Advances in Outcome Measurement for Neuropsychological Rehabilitation Following Brain Injury

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About this Research Topic

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Background

Neuropsychological rehabilitation after brain injury poses a great challenge to clinicians and practitioners due to large cognitive heterogeneity within the patient group. Effective rehabilitation requires interdisciplinary teamwork involving different professionals, such as medical staff, neuropsychologists, occupational therapists, physiotherapists, and speech and language therapists. Depending on the function impaired, cognitive interventions are either restorative, directed at a specific function, e.g. training of working memory, or compensatory through the establishment of strategies, e.g. training of cooking skills, taking notes during a meeting. Central to cognitive interventions are metacognitive approaches involving self-monitoring, emotional regulation, and consideration of subjective beliefs and experiences. Metacognitive approaches emphasize continuous and detailed feedback of performance, also providing clues for the therapist for further treatment.

The thorough assessment of the patient’s cognitive capacity requires the use of a wide range of neuropsychological measurements, a “test battery”. However, limitations in performance due to different residual symptoms constrain the use of many instruments or result in systematic loss of data.

Rehabilitation outcome is usually evaluated using a number of different approaches, for example following the ICF (International Classification of Functioning, Disability and Health) framework:

- on a functional level, e.g. neuroimaging, neurophysiology, neuropsychology,
- on an activity level, e.g. motor performance, such as gait speed, ADL (Activities of Daily Living)
- and at the level of participation, through ratings of patients, ratings of therapists, by significant others, or by evaluating economic aspects of the impact of brain injury and its rehabilitation.

Assessment and evaluation of treatment progress might be limited by methodological problems e. g. in the selection of assessment instruments and in the emphasis on early-stage measurements as well as endpoint measures. As such, repeated measurements with an increased number of measurement points across the early intervention phase after acquired brain injury permit a more detailed analysis of behavior and higher confidence in the results of the described intervention or process.

In addition, randomized control trials (RCT) would provide the strongest level of evidence, but they require the inclusion of comparable, relatively homogeneous comparison groups. Such groups are, however, not representative of the heterogeneous brain -injury population in clinical practice. Furthermore, basic pre- and post-measures, such as RCT’s, could prove to be somewhat insufficient in reflecting the full spectrum of changes in the most critical phases of the recovery process.

This Research Topic aims to present different methods for monitoring outcomes with a strong focus on cognitive rehabilitation following brain injury and provide a critical assessment of the present tools and methods. Original publications and short commentaries will illustrate, discuss, and analyze some of the limitations of methods that are currently being used.


The Guest Editors would like to express their profound gratitude to Dr. Gabriela Markovic for her valuable work in initiating and participating in this Research Topic.

Keywords: acquired brain injury, rehabilitation, evaluation, research methods, cognition

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