Cognitive Rehabilitation
What is it: Structured and evidence-based program targeting specific post-illness cognitive deficits.AKA: Cognitive Remediation Therapy, CRT- ⬤ Minimal research: Very little scientific study exists, with no or very few peer-reviewed studies. Insufficient data for conclusions.
- ⬤⬤ Limited research: Few studies exist, mostly small trials or case reports. Findings are preliminary and lack strong validation.
- ⬤⬤⬤ Moderately researched: Multiple studies, including mid-sized trials, exist. Some findings are replicated, but more research is needed.
- ⬤⬤⬤⬤ Well-researched: Supported by substantial evidence, including at least one large trial or meta-analysis.
- ⬤⬤⬤⬤⬤ Extensively studied: Numerous large studies and meta-analyses exist. Findings are widely accepted with strong scientific consensus.
- ⬤ Extremely Difficult to Access: Rare, experimental, or highly specialized. Requires multiple referrals, long wait times, travel, and strict follow-up.
- ⬤⬤ Difficult to Access: Limited to select centers with moderate barriers. Requires referral, potential travel, and wait times of weeks to months.
- ⬤⬤⬤ Moderately Accessible: Available in larger hospitals or clinics. Requires a basic referral, with moderate wait times and some coordination.
- ⬤⬤⬤⬤ Easy to Access: Widely available in most clinics. Minimal referral, short wait times, and simple preparation or follow-up.
- ⬤⬤⬤⬤⬤ Trivial to Access: Easily found in pharmacies or clinics. No referral needed, minimal wait, and straightforward access.
- ⬤ Up to $100
- ⬤⬤ Up to $500
- ⬤⬤⬤ Up to $2000
- ⬤⬤⬤⬤ Up to $10,000
- ⬤⬤⬤⬤⬤ More than $10,000
To calculate the reported effectiveness for a patient view, the model first analyses whether it can be ascertained that the person writing the review has had direct experience of the treatment for themselves or a loved one. If so, it then uses sentiment analysis to rate their view from 1-5 on how effective this treatment was for them, with 1 being the least effective, and 5 the most effective.
4 Resources
Referenced in this guide
20 Research papers
Referenced in this guide
4 Expert views
Contributed in this guide
29 Patient views
Contributed in this guide
Figure out what Cognitive Rehabilitation means for you
Page contents
Basics: What you need to know
Cognitive Remediation Therapy (CRT) for Long Covid is a specialized, evidence-based intervention designed to help individuals address the cognitive challenges that can persist after a COVID-19 infection. By focusing on targeted exercises and structured guidance, CRT professionals—such as neuropsychologists and occupational therapists—aim to rebuild attention, memory, and executive functioning skills systematically. This approach is more formal than general brain-training apps or self-guided exercises, as it follows carefully designed protocols that adjust to each patient’s progress.
History and development
- Rooted in Neurorehabilitation: CRT has its origins in treatments designed for injuries of the brain, including stroke and traumatic brain injury. Over time, these methods were adapted to help individuals with cognitive issues linked to other conditions, laying the groundwork for its use in Long Covid.
- Contributions from Researchers: Experts like Dr. Alice Medalia pioneered the use of cognitive remediation in psychiatric settings, and her work influenced how current CRT programs are structured. Although she focused on other conditions, her methods provided a stepping stone for broader adaptations.
- Integration in Clinical Practice: Early adopters in neurorehabilitation centers expanded CRT for use with various patient populations. With the rise of Long Covid, clinicians began tailoring these protocols to address post-viral cognitive symptoms.
- Refinement Over Time: As data grew, practitioners refined the structure and strategies, ensuring that each exercise was backed by measurable goals and ongoing assessments.
What is known
- Systematic Assessments: CRT programs typically begin with thorough cognitive testing to identify each patient’s specific deficits. This clarity helps in designing personalized tasks.
- Targeted Improvements: Evidence suggests that regular CRT sessions can enhance attention span, boost memory recall, and streamline executive functioning in many Long Covid patients.
- Progress Tracking: Clinicians use standardized tools to measure improvements over time. These metrics help confirm whether the therapy is effectively supporting recovery.
- Lesser-Known Benefits: Beyond direct cognitive gains, some patients report reduced mental fatigue and improved mood or self-confidence due to regaining control over daily functioning.
- Symptom Fluctuations: Though some patients see speedy improvements, others experience slower progress, highlighting the variability of Long Covid recovery.
What is not known
- Long-Term Outcomes: It remains unclear how sustained the benefits from CRT will be over several years, as long-term follow-up data are still emerging.
- Optimal Protocols: While multiple CRT strategies exist, researchers have not yet pinned down a universal model that works best for all forms of cognitive impairment related to Long Covid.
- Variations in Severity: It is unclear if CRT is equally effective for mild, moderate, or severe cognitive symptoms, and at what point during recovery it is best used.
- Trigger Risks: CRT can sometimes prompt frustration or mental fatigue, and there is limited data on how these temporary setbacks might impact overall recovery.
- Targeted Exercises: Uses specialized tasks to challenge attention, memory, and planning skills, ensuring gradual improvements.
- Adaptive Difficulty: Adjusts exercise complexity based on individual progress, preventing overwhelm.
- Personalized Strategies: Teaches coping methods like note-taking and mental chunking to manage daily tasks.
- Frequent Feedback: Provides real-time support and adaptation, helping maintain motivation.
- Continuous Monitoring: Tracks performance changes through standardized tests, enabling data-driven revisions.
- Possible Fatigue: Intensive cognitive exercises can cause or worsen mental tiredness.
- Emotional Frustration: Patients may experience discouragement if gains are slow.
- Limited Transfer: Some worry improvements might not carry over to complex real-world tasks.
- Variations in Response: Some experts believe results can differ widely among individuals.
- Resource Intensive: Critics argue it requires regular clinical visits and trained professionals, which increases cost and accessibility concerns.
- Ongoing Research: Many feel that more large-scale studies are needed to confirm long-term benefits.
Patient views
Experiences
- Patients appreciate learning strategies to reduce cognitive load and take breaks.
- Exercises and tips for memory and processing speed are seen as helpful.
- Therapy is valued for improving mindset and coping with cognitive challenges.
- Some find it empowering to understand and manage their limitations better.
Challenges
- Some patients find the therapy unhelpful or redundant with existing strategies.
- Travel to therapy sessions can be burdensome, especially without telehealth options.
- Insurance coverage issues make therapy inaccessible for some patients.
- Exercises may not lead to noticeable improvements in cognitive functioning.
Tips
- Take cognitive breaks and pace activities to avoid overexertion.
- Use timers or reminders to manage energy and focus effectively.
- Combine therapy with other treatments like medications or mindfulness.
- Be patient and open to trying different strategies for improvement.
To calculate the reported effectiveness for a patient view, the model first analyses whether it can be ascertained that the person writing the review has had direct experience of the treatment for themselves or a loved one. If so, it then uses sentiment analysis to rate their view from 1-5 on how effective this treatment was for them, with 1 being the least effective, and 5 the most effective.
Patient view
I went to speech/cognitive therapy in the early months of my long Covid. I don’t recall a ton about it but I did find it fairly helpful, mostly teaching or reminding me of things I could do to lighten the cognitive load and to take cognitive breaks
June 2024 • Turnto Comment
Patient view
I did speech therapy early on for cognitive issues. I was given some exercises and tips to help me with memory and my new issues with over stimulation/ slower processing speed, etc.. (long covid). It’s not a cure all but it does help some. I found it worthwhile
July 2024 • Turnto Comment
Expert views
What they liked
- Experts appreciate CRT's ability to address cognitive impairments like brain fog.
- They note it can improve daily functioning and quality of life.
- CRT is likened to physiotherapy for the brain, making it relatable.
