8ecenL Advances Cn

Cogn|t|ve kehab|||tat|on |n
1raumat|c 8ra|n In[ury
resenLed 8y rlya kuberan
-@8CuuC@C-
@raumaLlc braln ln[ury ls an lnsulL Lo Lhe braln noL of a
degeneraLlve or congenlLal naLure buL caused by an
exLernal physlcal force LhaL may produce a dlmlnlshed or
alLered sLaLe of consclousness whlch resulLs ln an
lmpalrmenL of cognlLlve ablllLles or physlcal funcLlonlng
@raumaLlc braln ln[ury may cause a focal corLlcal leslon
and subcorLlcal axonal ln[urles LhaL dlsconnecL Lhe fronLal
neLworks
Neotokebobllltotloo 20112816780
@8 can lead Lo deflclLs ln aLLenLlon worklng
memory moLlvaLlon and goal dlrecLed
behavlour LhaL lnLerfere wlLh rehablllLaLlon
and delay reLurn Lo normal soclal acLlvlLles
@he moLor recovery of @8 paLlenLs are Lhus
ofLen hlndered by Lhelr cognlLlve deflclLs
whlch are noL effecLlvely handled ln rouLlne
cllnlcal pracLlce
Neototebobll Neotol kepolt 20112566772
CCGNI1IVL kLnA8ILI1A1ICN
CognlLlve rehablllLaLlon ls a speclallzed
lnLerdlsclpllnary LreaLmenL approach Lo
develop Lhe cognlLlon affecLed by lnLernal and
exLernal ln[ury Lo Lhe braln
8ased on Lhe Lheory LhaL Lhe recovery of
funcLlon can occur Lhrough new learned
connecLlons esLabllshed Lhrough cognlLlve
reLralnlng exerclses
ndlan ! sychlaLry 20083028286
@he process of cognlLlve rehablllLaLlon lnvolves
assessmenL of cognlLlve funcLlons goal seLLlng and
applylng approprlaLe cognlLlve exerclses Lo lmprove
Lhe execuLlve funcLlons
@here are 2 Lypes of cognlLlve rehablllLaLlon
A) 8esLoraLlve rehablllLaLlon enables Lhe paLlenL Lo
develop losL funcLlons Lhrough speclallzed
compuLerlsed and manual cognlLlve exerclses
8) CompensaLory rehablllLaLlon helps Lhe paLlenL Lo
develop Lhe use of alds and Lools Lo overcome Lhe
lmpalrmenL
Neototebobll Neotol kepolt 1988297101
CompensaLory approach
nLernal sLraLegles Self regulaLory and/or
meLacognlLlve sLraLegles ( goal managemenL
Lralnlng Llme pressure managemenL
LxLernal sLraLegles Cb[ecLs or cues ln Lhe
envlronmenL LhaL help Lo compensaLe for
execuLlve deflclLs le wrlLLen lnsLrucLlons
learnlng meLhods checkllsLs elecLronlc devlce
prompLs and oLher forms of sLlmulaLlon
8esLoraLlve Approach
ncludes a number of compuLer or pen or
paper exerclses deslgned Lo lsolaLe speclflc
componenLs of lmpalred cognlLlon
lor eg
SelecLlve aLLenLlon
Memory for new lnformaLlon
CognlLlve rehablllLaLlon has been shown Lo be
effecLlve ln lmprovlng cognlLlve funcLlon for @8
paLlenLs especlally ln Lhe domaln of aLLenLlon
memory and execuLlve funcLlons
f cognlLlve pracLlce conLrlbuLes Lo funcLlonal
resLoraLlon of @8 paLlenLs Lhe acLlvlLy of fronLal
corLlcal neLworks mlghL be changed and may be
beLLer lnLegraLed durlng Lask performance
-eurorehabll -eural 8epalr 20092346877
8aslc AssumpLlons develop effecLlve lnLervenLlons
for cognlLlve dlsorders
8ehablllLaLlon speclallsLs cannoL lsolaLe cognlLlon
8ehablllLaLlon speclallsLs wlll need Lo adopL an
eclecLlc managemenL approach
8ehablllLaLlon speclallsLs need a way Lo
concepLuallze Lhe cognlLlve areas
8ehablllLaLlon speclallsLs need Lo apply currenL
knowledge from Lhe flelds of cognlLlve psychology
and Lhe neurosclences
9r|nc|p|es Cf Cogn|t|ve kehab|||tat|on
CognlLlve rehablllLaLlon emphaslzes collaboraLlon and acLlve
parLlclpaLlon
CognlLlve rehablllLaLlon ls goalorlenLed and whlle problem
