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Objectives To conduct an updated, systematic review of the clinical literature, classify studies based on the strength of research design, and derive consensual, evidence-based clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) or stroke. Data Sources Online PubMed and print journal searches identified citations for 250 articles published from 2009 through 2014. Study Selection Selected for inclusion were 186 articles after initial screening. Fifty articles were initially excluded (24 focusing on patients without neurologic diagnoses, pediatric patients, or other patients with neurologic diagnoses, 10 noncognitive interventions, 13 descriptive protocols or studies, 3 nontreatment studies). Fifteen articles were excluded after complete review (1 other neurologic diagnosis, 2 nontreatment studies, 1 qualitative study, 4 descriptive articles, 7 secondary analyses). 121 studies were fully reviewed. Data Extraction Articles were reviewed by the Cognitive Rehabilitation Task Force (CRTF) members according to specific criteria for study design and quality, and classified as providing class I, class II, or class III evidence. Articles were assigned to 1 of 6 possible categories (based on interventions for attention, vision and neglect, language and communication skills, memory, executive function, or comprehensive-integrated interventions). Data Synthesis Of 121 studies, 41 were rated as class I, 3 as class Ia, 14 as class II, and 63 as class III. Recommendations were derived by CRTF consensus from the relative strengths of the evidence, based on the decision rules applied in prior reviews. Conclusions CRTF has now evaluated 491 articles (109 class I or Ia, 68 class II, and 314 class III) and makes 29 recommendations for evidence-based practice of cognitive rehabilitation (9 Practice Standards, 9 Practice Guidelines, 11 Practice Options). Evidence supports Practice Standards for (1) attention deficits after TBI or stroke; (2) visual scanning for neglect after right-hemisphere stroke; (3) compensatory strategies for mild memory deficits; (4) language deficits after left-hemisphere stroke; (5) social-communication deficits after TBI; (6) metacognitive strategy training for deficits in executive functioning; and (7) comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability after TBI or stroke.

Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas M, Felicetti T, Laatsch L, Harley JP, Bergquist T, Azulay J, Cantor J, Ashman T. Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Objective To update our clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 2003 through 2008. Data Sources PubMed and Infotrieve literature searches were conducted using the terms attention , awareness , cognitive , communication , executive , language , memory , perception , problem solving , and/or reasoning combined with each of the following terms: rehabilitation , remediation, and training for articles published between 2003 and 2008. The task force initially identified citations for 198 published articles. Study Selection One hundred forty-one articles were selected for inclusion after our initial screening. Twenty-nine studies were excluded after further detailed review. Excluded articles included 4 descriptive studies without data, 6 nontreatment studies, 7 experimental manipulations, 6 reviews, 1 single case study not related to TBI or stroke, 2 articles where the intervention was provided to caretakers, 1 article redacted by the journal, and 2 reanalyses of prior publications. We fully reviewed and evaluated 112 studies. Data Extraction Articles were assigned to 1 of 6 categories reflecting the primary area of intervention: attention; vision and visuospatial functioning; language and communication skills; memory; executive functioning, problem solving and awareness; and comprehensive-holistic cognitive rehabilitation. Articles were abstracted and levels of evidence determined using specific criteria. Data Synthesis Of the 112 studies, 14 were rated as class I, 5 as class Ia, 11 as class II, and 82 as class III. Evidence within each area of intervention was synthesized and recommendations for Practice Standards , Practice Guidelines , and Practice Options were made. Conclusions There is substantial evidence to support interventions for attention, memory, social communication skills, executive function, and for comprehensive-holistic neuropsychologic rehabilitation after TBI. Evidence supports visuospatial rehabilitation after right hemisphere stroke, and interventions for aphasia and apraxia after left hemisphere stroke. Together with our prior reviews, we have evaluated a total of 370 interventions, including 65 class I or Ia studies. There is now sufficient information to support evidence-based protocols and implement empirically-supported treatments for cognitive disability after TBI and stroke.

Karyotyping of 3011 males at five Wisconsin state correctional institutions revealed that 1 % had a chromosome abnormality. The frequency of occurrence of the XYY complement was about 5 times that for newborn males. Approximately the same rate was found among 2556 males in the three penal institutions for adults. The frequency of XYY at the institution for juvenile offenders was about ten times background. The relatively low frequency of XYY (0.38 %) found at the mental-penal institution may have been due to previous sampling done there. Of the 16 XYY males discovered, only two were below the 85th percentile for height. A relatively low frequency of XYY was found among black males. Our data contradict the notion that a high rate for XYY among adult males in penal settings may be due to a disproportionately large number of tall men in prisons.

At the request of the membership, and at the direction of the President, Dr. Barbara Uzzell, and the Board of Directors (BoD), the National Academy of Neuropsychology (NAN) Policy and Planning Committee has developed the following 2001 Definition of a Clinical Neuropsychologist, as part of NAN’s White Paper series on Professional Policy and Practice. The entire NAN membership has had an opportunity for input to this definition, and it has been clearly endorsed by our membership and the BoD. We believe that the 2001 NAN Definition incorporates the best aspects of the previous work on Definitions of a Clinical Neuropsychologist, if one keeps in mind that the intent is to provide information to managed care and third party payers regarding general neuropsychological practice and minimal educational, experiential, and licensure requirements. An inclusive, expanded, and updated definition referencing the 1989 and 1984 definition articles, published by Division 40 (Clinical Neuropsychology) of the American Psychological Association (APA) was considered necessary as an internal NAN reference document. This 2001 NAN Definition of a Clinical Neuropsychologist underwent three major Policy and Planning Committee revisions, one full membership review and one membership vote (81% endorsement out of 789 votes), and two NAN BoD comprehensive discussions, resulting in unanimous approval by a formal vote of the Board of Directors on May 5, 2001.

