Neuropsychological Rehabilitation最新文献

Dementia and brain injury remain pressing areas for innovation and treatment that can improve the lives of those with such conditions. Every USA state has an assistive technology centre that includes aids for dementia and brain injury, and such centres are federally funded. In the Republic of Ireland, there are 22 "Memory Technology Resource Rooms', nationally funded, and they specialise in supporting conditions such as dementia and brain injury. In the UK, no such centres exist. The 10-year Health Plan for England has as its key goals applying advances in technology to healthcare and establishing neighbourhood health centres. We propose that the UK follow the examples of the USA and Ireland, and that each UK county has a Cognitive Assistive Technology centre, with a focus on cognitive aids and related smart home technologies for patients with dementia and other brain disorders that impact cognitive function.

Depression following Acquired Brain Injury (ABI) is common, persistent and debilitating, yet access to psychological treatment is limited. Digital therapies, provided alongside clinician support, may help overcome these barriers. This study evaluated the feasibility, acceptability, and potential benefits of a blended intervention for depression post-ABI, using a mixed-method approach. Individuals with ABI and depression were offered a 4-week intervention (MyACTION), delivered via a novel smartphone app, alongside weekly video therapy sessions. Measures of depression, anxiety, and self-efficacy were collected pre- and post-intervention. Feasibility was evaluated through recruitment, retention, engagement, and usability ratings. Acceptability was assessed via post-treatment interviews. Initial indication of benefit was evaluated through change in scores in outcome measures. Twenty-one individuals consented, 19 completed the intervention, and 18 completed post-intervention interviews. On average, 82% of daily app tasks were completed. Overall, the app received "good" usability ratings. Barriers and facilitators to engagement were (1) health status, (2) motivation, (3) perceived utility, (4) usability, (5) accessibility, and (6) timing. Reductions in depression and anxiety were observed post-intervention. MyACTION was feasible and acceptable for individuals with ABI and depression. High engagement and positive feedback suggest blended digital approaches may help increase access to psychological support in this population.

Meta-analyses on cognitive training (CT) for people with Parkinson's Disease (PD) report improvements in global cognition and it is recommended as a treatment for people with PD with mild cognitive impairment. However, few studies have assessed the experience of CT. Therefore, this study explored the experience of process-based CT in people with PD and focused on how participants engaged with and made use of the training in their everyday life. In this study, semi-structured, individual interviews were conducted with 18 people with PD who had completed 6-8 weeks of process-based CT. Reflexive thematic analysis was used to analyse the data. Three overarching themes were developed that reported on the participants' (1) dedication towards CT; (2) meaning of seeing change in cognitive performance during CT; and (3) inspiration to transfer the knowledge, strategies and mindset from training into everyday life. Furthermore, a route to transfer was described including emotional and motivational experiences. In conclusion, CT was experienced in an active, reflective manner whereby emotional and cognitive challenges during training are dealt with and are seen as important ingredients to attain transfer to everyday life. Future studies are encouraged to examine the link between such qualitative findings and quantitatively measured outcomes.Trial registration: ClinicalTrials.gov identifier: NCT03680170..

The valence-bias hypothesis refers to the tendency of some respondents to answer according to the positive/negative polarity of a question (its valence) rather than its specific content, potentially reducing the specificity of psychological and neuropsychological questionnaires, and increase correlations across different questionnaires and within items of the same questionnaire. This work examines the likelihood of valence-bias using findings from the 20-item Dysexecutive Questionnaire (DEX). We searched PubMed and Web of Science using the keyword "dysexecutive questionnaire" and selected studies reporting findings relevant to evaluating the valence-bias hypothesis. Included studies described the DEX's factorial structure and its correlations with performance-based executive function (EF) and other self-reported questionnaires. Subject-completed DEX (DEX-S total score) correlated positively with self-reported depression, anxiety, poor subjective quality-of-life, heightened self-awareness of difficulties, and personality traits associated with symptom reporting (high neuroticism, low conscientiousness). DEX-S correlated negatively with positive affect. Findings on the DEX's factorial structure were variable, but its reliability was consistently good to excellent. Correlations between DEX-S and performance-based EF were generally weak or non-significant, but significant when the DEX was completed by professionals. Overall, findings support the valence-bias hypothesis. While problematic for group-level studies, it may offer advantages for individualized clinical assessment and rehabilitation.

Evidence is needed about contextual-behavioural change processes that could be targeted by Acceptance and Commitment Therapy-based (ACT-based) interventions for specific populations and contexts, including those designed to help stroke survivors avoid or reduce depression. In this study, an online questionnaire survey with measures of depression (PHQ-9), psychological flexibility (AAQ-ABI), cognitive fusion (CFQ), valued living (VLQ), and stroke impact (SF-SIS) was completed by 81 stroke survivors (aged 29-85 years, 58.0% female, 49.4% post-ischaemic stroke, and 27.2% post-haemorrhagic stroke). Hierarchical linear regression and mediation analyses were used to test hypothesized associations between stroke impact, psychological flexibility, cognitive fusion, valued living, and depression. The results showed that cognitive fusion, stroke impact, gender, and ethnicity predicted depression independently of other factors, accounting for 60.2% of the variance in depression. Cognitive fusion almost entirely mediated the initially significant independent association between psychological flexibility and depression. The findings support the value of ACT-based interventions for stroke survivors and suggest that cognitive de-fusion is a change process that could be specifically targeted to avoid or reduce depression. Cognitive de-fusion may have a positive impact on depression because it helps with rebuilding personal identity following stroke.

