Neuropsychological Rehabilitation最新文献

Sleep disturbance and fatigue are persistent, clinically significant problems for many with acquired brain injury (ABI). A recent randomized controlled trial (RCT) demonstrated that cognitive and behavioral therapy tailored for post-ABI sleep and fatigue (CBT-SF) produced larger and faster effects compared to an active health education (HE) control intervention. The current study aimed to qualitatively explore the perspectives of the six clinicians, all clinical neuropsychologists, who delivered the CBT-SF and HE interventions to 126 individuals with ABI in the RCT. One-on-one semi-structured interviews were conducted, and transcripts were analyzed using reflexive thematic analysis. Seven themes were generated, encompassing client-related factors (Client Awareness and Readiness as Precursors to Engagement and Navigating Client Differences Throughout Treatment) and clinician-related factors that influenced treatment delivery (Building on Pre-Existing Expertise and Strengths and Challenges of Delivering a Manualized Intervention), as well as other themes directly related to treatment delivery itself (Challenges and Successes Relating to Client Engagement, CBT Strategies That Work, and Navigating Practical Considerations in Treatment Delivery). The findings reinforce the value of psychoeducation and cognitive-behavioral strategies for managing sleep and fatigue problems after ABI. They also provide valuable insights to guide the translation of CBT-SF from an RCT to real-world clinical practice.

It has been argued that Working Memory Training (WMT) has the potential to improve emotional regulation. In this study, we investigated whether 20 days of WMT improved general emotion regulation in healthy participants using resting high-frequency heart rate variability (HF-HRV) as a physiological indicator of general emotion regulation, and examined its maintenance effect three months later. The analysis of the linear mixed-effects (LME) model revealed that after completing 20 days of WMT, there was a significant improvement in the individual's resting HF-HRV. This improvement was observed to be stable even after 3 months, and the resting HF-HRV of the training group was significantly better than that of the control group. In addition, there was a positive correlation between the gain in resting HF-HRV and the gain in working memory in the training group, which persisted from post-test to follow-up, suggesting that the greater the gain in working memory, the greater the gain in emotional regulation. Our study provides the first evidence that WMT can effectively improve general emotional regulation ability, and this improvement can last for at least three months.

ABSTRACTThe benefits of assistive technology (AT) have been well established to positively support participation within disability. Clinicians have an important role in guiding clients to choose goal-centred AT. This study aims to explore (i) the frequency and types of AT prescribed by clinicians and (ii) real-world implementation of AT by clinicians, employing the ISO 9999 framework, and the challenges involved with AT prescription. An online survey was circulated to brain injury clinicians within New South Wales (NSW). Data were exported into IBM SPSS Statistics v.27 for analysis. Free text responses were analysed using a mixed-methods content analysis. A total of 31 AT products were reported 131 times by clinicians. The most frequently reported AT category was mainstream technology (n = 81), used amongst all professions. Using the ISO 9999 framework, the most reported class use of AT was "communication and information management" (n = 77/131). Challenges around AT implementation were funding acquisition, customizability of AT and time constraints with training. NSW clinicians have demonstrated varied use of AT to support cognitive, physical and communication functions. However, with the rapidly advancing nature of AT, there needs to be quicker approaches to generate high-quality evidence to support its use.

Spatial neglect commonly occurs after a stroke, resulting in diverse impacts depending on the type and severity. There are almost 300 tools for assessing neglect, yet there is a lack of knowledge on the psychometric properties of these tools. The objective of this systematic review, registered on Prospero (CRD42021271779), was to determine the quality of the evidence for assessing spatial neglect, categorized by neglect subtype. The following databases were searched on 3rd May 2022 from database inception: Ovid Emcare, Embase, Ovid MEDLINE, APA PsycINFO, Web of Science (SCI-EXPANDED; SSCI; A&HCI; ESCI) and Scopus. All primary peer-reviewed studies (>5 participants) of adults post stroke, reporting any psychometric property of 33 commonly used neglect assessment tools were included. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) risk of bias tool was used to assess the methodological quality of the studies and summarize the psychometric properties of each tool. 164 articles were included, with a total of 12,463 people with stroke. The general quality of the evidence was poor and no one tool had high-quality evidence of both validity and reliability. Eleven tools show some promise as they meet the minimum criteria for good measurement properties for both validity and reliability.

The use of single-case experimental design (SCED) to evaluate cognitive remediation is growing. SCEDs require rigorous methodology and appropriate choice of primary outcomes. To review primary outcomes that assess executive function impairments in patients with acquired brain injury (ABI). A scoping review was conducted using the Arksey and O'Malley framework and the PRISMA extension for scoping review (PRISMA-ScR). Five databases were searched resulting in the inclusion of twenty-one studies. Primary outcomes were extracted and classified according to the type of measure, ecological setting and sources of possible bias. A wide variety of primary outcomes were identified; the majority of which evaluated behavioural performance during a real-life activity or in a real-life simulated setting. The most frequent bias observed across outcomes was the coaching effect. The findings of this scoping review highlight the importance of selecting appropriate outcomes for repeated measures in SCED studies. Direct observation of the target behaviour is a potential gold standard for assessing the effectiveness of a cognitive intervention.

