Neuropsychological Rehabilitation最新文献

Neurological conditions, including dementia, Parkinson's disease, and stroke, are rising globally, increasing reliance on informal caregivers, particularly within ethnic minority communities. However, little is known about these caregivers' experiences in the European context. This review aimed to explore how ethnic minority informal caregivers construct meaning around and navigate their caregiving roles. A systematic search of four electronic databases in August 2024 identified 18 qualitative studies involving 258 caregivers from the UK (n = 14), Norway (n = 2), the Netherlands (n = 1), and Germany (n = 1). Thematic synthesis revealed two key caregiving narratives. First, preserving cultural identity through caregiving illustrates how caregiving serves as a means of upholding cultural values, reinforcing community identity, and maintaining the dignity and personhood of care recipients. Second, negotiating traditional expectations with modern realities highlights how caregivers balance inherited cultural norms with contemporary life demands, actively reinterpreting cultural beliefs and drawing upon resilience strategies shaped by migration experiences. Together, these findings indicate that caregiving among ethnic minority groups is both a means of preserving cultural identity and adapting to changing social norms. The findings are discussed and contextualized within existing theories and literature, offering implications for policy, healthcare services, and future research.

Understanding the factors that influence the return to physical activity can help to modify behaviour to enhance the recovery of symptoms and physical activity. We conducted 14 semi-structured interviews to explore the barriers and facilitators to returning to physical activity in adults following a mild traumatic brain injury (TBI). The study design was informed by the Theoretical Domains Framework and Capability, Opportunity and Motivation-Behaviour model. Ten key factors were identified in the analysis: four factors consistently acted as barriers (fatigue, sensory overload, symptoms, social expectations), four as facilitators (physical activity, assistive items, social support, health professional support), and two demonstrated a more complex, bidirectional influence (mental health, environment). These ten factors were organized to four overarching thematic groups: intrinsic factors, environmental and adaptive factors, social influences and symptom management. Adults with symptoms lasting greater than 10 days post-mild TBI report that a combination of symptoms, including fatigue and sensory overload prevent their ability to return to physical activity. The environment, social support structures, and access to health professional support facilitated individuals with returning to their physical activities. These findings should be considered when providing interventions to patients in clinical practice to enhance patients' recovery of symptoms and physical activity.

This systematic review and meta-analysis was conducted to evaluate the effectiveness of psychological therapies applied more than one year after an acquired brain injury (ABI) in reducing depressive symptoms. A systematic literature search of databases yielded 48 studies that evaluated a psychological intervention for people with an ABI, applied the intervention on average more than one year after the ABI, compared pre- and post-intervention validated measures of depression and were available in English. The intervention did not have to be implemented with the sole of aim of reducing depressive symptoms. There was a significant reduction in depressive symptoms in those who received a psychological intervention in 29 out of 48 studies. Thirty-one studies compared depression scores in an intervention and a control group and were included in the meta-analysis. The meta-analysis indicated a significant small overall effect size, -0.31, (standardized difference in means as the measure of ES; 95% CI, -0.53, -0.09, p = .0057, Tau² = 0.30), suggesting that psychological interventions are effective in reducing depressive symptoms in those with an ABI when compared to control conditions. The effect may be biased by a small-study effect and dependent effect sizes.

The ability to resume driving is a common goal for individuals who sustain a traumatic brain injury (TBI). Driving simulators present a potential avenue for driving rehabilitation. The aim of this study was to explore the perspectives of clinicians and individuals with lived experience of TBI about the use of modern driving simulators in clinical practice. Focus groups and interviews were conducted with nine clinicians (aged 23-57; 100% women) with 4-36 years of driving rehabilitation experience and eight individuals (aged 18-57; 62.5% women) who were 1-30 years post TBI. Focus groups and interviews were audio recorded and analysed inductively using thematic analysis. Two overarching themes were identified that encompassed participants' perspectives of the Perceived benefits and Considerations for implementation. Driving simulators were perceived by clinician and patient participants as potentially beneficial for assessing driving ability and readiness to drive, and as an additional rehabilitation tool. Implementation barriers, including cost, safety, ease of use and accessibility were identified, with some participants expressing concerns about usefulness in understanding real-world driving performance and providing false hope about return to driving for people with TBI. More research is needed to evaluate safe application, validity of simulators as an assessment tool and effectiveness.

Post-stroke fatigue (PSF) is a common symptom after stroke, without proven effective treatment. The Fatigue After STroke Educational Recovery (FASTER) randomized control trial evaluated a group-based, educational Fatigue Management Group (FMG) intervention. The current study explored the experiences of stroke patients, informal caregivers, and therapists when the FMG was delivered online (due to the COVID-19 pandemic). Participants included newly recruited adults (n = 6) with clinically significant fatigue (3-24 months post-stroke), their informal caregivers (n = 6), who attended as observers, and three therapists from the FASTER main trial. Separate online focus groups were conducted with each group, recorded, and analysed using inductive thematic analysis. Four key themes emerged: positive experiences of group membership, gaining understanding and strategies, navigating challenges in online setting, and future directions. Participants acknowledged the intervention for its educational value, normalization, cohesion, and emotional support, and appreciated new understanding of PSF. However, they also encountered challenges, including technological issues, difficulties concentrating, and therapists' struggles in addressing diverse participant needs and fatigue levels within time constraints. Suggested improvements to the intervention included extending its duration and including combinations of online and in-person sessions. Findings highlighted the importance of qualitatively examining intervention experiences in future trials for better optimization and effectiveness.