This study aimed to adapt and evaluate the feasibility, acceptability, mechanisms of change, and preliminary outcomes of Groups 4 Health, a social identity-informed group intervention, for individuals with acquired brain injury in an outpatient rehabilitation setting. The adaptation process involved three phases: modification for cognitive and language impairments, expert consultation, and in vivo consumer feedback. Five participants completed the five-session intervention with no dropouts and high adherence, demonstrating strong feasibility. Quantitative data were analysed descriptively, and qualitative data were explored using reflexive thematic analysis. Acceptability ratings were uniformly high, with participants rating the programme as relevant, enjoyable, and useful. Post-program interviews highlighted key engagement facilitators including accessible content, skilled facilitation, and meaningful peer connection. Participation was a catalyst for social re-engagement and increased confidence. Ratings of theorized mechanisms showed consistently high group identification, though findings for multiple group membership were mixed. No significant changes in psychological distress or loneliness were observed, likely due to the small sample and external factors (e.g., COVID-19). Participants recommended extending the programme to support deeper connection-building and skill consolidation. These findings support the programme's potential and inform future proof-of-concept research with larger samples, longer follow-up, broader outcome measurement, and exploration of mechanisms and moderating factors.

Prior neurostimulation research has underscored the importance of the left dorsolateral prefrontal cortex (DLPFC) in the modulation of autonomic nervous system responses, with activation of this region significantly enhancing heart rate variability (HRV) - a key indicator of autonomic flexibility. High test anxiety (HTA) individuals often demonstrate diminished HRV in evaluative scenarios, signalling reduced physiological adaptability to stress. This study investigates the effects of offline high-definition transcranial direct current stimulation (HD-tDCS) targeting the left DLPFC on nonlinear HRV measures in individuals with high levels of test anxiety. Two experiments were conducted: Experiment 1 measured HRV in 23 HTA participants before and after HD-tDCS application. Experiment 2 replicated the tDCS protocol with 24 participants with low test anxiety (LTA). Significant enhancement in nonlinear HRV post-HD-tDCS was observed in HTA group, whereas no notable changes were reported in HRV among LTA group. These results indicate that HD-tDCS targeting the left DLPFC may be an effective intervention for managing test anxiety, as it appears to improve autonomic regulation in individuals experiencing high anxiety levels.

Sensory hypersensitivity following acquired brain injury (ABI) is frequently reported and affects well-being, yet remains poorly understood. Research in neurotypical individuals suggests a link between hypersensitivity, insomnia, hyperarousal and perceived stress. This study examined the relationship between sensory sensitivity and insomnia in ABI patients and whether hyperarousal and/or perceived stress mediates this relationship. In an online cross-sectional cohort study among 188 chronic ABI patients of University Medical Centre Utrecht and 61 neurotypical controls, sensory hypersensitivity was measured using the Multi-Modal Evaluation of Sensory Sensitivity, insomnia using the Insomnia Severity Index, hyperarousal using the Hyperarousal Scale, and perceived stress using the Perceived Stress Scale. Associations were examined using multiple regression and mediation analyses with bootstrapping. The results confirmed that sensory hypersensitivity was frequent (66%) and persistent following ABI, mainly in visual and auditory modalities. Increased sensory hypersensitivity was related to higher severity of insomnia in ABI patients. This relationship was partially mediated by hyperarousal and perceived stress. Hyperarousal and perceived stress may underlie the link between sensory hypersensitivity and insomnia, although the direction of these effects remains unclear.

Spatial neglect (SN) is a disabling consequence of stroke requiring intensive rehabilitation. A prior study demonstrated that contralesional eye- and reaching movements can facilitate SN recovery (Congruent Movement Training, CMT). To increase CMT's accessibility, a tablet-based CMT game was designed. In addition, as therapy time is restricted, clinical implementation would be facilitated if CMT can be delivered in sessions not supervised by a clinician. In this study, end-user feedback was gathered on the tablet-based CMT and treatment delivery strategies. Fifteen clinicians and 10 SN patients played and evaluated the CMT game. The clinicians almost unanimously indicated a need to revise the in-game feedback on how patients played the game. Clinicians also deemed it feasible that some patients would use CMT training in unsupervised sessions. Eight right-hemispheric patients were able to use the CMT training and were positive about their experience. Two left-hemispheric patients were not able to use the training due to language comprehension difficulties. Six patients believed they could use CMT training independently. The results revealed two implementation barriers: the design of the feedback on game performance, and the accessibility for left-hemispheric patients. The results also clarified that unsupervised training is considered feasible by clinicians and patients.

The objective of this study was to evaluate fatigue trajectories of adolescents with paediatric acquired brain injuries (pABI) following metacognitive strategy training (paediatric Goal Management Training; pGMT) or psychoeducation (paediatric Brain Health Workshop; pBHW) for executive dysfunction in the chronic phase after injury. Five-year follow-up data of the CORE randomized controlled trial including participants aged 10-17 years at baseline, randomized to either pGMT or pBHW is presented. Fatigue was measured at five timepoints using the Paediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL MFS). Linear mixed models and Reliable Change Index (RCI) analyses were utilized to assess outcomes. A significant reduction in total fatigue (F_(4,62.820) = 2.81, p = .033) and cognitive fatigue (F_(4,59.622) = 4.89, p = .002) was observed based on parent-reported data. However, no significant differences emerged between intervention groups or for the group-by-time interaction. Clinically meaningful improvements in fatigue as determined by the RCIs, were noted in 67.6% of participants per parent-report. In conclusion, both pGMT and pBHW may contribute to sustained reductions in fatigue in young people with pABI, particularly cognitive fatigue. The high rate of clinically meaningful change highlights fatigue as a modifiable symptom that should be a key target in long-term rehabilitation strategies.