focused bullds on sLrengLhs
CognlLlve rehablllLaLlon has a prlmary focus on educaLlon wlLh
an emphasls on empowermenL selfconLrol and self
sufflclency
CognlLlve rehablllLaLlon sesslons are sLrucLured and LreaLmenL
plans and acLlvlLles are developed wlLh reference Lo boLh
assessmenL resulLs and currenL performance daLa
CognlLlve rehablllLaLlon goals may lnclude
lmprovlng cognlLlve and behavloral skllls
compensaLlng for cognlLlve and behavloral
llmlLaLlons and asslsLlng a cllenL Lo
undersLand and manage emoLlonal reacLlons
Lo changes ln hls or her funcLlonlng
CognlLlve rehablllLaLlon asslsLs cllenLs ln
achlevlng a more accuraLe undersLandlng of
Lhelr sLrengLhs and llmlLaLlonsand ln ad[usLlng
Lo ln[uryrelaLed changes ln funcLlonlng and ln
llfe clrcumsLances
CognlLlve exerclses lncludlng compuLerasslsLed
sLraLegles have been used Lo lmprove speclflc
neuropsychologlcal processes predomlnanLly
aLLenLlon memory and execuLlve skllls
CompensaLory devlces such as memory books
and elecLronlc paglng sysLems are used boLh Lo
lmprove parLlcular cognlLlve funcLlons and Lo
compensaLe for speclflc deflclLs @ralnlng Lo use
Lhese devlces requlres sLrucLured sequenced
and repeLlLlve pracLlce
Common|y used too|s for cogn|t|ve
rehab|||tat|on
MMSL (preferably a score of above 12/30)
8LA recovery sLage above 3
-europsychologlcal 8aLLery of @esLs Lo
quanLlfy componenLs llke aLLenLlon memory
execuLlve funcLlon
luncLlonal M8
Common|y descr|bed Cogn|t|ve strateg|es
SLraLegy Lralnlng
Coal managemenL Lralnlng
@lme pressure managemenL Lralnlng
ALLenLlon reLralnlng
MeLacognlLlve Lralnlng (self monlLorlng/self
regulaLlon)
Skllls acqulslLlon Lralnlng
CesLural sLraLegy Lralnlng
vlsual scannlng Lralnlng
Spaced reLrleval memory Lralnlng
valldaLed CompuLerbased nLervenLlonal @ools
ALLenLlon rocess @ralnlng
ConcenLraLlon Car (CCar)
@here ls exLenslve appllcaLlon of language and
modes of communlcaLlon ln cognlLlve Lralnlng
CommunlcaLlon skllls have also been lmproved
Lhereby leadlng Lo a beLLer soclal proflle
llolcol kebobllltotloo 2011 25 67592
uesplLe many descrlpLlons of speclflc sLraLegles
programs and lnLervenLlons llmlLed daLa on Lhe
effecLlveness of cognlLlve rehablllLaLlon programs are
avallable because of heLerogenelLy of sub[ecLs
lnLervenLlons and ouLcomes sLudled
CuLcome measures presenL a speclal problem slnce
some sLudles use global macro"level measures
(eg reLurn Lo work) whlle oLhers use
lnLermedlaLe" measures (eg lmproved memory)
8LCL-@ S@uuLS
8EARCH 8TRATEGY
Databases searched:
- Pubmed, Science direct, Cebp, Google scholar, Free
medical journals, Sagepub, Medline, Cinahl, Pedro.
$eIection criteria:
- Full text articles from 2007- 2011.
Keywords used:
- Cognitive rehabilitation, Traumatic brain injury, Executive
training, Attention training
0;08 of E;/03.0
1a- SR (with homogeneity)of RCTs.
1b- ndividual RCT (with narrow Confidence nterval)
1c- All or none case series
2a- SR (with homogeneity) of cohort studies.
2b- ndividual cohort study (including low quality RCT).
3a- SR (with homogeneity) of case-control studies
3b- ndividual Case-Control Study.
4- Case-series (and poor quality cohort and case control studies.
5- Expert opinion without explicit critical appraisal, or based on
physiology, bench research or first principles.
