Cognitive Rehabilitation Treatment Guidelines
and Clinical Efficacy Studies
Joseph A. Sandford, Ph.D., President, BrainTrain, Inc.

I am often asked how long a client needs to be treated with cognitive rehabilitation in order for it to be clinically efficacious. My recommendation is that a minimum of two hours of cognitive rehabilitation per week be completed (one half hour per day, four days per week) and that the treatment plan require that the client complete a minimum of 20 to 40 hours of training, depending upon the individual. The client can work both in the professional’s office and at home with the Captain's Log home training system. Thus, an initial treatment program will last about three to six months.

Insurance coverage varies according to insurance company and state, but all major carriers except Tricare do now cover Cognitive Rehabilitation. It is billed in 15 minute units with fees paid at $35 to $55 per unit, depending on the region of the country. A treatment plan is required and progress must be documented. In addition, the patient needs to be qualified to show that he or she can possibly benefit from this form of treatment. Currently, neurological disorders, strokes, cancer treatment (medicines used to treat cancer are toxic to the brain) and traumatic brain injuries are covered. Alzheimer's is usually not covered. I recommend that a prescription for cognitive rehabilitation be obtained from the treating physician and that the clinician also call the insurance company involved if there are specific concerns regarding the client’s policy.

The latest research documenting the clinical efficacy of cognitive rehabilitation was recently presented at the American Psychiatric Association Conference. A summary paper has been published and is referenced below along with a link to the Medscape report. (A free sign-up is needed to access Medscape).

Here is the link: http://www.medscape.com/viewarticle/722845?src=mp&spon=12&uac=14355MK

The abstract of the study is summarized below and can be accessed at http://www.medscape.com/medline/abstract/18056233

Abstract: A Meta-Analysis of Cognitive Remediation in Schizophrenia
Susan R. McGurk, Ph.D., Elizabeth W. Twamley, Ph.D., David I. Sitzer, Ph.D., Gregory J. McHugo, Ph.D., Kim T. Mueser, Ph.D.

Objective: This study evaluated the effects of cognitive remediation for improving cognitive performance, symptoms, and psychosocial functioning in schizophrenia.

Method: A meta-analysis was conducted of 26 randomized, controlled trials of cognitive remediation in schizophrenia including 1,151 patients.

Results: Cognitive remediation was associated with significant improvements across all three outcomes, with a medium effect size for cognitive performance (0.41), a slightly lower effect size for psychosocial functioning (0.36), and a small effect size for symptoms (0.28). The effects of cognitive remediation on psychosocial functioning were significantly stronger in studies that provided adjunctive psychiatric rehabilitation than in those that provided cognitive remediation alone.

Conclusions: Cognitive remediation produces moderate improvements in cognitive performance and, when combined with psychiatric rehabilitation, also improves functional outcomes.

(Am J Psychiatry 2007; 164:1791–1802)