Effectiveness of a Culturally Adapted Cognitive Rehabilitation Program for Traumatic Brain Injury in Saudi Arabia: A Retrospective Pilot Study

Traumatic brain injury (TBI) is a significant public health concern in Saudi Arabia, where access to specialized neurorehabilitation remains limited, and most cognitive rehabilitation protocols are imported from Western contexts with limited cultural tailoring. TBI frequently results in long-term cognitive impairments, particularly in memory, attention, and executive function. Although cognitive rehabilitation has shown promise internationally, the efficacy of such interventions can vary across cultures, with emerging evidence suggesting that culturally adapted programs may improve engagement and adherence. This retrospective pilot study aimed to evaluate the preliminary effectiveness and feasibility of a culturally adapted cognitive rehabilitation program that integrates linguistically and socially familiar tools for Saudi patients with TBI, encouraging further research in this area. This retrospective, single-arm pilot study was conducted at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia, between January 2021 and December 2024. Adult patients ( N = 11) with a documented diagnosis of TBI completed a 6-month cognitive rehabilitation program targeting attention, memory, and executive function domains. The intervention incorporated culturally familiar tools, including the Shaula mobile application and the Baloot card game, to enhance engagement. Global cognitive function was assessed using the Arabic version of the Montreal Cognitive Assessment (MoCA) at baseline and 6 months post-intervention, to evaluate potential cognitive improvements. The mean MoCA score improved from 18.36 [standard deviation (SD) = 5.57] at baseline to 22.63 (SD = 5.24) post-intervention. The mean difference of 4.27 points (SD = 4.49) on the raw MoCA scale represented a statistically significant within-participant improvement [ t (10) = 3.15, P = 0.010]. Males showed a larger mean improvement than females; however, this gender difference was not statistically significant ( P = 0.31 under the equal-variance assumption; P = 0.08 under the unequal-variance assumption) and should be interpreted cautiously given the minimal female subgroup ( n = 2). This retrospective, single-arm pilot study with a small sample size ( N = 11) and no control group provides preliminary evidence that a culturally adapted cognitive rehabilitation program may be associated with improved cognitive outcomes in Saudi patients with TBI. Embedding cognitive training within familiar Arabic-language digital exercises and a traditional card game suggests the program is feasible and acceptable in this context. These findings support the potential for such interventions to enhance engagement and adherence. However, larger prospective controlled trials with extended follow-up are necessary to confirm these initial results, clarify the specific contribution of cultural adaptation, and inform the development of context-appropriate neurorehabilitation services in the region.