A systematic review of the effect of early onset cognitive rehabilitation on acquired brain injury patients from a neural perspective

Cognitive impairments are a frequent consequence of acquired brain injury (ABI) and highly interfere with daily life functioning and quality of life. Therefore, these cognitive impairments are currently being addressed by compensatory approaches within neuropsychological rehabilitation. However, restoring the cognitive function would be preferred for patients and their surroundings. Several studies support this restorative approach, since they found that a period of increased neural plasticity is seen in the first three months after ABI. Neuropsychological rehabilitation starting within this period could maximize neural plasticity and therefore functional improvement. To examine this hypothesis and to provide guidelines for clinical practice and future research, a systematic review of randomized controlled trials on early onset cognitive rehabilitation programmes for ABI patients has been executed. A total of thirty studies were included from January 1970 till August 2010 studying 1988 patients. Thirty-seven per cent was found to be effective in restoring (partly) multiple domains of cognitive functioning, especially visuospatial functioning and awareness. The influence of intervention onset on cognitive functioning was evaluated by comparing the effectiveness of early onset rehabilitation programmes and late onset rehabilitation programmes. A new theoretical model, the Interplay Model, and guidelines for a more restorative approach in clinical practice and future research are discussed.