Description of an interdisciplinary, holistic cognitive rehabilitation program for adults with mild to moderate cognitive impairment after acquired brain injury

Figures & data

Figure 1. Frequency of treatment targets addressed by each clinician. Black columns represent primary treatment targets for that clinician. The program’s primary targets are: Global Psychosocial [1], Temperament and Personality [2], Attention [5], Memory (6), Emotional [8] Higher-level Cognitive [10], Conversation [21].

Table 1. Cognitive and mood profile of patients included in the program.

	Subjective cognitive complaint					Neuropsychological function		Mood
	^aFact-Cog					MoCA	SDMT	HAD
	Total	PCI	Oth	PCA	QoL			Anxiety	Depression
Mean (SD)	65 (23)	35 (15)	11 (4)	13 (5)	6 (4)	26 (3)	45 (12)	9 (4)	8 (4)
Min	12	5	1	4	0	19	20	2	0
Max	109	65	16	24	15	30	66	17	17
n	63	63	63	63	63	63	26	62	62

Fact-Cog: Functional Assessment of Cancer – Cognition total – max score: 132 (higher score = less cognitive complaint); Fact-Cog: PCI – Perceived Cognitive Impairment – max score: 72; a score ≤ 60 is associated with a clear cognitive complaint [33]; Fact-Cog: Oth – Comments from Others – max score: 16; Fact-Cog: PCA – Perceived Cognitive Abilities – max score: 28; Fact-Cog: QoL – Quality of Life – max score: 16; MoCA: Montreal Cognitive Assessment – max score: 30 (higher score = better cognitive function); SDMT: Symbol Digits Modalities Test (no maximum score) (higher score = faster information processing); HAD-A: Hospital Anxiety and Depression – Anxiety – max score: 21 (higher score = more anxiety); HAD-D: Hospital Anxiety and Depression – Depression – max score: 21 (higher score = more depression).

^aThe Fact-Cog is a patient-reported outcome measure designed to measure perceived cognitive function and its impact on quality of life [34,35]. It takes approximately 10 minutes to complete. Its four-dimensional structure provides clinically-informative information about the patient’s perception of their cognitive impairments and aptitudes, comments they have received from others, and the impact of their cognitive difficulties on their quality of life. It is standard practice in our service to use it in consultations for patients who complain of cognitive difficulties, regardless of aetiology. Our team is currently collecting data with the aim of expanding its validation to include acquired brain injury patients.

Table 2. ICF domains targeted in the program.

N° [ ]	ICF domain	ICF second-level code	Clinician
			OT	Neuropsy	APA	PMR
	BODY FUNCTIONS
	Global Mental Functions
1	Global Psychosocial	b122	X	X	X	X
2	Temperament and Personality	b126	X	X		X
3	Energy and Drive	b130	X	X	X	X
4	Sleep	b134				X
	Specific Mental Functions
5	Attention	b140	X	X	X	X
6	Memory	b144	X	X	X	X
7	Psychomotor	b147			X	X
8	Emotional	b152	X	X	X	X
9	Thought	b160	X	X
10	Higher-level cognitive	b164	X	X	X	X
11	Calculation functions	b172	X		X
12	Mental function of sequencing complex movements	b176			X
13	Experience of Self and Time	b180	X	X	X	X
	Pain
14	Sensation of Pain	b280			X	X
	Additional functions and sensations of the cardiovascular and respiratory systems
15	Exercise Tolerance Functions	b455			X
	ACTIVITIES AND PARTICIPATION
	Learning and Applying Knowledge
16	Focusing Attention	d160	X	X	X
17	Solving Problems	d175	X	X	X
18	Making Decisions	d177	X	X	X
	General Tasks and Demands
19	Undertaking Multiple Tasks	d220	X	X	X	X
20	Handling stress and other psychological demands	d240	X	X	X	X
	Communication
21	Conversation	d350	X	X	X	X
22	Discussion	d355	X	X
	Domestic Life
23	Preparing Meals	d630	X
	Interpersonal Interactions and Relationships
24	Basic interpersonal interactions	d710	X	X	X
25	Complex interpersonal interactions	d720	X	X	X
26	Formal Relationships	d740	X	X		X
27	Informal Social Relationships	d750	X	X	X
	Major Life Areas
28	Work and employment, other specified and unspecified	d859		X		X
	Community, Social and Civic Life
29	Recreation and Leisure	d920	X	X	X

List of second-level ICF domains targeted in at least one program session. Numbers in the left-hand column are used in Annexes A1 to A4 to code targets in each session. A cross indicates that this target is addressed in one or more of that clinician’s sessions. 

Figure 2. Logic Model of a multidisciplinary rehabilitation program for mild-to-moderate cognitive impairment showing relationships between the program’s various components and outlining its causal assumptions.

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