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Neurocognitive Engagement Therapy: An Innovative Rehabilitation Approach for Those With Cognitive Impairment

Howanitz, Jennifer, BS, MPT, GCS; Carney, Kelly, O'Shea, PhD, ABPP, CMC; Lichtenberg, Peter, A., PhD, ABPP; Donlan, Alice, PT, MBA, DPT, GCS, RAC-CT; Sugarman, Michael, A., PhD; Malek, Kay, PT, PhD

Topics in Geriatric Rehabilitation: January/March 2018 - Volume 34 - Issue 1 - p 36–47
doi: 10.1097/TGR.0000000000000172
Thinking About Cognition: From Advances in Neuroanatomy to Outcomes Assesment

Background and Purpose: Physical rehabilitation therapists are recognizing increasing numbers of older clients presenting with cognitive impairment in the post–acute setting. Therapists working with these patients often feel ill-prepared to address the special challenges of this population and often experience difficulty fully engaging the client in therapy. Decreased engagement in a therapy plan of care may lead to worse functional outcomes and increased debility. The purpose of this study was to examine the efficacy of neurocognitive engagement therapy (NET), a new model for rehabilitation, through a randomized clinical trial. Neurocognitive engagement therapy utilizes evidence-based best practices in dementia care as well as task-specific practice to increase engagement and therapeutic gains among individuals with cognitive impairment in the post–acute setting.

Methods: Eighty-five subacute rehabilitation patients participated in the study, with 43 in the active group who received care based on the NET model and 42 in the control group who received traditional post–acute rehabilitation services. The groups were randomly assigned by location of the post–acute admission. The Pittsburgh Rehabilitation Participation Scale was used to measure patient engagement in physical, occupational, and speech therapy. The Modified Barthel Index was used to assess change in overall function.

Results and Discussion: Results revealed that Active group participants demonstrated higher mean engagement ratings across all 3 NET therapy types (Ps ≤ .05), with the same mean number of sessions. A Group-by-Time ANOVA revealed a significant interaction effect (P = .05) for pre-/postfunctional gains on the Barthel, indicating more functional gains in the Active group. After accounting for individual differences in engagement, hierarchical multiple linear regression modeling demonstrated that engagement mediated the effects on functional improvement. That is, active patients appeared to have greater functional gains because they had higher engagement.

Conclusion: The results suggest that NET is efficacious for cognitively impaired patients. Patients who received NET were more engaged in the process of therapy and had greater functional gains than those who were cognitively impaired and received traditional rehabilitation.

NET Program Development, Phoebe Center for Excellence in Dementia Care, Phoebe Ministries, Allentown, Pennsylvania (Ms Howanitz); Memory Care Services, Acts Retirement-Life Communities, West Point, Pennsylvania (Dr Carney); Institute of Gerontology and Merrill Palmer Skillman Institute and Wayne State University, Detroit, Michigan (Dr Lichtenberg); American Board of Physical Therapy Specialties, Rehabilitation and Outpatient Services, Phoebe Ministries, Allentown, Pennsylvania (Dr Donlan); Postdoctoral Fellow in Clinical Neuropsychology, Bedford VAMC, Bedford, Massachusetts (Dr Sugarman); and Doctor of Physical Therapy Program, DeSales University, Center Valley, Pennsylvania (Dr Malek).

Correspondence: Jennifer Howanitz, BS, MPT, GCS, NET Program Development, Phoebe Center for Excellence in Dementia Care, Phoebe Ministries, 1925 Turner St, Allentown, PA 18104 (

The study was partially funded by the 2013 Brodsky Innovation Grant from the Alzheimer's Foundation of American and from the Scholler Foundation.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.