Preston
authors.initials: JP
authors.lastname: Harley
authors.forename: Linda
authors.initials: L
authors.lastname: Laatsch
authors.forename: Philip A
authors.initials: PA
authors.lastname: Morse
authors.forename: Jeanne
authors.initials: J
authors.lastname: Catanese
mesh_terms: D001930:Brain Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D003072:Cognition Disorders / Q000503:physiopathology / Q000534:rehabilitation*; D019317:Evidence-Based Medicine; D006801:Humans; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation