Effects of cognitive treatment in psychiatric rehabilitation. Viewing less to see better. Efficacy and specificity of intensive cognitive rehabilitation of attention and executive functions in multiple sclerosis. TENS and optokinetic stimulation in neglect therapy after cerebrovascular accident: a randomized controlled study. Microcomputer-based rehabilitation for unilateral left visual neglect: a randomized controlled trial. Cognitive rehabilitation in the elderly: effects on strategic behavior in relation to goal management. A randomized, two-year study of the efficacy of cognitive intervention on elderly people: the Donostia Longitudinal Study. Cognitive rehabilitation combined with drug treatment in Alzheimer's disease patients: a pilot study. A controlled clinical trial on the effects of motor intervention on balance and cognition in institutionalized elderly patients with dementia. Evaluation of rehabilitation of memory in neurological disabilities (ReMiND): a randomized controlled trial. Unilateral neglect syndrome rehabilitation by trunk rotation and scanning training. Effects of cognitive training interventions with older adults: a randomized controlled trial. Randomized controlled trial of cognitive behaviour therapy for repeated consultations for medically unexplained complaints: a feasibility study in Sri Lanka. Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. The effects of a rehabilitation program with mnemotechniques on the institutionalized elderly subject. Visuomotor imagery as a new tool in the rehabilitation of neglect: a randomised controlled study of feasibility and efficacy. A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury. Comparison of remedial and compensatory interventions for adults with acquired brain injuries.
Ninety subjects with severe and disabling psychiatric conditions, predominantly schizophrenia, participated in a controlled-outcome trial of the cognitive component of Integrated Psychological Therapy (IPT), a group-therapy modality intended to reestablish basic neurocognitive functions. The cognitive therapy was delivered to subjects in the experimental condition during intensive 6-month treatment periods. Control subjects received supportive group therapy. Before, during, and after the intensive treatment period, all subjects received an enriched regimen of comprehensive psychiatric rehabilitation, including social and living skills training, optimal pharmacotherapy, occupational therapy, and milieu-based behavioral treatment. IPT subjects showed incrementally greater gains compared with controls on the primary outcome measure, the Assessment of Interpersonal Problem-Solving Skills, suggesting that procedures that target cognitive impairments of schizophrenia spectrum disorders can enhance patients' response to standard psychiatric rehabilitation, at least in the short term, in the domain of social competence. There was equivocal evidence for greater improvement in the experimental condition on the Brief Psychiatric Rating Scale disorganization factor and strong evidence for greater improvement on a laboratory measure of attentional processing. There was significant improvement in both conditions on measures of attention, memory, and executive functioning, providing support for the hypothesis that therapeutic procedures that target impaired cognition enhance response to conventional psychiatric rehabilitation modalities over a 6-month timeframe. To assess the efficacy, as well as the long term duration, of a new procedure for the rehabilitation of visuospatial neglect in patients with right hemisphere stroke.
                Patients with right unilateral hemispheric damage identified with neglect were assigned to a treatment (T+) or a control (T-) group. The treatment consisted in abolishing all visual inputs from the right hemispace for one week by means of specially devised hemiblinding goggles. Patients' visuospatial abilities were tested and compared between groups immediately after the week of treatment. Both groups were further assessed one week after treatment suspension for evaluation of long term beneficial effects.
                Following the treatment, a substantial amelioration of visuospatial neglect symptoms was selectively observed in the T+ group. In contrast, untreated patients showed only weak signs of recovery. Most important, the amelioration obtained in the T+ group of patients was not ephemeral, being significantly maintained after a further period of one week, even after suspension of the treatment.
                The protracted efficacy of the proposed "hemiblinding technique" may have important implications for the recovery of visuospatial neglect and may be a very promising tool for investigating both the cognitive and the neural basis of neglect rehabilitation. To evaluate the efficacy of a computer-based intensive training program of attention, information processing and executive functions in patients with clinically-stable relapsing-remitting (RR) multiple sclerosis (MS) and low levels of disability. DESIGN, PATIENTS AND INTERVENTIONS: A total of 150 patients with RR MS and an Expanded Disability Status Scale (EDSS) score of < or =4 were examined. Information processing, working memory and attention were assessed by the Paced Auditory Serial Addition Test (PASAT) and executive functions by the Wisconsin Card Sorting Test (WCST). Twenty patients who scored below certain cut-off measures in both tests were included in this double-blind controlled study. Patients were casually assigned to a study group (SG) or a control group (CG) and underwent neuropsychological evaluation at baseline and after 3 months. Patients in the SG received intensive computer-assisted cognitive rehabilitation of attention, information processing and executive functions for 3 months; the CG did not receive any rehabilitation.