- It has shown success in treating brain injury-like symptoms in Long Covid.
What they didn't like
- Experts highlight limited access to trained CRT professionals.
- They note CRT can be exhausting for patients with severe fatigue.
- Misunderstanding CRT as psychological rather than medical is a concern.
- Some patients may feel stigmatized by being referred to cognitive therapies.
What are they unsure about
- Experts are unsure about CRT's long-term effectiveness for all patients.
- They question how to balance CRT with patients' fatigue levels.
- The best way to scale CRT for widespread use remains unclear.
- Experts are uncertain about how to improve primary care referrals to CRT.
4 expert views
Expert view
Dr. Jim Jackson, a research professor of Medicine and Psychiatry at Vanderbilt University Medical Center, emphasizes the importance of cognitive rehabilitation for Long Covid patients. He likens this therapy to physiotherapy for the brain, aiming to address actual brain injuries rather than psychological issues. Dr. Jackson highlights the relapsing and remitting nature of Long Covid, where patients experience fluctuating cognitive abilities influenced by stress and environmental factors. He also discusses the need for supportive messaging and strategies to help patients avoid negative thought patterns, which can hinder recovery.
May 2023 • Episode 56: Dr Jim Jackson - Neuropsychology and Cognitive Rehabilitation
Expert view
Dr. Jim Jackson, a research professor of Medicine and Psychiatry at Vanderbilt University Medical Center, emphasizes the importance of cognitive rehabilitation for Long Covid patients, likening it to physiotherapy for the brain. He argues that the cognitive issues experienced by these patients are more akin to brain injury than mere brain fog, which can be debilitating enough to disrupt careers and relationships. Dr. Jackson highlights challenges such as the limited availability of specialists like rehabilitation psychologists and occupational therapists, and the need for primary care providers to recognize these cognitive issues as brain injuries and make appropriate referrals. He also stresses the importance of messaging that affirms patients' dignity and avoids suggesting that their condition is psychosomatic.
May 2023 • TLC Sessions Podcast
What and who it targets
Cognitive impairment
Targets cognitive deficits like memory and attention.
Attention deficit
Focuses on improving attention and concentration.
Brain fog sufferers
Improves clarity and cognitive processing.
Relevant research
How much evidence on this?
- Cognitive rehabilitation has been studied for Long Covid since 2022.
- At least 7 studies or protocols are available on this topic.
- Research includes randomized controlled trials and multidisciplinary approaches.
- Studies focus on memory, attention, and cognitive dysfunction.
Research focusing on
- Improves attention, memory, and cognitive flexibility in some patients.
- Post-treatment care includes managing fatigue and sleep issues.
- Techniques vary: telehealth, group therapy, and digital tools.
- Researchers are exploring combined therapies like tDCS and BrainHQ.
What needs more research?
- Long-term effectiveness of cognitive rehabilitation is unclear.
- Optimal duration and intensity of therapy remain undefined.
- Mechanisms behind cognitive improvement are not fully understood.
- Best patient subgroups for this therapy are not identified.
- ⬤ Minimal research: Very little scientific study exists, with no or very few peer-reviewed studies. Insufficient data for conclusions.
- ⬤⬤ Limited research: Few studies exist, mostly small trials or case reports. Findings are preliminary and lack strong validation.
- ⬤⬤⬤ Moderately researched: Multiple studies, including mid-sized trials, exist. Some findings are replicated, but more research is needed.
- ⬤⬤⬤⬤ Well-researched: Supported by substantial evidence, including at least one large trial or meta-analysis.
- ⬤⬤⬤⬤⬤ Extensively studied: Numerous large studies and meta-analyses exist. Findings are widely accepted with strong scientific consensus.
Research
This study developed a cognitive rehabilitation protocol for individuals experiencing cognitive symptoms after COVID-19, such as memory decline and lack of attention. The protocol included weekly 60-minute sessions over six months, with activities targeting attention and memory, and homework assignments to reinforce learning.
