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. 2016 Oct 27:10:537.
doi: 10.3389/fnhum.2016.00537. eCollection 2016.

Cognitive Training for Post-Acute Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Harry Hallock  1 , Daniel Collins  1 , Amit Lampit  2 , Kiran Deol  3 , Jennifer Fleming  4 , Michael Valenzuela  1
Affiliations

Cognitive Training for Post-Acute Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Harry Hallock et al. Front Hum Neurosci. .

Abstract

Objective: To quantitatively aggregate effects of cognitive training (CT) on cognitive and functional outcome measures in patients with traumatic brain injury (TBI) more than 12-months post-injury. Design: We systematically searched six databases for non-randomized and randomized controlled trials of CT in TBI patients at least 12-months post-injury reporting cognitive and/or functional outcomes. Main Measures: Efficacy was measured as standardized mean difference (Hedges' g) of post-training change. We investigated heterogeneity across studies using subgroup analyses and meta-regressions. Results: Fourteen studies encompassing 575 patients were included. The effect of CT on overall cognition was small and statistically significant (g = 0.22, 95%CI 0.05 to 0.38; p = 0.01), with low heterogeneity (I2 = 11.71%) and no evidence of publication bias. A moderate effect size was found for overall functional outcomes (g = 0.32, 95%CI 0.08 to 0.57, p = 0.01) with low heterogeneity (I2 = 14.27%) and possible publication bias. Statistically significant effects were also found only for executive function (g = 0.20, 95%CI 0.02 to 0.39, p = 0.03) and verbal memory (g = 0.32, 95%CI 0.14 to 0.50, p < 0.01). Conclusion: Despite limited studies in this field, this meta-analysis indicates that CT is modestly effective in improving cognitive and functional outcomes in patients with post-acute TBI and should therefore play a more significant role in TBI rehabilitation.

Keywords: TBI; closed head injury; cognitive outcome; cognitive training; neuropsychological outcome; rehabilitation; traumatic brain injury.

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Figures

FIGURE 1
FIGURE 1
Flowchart of trial identification and selection. Note that a single study could be excluded on more than one criterion, but appears only once in the chart.
FIGURE 2
FIGURE 2
Efficacy of cognitive training (CT) on (A) overall cognitive outcomes; (B) executive function; and (C) verbal memory. Effect estimates are based on a random-effects model.
FIGURE 3
FIGURE 3
Funnel plots.
FIGURE 4
FIGURE 4
Efficacy of CT on (A) working memory; (B) attention; and (C) processing speed. Effect estimates are based on a random-effects model.
FIGURE 5
FIGURE 5
Efficacy of CT on (A) non-verbal memory; (B) visuospatial; and (C) language. Effect estimates are based on a random-effects model.
FIGURE 6
FIGURE 6
Efficacy of CT on (A) overall functional outcomes; (B) instrumental activities of daily living (IADL); and (C) dysexecutive functions. Effect estimates are based on a random-effects model.
FIGURE 7
FIGURE 7
Subgroup analysis of moderators for (A) overall cognitive outcomes, and (B) overall functional outcomes.
FIGURE 8
FIGURE 8
Matrix of training content against effect size of each cognitive outcome from the individual studies. Gray cells indicate the study trained in the domain. EF = executive functions; WM = working memory. ∗∗p < 0.05
See this image and copyright information in PMC

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