                Ambulatory patients were sent by the MS referral center.
                Improvement in neuropsychological test and scale scores.
                After rehabilitation, only the SG significantly improved in tests of attention, information processing and executive functions (PASAT 3'' p=0.023, PASAT 2'' p=0.004, WCSTte p=0.037), as well as in depression scores (MADRS p=0.01). Neuropsychological improvement was unrelated to depression improvement in regression analysis.
                Intensive neuropsychological rehabilitation of attention, information processing and executive functions is effective in patients with RR MS and low levels of disability, and also leads to improvement in depression. In a randomized controlled type Ib study, the effectiveness of three different forms of therapy for the treatment of visual neglect was assessed by comparing therapy outcomes in three groups of patients after cerebrovascular accidents.
                A control group received only standard exploration training, whilst the second and third group received exploration training combined with either contralateral transcutaneous electrical nerve stimulation (TENS) or optokinetic stimulation (OKS) respectively.
                It was found that exploration training alone resulted in no improvement on both standard neglect tests (NTs) and everyday-relevant measures of reading and writing performance. In contrast, the groups receiving TENS or OKS showed significant improvements in both sets of measures with the difference that for the TENS group the improvement in NT scores at the end of therapy had disappeared 1-week later. However, both treatments resulted in significant improvements in reading and writing which were still present upon retesting 1-week after the end of therapy.
                Both methods can be recommended for neglect therapy and are superior to exploration therapy alone. Microcomputers are widely used in cognitive rehabilitation of brain damage. Unilateral neglect is commonly a target of cognitive rehabilitation, both computer-based and non-computer-based. This study reports the results of a randomized controlled trial of computer-based rehabilitation with blind follow-up for six months. Thirty-six patients with unilateral neglect, as defined by the behavioral subtests of the Behavioural Inattention Test, were randomized into two groups. One group of 20 subjects received a mean of 15.5 (SD = 1.8) hours of computerized scanning and attentional training; the second group of 16 subjects received a mean of 11.4 (SD = 5.2) hours of recreational computing (selected to minimize scanning and timed attentional tasks). Blind follow-up at the end of training and six months after revealed no statistically or clinically significant results between groups. These findings argue against routine clinical use of this type of computerized training until further studies establish what type, frequency, and duration of training produces clinically significant changes in unilateral visual neglect if, indeed, computerized training can have an effect with this type of disorder. Executive functions are highly sensitive to the effects of aging and other conditions affecting frontal lobe function. Yet there are few validated interventions specifically designed to address executive functions, and, to our knowledge, none validated in a healthy aging sample. As part of a large-scale cognitive rehabilitation randomized trial in 49 healthy older adults, a modified Goal Management Training program was included to address the real-life deficits caused by executive dysfunction. This program emphasized periodic suspension of ongoing activity to establish goal hierarchies and monitor behavioral output. Tabletop simulated real-life tasks (SRLTs) were developed to measure the processes targeted by this intervention. Participants were randomized to two groups, one of which received the intervention immediately and the other of which was wait-listed prior to rehabilitation. Results indicated improvements in SRLT performance and self-rated executive deficits coinciding with the training in both groups. These gains were maintained at long-term follow-up. Future research will assess the specificity of these effects in patient groups. Research on non-pharmacological therapies (cognitive rehabilitation) in old age has been very limited, and most has not considered the effect of interventions of this type over extended periods of time.
                To investigate a new cognitive therapy in a randomized study with elderly people who did not suffer cognitive impairment.
                The efficacy of this therapy was evaluated by means of post-hoc analysis of 238 people using biomedical, cognitive, behavioural, quality of life (QoL), subjective memory, and affective assessments.
                Scores for learning potential and different types of memory (working memory, immediate memory, logic memory) for the treatment group improved significantly relative to the untreated controls.
                The most significant finding in this study was that learning potential continued at enhanced levels in trained subjects over an intervention period lasting two years, thereby increasing rehabilitation potential and contributing to successful ageing. To study the efficacy of cognitive rehabilitation combined with acetylcholinesterase inhibitor (AChE-I) treatment in patients with mild Alzheimer's disease and their relatives.