LLVLLS CI LVIDLNCL NUM8Lk CI Ak1ICLLS
LLVLL 1 2
LLVLL 2 2
LLVLL 3 0
LLVLL 4
1
LLVLL S 1
8LvLW A8@CLL (ML@A A-AL?SS)
Lv|dence 8ased Cogn|t|ve kehab|||tat|on
Updated kev|ew of the L|terature from 2003
through 2008 (1b)
Clcerone ku Langerbahn uM 8raden C
Malec !l kalmar k lraas M eL al
tcb lbys MeJ kebobll 201192519J0
Cb[ect|ve @o updaLe our cllnlcal
recommendaLlons for cognlLlve rehablllLaLlon
of people wlLh LraumaLlc braln ln[ury based on
a sysLemaLlc revlew of llLeraLure from 2003
Lhrough 2008
Study se|ect|on 112 ouL of 141 arLlcles were
fully revlewed and evaluaLed afLer excluslon of
nonLreaLmenL sLudles descrlpLlve sLudles
revlews cllnlcal commenLarles
Data Lxtract|on ArLlcles were asslgned Lo 16
caLegorles reflecLlng Lhe prlmary area of
lnLervenLlon aLLenLlon vlslon and vlsuospaLlal
funcLlonlng language and communlcaLlon
skllls memory execuLlve funcLlonlng and
problem solvlng awareness
Data Synthes|s 14 arLlcles were raLed class 1
3 1b 11 2 82 3
Lvldence was synLheslzed and recommended
as a) racLlce sLandards b) racLlce guldellnes
c) racLlce opLlons
varlous SLraLegles used ln Lhe SLudles
8evlewed
1 8emedlaLlon Cf ALLenLlon
ulrecL aLLenLlon Lralnlng
MeLacognlLlve Lralnlng
Speclflc aLLenLlon Lralnlng
CompuLer based lnLervenLlons
Conc|us|on
SubsLanLlal evldence supporLlng Lhe use of dlrecL
aLLenLlonal Lralnlng and meLacognlLlve Lralnlng afLer @8
Lo promoLe developmenL of selfdlrecLed sLraLegles
Self monlLorlng and self regulaLlon help ln execuLlve
funcLlonlng deflclLs
vlsuospaLlal rehablllLaLlon LhaL lncludes vlsual scannlng
Lralnlng
CesLural sLraLegy Lralnlng for apraxla
CognlLlve rehablllLaLlon ls shown Lo be of greaLer
beneflL Lhan convenLlonal rehablllLaLlon ln 94 of
comparlson sLudles
8A-uCMLu CC-@8CLLLu @8AL
kehab|||tat|on of 1raumat|c 8ra|n In[ury |n
Act|ve Duty M|||tary 9ersonne| and Veterans
Defense and Veterans 8ra|n In[ury Center
kandom|zed Contro||ed 1r|a| of 1wo
kehab|||tat|on Approaches (1b)
vanderploeg 8u Schwab k Walker WC lraser
!A Slgford 8! uaLe LS
tcb lbys MeJ kebobll 2008892227J9
Cb[ect|ves @o deLermlne Lhe relaLlve efcacy of 2
dlfferenL acuLe LraumaLlc braln ln[ury (@8)
rehablllLaLlon approaches cognlLlve dldacLlc versus
funcLlonalexperlenLlal and secondarlly Lo
deLermlne relaLlve efcacy for dlfferenL paLlenL
subpopulaLlons
9art|c|pants 360 adulL veLerans or acLlve duLy
mlllLary servlce members wlLh moderaLe Lo severe
@8
Intervent|ons 1 Z 2 Z hours of proLocol
speclflc cognlLlvedldacLlc versus funcLlonal
experlenLlal rehablllLaLlon Lherapy lnLegraLed
wlLh dally physlcal Lherapy
uuraLlon of proLocol LreaLmenL varled beLween
2060 days dependlng on cllnlcal needs and
progress of Lhe paLlenLs
CognlLlvedldacLlc LreaLmenL LargeLed 4
cognlLlve domalns of aLLenLlon memory
execuLlve funcLlons and pragmaLlc
communlcaLlon
rogresslvely more dlfflculL paperandpencll
or compuLerlzed cognlLlve Lasks
luncLlonalexperlenLlal LreaLmenL usage of
realllfe performance slLuaLlons and common
Lasks Lo remedlaLe or compensaLe for
funcLlonal deflclLs afLer braln ln[ury
Cutcomes 1year global funcLlonal measures
and reLurn Lo work
Conc|us|ons -o dlfference beLween cognlLlve
dldacLlc and funcLlonalexperlenLlal
