Evidence-base in cognitive rehabilitation
Prof Philippe AZOUVIa
a AP-HP, Hôpital Raymond Poincaré, service de MPR
Cognitive rehabilitation is now a part of routine treatment in many neurological rehabilitation units.
However, the objective evaluation of its efficacy is difficult, due to a number of methodological limitations in many published studies in the field: small number of patients, lack of blind assessment, lack of assessment of generalization to daily-life functioning, short follow-up duration after the end of treatment, poor control of confounding factors.
Nevertheless, recent systematic reviews and meta-analyses have permitted to reach a relative consensus regarding the effectiveness of cognitive rehabilitation and how it should be delivered to patients with brain injuries. Specific individualized intensive training is recommended except in the case of very severe memory and/or executive functions deficits, which may only be improved by compensatory strategies. Such training should focus on tasks that have some ecological validity, to improve generalization to everyday life. Such interventions have been found beneficial, in comparison to spontaneous recovery, but effect-sizes remain globally in the small to moderate range (about 0.3). Early interventions seem more effective, but training at a chronic stage may still be useful at least in some cases.
Other factors should be taken into consideration, and may impact treatment efficacy: patient’s awareness, motivation, mood impairments and behavioral modifications, and social and family support.