Introduction

Ongoing advances in medical care and medical management, following an insult to the brain (e.g., brain injury, tumor, and stroke), have increased clients' likelihood of survival. Although more clients are surviving, they are faced with numerous enduring physical, cognitive, and behavioral difficulties. Often, life quality is also diminished due to impaired functional skills. Most survivors are unable to return to work or school, live independently, support themselves financially, or participate in social activities. In order to ameliorate functional problems, and increase the likelihood of return to productive living, many clients participate in a program of cognitive rehabilitation.

Cognitive rehabilitation includes a variety of approaches and techniques, including computer training, memory retraining, social skills training, life skills training, use of prosthetic devices, stimulation therapy, process training, attention and concentration training, stimulus response conditioning, strategy training, domain-specific training, cognitive cycle techniques, enhancement of physical and emotional health and social functioning, and nutrient and drug treatment. However, given the numerous approaches, development of a standard treatment protocol has been unsuccessful. No consensus exists regarding which approaches or techniques should be used.

There are few research studies regarding cognitive rehabilitation techniques, and these have limited generalizability. For example, studies often used single-subject designs, selectively enrolled clients, and showed therapy benefits in terms of only paper-and-pencil tests. Studies have not been consistent regarding efficacy, do not provide long-term outcome information, and do not adequately describe therapy candidate characteristics. Furthermore, most prior research has failed to recognize and control for the factors influencing cognitive rehabilitation, including a person's physiological state, perceptual skills, emotional status, level of motivation, and social states (e.g., marital status, education level, and socioeconomic status).

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