Roadmap for cognitive neurorehabilitation: challenges and opportunities

Cognitive deficits affect 40-50% of patients after acquired brain injury, with a profound impact on participation, work capacity and quality of life. Cognitive neurorehabilitation is a relevant and promising approach to promote cognitive recovery, but the evidence remains limited. This review discusses the clinical state-of-the-art, open questions in clinical research, and outlines a roadmap for future development of this rapidly evolving domain.

While optimal contemporary cognitive neurorehabilitation is multimodal and interprofessional, the currently available evidence is diluted by heterogeneous treatment content and patient characteristics, as well as by inadequate methodology and reporting. Several questions remain open: the optimal dose and frequency of therapy, the preferable sequence of treatments, and the factors that moderate treatment effects. We highlight the pressing need for rigorously designed randomized controlled trials (RCTs) with active control conditions, everyday-relevant outcome measures, time by group interaction analyses and long-term follow-up.

Future development of cognitive neurorehabilitation depends on RCTs and single-case experiments using cutting-edge methodology. We propose a roadmap with four tiers: mechanisms and efficacy, assessment of moderating factors, clinical validity as well as consideration of socio-economic impact and implementation from the outset. International collaboration in designing, developing and validating the approaches is warranted to ensure standardization and broad uptake. These efforts will promote the quality and accessibility of cognitive neurorehabilitation.