The relationship of cognitive retraining to neurological patients' work and school status

Authors: Kolakowsky-Hayner, S. A., Wright, J., Shem, K., Medel, R., & Duong, T.
Year Published 2007
Publication Brain Injury
Volume 21
Number 11
Pages 1097-1107
Publisher Informa Healthcare

The goals of cognitive retraining are to help patients: ameliorate difficulties in cognitive functioning, develop ways to compensate for those problems and improve their awareness and appreciation of how neurobehavioural strengths and difficulties impact and generalize to the home and community. Cognitive training has been viewed as a holistic
milieu-oriented approach for people with brain injuries. However, there is considerable scepticism about the benefits of this approach from both healthcare workers and insurance companies. High quality research is needed to on how the effectiveness of cognitive retraining.


The purpose of the study was to explore the relationship of cognitive retraining performance to discharge productivity status. The hypotheses were:
1)Work/school status at discharge will be related to Working Alliance ratings, Cognitive Retraining scores and CRBC ratings;
2) Better Working Alliance scores will be associated with better scores on the CRBC with regard to Use of Compensatory Strategies, Seeing the Big Picture and Independence in Scoring and Record Keeping


The study took place in a neurorehabilitation therapy department in a large healthcare center located in Arizona.


The study examined scores on Cognitive Retraining tasks and variables associated with those task and return to work or school outcomes for 101 patients who had participated in neurotherapies at a large medical center in Arizona within a seven year time span. This included patients who had participated in either or both the Work or School Re-entry programmes and by the time of discharge had completed 4 study Cognitive Retraining tasks. The majority of participants were male (63%). The mean age of participants was 35 years with an average of 14 years of education. Around 64% had sustained traumatic brain injury, 22% had cerebrovascular accident and the remaining 14% had other causes of brain injury. Around 59% of the sample had Glasgow Coma Scale data. The majority or 71% had severe brain injuries.

The majority or 86% of the participants had a primary goal of return to work and the remaining had the goal of return to school. Among those with the return to work goal the majority or 71% had been in both the Work Re-entry and Home Independence programmes. Of those who planned to return to school, the majority or 79% attended the School Re-entry and Home Independence programmes.

Data Collection

Cognitive retraining data was taken from participants' Cognitive Retraining charts. More specific, this included: initial, last, best and mean scores for each of the four study tasks. Data on process variables associated with the tasks came from the Cognitive Retraining Behaviour Checklist completed by the person's primary therapist. Scores on Working Alliance came from patient charts. Information on participant's employment and/or school status also came from the chart.


No comparison condition.


The majority or (82.2%) of the sample returned to paid work or school. Better performance on two cognitive retraining tasks related to information processing speed, visual scanning, visuospatial skills and memory were associated with return to the same level of work/school with and without modifications. Selected process variables related to the patients' behavioural approach to cognitive retraining tasks were associated with better work/school outcomes. Positive working alliance ratings related to their behavioural approach to cognitive retraining tasks.


The information provided should help clinicians fine-tune Cognitive Retraining interventions to help patients achieve their maximal level of functioning.

Disabilities Traumatic brain injury (TBI)
Populations Male & Female
Outcomes Employment acquisition | Return to work
Research Design Mixed methods
Peer Reviewed Yes