Quick answer
Cognitive rehabilitation is therapy that helps people improve or work around problems with attention, memory, planning, problem-solving and communication after a brain injury. The American Congress of Rehabilitation Medicine’s Cognitive Rehabilitation Task Force has reviewed 491 studies and issued 29 evidence-based recommendations, including its strongest level of support for attention training, memory strategy training, metacognitive strategy training and comprehensive neuropsychological rehabilitation after TBI.[1]
What cognitive rehabilitation is
A TBI can affect how a person thinks, understands, communicates and acts.[2] Cognitive rehabilitation, sometimes called cognitive rehabilitation therapy (CRT), targets those changes. BrainLine, a national TBI education service, describes two broad strategies: direct training to strengthen an impaired skill, and training in compensatory strategies that help a person perform everyday tasks despite the impairment.[3]
Who it’s for
Cognitive rehabilitation is used after TBI of any severity, as well as after stroke and other acquired brain injuries.[1] NINDS notes that neuropsychological tests measuring memory, concentration, information processing, executive functioning, reaction time and problem-solving are often used after a mild TBI.[2] Results from this kind of testing can help identify which skills therapy should focus on.
For people with lasting symptoms after a concussion, cognitive rehabilitation may be one part of treatment. See Post-concussion syndrome.
Main approaches
Attention training
Structured exercises to improve focus and working memory, combined with strategies for managing attention in daily life.[1]
Memory strategies
Internal techniques such as visual imagery and association, and external aids such as notebooks and electronic reminders.[4]
Metacognitive strategy training
Teaching self-monitoring and self-regulation for problem-solving, planning, goal management and emotional control.[4]
Social communication
Training in conversational skills and recognizing emotions from facial expressions.[4]
What the evidence supports
The most widely cited evidence review is the Cognitive Rehabilitation Task Force’s 2019 systematic review in the Archives of Physical Medicine and Rehabilitation.[1] Across its reviews, the task force has evaluated 491 studies and made 29 recommendations: 9 Practice Standards (the strongest level), 9 Practice Guidelines and 11 Practice Options.[1]
Practice Standards that apply after TBI include:[1][4]
- Attention: combining direct attention training with metacognitive strategy training to improve task performance and carry gains into daily life
- Memory: compensatory strategy training for mild memory impairment, including internal strategies and external aids
- Executive function: metacognitive strategy training for mild to moderate problems with planning, problem-solving and emotional self-regulation
- Social communication: interventions targeting conversational skills and emotion recognition
- Comprehensive programs: comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability, regardless of injury severity or time since injury
For severe memory impairment after TBI, the task force recommends external compensatory aids applied directly to everyday activities (a Practice Guideline).[4]
Who provides it
Cognitive rehabilitation is typically delivered by speech-language pathologists, neuropsychologists, occupational therapists and other rehabilitation professionals, in inpatient, outpatient or community programs. A meta-analysis of studies of veterans and service members with TBI found the greatest improvement with clinician-administered programs focused on teaching strategies.[5]
Computer and app-based training
The 2019 task force review recommends that computer-based working memory training be considered as part of post-acute rehabilitation.[4] That meta-analysis notes that current guidelines say such programs should be managed by a rehabilitation clinician, and that computer-based training without a therapist was not recommended.[5]
This page provides general information from the sources listed below. It is not medical advice and is not a substitute for evaluation by a qualified healthcare provider. In an emergency, call 911.
Sources
- Cicerone KD, et al. “Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014.” Archives of Physical Medicine and Rehabilitation, 2019;100(8):1515–1533 (PubMed abstract). https://pubmed.ncbi.nlm.nih.gov/30926291/
- National Institute of Neurological Disorders and Stroke. “Traumatic Brain Injury (TBI).” https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi
- BrainLine. “Cognitive Rehabilitation Therapy (CRT).” https://www.brainline.org/treatment/cognitive-rehabilitation-therapy-crt
- American Speech-Language-Hearing Association, Evidence Maps. Summary of Cicerone KD, et al. (2019). https://apps.asha.org/EvidenceMaps/Articles/ArticleSummary/455050a6-6a30-4655-8984-706291d7b8fd
- “Meta-Analysis of Cognitive Rehabilitation Interventions in Veterans and Service Members with Traumatic Brain Injuries.” PubMed Central. https://pmc.ncbi.nlm.nih.gov/articles/PMC11227399/
Sources last checked: October 11, 2026
