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Do cognitive interventions improve occupational performance in patients who have a TBI? Courtney Ulrick:

Do cognitive interventions improve occupational performance in patients who have a TBI? Courtney Ulrick Critically Appraised Topic Summary of Search: The following four articles include quality information, which aided in answering my research question. All of the articles used multiple measures that were reliable and valid. Two of the studies included follow up measures, which increased the value in the findings. A long with strengths to the studies there were several weaknesses amongst the articles, predominantly being the insignificant sample sizes used in each experiment as well as frequent drop outs and lack of power analysis. Through all of my findings, I concluded that cognitive training was a useful technique to incorporate into occupational therapy rehabilitation interventions when working with individuals with a TBI in order to increase independence in occupation. These clinical findings, however, were not directly found in any of the articles that I chose to appraise . Implications for Practice, Education, Future Research:   There is multitude of research regarding various positive outcomes from the use of cognitive intervention for individuals with traumatic brain injury(TBI). Current research supports when using cognitive intervention to treat individuals with TBI, there is opportunity to increase skills such as problem solving, attention, and memory. These are functions that are generally effected as the result of a TBI. One study found that certain types of cognitive intervention can be linked to emotion-regulation, decrease in hopelessness and decrease in suicidal ideation for people with TBI. however, there is limited research that relates these outcomes to the impact on participation in individual’s occupations   Cicerone, K., Mott, T., Azulay , J., Sharlow-Galella , M., Ellmo , W., Paradise, S., Friel , J. (2008). A randomized control trial of holistic neuropsychologic rehabilitation after Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation, [Cicerone et al., 2008] Lannin , N., Carr , B., Allaous , J., Mackenzie, B., Falcon, A., & Tate, R. (2014). A randomized controlled trial of the effectiveness of handheld computers for improving everyday memory functioning in patients with memory impairments after acquired brain injury. Clinical Rhabilitation . (28) 5, 470-481. [ Lannin et., al 2014 ] Simpson, G. K., Tate, R. L., Whiting, D. L., & Cotter, R. E. (2011). Suicide prevention after traumatic brain injury: A randomized controlled trial of a program for the psychological treatment of hopelessness. The Journal of Head Trauma Rehabilitation, 26 (4), 290-300. [Simpson et al., 2011 ] Constantinidou , F., Thomas, R., & Robinson, L. (2008). Benefits of categorization training in patients with traumatic brain injury during post-acute rehabilitation: Additional evidence from a randomized controlled trial. Journal of Head Trauma Rehabilitation, 23 (5), 312-327 16p. [ Constantinidou et al., 2008] Level of Evidence; Design Type Level II Evidence ; RCT   Level II Evidence ; RCT Level III evidence; RCT   Level III evidence; RCT Subject description 68 adults with a diagnosis of moderate to severe TBI > 3 months prior to study. 42 adult with a diagnosis of TBI with functional memory deficit 17 adults with a diagnosis of TBI and/or mod- severe hopelessness 35 adults with moderate to severe TBI > 4 years prior to study Intervention investigated intensive cognitive rehabilitation. Impact on employment, socialization and home productivity. Treatment was 15 hrs/ wk for 16 weeks. Impact of OT with use of a personal digital assistant (PDA) on memory function. training was 5, 7 hour sessions over 8 weeks. Impact of WtoH program on hopelessness and suicidal ideation secondary to TBI. Treatment was 2 hour sessions for 10 weeks. Effects of categorization program on neuropsychological performance. Treatment was 4.5 hours for 14 weeks Comparison intervention Standard neurorehabilitation 15 hrs/ wk for 16 weeks.   Standard occupational therapy for 9, 40 minute sessions over 8 weeks. Impact of standard care from brain injury rehabilitation unit   Traditional cognitive rehabilitation Outcome measures used   Booklet Category Test, CVLT II, CIQ, COWAT, PQOL, Sesx , TMT A,B, Vocational Integration Scale   BADS, COWAT, DKEFS, GAS, MCQ, MFQ, RBMT, WTAR, BHS, BSS, HADS-depression, Herth Hope Index, Rosenberg Self-esteem Scale, Social Problem Solving Scale CP Test part 1 & 2, Probe Task Test, WASI, RCFT, TMT A,b , WMS II, CVLT II, COWAT, MPAI III, CIQ, WCST, Booklet Category Test, WJ III Statistical significance between groups (Results and Conclusions) ? Both groups showed improvements, ICRP was most significant. CIQ, PQOL and secondary outcomes had significant improvements. Employment- 16/34 ICRP vs. 7/34 NP   Group using PDA had most significant improvements in decreasing functional memory impairment (MFQ). PDA decreased used of compensatory strategies BSS for WtoH group showed significant changes, P>.05 . Decreased scores on BHS by 1 degree of severity. Standard BIRU treatment group had increased hopelessness before WtoH . Both groups improved on CP test 1 & 2. CP group more significant. CP group improved on 12 neuropsychological measures, traditional group improved on 7 Limitations of Study Small sample size, no power analysis, therapists not blind to treatment, subjective outcome measures Small sample size, authors were data analyzers, therapists were not blind to treatment, subjective measures Small sample size, intention to treat analysis for dropouts, no description of standard care Small sample size, intention to treat analysis for high number of drop outs, no power analysis