approaches Lo braln ln[ury rehablllLaLlon on 1
year global ouLcome measures
aLlenLs ln Lhe cognlLlve LreaLmenL group
performed had beLLer cognlLlve performance
Lhan paLlenLs ln Lhe funcLlonal Lralnlng group
?ounger paLlenLs beneflLLed beLLer from
cognlLlve Lralnlng whlle older paLlenLs fared
beLLer wlLh funcLlonal Lralnlng
8A-uCMLu CC-@8CLLLu @8AL
A kandom|zed Contro||ed 1r|a| of no||st|c
Neuropsycho|og|c kehab|||tat|on After
1raumat|c 8ra|n In[ury (1b)
Clcerone ku MoLL @ azulay ! SharlowCalella MA
Lllmo W! aradlse S lrlel !C
tcb lbys MeJ kebobll 20088922J950
Cb[ect|ve @o evaluaLe Lhe effecLlveness of
comprehenslve hollsLlc neuropsychologlc
rehablllLaLlon compared wlLh sLandard
mulLldlsclpllnary rehablllLaLlon for people wlLh
@8
9art|c|pants 68 paLlenLs wlLh @8 (moderaLe
Lo severe @8 (aL leasL 3 monLhs posL ln[ury)
wlLh adequaLe language and expresslon and
comprehenslon Lo parLlclpaLe ln verbally
based group lnLervenLlons
Intervent|ons
uuraLlon 13 hours per week of Lherapy for 16
weeks
nLenslve cognlLlve rehablllLaLlon program
lnLegraLlon of lnLervenLlons for cognlLlve
deflclLs emoLlonal dlfflculLles lnLerpersonal
behavlours and funcLlonal skllls
Lmphasls on performance feedback and acLlve
selfevaluaLlon
MeLacognlLlon (selfmonlLorlng and self
regulaLlon) wlLh emoLlonal regulaLlon
Structure of the program
Weeks 14 engagemenL ln LreaLmenL use of
peer and LheraplsL feedback sLraLegles for
malnLalnlng aLLenLlon faclllLaLlon of
awareness of llmlLaLlon and use of
compensaLory sLraLegles
Weeks 38 Lask analysls plannlng and
organlsaLlon goal seLLlng and soclal problem
solvlng
Weeks 912 AppllcaLlon and carry over of
compensaLory sLraLegles
Weeks 1316 generallsaLlon of sLraLegles Lo
everyday funcLlonlng and LranslLlon Lo Lhe
communlLy
Cutcomes
LmoLlonal monlLorlng Lhrough Lhe use of a CognlLlve
Lnergy Scale
CommunlLy lnLegraLlon quesLlonnalre
ercelved quallLy of llfe quesLlonnalre
ercelved self efflcacy
CommunlLy based employmenL
Conc|us|on
A hollsLlc neuropsychologlcal rehablllLaLlon shows
lmproved lmproved confldence ln Lhelr ablllLy Lo
manage cognlLlve sympLoms and Lhereby enhanclng
Lhelr funcLlonal skllls and quallLy of llfe
8LvLW A8@CLL (ML@AA-AL?SS)
Methodo|og|ca| ua||ty of kesearch on
Cogn|t|ve kehab|||tat|on After 1raumat|c
8ra|n In[ury (2a)
kelLh u Clcerone !oanne Azulay CharloLLe @roLL
tcb lbys MeJ kebobll 2009 90 5oppl 1
Cb[ect|ve @o evaluaLe Lhe meLhodologlcal quallLy of
research on cognlLlve rehablllLaLlon afLer LraumaLlc
braln ln[ury
Data Sources Secondary analysls of sLudles
ldenLlfled ln prlor sysLemaLlc revlews of cognlLlve
rehablllLaLlon
Data Lxtract|on 16 evaluaLlve crlLerla for Lhe 8C@s
8 for lnLernal valldlLy 3 for descrlpLlve and 3 for
sLaLlsLlcs
Data Synthes|s 32 8C@s and 21 CbservaLlonal
sLudles were lndependenLly revlewed and raLed by 2
auLhors
Conc|us|on
Several hlgh quallLy 8C@s supporL Lhe effecLlveness of
lnLervenLlons for aLLenLlon communlcaLlon skllls and
execuLlve funcLlonlng afLer @8
Several hlgh quallLy observaLlonal sLudles supporL
Lhe effecLlveness of comprehenslve hollsLlc
rehablllLaLlon afLer @8 lncludlng lmprovemenL ln
parLlclpaLlon ouLcomes
