The efficacy of computerized cognitive rehabilitation in improving attention and executive functions in acquired brain injury patients, in acute and post-acute phase.

Abstract

BACKGROUND\nCognitive deficits, particularly executive dysfunction is common following acquired brain injury (ABI) and has detrimental effect on functional status and autonomy in daily life. Among various cognitive training methods, computerized cognitive rehabilitation (CCR) has been investigated as an alternative method to therapistdriven cognitive rehabilitation (TCR). However, previous studies have shown conflicting results on the superiority or inferiority of CCR and TCR.\n\n\nAIM\nTo investigate the efficacy of TCR and CCR in improving executive function in patients with acute-to-subacute ABI.\n\n\nDESIGN\nA prospective, assessor-blinded randomized controlled trial.\n\n\nSETTING\nHospitalized care setting in the department of rehabilitation in a university hospital.\n\n\nPOPULATION\nThirty-two acute-to-subacute (less than 3 months after onset) ABI patients with executive dysfunctions were included in this study. The mean time after injury was 25.1±18.1 days.\n\n\nMETHODS\nParticipants were assigned to the TCR group (n=14) or the CCR group (n=18). Each group performed TCR or CCR for 30 minutes each day for two weeks in addition to routine rehabilitation. Neurocognitive function tests to assess complex attention, executive function, general cognitive function (mini-mental status examination (MMSE) and Montreal cognitive assessment (MoCA)), and functional evaluations (modified Barthel index (MBI)) were performed at baseline (T0) and at the end of treatment (T1).\n\n\nRESULTS\nThe TCR and CCR groups showed significant improvements in the MMSE (p=.004., .000), MoCA (p=.003, .006), and MBI (p=.000, .000) scores. TCR and CCR groups both showed significant improvements in some of the complex attention tests (trail-making test A, p=.002, .005) and executive function tests (trail-making test B, p=.016, .016). The TCR group showed significant improvements in the additional executive function tests (phonemic fluency test, p=.004, semantic fluency test, p=.001), while the CCR group showed significant improvements in the additional complex attention tests (symbol search, p=.02, digit symbol coding, p=.002). In the intergroup comparison of the changes from pre- to post-intervention, only the TCR group showed a significant improvement in the phonemic fluency test (p=.013).\n\n\nCONCLUSIONS\nTCR might be more effective than CCR in improving frontal loberelated executive function in ABI patients. CCR might be beneficial for improving psychomotor speed and working memory.\n\n\nCLINICAL REHABILITATION IMPACT\nTCR or CCR should be chosen according to the targeted domain of cognitive dysfunction in acute-to-subacute ABI patients.