Conclusions

  1. There is Level 2 evidence to suggest that specific structured training programs designed to improve attention are ineffective or at best equivocal in their effects on attention.
     
  2. There is Level 2 evidence that dual task training has a positive effect on divided attention.
     
  3. There is Level 2 evidence that dual-task training on is effective on the speed of processing.
     
  4. There is Level 3 evidence that individuals with a TBI perform poorly on dual task activities due to their inability to maintain a measure of sustained attention.
     
  5. There is Level 3 evidence that reaction times of those with a TBI are slower than the reaction times of those without.
     
  6. There is Level 1a evidence supporting the use of active or high tech external aids (assistive technology) as a compensatory strategy for memory impairments.
     
  7. There is Level 2 evidence supporting the use of passive or no tech/low tech aids in improving memory impairments post ABI.
     
  8. There is conflicting evidence supporting the use of computer assisted cognitive retraining as an adjunct to the rehabilitation program, especially regarding attentional retraining following brain injury. Although some improvement in memory was found in a few of the studies it was not found in all. General cognitive functioning did appear to benefit from computer assisted cognitive retraining; however, further study confirming these findings need to be conducted.
     
  9. There is Level 2 evidence of a positive impact on visual and verbal learning post exercise intervention for brain injury survivors.
     
  10. There is Level 3 evidence from one study indicating that VR programs do not enhance cognitive functioning post TBI in individuals who have sustained a TBI.
     
  11. There is Level 2 evidence (from several studies) that internal strategies appear to be an effective aid in improving recall performance. 
     
  12. There is Level 3 evidence from several case-control studies that internal strategies appear to assist in improving recall performance.
     
  13. There is Level 2 evidence indicating that memory-retraining programs appear effective, particularly for functional recovery although performance on specific tests of memory may or may not change. 
     
  14. There is Level 3 evidence supporting spaced retrieval practice as an effective method of improving memory post ABI.
     
  15. There is Level 3 evidence suggesting that the spacing of repetitions improves memory post ABI.
     
  16. There is Level 1b evidence, from one RCT, that cranial electrotherapy stimulation did not help to improve memory and recall following brain injury.
     
  17. Despite the success of several of these programs, there is conflicting evidence supporting the use of group-based interventions to treat executive dysfunction post ABI.
     
  18. There is Level 2 evidence to suggest that goal training is effective in improving attention and executive control.
     
  19. There is Level 1b evidence to suggest goal management training is effective in teaching individuals post ABI to set goal, plan and initiate tasks.
     
  20. There is Level 2 evidence, based on a single RCT, that goal management training is effective for improving paper and pencil everyday tasks and meal preparation skills for persons with an ABI.
     
  21. There is Level 4 evidence, based on a single group intervention, that goal planning in the form of leisure activities is effective for achieving identified goals following injury.
     
  22. There is conflicting evidence as to the effectiveness of cognitive rehabilitation programs focusing on memory strategies and selective attention.
     
  23. There is Level 2 evidence that general cognitive rehabilitation therapy post acquired brain injury is effective for improving cognition. Although there are variable strategies and protocols for cognitive rehabilitation, all comprehensive interventions appear to provide benefit.
     
  24. There is Level 4 evidence that working memory training is effective in recovering the central executive system of working memory
     
  25. There is Level 4 evidence that an outpatient day program is effective for assisting brain injury survivors in returning to competitive employment.
     
  26. Based on a single RCT, there is Level 1b evidence that donepezil improves attention and short-term memory.
     
  27. Although several of the studies reviewed found methylphenidate did improve cognitive functioning post ABI, the results were conflicting. To date there is no clear evidence supporting the administration of methylphenidate in individuals who have a moderate to severe ABI.
     
  28. There is Level 1b evidence showing that sertraline does not improve cognitive functioning in individuals who have sustained a moderate to severe ABI.
     
  29. There is Level 2 evidence that amantadine does not help to improve learning and memory deficits based on the conclusions of a single group intervention study.
     
  30. There is Level 2 evidence from one RCT that amantadine does not help to improve overall cognitive functioning based on the conclusions of a single RCT.
     
  31. Based on a single RCT, there is Level 1b evidence that pramiracetam produces significant clinical improvements on males’ memory which is sustained at one month following discontinuation of the drug.
     
  32. Based on a single RCT, there is Level 1b evidence that physostigmine improves memory in men with brain injury.
     
  33. Based on a two RCTs there is conflicting evidence supporting the use of bromocriptine to enhance cognitive functioning.
     
  34. There is Level 4 evidence that bromocriptine improves all motivational deficits except mood.
     
  35. There is Level 5 evidence, from one observational study, that bromocriptine significantly improves memory impairments.
     
  36. There is Level 4 evidence that cerebrolysin, a neurotrophic and neuroprotective medication appears to have potential benefit to improve outcome and cognitive functioning post-brain injury; however, controlled trials will be necessary to evaluate this further. 
     
  37. There is Level 1b evidence suggesting rhGH does assist in improving cognitive functioning in individuals who are GHD post ABI.
     
  38. There is Level 2 evidence showing the administration of rhGH does improve cognitive rehabilitation in those who have sustained a moderate to severe TBI.