Functional assessment scales are commonly used quality-of-service and effectiveness indicators in rehabilitation. Although there are many advantages to using functional scales for these purposes, data from such ordinal scales are not generally appropriate for mathematical operations. Modern psychometric techniques can overcome this limitation, however. This article describes a Rasch analysis of the Patient Evaluation and Conference System, a 93-item, multidisciplinary functional assessment system. This analysis produced five scales that meet current psychometric criteria for reliable and valid measurement: Impairment Severity, Applied Self-care, Motoric Competence, Cognition, and Community Reintegration. These scales are described, and current research directions are discussed.

Cicerone KD, Dahlberg C, Malec JF, Langenbahn DM, Felicetti T, Kneipp S, Ellmo W, Kalmar K, Giacino JT, Harley JP, Laatsch L, Morse PA, Catanese J. Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. Objective To update the previous evidence-based recommendations of the Brain Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 1998 through 2002. Data Sources PubMed and Infotrieve literature searches were conducted using the terms attention , awareness , cognition , communication , executive , language , memory , perception , problem solving , and reasoning combined with each of the terms rehabilitation , remediation , and training . Reference lists from identified articles were reviewed and a bibliography listing 312 articles was compiled. Study Selection One hundred eighteen articles were initially selected for inclusion. Thirty-one studies were excluded after detailed review. Excluded articles included 14 studies without data, 6 duplicate publications or follow-up studies, 5 nontreatment studies, 4 reviews, and 2 case studies involving diagnoses other than TBI or stroke. Data Extraction Articles were assigned to 1 of 7 categories reflecting the primary area of intervention: attention; visual perception; apraxia; language and communication; memory; executive functioning, problem solving and awareness; and comprehensive-holistic cognitive rehabilitation. Articles were abstracted and levels of evidence determined using specific criteria. Data Synthesis Of the 87 studies evaluated, 17 were rated as class I, 8 as class II, and 62 as class III. Evidence within each area of intervention was synthesized and recommendations for practice standards, practice guidelines, and practice options were made. Conclusions There is substantial evidence to support cognitive-linguistic therapies for people with language deficits after left hemisphere stroke. New evidence supports training for apraxia after left hemisphere stroke. The evidence supports visuospatial rehabilitation for deficits associated with visual neglect after right hemisphere stroke. There is substantial evidence to support cognitive rehabilitation for people with TBI, including strategy training for mild memory impairment, strategy training for postacute attention deficits, and interventions for functional communication deficits. The overall analysis of 47 treatment comparisons, based on class I studies included in the current and previous review, reveals a differential benefit in favor of cognitive rehabilitation in 37 of 47 (78.7%) comparisons, with no comparison demonstrating a benefit in favor of the alternative treatment condition. Future research should move beyond the simple question of whether cognitive rehabilitation is effective, and examine the therapy factors and patient characteristics that optimize the clinical outcomes of cognitive rehabilitation.

Cicerone KD, Dahlberg C, Kalmar K, Langenbahn DM, Malec JF, Bergquist TF, Felicetti T, Giacino JT, Harley JP, Harrington DE, Herzog J, Kneipp S, Laatsch L, Morse PA. Evidence-based cognitive rehabilitation: recommendations for clinical practice. Arch Phys Med Rehabil 2000;81:1596-615. Objective: To establish evidence-based recommendations for the clinical practice of cognitive rehabilitation, derived from a methodical review of the scientific literature concerning the effectiveness of cognitive rehabilitation for persons with traumatic brain injury (TBI) or stroke. Data Sources: A MEDLINE literature search using combinations of these key words as search terms: attention , awareness , cognition , communication , executive , language , memory , perception , problem solving , reasoning , rehabilitation , remediation , and training . Reference lists from identified articles also were reviewed; a total bibliography of 655 published articles was compiled. Study Selection: Studies were initially reviewed according to the following exclusion criteria: nonintervention studies; theoretical, descriptive, or review papers; papers without adequate specification of interventions; subjects other than persons with TBI or stroke; pediatric subjects; pharmacologic interventions; and non-English language papers. After screening, 232 articles were eligible for inclusion. After detailed review, 61 of these were excluded as single case reports without data, subjects other than TBI and stroke, and nontreatment studies. This screening yielded 171 articles to be evaluated. Data Extraction: Articles were assigned to 1 of 7 categories according to their primary area of intervention: attention, visual perception and constructional abilities, language and communication, memory, problem solving and executive functioning, multi-modal interventions, and comprehensive-holistic cognitive rehabilitation. All articles were independently reviewed by at least 2 committee members and abstracted according to specified criteria. The 171 studies that passed initial review were classified according to the strength of their methods. Class I studies were defined as prospective, randomized controlled trials. Class II studies were defined as prospective cohort studies, retrospective case-control studies, or clinical series with well-designed controls. Class III studies were defined as clinical series without concurrent controls, or studies with appropriate single-subject methodology. Data Synthesis: Of the 171 studies evaluated, 29 were rated as Class I, 35 as Class II, and 107 as Class III. The overall evidence within each predefined area of intervention was then synthesized and recommendations were derived based on consideration of the relative strengths of the evidence. The resulting practice parameters were organized into 3 types of recommendations: Practice Standards , Practice Guidelines , and Practice Options . Conclusions: Overall, support exists for the effectiveness of several forms of cognitive rehabilitation for persons with stroke and TBI. Specific recommendations can be made for remediation of language and perception after left and right hemisphere stroke, respectively, and for the remediation of attention, memory, functional communication, and executive functioning after TBI. These recommendations may help to establish parameters of effective treatment, which should be of assistance to practicing clinicians. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation