Drew Nagele, PsyD, CBIST, FACRM

The body of evidence-based research supporting the use of cognitive rehabilitation in children with brain injury continues to grow. Systematic review of this literature from 1980 to 2006 1 found only 28 studies that included actual interventions, the majority of which were Class III/IV studies, from which the authors were able to put forth only 2 treatment recommendations and 1 treatment option. In stark contrast, a recent systematic review of pediatric cognitive rehabilitation interventions published between 2006 and 2017 2 found 56 studies, including 27 Class 1 studies. This review produced 22 practice recommendations, including interventions to improve attention, memory, executive functioning and emotional/ behavioral functioning. A number of the interventions were family/caregiver focused and many provided evidence for the use of technology in delivering interventions.

One of the major issues for children to actually receive these interventions that are demonstrated to work is how training is provided on cognitive rehabilitation and how these services are made available to children. 3 Typically, cognitive rehabilitation has been the purview of neuropsychologists, rehabilitation psychologists, speech-language pathologists, and occupational/physical therapists in the medical/rehab system. However, decreasing lengths of hospital stays and lack of access to outpatient services can dramatically limit a child’s access to cognitive rehabilitation. In school systems, cognitive rehabilitation strategies can be built into the student’s learning support program, either through direct instruction by teachers and special educators as well by ancillary school therapy services (speech therapy, occupational therapy, and school psychology). However, the expertise to integrate cognitive rehabilitation strategies into the student’s everyday life experience is not uniformly available throughout US schools.

There are a number of Return to School brain injury consulting programs throughout the country, that utilize various training/ consultation models to infuse strategies and techniques that are demonstrated to work into the student’s learning program. Such programs include BrainSTEPS (Pennsylvania)4, COKids (Colorado)5, CBIRT Teams (Oregon) 6, Project BRAIN (Tennessee)7, and Columbus City Schools Traumatic Brain Injury Project & School Based Concussion Management Program (Ohio)8. Some of these brain injury consulting programs are currently the subject of a CDC funded RCT to establish evidence of the benefit to students with TBI.

Advocacy is needed to increase awareness that cognitive rehabilitation works, and that training is needed for teachers and healthcare providers. Improved collaboration between medical rehabilitation providers and educators would ensure that students’ specific learning needs are identified as early as possible, and to provide cognitive rehabilitation strategies and learning supports as soon as the student returns to school, as well as throughout key points in transition to adult roles.

1 .Laatsch, L., Harrington, D., Hotz, G., Marcantuono, J., Mozzoni, M., Walsh, V., Hersey, K.P., An evidence-based review of cognitive and behavioral rehabilitation treatment studies in children with acquired brain injury. (2007), Journal of Head Trauma Rehabilitation, 22(4), pp. 248-256 2. Laatsch, L., Dodd, J., Brown, T., Ciccia, A., Connor, F., Davis, K., Doherty, M., Mark Linden, M, Locascio, G., Lundine, J., Murphy, S., Nagele, D., Niemeier, J., m, Adam Politis, A., Rodeo, C., Slomine, B., Smetanar, R., and Yaegers, L. Evidence-based systematic review of cognitive rehabilitation, emotional, and family treatment studies for children with acquired brain injury literature: From 2006 to 2017. (2019). Neuropsychological Rehabilitation. https://doi.org/10.1080/09602011.2019.1678490 3. Nagele, D. Advocacy in Service Delivery, in Cognitive Rehabilitation for Pediatric Neurological Disorders. Editors Gianna Locascio and Beth Slomine, Cambridge University Press, London, 2018. 4. Brain Injury Association of Pennsylvania, Pennsylvania Department of Health, Pennsylvania Department of Education. BrainSTEPS. www.brainsteps.net Accessed on September 1, 2020. 5. Colorado Department of Education, Colorado Brain Injury Program. Colorado Kids Brain Injury Resource Network. http://cokidswithbraininjury.com Accessed on September 1, 2020. 6. University of Oregon, The Center for Brain Injury Research and Training (CBIRT) – www.cbirt.org. Accessed on September 1, 2020. 7. Tennessee Disability Coalition and TN Departments of Health and Education, Division of Special Populations. Project BRAIN. http://tndisability.org/brain. Accessed September 1, 2020. 8. Columbus City Schools & Disability Rights Ohio. Columbus City Schools Traumatic Brain Injury Project & School Based Concussion Management Program. https://www.ccsoh.us/Page/1218 Accessed on September 1, 2020.

Dr. Drew Nagele is a NeuroRehabilitation Psychologist with a 35 year career in creating and running brain injury rehabilitation programs for children, adolescents, and adults with acquired brain injury. He serves on the Board of Governors of BIAA's Academy for Certification of Brain Injury Specialists (ACBIS) which is developing an advanced practice certification in NeuroRehabilitation. As Clinical Professor at the Philadelphia College of Osteopathic Medicine he teaches Neuropsychology, Neuropathology, and Cognitive Rehabilitation. He Co-Chairs the National Collaborative on Children’s Brain Injury and the ACRM Pediatric and Adolescent Task Force, and is a Fellow of the American Congress of Rehabilitation Medicine.