Visuospatial neglect (VSN) is a common post-stroke disorder characterized by impaired attention toward the contralesional hemispace, affecting interaction with the environment. Traditional assessments (e.g., pen-and-paper tests) may not detect subtle deficits in visual search behaviour, particularly in complex, dynamic settings. This study introduces an immersive virtual reality (VR) visual search task designed to assess visual search behaviour across peri- and extra-personal spaces. By integrating eye-and-head tracking, we aimed to characterize search behaviour and evaluate group differences among individuals with stroke with VSN (VSN+, n = 11), those without VSN (VSN-, n = 10), and healthy controls (HC, n = 11). Additionally, we examined how task parameters (target position, spatial context, and difficulty) influenced search behaviour. Results show that VSN+ exhibited least efficient search strategies, with longer search times than VSN- and HC and more extended search paths than HC. Notably, VSN- also demonstrated visual search inefficiencies, suggesting that conventional assessments may overlook subtle visuospatial impairments. Search deficits were most pronounced in extra-personal space and under increased task demands. Despite a limited sample size, these findings highlight the potential of VR-tasks to characterize visual search behaviour. Further research on larger, more diverse samples is needed to evaluate its potential diagnostic utility.

Prolonged Disorders of Consciousness (PDoC) are complex conditions characterised by sustained consciousness impairment lasting over four weeks following sudden-onset severe brain injuries. These conditions pose emotional and social challenges for family members. This study aims to enhance understanding of the lived experiences of male family members dealing with PDoC in the UK. Semi-structured interviews were conducted with six adult male family members, and Interpretative Phenomenological Analysis (IPA) revealed three Group Experiential Themes: (1) "Facing the Unknown: The Emotional Journey"; (2) "Finding Meaning and Navigating Forward"; and (3) "The Landscape of Care". The findings highlight the emotional challenges faced by male family members and their efforts to find meaning, resilience and navigate the care pathway. Insights for professionals include the need for a family-orientated approach that offers understanding, compassion, holistic support and collaboration in care.

People with aphasia may present with cognitive impairments beyond language. In this population, reliance on language-based assessments of cognition may lead to unreliable metrics of cognitive performance across clinical and research settings. We investigated the underlying philosophy and practice of assessing cognition in people with aphasia. An e-survey was developed for multidisciplinary clinicians and researchers. Snowball sampling was used to recruit international participants. The e-survey comprised 29 items (a mix of multiple-choice and open-ended items) addressing definitions of cognition, assessment of cognition, tools used to assess cognition and participant demographics. Data were analysed using descriptive statistics and thematic analysis. 291 respondents participated from a range of disciplines and countries. Over 80% of respondents considered it important to assess attention, executive functions, learning and memory. The main barrier to assessment was the lack of appropriate tools available for people with aphasia. Responses indicated that whilst professionals felt that understanding the interaction between language and cognition in aphasia was important for providing optimal care. This study highlights the need for better awareness and training in the assessment of cognition in people with aphasia, and for psychometrically robust assessments, appropriate for the assessment of cognition in the presence of aphasia.

Introduction: Some people with multiple sclerosis (pwMS) exhibit high cognitive reserve (CR), potentially mitigating cognitive decline. Cognitively stimulating activities (CSAs) contribute to CR, suggesting that interventions entailing CSAs may enhance cognitive function in MS.

Objectives/aims: To evaluate the feasibility of an intervention designed to increase CSA participation (e.g., reading, writing, language learning).

Methods: Participants were interviewed after a 12-week intervention in a randomized controlled trial. Participants were selected based on prespecified criteria to ensure sample diversity. Interviews were transcribed verbatim and analyzed using an inductive content analysis approach.

Results: 14 participants were interviewed. The intervention was deemed feasible and acceptable by participants. Benefits included subjective cognitive improvements, increased impairment awareness, and engagement in compensatory strategies. Some reported indirect benefits, including improvements in mood and physical functioning. Barriers included a lack of training structure, technical aspects of the intervention, busy schedules, and guilt from not strictly adhering to protocol. Barriers were most prevalent in participants with progressive MS, younger age, busy schedules, and high pre-intervention activity levels.

Conclusion: An individualized intervention to increase CSAs in pwMS is feasible. Future interventions could benefit from including people with low to medium participation in CSAs and should consider implementing measures of progress along the way to maintain motivation.

Challenging behaviours following acquired brain injury can lead to social isolation, reduced quality of life, and carer distress. The online "Carers Way Ahead" (CWA) support programme advises families how to manage behaviours and promotes self-care. An RCT determined if CWA reduces challenging behaviours and improves carer mood, family function and general health. 44 carers of individuals with ABI were randomly allocated to Active Treatment (n = 23; 10-week intervention) or Waitlist control (n = 21). A clinical psychologist provided input as needed. Primary and secondary outcomes were measured pre and post intervention and, where possible, at 6- and 12-month follow-up. Following intervention, the Active group reported reduced depression, anxiety, and stress (d:.84-1.22). No other outcomes were significant. Post hoc, pre-post analyses of everyone who received the intervention (N = 35) indicated improved behaviour, carer mood, family functioning, and strategy use, with many gains sustained at 6 months post-intervention. On average, clinicians provided two hours of support per carer. To conclude, CWA is effective for improving carer mood. The RCT was underpowered, so changes in other outcomes remain ambiguous, but future studies may address this. CWA is now available in seven languages https://cwa.psy.unsw.edu.au/.