                Thirteen patients with mild Alzheimer's disease treated with rivastigmine 6-12 mg/day for more than two months started cognitive rehabilitation training. Before and after the cognitive rehabilitation training patients were assessed through cognitive tests, activities of daily living scale, neuropsychological battery and scales to evaluate caregivers' depressive and anxiety symptoms. Six patients were randomized to a combined treatment group (AChE-I plus cognitive rehabilitation and caregiver support) and seven patients to a control group (AChE-I only) and followed up for five months.
                Mini-Mental State Examination (MMSE) scores (p = 0.047) and backward digit span scores (p = 0.018) were significantly different between the groups on follow-up. The combined treatment group showed a better positive treatment effect on cognitive and neuropsychological tests applied to patients and reduction of psychiatric symptoms was observed in their caregivers (nonsignificant).
                Cognitive rehabilitation associated with AChE-I treatment can potentially be useful to stabilize or improve cognitive and functional performance of patients with mild Alzheimer's disease and can reduce caregivers' psychiatric symptoms. To analyse the effects of two interventions on the cognition and balance of institutionalized elderly people with mixed dementia.
                Fifty-four participants were allocated into three groups. Group 1 was assisted by an interdisciplinary programme comprising physiotherapy, occupational therapy and physical education. A physiotherapist alone carried out the intervention in group 2. Group 3 was considered as control. Assessors were blinded to guarantee the absence of bias. Cognitive functions were analysed with the Mini-Mental State Examination and the Brief Cognitive Screening Battery. Balance was assessed with the Berg Balance Scale and the Timed Get-Up-and-Go Test. Multiple analysis of variance (MANOVA) was used to test possible main effects of the interventions.
                The results showed benefits on the balance of subjects in both groups 1 (F=3.9, P<0.05) and 2 (F=3.1, P<0.05), compared with group 3. MANOVA did not indicate benefits on the cognitive functions between groups 1 and 3 (F=1.1, P>0.05) and groups 2 and 3 (F=1.6, P>0.05). However, univariate analysis indicated some benefits of the interdisciplinary intervention on two specific domains measured by the Brief Cognitive Screening Battery (F=26.5, P<0.05; F=4.4, P<0.05).
                Six months of multidisciplinary or physiotherapeutic intervention were able to improve a person's balance. Although global cognition did not improve through treatment, when the intervention was carried out on a multidisciplinary basis we observed an attenuation in the decline of global cognition on two specific cognitive domains. Exercises applied in different contexts may have positive outcomes for people with dementia. The evidence for the effectiveness of memory rehabilitation is inconclusive. The aim was to compare the effectiveness of two group memory rehabilitation programmes with a self-help group control.
                Single-blind randomized controlled trial.
                Participants with memory problems following traumatic brain injury, stroke or multiple sclerosis were recruited from community settings.
                Participants were randomly allocated, in cohorts of four, to compensation or restitution group treatment programmes or a self-help group control. All programmes were manual-based and comprised two individual and ten weekly group sessions.
                Memory functions, mood, and activities of daily living were assessed at baseline and five and seven months after randomization.
                There were 72 participants (mean age 47.7, SD 10.2 years; 32 men). There was no significant effect of treatment on the Everyday Memory Questionnaire (P = 0.97). At seven months the mean scores were comparable (restitution 36.6, compensation 41.0, self-help 44.1). However, there was a significant difference between groups on the Internal Memory Aids Questionnaire (P = 0.002). The compensation and restitution groups each used significantly more internal memory aids than the self-help group (P < 0.01). There were no statistically significant differences between the groups on measures of mood, adjustment and activities of daily living (P > 0.05).
                There results show few statistically significant effects of either compensation or restitution memory group treatment as compared with a self-help group control. Further randomized trials of memory rehabilitation are needed. Assessment of a new rehabilitation method for unilateral neglect syndrome (UNS), using a specific device (Bon Saint Come's device) that associates exploratory reconditioning with voluntary trunk rotation.
                Study 1, randomized control trial during 2 months; study 2, nonrandomized control trial during 2 months.
                Neurorehabilitation units in private and public center.
                In study 1, 22 consecutive patients with UNS resulting from recent stroke (< 3 months) were randomly assigned to an Experimental Group (11 patients) or to a Control Group (11 patients). The 2 groups were very similar in terms of general and neurological data. In study 2, 5 consecutive patients with chronic UNS resulting from an old stroke (> 6 months) showing the same characteristics were included.
