The relationship of cognitive retraining to neurological patients' work and school status

Abstract

Primary objective: To explore the relationship of cognitive retraining performance to discharge productivity status.

Methods and procedures: One hundred and one brain-injured patients from a holistic milieu-oriented work/school re-entry programme.

Experimental interventions: Initial, last, mean and best cognitive retraining scores; cognitive retraining behavioural checklist ratings; and working alliance scores.

Main outcomes and results: Most (82.2%) of the sample returned to paid work or school. Better performance on two cognitive retraining tasks addressing information processing speed, visual scanning, visuospatial skills and memory were associated with return to the same level of work/school with and without modifications. Selected process variables related to the patients' behavioural approach to cognitive retraining tasks (e.g. their use of compensations, organizational and abstraction skills, procedural skills and unassisted task recall) were associated with better work/school outcomes. Patients' positive working alliance ratings related to their behavioural approach to cognitive retraining tasks. This highlights the importance of combining interventions targeting both the therapeutic interactive process and skill remediation to maximize work/school reintegration.

Conclusions: Cognitive Retraining exercises that incorporate both process variables and metacognitive skills, as well as a better working alliance with patients, positively related to return to work and school at the time of discharge from a holistic milieu-oriented programme.