A 8CSLC@vL -C-8A-uCMLu CC-@8CLLLu @8AL
9|ast|c|ty of the Attent|ona| Network after 8ra|n
In[ury and Cogn|t|ve rehab|||tat|on (2b)
?unPee klm Wookyoung ?oo MyoungPwan
ko ChangPyun ark sung @ae klm uuk L -a
Neototebobll Neotol kepolt 2009 2J 46877
Cb[ect|ve Lo dellneaLe Lhe cerebral aLLenLlonal neLwork ln
paLlenLs wlLh LraumaLlc braln ln[ury and assess for adapLaLlons
ln Lhls neLwork ln response Lo a rehablllLaLlon lnLervenLlon
Methodo|ogy
9art|c|pants 17 paLlenLs wlLh moderaLe LraumaLlc dlffuse
axonal ln[ury of Lhe braln and 13 healLhy conLrol sub[ecLs
(ModeraLe @8 CCS of 912 on arrlval wlLh no subsequenL
deLerloraLlon
Lxcluslon of paLlenLs wlLh preexlsLlng neuropsychlaLrlc lllnesses
or space occupylng leslons)
CognlLlve Lralnlng performed uslng ComCog sofLware
developed Lo Lraln aLLenLlon funcLlons
ConslsLs of 10 dlfferenL aLLenLlon Lasks Lo Lraln vlsual and
audlLory aLLenLlon vlgllance dlvlded aLLenLlon and
perslsLence
Lach Lask had several subLasks wlLh varlous levels of Lask
dlfflculLy
30 mlns per sesslon 3 Llmes per week for 4 consecuLlve
weeks
CuLcome Measures fM8 (before and afLer compleLlng Lhe
Lralnlng program) uslng a behavloural Lask ln Lhe form of
vA@ paradlgm (coverL shlfLlng of aLLenLlon)
kesu|ts
8ehavloral Lask AfLer 4 weeks of cognlLlve Lralnlng Lhe @8
paLlenLs had slgnlflcanL lmprovemenL ln boLh Lask accuracy
and reacLlon Llme
fM8 ncreased acLlvaLlon ln Lhe bllaLeral anLerlor clngulaLe
gyrus and precuneus cerebellum and LemporoocclplLal
reglon
(8efore Lralnlng Lhere was mlnlmal acLlvaLlon ln Lhe lnsular
corLex and Lemporal lobe and sllghLly beLLer acLlvaLlon ln
Lhe fronLal lobe)
CASL SL8LS
1ra|n|ng pat|ents |n 1|me 9ressure
Management a Cogn|t|ve Strategy for Menta|
S|owness (4)
Wlnkens L PeugLen CMv Wade u@ lasoLLl L
llo kebobll 20092J7991
9urpose @o provlde cllnlcal pracLlLloners wlLh a
framework for Leachlng paLlenLs @lme
ressure ManagemenL a cognlLlve sLraLegy
kat|ona|e 8ased on Mlchon's Lask analysls
descrlblng Lhe levels of declslonmaklng ln
complex cognlLlve Lasks
1heory |nto 9ract|ce SufflclenL awareness ls
needed Lo recognlze LhaL Lherels a deflclL and
behavloural change ls necessary AdequaLe
moLlvaLlon ls needed Lo learn Lhe sLraLegy
Lralnlng should be ad[usLed Lo lndlvldual's
learnlng ablllLles and cognlLlve skllls
9art|c|pant
43 year old man wlLh braln ln[ury wlLh complalnLs
of decreased Lempo ln performlng household
Lasks
38 year old woman wlLh braln ln[ury wlLh
complalnLs of dlfflculLy ln performlng several
Lasks ln a shorL amounL of Llme
Cogn|t|ve Def|c|t MenLal slowness
1reatment Durat|on 1 hour per week for 812
weeks
Conc|us|on Lven severe @8 paLlenLs may
beneflL from Llme pressure managemenL lf
Lhe Lralnlng ls ad[usLed Lo Lhe paLlenL's
lndlvldual level of readlness cognlLlve sklll and
awareness
@he dlscussed framework can be effecLlvely
modlfled accordlng Lo Lhe paLlenL's problem
areas and applled lnLo cllnlcal pracLlce
8LvLW A8@CLL
kehab|||tat|on of execut|ve d|sorders after bra|n
|n[ury Are |ntervent|ons effect|ve? (S)
u P L 8oelen ! M Splkman L lasoLLl
!ournal of -europsychology 2011 3 73113
Cb[ect|ve Lo evaluaLe Lhe exLernal and lnLernal valldlLy of
