Neuropsychological Rehabilitation最新文献

Concussions are commonly occurring injuries in sport. The short-term impacts of concussions, including symptoms and recovery trajectories, often are the focus of concussion research. However, limited studies have explored the long-term consequences of concussions, especially in adolescents. The purpose of this study was to explore adults' experiences with concussions sustained during their adolescence (5-15 years prior). This qualitative study was guided by an interpretivist philosophy. Twenty young adults (11 men, 9 women, median age 26) who had sustained at least one sport-related concussion during their adolescence participated in a one-on-one semi-structured interview. We aimed to explore their experiences with their concussion at the time of injury and any consequences they experienced as a result of their concussion. We organized participants' concussion experiences into six main themes: (1) Concussion diagnosis and experiences with health care providers; (2) Emotional symptoms following concussion; (3) Concussion recovery; (4) Change in sport participation and engagement; (5) Concern about the potential long-term consequences; and (6) Impact on social relationships. We used the Biopsychosocial Model of Sport Injury Rehabilitation to organize the themes. Future research should explore how acute multi-disciplinary support could reduce the negative long-term consequences of concussion in adolescents.

A tailored psychological intervention has the potential to prevent and manage migraines in relapsing-remitting multiple sclerosis (RRMS) and improve wellbeing and meaningful participation. Acceptability of this approach is yet to be established. We explored participant perspectives on the content and delivery of a five-week telehealth intervention, tailored to RRMS and migraine, combining CBT and cognitive strategies (CBT-MMS). Transcripts from qualitative interviews were analysed through reflexive and codebook thematic analyses. Participants were 27 adults aged 22-59 years old with a RRMS history of 5.96±5.57 years, migraine history of 16.30±13.69 years, and 8.26±6.44 days of migraine per month. Five themes were generated reflecting the perceived value of CBT-MMS, including: 1-Feeling lost within a health system that has not met their needs, 2-Understanding their struggles and strengths, 3-Supported through a new therapeutic endeavour, 4-Developing a toolkit for life's challenges, and 5-One size CBT does not fit all. The therapy content and delivery were considered acceptable and relevant, though more detailed migraine education and cognitive strategy implementation were recommended. Our findings highlight the benefits of tailoring interventions to the individual with RRMS and their specific needs, and building self-efficacy through guided and practical strategies delivered by a supportive therapist.

Approximately 50% of people with relapsing-remitting multiple sclerosis (RRMS) have comorbid migraine. This pilot randomized controlled trial examined the feasibility and preliminary efficacy of a five-week cognitive behaviour therapy targeted to treating migraine in RRMS (CBT-MMS). Participants with RRMS and ≥3 migraine days per month (MMD) received CBT-MMS or a nine-week waitlist. Feasibility was assessed by rates of retention, follow-up and outcome responses. Candidate primary outcomes were MMD, migraine duration, and pain intensity at baseline, post-treatment, and one-month follow-up. Secondary outcomes included mood, fatigue, self-efficacy, pain catastrophizing, disability and quality of life. Data were analyzed through multilevel modelling. Participants were 31 adults aged 22-59 with 8.32 ± 6.12 MMD at baseline. The retention rate was 96.77%. From baseline, the CBT-MMS group (n=21) had significantly fewer MMD and shorter migraine duration (in hours) at post-treatment (EMM=3.05 days, 95%CI [-5.32, -2.13]; EMM=6.34 h, 95%CI [-10.62, -5.15], respectively) and follow-up (EMM=2.82 days, 95%CI [-5.58, -2.33]; EMM=7.20 h, 95%CI [-9.64, -4.39], respectively). The waitlist group (n=10) had no such within-group changes. Treatment gains were found for anxiety, self-efficacy, and migraine-related disability, and no effects were found on remaining outcomes. These findings provide preliminary support for the feasibility and efficacy potential of CBT-MMS, warranting a larger-scale trial.

