ASHA's Evidence-based Clinical Practice Guideline on Cognitive Rehabilitation in Individuals with Acquired Brain Injury

Objective(s) To investigate the effects of cognitive rehabilitation in individuals with acquired brain injury. Data Sources Systematic search of 16 databases from 1980 through October 2020. Panel consisted on 9 subject matter experts (4 SLPs, 1 neuropsychologist, 1 patient advocate, 1 physician, 1 OT and 1 vocation rehabilitation specialist) and 2 SLP methodologists. Over 100 included studies identified. Study Selection Inclusion: in English from 1980 onward; original data; participants aged 18 years of age or older with an acquired brain injury; randomized or controlled trial; examined a cognitive treatment, strategy or intervention used by an SLP Data Extraction Data extracted included participants, intervention, characteristics and outcomes of interest. Quality was assessed by same 2 masked reviewers using the Cochrane Risk of Bias Tool. Data Synthesis Overall, cognitive rehabilitation showed small effects ranging from SMD 0.24 (0.07-0.4) to SMD 0.38 (0.23-0.53) depending on outcome compared to no treatment or active control. Heterogeneity of populations (TBI, stroke, hypoxia, anoxia, epilepsy etc.) and treatments (all cog rehab included) contribute to variations. Conclusions Cognitive rehabilitation overall showed small effects compared to control. Contextualized cognitive treatment and memory treatments showed moderate effects compared to control. The guideline panel made a recommendation in favor of cognitive rehabilitation by also considering priority of the problem, balance of desirable and undesirable effects, certainty of evidence, values, cost effectiveness, equity, acceptability and feasibility. Author(s) Disclosures 5/11 authors have declarations, details exceed word count.