                In study 1, patients in Group E followed the experimental program 1 hour a day for 1 month (20 hours) and Group C followed usual neurorehabilitation during the same time. In study 2, every patient followed the experimental program 1 hour a day for 1 month (20 hours).
                Assessment in both studies was done at day 0, day 30, and day 60 using a battery of UNS tests (Albert, Scheckenberg, bell) and an activities of daily living (ADL) test (the Functional Independence Measure [FIM]). Mean scores of each test were compared between the 2 groups with the Wilcoxon nonparametric test.
                In study 1 all UNS test results and the FIM improved significantly more in Group E than in Group C. In Group E, UNS disappeared in 5 patients and improved in 6. In Group C, UNS disappeared in 1 patient, improved in 4, and was unchanged in 6. In Study 2, UNS remitted in 2 patients, improved in 2 patients, and was unchanged in 1.
                The Bon Saint Come method seems to significantly improve recent and chronic UNS, as well as ADL function. These encouraging results could have resulted from a synergistic effect of spatial reconditioning and voluntary trunk rotation. It must be assessed by a new study with more patients. Cognitive function in older adults is related to independent living and need for care. However, few studies have addressed whether improving cognitive functions might have short- or long-term effects on activities related to living independently.
                To evaluate whether 3 cognitive training interventions improve mental abilities and daily functioning in older, independent-living adults.
                Randomized, controlled, single-blind trial with recruitment conducted from March 1998 to October 1999 and 2-year follow-up through December 2001.
                Volunteer sample of 2832 persons aged 65 to 94 years recruited from senior housing, community centers, and hospital/clinics in 6 metropolitan areas in the United States.
                Participants were randomly assigned to 1 of 4 groups: 10-session group training for memory (verbal episodic memory; n = 711), or reasoning (ability to solve problems that follow a serial pattern; n = 705), or speed of processing (visual search and identification; n = 712); or a no-contact control group (n = 704). For the 3 treatment groups, 4-session booster training was offered to a 60% random sample 11 months later.
                Cognitive function and cognitively demanding everyday functioning.
                Thirty participants were incorrectly randomized and were excluded from the analysis. Each intervention improved the targeted cognitive ability compared with baseline, durable to 2 years (P<.001 for all). Eighty-seven percent of speed-, 74% of reasoning-, and 26% of memory-trained participants demonstrated reliable cognitive improvement immediately after the intervention period. Booster training enhanced training gains in speed (P<.001) and reasoning (P<.001) interventions (speed booster, 92%; no booster, 68%; reasoning booster, 72%; no booster, 49%), which were maintained at 2-year follow-up (P<.001 for both). No training effects on everyday functioning were detected at 2 years.
                Results support the effectiveness and durability of the cognitive training interventions in improving targeted cognitive abilities. Training effects were of a magnitude equivalent to the amount of decline expected in elderly persons without dementia over 7- to 14-year intervals. Because of minimal functional decline across all groups, longer follow-up is likely required to observe training effects on everyday function. Research on the management and the outcome of treatment of medically unexplained symptoms is very limited. Development of simple but effective techniques for treatment and demonstration of their effectiveness when applied in primary health care are needed.
                A randomized controlled trial was carried out with follow-up assessments at 3 months after baseline assessments using the Short Explanatory Model Interview (SEMI), General Health Questionnaire (GHQ-30), Bradford Somatic Inventory (BSI) and patient satisfaction on a visual analogue scale. The study was carried out in a general out-patient clinic in Sri Lanka. The intervention group received six, 30 min sessions based on the principles of cognitive behavioural therapy over a period of 3 months. The control group received standard clinical care.
                Eighty patients out of the 110 patients referred, were eligible. Sixty-eight were randomly allocated equally to the control and treatment groups. All 34 in the treatment group accepted the treatment offer and 22 completed between three and six sessions. At 3 months, 24 in the treatment and 21 in the control group completed follow-up assessments. Intention-to-treat analysis revealed significant differences in mean scores of outcome measures (adjusted for baseline scores) between control and intervention groups respectively--complaints 6.1 and 3.8 (P = 0.001), GHQ 10.4 and 6.3 (P = 0.04), BSI score 15.6 and 132 (P < 0-01), visits 7.9 and 3.1 (P = 0.004).
