Neuropsychological Rehabilitation最新文献

Cognitive impairment is a debilitating problem in Parkinson's disease (PD) with no effective treatment. This pilot randomized controlled trial (ClinicalTrials.gov identifier NCT05495997) tested the feasibility of a personalized mental imagery (MI) intervention focusing on goal-directed activities of daily living in people with PD. We screened 51 and randomized 30 nondemented people with PD. During the six-week training period delivered remotely, PD-MI group practiced MI and PD-Control group received psychoeducation on cognitive health in PD. The primary objective was testing protocol feasibility. We also collected cognitive and functional MRI data at baseline, six weeks, and 18 weeks, specifically, to assess the feasibility of using the Neuro-QoL Cognitive Function (CF) self-report survey and brain functional connectivity as potential efficacy outcome measures in a future definitive trial. Retention and participant compliance with study procedures were 100% during six weeks. There were (1) group differences in the Neuro-QoL-CF T-scores at six and 18 weeks, driven by a reduction in the control group scores, (2) stronger frontoparietal connectivity at six weeks, and (3) weaker visuospatial-motor connectivity at 18 weeks during MI tasks in the PD-MI compared to the PD-Control group. These cognitive and brain connectivity changes should be tested in a fully powered trial.

The SmartPrompt2 iPhone app was designed according to a neuropsychological framework, empirical data, and participant feedback to support efficient completion of everyday tasks at home by sending personalized prompts to participants' smartphones. Feasibility, efficacy in the home environment, and usability were examined in ten participants with MCI or mild dementia and their care-partners (NCT04313582). Participants and care-partners identified two individually relevant tasks for the participant to complete for two weeks with the SmartPrompt2 app (SP condition) two weeks without it (Control condition; order counterbalanced). SmartPrompt2 alerted them to complete daily tasks at times specified by the participant/care-partner using personalized images, audio, rewards, and motivational and logging features targeting common errors. Care-partners reported significantly higher task completion and lower burden during the SP condition versus Control. There was no significant difference in participants' average frustration between conditions. Usability ratings were high at the end of the study, and all participants requested to keep the app. Larger and longer effectiveness studies are needed, but preliminary data support the feasibility, efficacy and usability of the SmartPrompt2 for improving everyday function in older adults with cognitive impairments.Trial Registration: NCT04313582.

Persons with acquired brain injury (ABI) often experience mood problems like depression. While psychotherapy is widely accepted for managing depression in populations without ABI, its effectiveness for post-ABI depression is uncertain. The working mechanisms of psychotherapy in persons with ABI may differ from idiopathic depression. This scoping review aimed to identify studies on psychotherapeutic interventions for post-ABI depression, assess the use of process measures (instruments measuring the mechanisms of psychotherapy), and report effects on both process and primary outcome measures. In the 47 included studies, Cognitive Behavioural Therapy, Problem Solving Therapy, and Third-Wave Therapies were most frequently investigated. Results indicated that less than half of the studies implemented a process measure. Studies into Third-Wave Therapies most frequently implemented process measures. Around half of the studies found significant time or interaction effects on the process measure, while not necessarily finding effects on outcome measures for depression. Moreover, the review could not identify a specific type of intervention effective in improving depressive symptoms and the underlying process. Our findings emphasize that it is still unclear which psychotherapy works for whom, and how. To enhance understanding of effective interventions for post-ABI depression, it is crucial to incorporate process measures in future intervention studies.

Prism adaptation (PA) is a well-established method for sensorimotor recalibration and influencing visuospatial processing. It is also one of the rehabilitation approaches for neglect patients. Recent studies have shown effective adaptation in virtual reality (VR) settings simulating the classic PA procedure. However, no research has explored prism adaptation in augmented reality (AR), which combines the advantages of VR with greater ecological validity, allowing individuals to perform a virtual PA procedure in a real environment with natural visual feedback from their own hand. The present study introduces Augmented Reality Prism Adaptation (ARPA), a novel procedure that incorporates the benefits of AR with the classic PA technique. Forty-eight healthy participants underwent either leftward or rightward ARPA, and their sensorimotor and visuospatial aftereffects were evaluated immediately post-ARPA and over a 40-minute period. Results revealed significant and long-lasting sensorimotor aftereffects following both leftward and rightward ARPA, while only leftward ARPA induced an immediate rightward visuospatial aftereffect. Importantly, we investigated the generalization of these changes to the real environment, finding that ARPA-induced sensorimotor aftereffects extended beyond the virtual setting. While these findings show that ARPA produces both sensorimotor and visuospatial aftereffects, further research is essential to evaluate its applicability and effectiveness in neglect rehabilitation.

ABSTRACTMaintaining the ability to navigate through one's environment is an important component of quality of life after cerebrovascular accidents (CVA). Yet, navigation ability is not commonly assessed in post-CVA rehabilitation, and when it is, assessment methods are quite varied. Here, we assessed navigation impairment in thirty-four individuals with left and right CVA compared to sixteen neurotypical controls. We had three primary aims, (1) to confirm the presence of route and survey learning impairment post-stroke as assessed by a real-world task, (2) to assess whether navigation impairments are more likely to be detected when assessment is performed in certain locomotion conditions (walking, wheelchair, and video), and (3) to evaluate potential underlying causes of navigation impairment. Results reveal an impairment for individuals with CVA relative to controls on the route memory task. We also observed a benefit of real-world navigation, as individuals with CVA were particularly impaired in the video condition. Heading sensitivity and, to a lesser degree, lateralized attention were two underlying abilities contributing to route memory when walking. Together these results are consistent with the importance of real-world methods of assessing navigation in stroke, and suggest the possibility that treatment of deficits in heading sensitivity may improve spatial navigation.