We aimed to assess the convergence, feasibility, and acceptability of the Oxford Digital Multiple Errands Test (OxMET) and the in-person Multiple Errands Test-Home version (MET-Home). Participants completed OxMET, MET-Home, Montreal Cognitive Assessment (MoCA), and questionnaires on activities of daily living, depression, technology usage, mobility, and disability. Forty-eight stroke survivors (mean age 69.61, 41.67% female, and average 16.5 months post-stroke) and 50 controls (mean age 71.46, 56.00% female) took part. No performance differences were found for healthy and stroke participants for MET-Home, and only found below p = .05 for OxMET but not below the corrected p = .006. Convergent validity was found between MET-Home and OxMET metrics (most r ≥ .30, p < .006). MET-Home accuracy was related to age (B = -.04, p = .03), sex (B = -.98, p = .03), disability (B = -0.63, p = .04), and MoCA (B = .26, p < .001), whereas OxMET accuracy was predicted by MoCA score (B = .40, p < .001). Feedback indicated that the OxMET was easy and fun and more acceptable than the MET-Home. The MET-Home was more stressful and interesting. The MET tasks demonstrated good convergent validity, with the OxMET digital administration providing a more feasible, inclusive, and acceptable assessment, especially to people with mobility restrictions and more severe stroke.

Systematic exposure to odours (olfactory training, OT) is a method of smell loss treatment. Due to olfactory system projections to prefrontal brain areas, OT has been hypothesized to enhance cognitive functions, but its effects have been studied predominantly in adults. This study tested OT effects on working memory (WM), i.e., the ability to store and manipulate information for a short time, in healthy children aged 6-9 years. We expected OT to improve olfactory WM and establish cross-modal transfer to visual and auditory WM. Participants performed 12 weeks of bi-daily OT with either 4 odours (lemon, eucalyptus, rose, cloves; OT group) or odourless propylene glycol (placebo group). Pre- and post-training, participants' WM was measured utilizing odours (olfactory WM) or pictures (visual WM) and a word-span task (auditory WM). 84 children (40 girls) completed the study. The analyses revealed no changes in the WM performance following OT. The olfactory WM task was the most difficult for children, highlighting the need to include olfactory-related tasks in educational programmes to improve children's odour knowledge and memory, just as they learn about sounds and pictures. Further neuroimaging research is needed to fully understand the impact of OT on cognitive functions in children.

Goal Attainment Scaling (GAS) is a method for writing person-centred approach evaluation scales that can be used as an outcome measure in clinical or research settings in rehabilitation. To be used in a research setting, it requires a high methodological quality approach. The aim of this study was to explore the feasibility and reliability of the GAS quality rating system, to ensure that GAS scales used as outcome measures are valid and reliable. Secondary objectives were: (1) to compare goal attainment scores' reliability according to how many GAS levels are described in the scale; and (2) to explore if GAS scorings are influenced by who scores goal attainment. The GAS scales analysed here were set collaboratively by 57 cognitively impaired adults clients and their occupational therapist. Goals had to be achieved within an inpatient one-month stay, during which clients participated in an intervention aimed at improving planning skills in daily life. The GAS quality rating system proved to be feasible and reliable. Regarding GAS scores, interrater reliability was higher when only three of the five GAS levels were described, i.e., "three milestone GAS" (0.74-0.92), than when all five levels were described (0.5-0.88), especially when scored by the clients (0.5 -0.88).

To explore the long-term effectiveness of a paediatric adaptation of Goal Management Training (pGMT), relative to a psychoeducative program (pBHW), in reducing fatigue after pABI 2 years post-intervention. Thirty-eight youths and their parents completed the Paediatric Quality of Life - Multidimensional Fatigue Scale. Primary outcome measures were Total Fatigue Score, General fatigue, Cognitive fatigue, and Sleep/rest fatigue (parent-report). No significant differences in fatigue symptoms by the parental report was observed between the intervention groups at the 2-year follow-up (total score: F = .16, p = .69; general fatigue: F = .36, p = .55; sleep/rest: F = .48, p = .49; and cognitive fatigue: F = .09, p = .76), nor any time*group interactions (total score: F = .25, p = .86; general fatigue: F = .39, p = .76; sleep/rest: F = .20, p = .89; and cognitive fatigue: F = .08, p = .97). In total, 45% of the participants in the pGMT group and 25% in the pBHW group demonstrated a reliable positive clinical change. The significant improvements in fatigue symptoms that were demonstrated 6 months post-intervention could not be confirmed in this 2-year follow-up study. However, a continued positive tendency on most dimensions of fatigue for the participants in the pGMT group could be observed, suggesting that cognitive rehabilitation may help reduce fatigue.

There is a need for accessible rehabilitation that promotes meaningful participation, wellbeing, and adjustment to life with acquired brain injury (ABI). VaLiANT (Valued Living After Neurological Trauma) is an 8-week holistic group intervention that integrates Acceptance and Commitment Therapy (ACT) and cognitive rehabilitation techniques to support adjustment and meaningful reengagement in life. This Phase II pilot randomized controlled trial explored feasibility and preliminary efficacy signals to determine the viability of a larger trial. Adults (>3 months post-ABI) were randomly allocated to VaLiANT plus treatment-as-usual (TAU), or TAU waitlist-control, with assessments at baseline, post-intervention (8 weeks), and follow-up (16 weeks). Feasibility criteria included recruitment, dropout, outcome assessment completion, adherence, and delivery fidelity. Preliminary treatment effects were assessed on a range of adjustment-related outcomes using mixed linear models, proportions of reliable change, and minimal clinically important differences. 54 participants were recruited (M_age= 50.6, M_{years-post-injury} = 5.4) predominately with stroke (52%) and traumatic brain injury (22%). All feasibility criteria were met. Treatment effects were identified on measures of psychological distress, experiential avoidance, valued living, and self-identity, but not meaningful participation, quality-of-life, or wellbeing. A larger trial is viable but VaLiANT will benefit from refinement first to improve its impact on all intended outcomes.Trial registration: ACTRN12619001243101.