Acquired Brain Injuries (ABIs) cause long-term disruption to young individuals' development. Persistent cognitive fatigue is a commonly reported sequela following pediatric ABI. Currently, there are no evidence-based interventions targeting cognitive fatigue post-ABI amongst pediatric patients. The current systematic review and meta-analysis aimed to review research on the efficacy of pharmacological and non-pharmacological interventions for cognitive fatigue following pediatric ABI. The review searched terms through relevant databases (including Medline, PsychInfo, Embase, Cinahl and Scopus), using specific inclusion criterion. A total of 6,511 articles were identified. Five articles met the inclusion criteria, and three were of excellent quality. These were categorized into behavioural (Gagnon et al., 2016; Gauvin-Lepage et al., 2020; Hypher et al., 2022; Renaud et al., 2020) and pharmacological interventions (Sakellaris et al., 2008). A meta-analysis of the behavioural interventions using random-effects models was conducted and demonstrated a statistically significant effect on reducing cognitive fatigue from both a self-report and caregiver-report perspective. Although not included in the meta-analysis, Sakellaris et al. (2008) findings also demonstrated creatin as an effective pharmacological intervention. The scarcity of available studies impacted the findings, and thus, further investigation is warranted to support specific treatment guidelines.

This study aimed to determine the Turkish validity and reliability of the stigma scale developed for stroke patients. This methodological study was conducted with 160 patients diagnosed with stroke in the Neurology Department of Kutahya Health Sciences University Evliya Çelebi Training and Research Hospital Additional Building. A Patient Information Form, the Stroke Stigma Scale, and the Neuro Quality of Life (Neuro-QoL)-Stigma Scale were used for data collection. A four-factor structure with a total variance of 52.82% was obtained from the exploratory factor analysis. The chi-square/degree of freedom of the Stroke Stigma scale was 1.931 (CMIN/DF < 5) and the p-value was <.001. The root mean square error of approximation (RMSEA) value was .07. When the Cronbach alpha coefficients were examined for internal consistency, it was determined that the Cronbach alpha value of the total scale was .74 and the Cronbach alpha values of the subdimensions were .67, .63, .57, and .60, respectively. In addition, a moderate positive correlation was determined between the Stroke Stigma Scale and the Neuro-QoL-Stigma Scale. According to the results, the Turkish version of the Stroke Stigma Scale was found to be valid and reliable for the Turkish population.

Introduction: To assess the impact of cognitive impairment, upper limb apraxia, and spatial neglect on upper limb performance in adults with stroke.

Methods: This prospective cross-sectional study evaluated upper limb performance dependency in adults with acute/early subacute stroke. The Upper Limb (UL)-LIMOS assessed upper limb performance; while upper limb motor impairment was evaluated with the Fugl Meyer Assessment-Upper Extremity (FMA-UE), general cognitive function with the Montreal Cognitive Assessment, spatial neglect with the Catherine Bergego Scale, and upper limb apraxia with the Apraxia Screen of TULIA.

Results: We recruited 407 adults with stroke. Minimal or no upper limb motor impairments were present in 270 out of 407 (66.3%) adults, among whom 38.5% still exhibited poor upper limb performance. There were weak to moderate correlations between UL-LIMOS and MoCA (r = .213), spatial neglect (r = -.415), and apraxia (r = .190). General cognition, spatial neglect strongly predicted upper limb performance (R2 = 0.34).

Conclusion: Almost 40% of adults with acute stroke, who do display minimal upper limb impairments, demonstrate poor performance in upper limb tasks, attributed to impaired general cognition, spatial neglect, and/or, to a lesser extent, upper limb apraxia. Hence, there is need for cognitive-motor therapies to be integrated into early rehabilitation settings to address these challenges effectively.

Prior research provides little guidance on how to support return to school post-concussion. Peer support may be one strategy to enable adolescents to return to school post-concussion. The purpose of this study was to explore what high school students preferred in a school-based peer support program post-concussion. We conducted a qualitative instrumental case study in one high school in Calgary, Canada. Seven semi-structured focus groups were conducted with 53 high school students (16 boys, 36 girls, 1 preferring not to disclose gender; median age = 16 years, range = 15-18 years). All adolescents were enrolled in a sport medicine course and had either a history of concussion (n = 20) or were interested in supporting peers who had sustained a concussion (n = 33). Focus group questions aimed to solicit which factors the adolescents believed should be considered in the development of a post-concussion peer support program. We analyzed the focus group transcriptions using content analysis. Adolescents preferred a one-on-one Buddy Program. A one-on-one environment would provide a trusting and confidential relationship between the student with a concussion and their buddy. Peer support could include social support, advocacy support for academic accommodations, tutoring support, and concussion education. In future, the Buddy Program should be piloted in high schools.

