Examination of cognitive flexibility over time in response to a cognitive rehabilitation program in pediatric traumatic brain injury patients

Traumatic brain injury (TBI), one of the leading health concerns in the United States, can affect the functioning and development of many children and adolescents. These brain insults can result in deficits in a variety of neuropsychological skills, particularly in executive functioning. Executive functioning is a difficult neuropsychological construct to define since it is often thought to be an overarching umbrella of various neurocognitive skills. One specific executive skill is cognitive flexibility, the mental ability to switch between thinking about two different concepts and discerning multiple concepts simultaneously. Cognitive flexibility relates to various areas of functioning such as academic, social, behavioral, and adaptive abilities. Cognitive rehabilitation, which has been a standard practice since the 1980s, is a commonly used intervention to enhance functioning of those who have sustained a traumatic brain injury, particularly in outpatient settings. Assessment of executive functioning and cognitive flexibility has also evolved with more focus on the pediatric population, especially with the development of the Delis-Kaplan Executive Function System (D-KEFS) and the Comprehensive Trail-Making Test (CTMT). The purpose of this study is to examine cognitive flexibility skills over time with exposure to a hospital outpatient cognitive rehabilitation program for TBI-affected children and adolescents. Another main goal of this study is to examine longitudinal effects of the program among TBI-affected groups based on the previous program participation and whether patients were receiving speech, occupational, and/or physical therapy. This will also attempt to examine the effectiveness of the cognitive rehabilitation program compared to exposure to therapy at a longitudinal time point. Patients completed neuropsychological tasks at three different time points: Before the start of the program, immediately after discharge, and a final point of evaluation between 6 and 13 months after the time of injury. This process was designed to examine possible effects of cognitive rehabilitation on specific skills over time. Repeated-measures ANOVA and one-way ANOVA were used for data analyses.