The study found that the rehabilitation activities, which focused on different types of attention and memory, indirectly improved other cognitive functions like reasoning and language. The difficulty of tasks was gradually increased, and the approach showed promise based on evidence from similar treatments for other conditions.
For individuals with Long Covid, this study suggests that structured cognitive rehabilitation could help improve memory, attention, and other cognitive functions. Caregivers and patients might find this approach useful for managing cognitive challenges associated with the condition.
The study was published in a reputable journal, 'Dementia & Neuropsychologia,' and is based on established methods of cognitive rehabilitation. However, it is a proposed protocol and not a randomized controlled trial, which limits the strength of its evidence.
June 2024 • Dementia & neuropsychologia
Research
This study explored the feasibility and effectiveness of a new rehabilitation method called Constraint-Induced Cognitive Therapy (CICT) for treating cognitive issues, such as brain fog, in individuals with Long COVID. Sixteen participants who were at least three months post-COVID infection and experiencing mild cognitive impairment were randomized to either receive CICT immediately or continue with their usual treatment before crossing over to CICT.
The study found that CICT led to significant improvements in daily life activities, measured by the Canadian Occupational Performance Measure, and reduced brain fog symptoms, as assessed by the Mental Clutter Scale. Additionally, four out of five non-retired participants who underwent CICT returned to work, while none in the treatment-as-usual group did.
For individuals living with Long COVID, this study suggests that CICT could be a promising option to improve cognitive function, daily life activities, and even help with returning to work. It provides hope for addressing the disabling effects of brain fog associated with Long COVID.
As a pilot study, the findings are preliminary and based on a small sample size, which limits generalizability. However, the study was published in medRxiv, a reputable preprint server for health sciences, and the results warrant further investigation through larger-scale trials.
July 2024 • medRxiv : the preprint server for health sciences
Accessibility
- ⬤ Extremely Difficult to Access: Rare, experimental, or highly specialized. Requires multiple referrals, long wait times, travel, and strict follow-up.
- ⬤⬤ Difficult to Access: Limited to select centers with moderate barriers. Requires referral, potential travel, and wait times of weeks to months.
- ⬤⬤⬤ Moderately Accessible: Available in larger hospitals or clinics. Requires a basic referral, with moderate wait times and some coordination.
- ⬤⬤⬤⬤ Easy to Access: Widely available in most clinics. Minimal referral, short wait times, and simple preparation or follow-up.
- ⬤⬤⬤⬤⬤ Trivial to Access: Easily found in pharmacies or clinics. No referral needed, minimal wait, and straightforward access.
- ⬤ Up to $100
- ⬤⬤ Up to $500
- ⬤⬤⬤ Up to $2000
- ⬤⬤⬤⬤ Up to $10,000
- ⬤⬤⬤⬤⬤ More than $10,000
Method to access
- Requires referral to specialized clinics or centers.
- Telehealth options available at some locations.
- At-home options include digital tools like Lumosity, BrainHQ, and Constant Therapy.
Cost
- In-person therapy: $1,000–$2,000 per month in the US.
- At-home tools: $10–$30 per month for apps like Lumosity and BrainHQ.
- Costs vary by region and provider.
Insurance cover
- Commonly covered by health insurance in the US, but may require documentation of cognitive deficits.
- Medicare often covers CRT with copayments.
- Coverage varies in Europe and other regions; patients should verify with their providers.
Locations
- UNC COVID Recovery Clinic, Chapel Hill, NC.
- ReCOVer Long COVID Clinic, Boston Medical Center.
- Spaulding Rehabilitation Hospital, multiple locations in Massachusetts.
- Kliniken Schmieder, Germany.
- ColumbiaDoctors, New York, NY.
- Shirley Ryan AbilityLab, Chicago, IL.
Related clinical trials
Frequently asked questions
Key resources
Explore other treatments
It's a lot of information, isn't it?
Turnto's personal AI Assistant can help you figure out what this all means for you
© 2026 Turnto