This study examined the feasibility of "Concussion Essentials" (CE), an individualized, multimodal intervention for persisting post-concussion symptoms (pPCS). Thirteen 6-18 year-olds with pPCS at 1-month post-concussion, as determined by the Post Concussion Symptom Inventory - Parent Report (PCSI-P), completed education, physiotherapy, and psychology modules, for up to 8-weeks or until pPCS resolved. Intervention participants were matched to a longitudinal observational cohort who received usual care (n = 13). The study enrolled 70% of participants symptomatic on screening and the dropout rate was <30% between baseline and post-programme assessments (4-weeks to 3-months post-injury). Symptoms improved for 100% of CE participants, with the number of symptomatic items on the PCSI-P reducing from 4-weeks, Median (IQR) = 14.0 (8.0-19.0) to 3-months, Median (IQR) = 1.0 (0.0-5.0). Comparatively, symptoms improved for approximately half of matched usual care participants. CE participants (n = 8) and their parents (n = 11) completed acceptability questionnaires. Most parents (91%) agreed CE was acceptable for children with concussion. All participants agreed CE was appropriate for concussion, while approximately 88% agreed they enjoyed the intervention and would recommend CE to others. Findings suggest CE is a feasible and acceptable treatment for paediatric pPCS. Further investigation within a larger scale randomized clinical trial is warranted.

Objective: To synthesise the qualitative research related to the processes of loss and grief experienced by adults who have sustained a moderate to severe ABI.

Method: We conducted a systematic review and thematic synthesis of the experiences of loss and grief in adults with moderate to severe ABI. Five electronic database searches (PubMed, CINAHL, EMBASE, PsycINFO and Scopus) were conducted, identifying 2434 studies, of which 25 met inclusion criteria.

Findings: Thematic synthesis generated four overarching analytical themes: the loss within me; devaluation of social roles and social identity; acceptance of grief and loss as an active process; and an ambivalent experience of loss. Our findings indicate that the experiences of grief and loss following brain injury are dynamic processes, requiring significant adjustment to and reappraisal of the sense of self, an often uncomfortable reconstruction and sometimes reluctant acceptance of new personal and social identities, and development of tolerance for the ambiguity of one's experience.

Conclusion: Findings suggest that people with moderate to severe ABI go through a significant process of change and adaptation in relation to grief and loss and their sequelae. Given the enduring nature of the injury and changing needs of the individual, rehabilitation may need to be increasingly personalised and responsive.

Prospective memory (PM) impairment is a common consequence of moderate-severe traumatic brain injury (TBI). Compensatory strategy training and rehabilitation (COMP) is the usual treatment of PM deficits through environmental modification and the use of assistive methods such as diaries and routines. The study intends to examine the changes in white matter integrity, as measured by advanced diffusion magnetic resonance imaging (dMRI) following COMP intervention in moderate-severe TBI patients. Nine COMP intervention and twelve routine care comparison cohort moderate-severe TBI patients were recruited from level 1 trauma centres in the Brisbane metropolitan area. Both groups were imaged at least one-month post-TBI for a baseline scan. COMP group was imaged again after a 6-week COMP intervention program and the comparison group was imaged again at least 6 weeks after the baseline scan. MRI scan included structural imaging and dMRI, which the latter fitted for the Neurite Orientation Dispersion and Density Imaging (NODDI) model. Only the comparison group had decreased Neurite Density Index in the major white matter tracts and increased isotropic diffusion in the fluid space between the cortical folds. Our results indicated that COMP intervention slowed down the neural degeneration in moderate-severe TBI patients as compared to routine medical care/rehabilitation.