In reviewing the literature with regards to cognitive-communication interventions in acquired brain injury, Ylvisaker and Urbanczyk (1990) compared methods of cognitive retraining to more functional integrative methods set in real life activities. They described cognitive retraining approaches as “mental muscle building designed to improve aspects of cognition through repetition”. While they acknowledged that a number of studies had demonstrated statistically significant improvements on testing following a period of intensive cognitive retraining, they asserted that these improvements did not translate to functional improvements in daily communication (Ylvisaker & Urbanczyk, 1990, p. 222). Ylvisaker and Urbanczyk (1990) cautioned that efficacy of interventions must make a difference during everyday tasks, and generalize to everyday settings where the individual communicates on a daily basis.
Further, the authors indicate that there are several challenges to conducting treatment efficacy research in the field of cognitive-communication disorders. These include the following: significant heterogeneity within ABI, the confounding effects of spontaneous recovery, the need for highly individualized treatment, difficulties in generalizing from single-case illustrations, the need to measure improvement “in messy real world tasks” rather than on standardized psychometrically sound instruments and finally, the need for multifaceted, integrated rehabilitation which poses measurement problems.
Several authors have reviewed a variety of studies focusing on cognitive-communication therapies used to assist those post ABI (Kennedy et al., 2008; Coelho et al., 1996; MacDonald and Wiseman-Hakes, 2010). In an earlier review conducted by Coelho et al. (1996), the concluding findings suggest that those who sustain an ABI benefit from the work of a Speech-Language Pathologist. Study authors found evidence to suggest that individuals undergoing therapy showed gains in receptive and expressive language, speech production, reading, writing, and cognition. Further they noted that patients with more severe cognitive-communication deficits are more effectively remediated when treatment is directed toward the development of compensatory strategies such as the use of memory aids (e.g. appointment book, alarm watch, or a detailed daily schedule) (Coelho et al., 1996). Additionally, Coelho and colleagues (1996) reported that although interventions directed at particular cognitive deficits are important; clinicians must attend to broader issues of social skills retraining, timing of treatment during recovery, treatment location and its effectiveness (e.g. hospital, home, school, work). Study results from Mack et al. (1992) suggest that intervention programs offered earlier post injury result in shorter rehabilitation stays. Further, for individuals with comparable disabilities, those who receive rehabilitation have better than average cost outcomes compared to those not receiving these services (Aronow, 1987). For individuals with profound deficits following their ABI, treatment focusing on environmental modification or the arrangement of permanent support systems may be most effective (e.g. training family members/significant others to encourage patient/client during activities of daily living) (DePompei & Williams, 1994; Story, 1991).
Although the findings of these studies were reported over twenty years ago, the same principles hold true today in discussions of cost effectiveness in therapy within both the hospital and outpatient settings.