                Intervention based on cognitive behavioural therapy is feasible and acceptable to patients with medically unexplained symptoms from a general out-patients clinic in Sri Lanka. It had a significant effective in reducing symptoms, visits and distress, and in increasing patient satisfaction. A recent Cochrane review of reality orientation therapy identified the need for large, well-designed, multi-centre trials.
                To test the hypothesis that cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life.
                A single-blind, multi-centre, randomised controlled trial recruited 201 older people with dementia. The main outcome measures were change in cognitive function and quality of life. An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures.
                One hundred and fifteen people were randomised within centres to the intervention group and 86 to the control group. At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination (P=0.044), the Alzheimer's Disease Assessment Scale - Cognition (ADAS-Cog) (P=0.014) and Quality of Life - Alzheimer's Disease scales (P=0.028). Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group.
                The results compare favourably with trials of drugs for dementia. CST groups may have worthwhile benefits for many people with dementia. After having screened the cognitive functions in 103 institutionalized elderly subjects in Terni, a sample affected by mnemic deficit was obtained so as to verify the use of mnemotechniques on the same. Generally the findings show an improvement in cognitive performance in those treated which leads to suppose that our patients were affected by apparent cognitive deficits rather than real ones, supporting in any case the use of neuropsychological rehabilitative treatment in institutionalized subjects. The aim of this study was to investigate the feasibility of mental practice of positions and movements of the contralesional upper limb in sub-acute neglect patients and the efficacy of the approach in modifying visuospatial and representational neglect symptoms.
                Fifteen sub-acute neglect patients received two daily half-hour sessions of visuomotor-imagery therapy over a 3-week period as an add-on treatment and were compared to a control group of 15 sub-acute neglect patients without supplementary therapy. Feasibility was assessed using verbal-feedback protocols. Efficacy was determined using various standardised functional-outcome measures and neuropsychological tests.
                According to therapy protocols, compliance and subjective-gain ratings were high. The results suggest that imagined activation of the contralesional upper limb significantly reduces the severity of neglect in drawing/copying tasks as well as enhancing sensation in the affected arm.
                We conclude that (i) kinaesthetic visuomotor imagery is a feasible technique for sub-acute neglect patients and that (ii) imagery practice leads to improvements in the perception of body and space. Future research is required to specify criteria for indication and contraindication. To evaluate the effectiveness of comprehensive, holistic neuropsychologic (NP) rehabilitation compared with standard, multidisciplinary rehabilitation for people with traumatic brain injury (TBI).
                Randomized practical controlled trial.
                Postacute brain injury rehabilitation center within a suburban rehabilitation hospital.
                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.
                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).
                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.
                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.
                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. To examine the effects of a compensatory intervention versus a remedial intervention for deficits in visual processing of adults with acquired brain injuries (ABI).
                A cognitive rehabilitation program at a large comprehensive rehabilitation hospital in the New York City metropolitan area.
                Thirty adults with ABI were matched according to severity of injury, gender, age, and time post-injury, and randomly assigned to the remedial or compensatory group.
                The remedial intervention consisted of four 45-minute sessions (once weekly) of participation in computer tasks without instruction in compensatory strategies. The compensatory intervention consisted of four 45-minute sessions of instruction in the use of three internal compensatory strategies, including verbalization, chunking, and pacing.
                Pretest/posttest measures included three functional computer tasks. Weekly measures included a computerized version of the Paced Auditory Serial Addition Task (PASAT) and two computerized matching tasks.
                Both groups exhibited statistically significant improvement of comparable degree on posttests and weekly measures. Further analysis revealed that 80% of both groups used compensatory strategies, regardless of intervention method. Those who used strategies demonstrated better performance than those who did not.
                The ability to use internal compensatory strategies may be a significant confound in research examining the effects of the various cognitive rehabilitation intervention methods.
The effectiveness of cognitive rehabilitation interventions for reducing the disabling effects of neglect and increasing independence remains unproven. As a consequence, no rehabilitation approach can be supported or refuted based on current evidence from RCTs. However, there is some very limited evidence that cognitive rehabilitation may have an immediate beneficial effect on tests of neglect. This emerging evidence justifies further clinical trials of cognitive rehabilitation for neglect. However, future studies need to have appropriate high quality methodological design and reporting, to examine persisting effects of treatment and to include an attention control comparator.