A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury.
OBJECTIVE
To evaluate the effectiveness of comprehensive, holistic neuropsychologic (NP) rehabilitation compared with standard, multidisciplinary rehabilitation for people with traumatic brain injury (TBI).


METHODS
Randomized practical controlled trial.


METHODS
Postacute brain injury rehabilitation center within a suburban rehabilitation hospital.


METHODS
Participants with TBI were recruited from clinical referrals and referrals from the community. Sixty-eight participants who met inclusion criteria were randomly allocated to treatment conditions. Most participants (88%) had sustained moderate or severe TBI, and greater than half (57%) were more than 1 year postinjury at the beginning of treatment.


METHODS
Treatment was conducted 15 hours per week for 16 weeks. Standard neurorehabilitation consisted primarily of individual, discipline specific therapies (n=34). Intensive cognitive rehabilitation emphasized the integration of cognitive, interpersonal, and functional interventions within a therapeutic environment (n=34).


METHODS
Primary outcomes were the Community Integration Questionnaire (CIQ) and Perceived Quality of Life scale (PQOL). Secondary outcomes included NP functioning, perceived self-efficacy, and community-based employment.


RESULTS
NP functioning improved in both conditions. Intensive cognitive rehabilitation participants showed greater improvements on the CIQ (effect size [ES]=0.59) and PQOL (ES=0.30) as well as improved self-efficacy for the management of symptoms (ES=0.26) compared with standard neurorehabilitation treatment. These gains were maintained at the 6-month follow-up. Standard neurorehabilitation participants showed improved productivity at the 6-month follow-up associated with the need for continued rehabilitation.


CONCLUSIONS
Improvements seen after intensive cognitive rehabilitation may be related to interventions directed at the self-regulation of cognitive and emotional processes and the integrated treatment of cognitive, interpersonal, and functional skills. The results show the effectiveness of comprehensive holistic NP rehabilitation for improving community functioning and quality of life after TBI compared with standard rehabilitation.
Cicerone
Keith D
KD
Department of Cognitive Rehabilitation, JFK-Johnson Rehabilitation Institute, Edison, NJ 08820, USA. kcicerone@solarishs.org
Mott
Tasha
T
Azulay
Joanne
J
Sharlow-Galella
Mary A
MA
Ellmo
Wendy J
WJ
Paradise
Susan
S
Friel
John C
JC
D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation*; D003072:Cognition Disorders / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D006694:Holistic Health; D006801:Humans; D008297:Male; D009511:New England; D011788:Quality of Life; D012960:Socioenvironmental Therapy