Research on health-technology for people with acquired brain injury (ABI) is evolving rapidly and accelerated during the COVID-19 pandemic. But there is little information on what ABI stakeholders want from this research. We conducted a mixed methods study using an online survey with data collected twice, before and during, the COVID-19 pandemic. Participants were 18 + from three self-identified stakeholder groups: (1) people with ABI, (2) ABI carers, and (3) ABI healthcare professionals. There were 252 participants (55.8%) before the COVID-19 pandemic and 200 (44.2%) during the COVID-19 pandemic. Half (49.3%, n = 223) were healthcare professionals, one third (33.6%, n = 152) people with ABI, and the remainder (17.0%, n = 77) carers. Most had experience with technology (97.8%, n = 224) and acknowledged its value in supporting mental health. Nine key research priorities were identified pre-pandemic, spanning innovative technologies for specific purposes (aiding cognition, managing emotions, accessing support groups, and gaining information), and general barriers and facilitators to using technology. These themes were also present during the COVID-19 pandemic. However, the second cohort were less enthusiastic about, and some (medics, physiotherapists, and social workers) were less willing to use technology to support mental health, highlighting challenges that were not previously apparent.

As low-grade gliomas (LGG) are slow-growing brain tumours, the course of the disease is hard to predict. The aim of this study was to investigate the relatives' experiences of living close to a person with LGG (grade 2). It is based on semi-structured interviews with 15 family members (60% women, mean age 47 years). The interviews were conducted by telephone three and seven years after diagnosis.The thematic analysis resulted in one overarching and recurring theme, namely the difficulties of communicating openly about what the disease entails, as well as four related themes. LGG is perceived as a scary and mysterious disease requiring new priorities to be set up in families to fulfil the needs of the person with LGG. A tangible impact is an altered relationship due to a stealthy change in the person with LGG. Living with a person with LGG for many years can be likened to travelling a long and lonely road.The relatives expressed the concern that they receive insufficient support from the healthcare system. The key clinical implication is to meet the relatives' own right to support, as well as providing information about the changeability of the disease and possible personality changes.

We aimed to explore the perspectives of ischaemic stroke patients treated with endovascular clot retrieval (ECR), intravenous tissue plasminogen activator (t-PA), or conservative management in the early stages of stroke recovery. Thirty-one semi-structured interviews were qualitatively analysed using a reflexive thematic analysis approach. Three themes were generated: (1) Experiencing ongoing impairments after stroke; (2) Coping with life after stroke; and (3) Invisible difficulties are easily missed when visible outcomes are positive. Participants (ECR = 11, t-PA = 10, conservative management = 10; mean age = 62.9 ± 17.5; 20 male, 11 female) experienced ongoing impairments after stroke including physical problems, fatigue and sleep issues, communication difficulties, and cognitive impairment. They described these difficulties as impacting their ability to cope with life after stroke, including reduced participation, loss of independence, adjustment difficulties, and identity changes, which were associated with negative emotions. In participants with positive visible (e.g., physical) outcomes, particularly those in the ECR group, invisible difficulties were underrecognized and untreated due to a lack of services post-discharge, with this causing uncertainty in recovery. Invisible difficulties are common for all stroke survivors regardless of acute medical treatment and rehabilitation services need to place greater emphasis on managing invisible difficulties earlier in the recovery process.

The Making Sense of Brain Tumour programme delivered via videoconferencing (Tele-MAST) demonstrated efficacy for improving mental health and quality of life in people with primary brain tumour (PBT). This study explored the perceived need for and benefits of the Tele-MAST programme, from the perspectives of individuals with PBT and family members. Individuals with PBT completed semi-structured interviews prior to Tele-MAST, after Tele-MAST, and at 3-months follow-up. Twenty-four participants (M age = 46.26, SD = 11.45; 63% high-grade glioma) commenced Tele-MAST (including 6 couples) and 16 completed the programme (67% retention). Reflexive thematic analysis identified PBT as a unique and complex illness with multiple unknowns and emotional impacts. Individuals often felt lost and cast aside in the healthcare system as they searched for understanding and hope regarding the illness. Unmet psychological support needs were typically addressed by experiencing Tele-MAST, a person-centred intervention in which the complexities of PBT were understood from the outset and individuals felt supported to cope with and find meaning in their illness. Providing early and ongoing access with longer-term support options was considered key to improving Tele-MAST. These findings underscore the value of early access to tailored psychological support delivered flexibly according to individuals' ongoing support needs and preferences.

Traumatic Brain Injury (TBI) often results in impairments to executive functioning. Self-instruction (SI) and music-based interventions have both independently shown promise in improving cognitive and executive functioning, however, they have not been studied in combination. This study explores the feasibility and potential benefits of combining rhythmic music-based intervention and SI for individuals with a history of TBI experiencing executive dysfunction. Four male participants (aged 38-64) with severe TBI participated in a twice-weekly intervention combining rhythmic music-based intervention and SI over five weeks. Participants were assessed pre- and post-intervention using the BRIEF-A for executive functioning, along with secondary measures, the Frontal Assessment Battery (FAB), Depression, Anxiety and Stress Scale (DASS-42), Seashore Rhythm Test (SRT), Letter Number Task (LNT), and Quality of Life After Brain Injury Scale (QOLIBRI). Feasibility was assessed through a questionnaire. Three of four participants reported significant improvements in behaviour regulation, and three of four informants reported observing significant improvements in participants' overall executive functioning. These findings indicate that combining rhythmic music-based intervention with SI is a feasible, well-tolerated, and potentially effective intervention for improving executive functioning in individuals with TBI. Future randomized controlled trials are needed to confirm the efficacy of the intervention.