Cognitive Rehabilitation and Cognitive-Linguistic Recovery

Academically-focused cognitive rehabilitation supports cognitive-linguistic recovery in college-bound adults with brain injury BACKGROUND ICCR Program • Young adults are a frequently-affected and growing population to suffer acquired brain injury (ABI).1,2 • Skills important for success in college (e.g., attention, language) are often impaired after ABI, making participation difficult.3,4 • Limited cognitive rehabilitation (CR) services for young adults with ABI interested in college are available within the current continuum of care.5,6 Day Programs Residential Programs 10:00 Tuesday Thursday Friday Economics Lecture Biology Lecture Economics Lecture BioIogy Lecture Review Review Review Review Practice Quiz ?’s Practice Quiz ?’s Practice Quiz ?’s Practice Quiz ?’s Lunch Lunch Lunch Lunch Statistics English Literature Statistics English Literature Tech Tech Tech Tech 11:00 12:00 2:00 3:00 Support Groups • Gold standard CR suggests targeting multiple cognitive-linguistic domains in everyday contexts with a combination of restorative and compensatory approaches in individual and group settings.7 • Principles of neuroplasticity also emphasize the importance of repetition, intensity, specificity, salience and age for cognitive rehabilitation and recovery.8,9 • Drawing on this evidence base, intensive cognitive-communication rehabilitation (ICCR) provides classroom-style lectures, strategy instruction, individual rehabilitation and technology training as a ramp to college success. • Initial findings10 suggest that ICCR (n = 4) supports return to college by promoting significant gains in cognitive-linguistic function, life participation and quality of life. Other Activities Monday Vocational Rehab. CR for college success DISCUSSION Sample Weekly Treatment Schedule 1:00 Outpatient Care METHODS (cont’d) Take quizzes & cumulative exams Receive individual SLT targeting discrete skills & strategy training Attend sessions about college transition process Note: ~300 hours/semester; Typically 6 students in the class; May attend multiple semesters of the program until they are ready to transition to post-secondary education Data Analysis • Linear mixed effects regression models were performed separately for each participant group and assessment measure: • Dependent variable: Accuracy on the assessment measure • Independent variables: • Fixed factors: Semester & Total N of semesters (covariate) • Random factor: Participant (intercept) Β = 1.36, SE = .23, t(38) = 5.81, p < .001 Β = 1.00, SE = .28, t(8) = 3.50, p < .01 Β = 2.74, SE = .32, t(38) = 8.43, p < .001 Β = 4.33, SE = 1.18, t(8) = 3.68, p < .001 Β = 1.91, SE = .35, t(38) = 5.51, p < .001 Β = 1.75, SE = .93, t(8) = 1.89, N.S. Β = 0.66, SE = .25, t(38) = 2.60, p < .05 Β = -.53, SE = .70, t(8) = -.76, N.S. Β = 1.34, SE = .23, t(37) = 5.93, p < .001 Β = 1.17, SE = .43, t(3) = 2.71, N.S. Β = 1.43, SE = .59, t(38) = 2.42, p < .05 Β = 4.25, SE = 1.71, t(7) = 2.50, p < .05 Demographic Information ICCR students (n=12) Control participants (n=6) Etiology Sex Pre-tx WAB Pre-tx RBANS Age MPO 25.9 (3.9) TBI = 7 58.3 Stroke = 4 (33.1) Tumor = 1 M=9 F=3 14.0 (1.4) 74.2 (21.2) 52.5 (9.7) 25.4 (3.9) 60.8 TBI = 4 (45.4) Stroke = 2 M=2 F=4 12.8 (0.9) 89.5 (9.1) 60.3 (10.7) Note: Mean (SD); MPO = months post onset; Edu. Level = Education level; Tx = treatment; Pre-tx WAB = Aphasia Quotient (out of 100; higher score = less severe); Pre-tx RBANS = Total Index Score (Standard Score: Mean = 85; SD = 10) Note: Statistics are for Semester, not Total N of semesters as they were all N.S. Domain Scores Assessment Selected Assessments • Western Aphasia Battery - Revised (WAB)11 • Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)12 • Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN)13 • Discourse Comprehension Test14 RESEARCH POSTER PRESENTATION DESIGN © 2015 www.PosterPresentations.com WAB RBANS SCCAN DCT Outpatient Care Residential Programs METHODS Edu. Level CONCLUSIONS Day Programs Vocational Rehab. RESULTS Composite Scores PRIMARY AIM • Do young adults with ABI demonstrate significant improvements in cognitive-linguistic function over the course of multiple 12-week semesters of ICCR? • On all six cognitive-linguistic assessments, ICCR students’ scores significantly improved as the number of semesters in ICCR increased, indicating a cumulative benefit of the program. • ICCR students also demonstrated significant longitudinal gains across a range of cognitive-linguistic domains (e.g., attention, memory, naming). • Overall, fewer significant changes were observed in the active deferred treatment controls over time, suggesting ICCR resulted in the experimental participants’ gains. • This study expands and confirms our previous work10 supporting the efficacy of ICCR for improving cognitive-linguistic functions important for college success. • Further, it builds upon the growing evidence base showing the benefits of intensive rehabilitation for improving cognitive-linguistic function in individuals with ABI.15 • As this program’s structure incorporates principles of neuroplasticity,8 future work should examine the brain reorganization underpinning these longitudinal gains. Domain Spontaneous Speech Repetition Naming & Word Finding Writing Constructional, Visuospatial, Calculation Immediate Memory Visuospatial/Constructional Oral Expression Orientation Memory Attention Problem Solving Reading ICCR students Note: Checkmark = statistically significant change over time Active Controls Summary • ICCR students’ scores on both linguistic and non-linguistic domains over time (13 subtests). • Control participants’ scores improved on only four subtests. CR for college success Support Groups • ICCR is a first step in filling the gap in CR services for young adults with ABI interested in college.