Effectiveness of Functional Cognition Intervention for Adults with Traumatic Brain Injuries: A Systematic Review

Purpose: An estimated 5.3 million Americans are living with a permanent disability due to having a traumatic brain injury (TBI) (CDC, 1999). A common deficit seen in this population includes impaired functional cognition, which is the ability to use and integrate thinking and processing skills to complete complex instrumental activities of daily living (IADLs) (Giles et al., 2017). Occupational therapy practitioners support individuals post-TBI by creating and implementing occupation-based interventions during rehabilitation to optimize functional cognition and improve individuals\u27 ability to complete IADLs. This study aims to identify the effectiveness of interventions within the scope of occupational therapy practice to improve functional cognition in adults with post-TBI. Design: This systematic review included randomized controlled trials published in peer-reviewed journals between 2010 and 2022, which addressed adults with TBI, and implemented functional cognition interventions which were within the scope of occupational therapy practice. Method: Results from four literature databases produced 1154 articles. Duplicate articles were removed (n=19). Teams of two researchers screened the titles and abstracts of each of the remaining 1135 articles to determine eligibility for full-text review. Next, the full text of 289 articles were reviewed to determine if they met the study’s inclusion criteria; eight articles were included in the systematic review. The U.S. Preventative Services Task Force levels of certainty and grade definitions were used to describe the strength of evidence. Results: The eight studies included in this systematic review were categorized into two themes: simulated electronic-based interventions and metacognitive strategy training. Three articles addressed simulated electronic-based interventions, which examined the effectiveness of Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) and virtual reality training (VTR). All three articles supported the use of simulated electronic-based interventions, though the strength of evidence is classified as moderate, given their methodological limitations, which included small sample sizes and differences in participant characteristics at baseline. Five articles addressed metacognitive strategy training, of which four supported its effectiveness. This evidence is classified as moderate, in light of methodological limitations, including small sample sizes and heterogeneity of the interventions. Conclusion: Occupational therapists have a critical role in selecting and implementing intervention strategies that will aid in rehabilitating functional cognition. Based on the findings of this review, occupational therapy practitioners should consider routinely implementing metacognitive strategy training and simulated electronic-based interventions to enhance functional cognition in adults following a TBI. Occupational therapy educational programs should address these interventions in occupational curricula. Additional research is warranted to address the heterogeneity of outcome measures and interventions. Center for Disease Control and Prevention. (1999). Report to Congress: Traumatic brain injury in the United States. U.S. Department of Health and Human Services. https://www.cdc.gov/traumaticbraininjury/ Giles, G. M., Edwards, D. F., Morrison, M. T., Baum, C., & Wolf, T. J. (2017). Screening for functional cognition in postacute care and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The American Journal of Occupational Therapy, 71(5), 7105090010. https://doi.org/10.5014/ajot.2017.715001https://digitalcommons.unmc.edu/cahp_ot_sysrev/1002/thumbnail.jp