sLudles on Lhe effecLlveness of lnLervenLlons for execuLlve
dlsorders
Stud|es 46 papers descrlblng 34 sLudles conducLed ln Lhe
lasL Lwo decades
ncluslon crlLerla for papers
a) sLudles deallng wlLh acqulred braln damage wlLh no oLher
psychlaLrlc lllness or congenlLal braln damage
b) AdulL parLlclpanLs
c) AL leasL one quanLlLaLlve ouLcome measure
d) CuanLlLaLlvely analysed lnLervenLlon effecLs
e) Speclflc effecLs of execuLlve lnLervenLlon can be
deLermlned lf lL was a parL of a hollsLlc approach
Method SLudles have been dlvlded lnLo Lhree LreaLmenL
caLegorles compensaLory approach (lnLernal and exLernal
sLraLegles) resLoraLlve approach and behavlour
modlflcaLlon
lurLher sLraLlflcaLlon of each caLegorles by level of evldence
from 8C@s Lo slngle case sLudy deslgns
CompensaLory approach
a) nLernal sLraLegles self regulaLory/meLa cognlLlve
b) LxLernal sLraLegles
8esLoraLlve approach repeaLed compuLerlzed exerclses o
repeaLed admlnlsLraLlon of sLandardlsed LesLs
8ehavlour modlflcaLlon lnLervenLlons based on learnlng
prlnclples and behavlour Lherapy
Conc|us|ons Lhe resulLs of mosL of Lhe sLudles
seem Lo be encouraglng buL Lhe
meLhodologlcal rlgour of a number of sLudles
can be lmproved
nLernal valldlLy can be lmproved lf Lhe chosen
deslgn sufflclenLly conLrols Lhe alLernaLlve
explanaLlons LhaL may lnfluence Lhe
performance on ouLcome measures
LxLernal valldlLy of Lhe meLhodology ln Lerms
of lLs generallsaLlon Lowards Lhe paLlenL
populaLlon has been scarcely explored
Imp||cat|ons for C||n|ca| 9ract|ce
@here conLlnues Lo be much debaLe among
researchers abouL
when Lo lnlLlaLe LreaLmenL
WhaL speclflc sLraLegles Lo employ
WhaL lnLenslLy of LreaLmenL Lo provlde
lor how long Lhe LreaLmenL has Lo be
conLlnued
CognlLlve Lralnlng can be easlly lncorporaLed lnLo
Lhe rehablllLaLlon of paLlenLs posL LraumaLlc braln
ln[ury
@he sLraLegles are Lhe mosL effecLlve ln mlld Lo
moderaLe LraumaLlc braln ln[ury
CerLaln sLraLegles llke vlsual scannlng have known
Lo be effecLlve even ln severe @8
CognlLlve reLralnlng needs Lhe paLlenL Lo have
achleved aL leasL Lhe 3
Lh
sLage of recovery ln Lhe
8LA scale
ALLenLlonal sLraLegles ln Lhe form of slmple
compuLergeneraLed Lasks can be used for
dlmlnlshlng cognlLlve deflclLs and lmprovlng
Lask performance
MeLacognlLlve sLraLegles can be added on Lo
Lhe paLlenL's rouLlne moLor Lralnlng Lhereby
enhanclng Lhe moLor skllls ln a paLlenL
Imp||cat|ons for kesearch
ueveloplng sLandardlsed and sysLemaLlc
LreaLmenL proLocol for each domaln ln
cognlLlve rehablllLaLlon for @8 paLlenLs
Plgh quallLy 8C@s comparlng Lhe effecL of
cognlLlve rehablllLaLlon wlLh oLher
lnLervenLlonal approaches ln @8
Lxplorlng Lhe use of cognlLlve rehablllLaLlon ln
oLher neurologlcal condlLlons wlLh cognlLlve
deflclLs
ueveloplng approprlaLe and sLandardlsed
screenlng Lools for selecLlon of paLlenLs for
each form of lnLervenLlonal cognlLlve sLraLegy
Laslly appllcable less sophlsLlcaLed sLraLegles
for cognlLlve Lralnlng can be formulaLed and
LesLed for Lhelr effecLlveness
LffecL of cognlLlve rehablllLaLlon on varlous
moLor ouLcomes have noL been explored
wldely and can be researched upon
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