Neuropsychological Rehabilitation最新文献

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.

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.

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.

Previous research has established that children and young people exposed to complex trauma (i.e., abuse and/or neglect; and/or domestic, family, and sexual violence) have significantly greater deficits in executive function (EF) and a higher incidence of psychopathology. Poor EF is associated with poorer academic, social, and relational outcomes across the lifespan and poorer overall wellbeing. Despite this, the efficacy of interventions aimed at remediating executive dysfunction in this population have not been established. The current PRISMA-guided systematic review aimed to critically analyse the existing evidence and inform practice guidelines for clinicians working with impacted children and young people. A systematic search identified six studies: three utilized computerized cognitive training, two utilized individual education plans, and one utilized trauma-focused cognitive behavioural therapy. Findings identified two approaches that produced significant improvements in EF and warrant further investigation with more rigorous methodology: computerized cognitive training and trauma-focused cognitive behavioural therapy. Several methodological limitations were identified, including a lack of adequate control groups, little consensus on classification of EF domains, and failure to delineate trauma type, onset, and duration. This review highlights the need for further methodologically robust research to inform clinical practice guidelines for EF interventions for young people exposed to complex trauma.

Background: Most individuals who sustain a mild uncomplicated Traumatic Brain Injury (mTBI) recover within 1-3 months. However, a significant proportion consistently report ongoing cognitive, psychological, and somatic sequelae, which can be functionally disabling and hinder active participation in society following injury. The present study examined dispositional mindfulness as a targetable protective factor as it pertains to psychological, cognitive, and functional outcomes in the post-acute stage of mTBI. Method. In this cross-sectional study, 45 litigating individuals with persistent symptoms in the post-acute stage following mTBI completed a comprehensive neuropsychological assessment, which included current and retrospective pre-injury ratings of the Five-Facet Mindfulness Questionnaire. Results. Mindfulness was significantly associated with depression and anxiety but not with objective cognitive performance on measures of attention or working memory. Lower mindfulness was observed in individuals who had returned to work following injury compared to those who had not, specifically in the Observing and Describing facets. Pre-injury mindfulness significantly predicted scores on the Psychiatric Impairment Rating Scale, with higher Observing scores predicting worse functioning. Future research employing experimental and longitudinal designs can further elucidate these relationships.

Traumatic brain injury (TBI) and concussion present ongoing challenges in symptom management and care continuity. Traditional clinical methods may overlook key patient concerns during recovery. Social media platforms such as Reddit provide unsolicited, real-world accounts of the TBI experience, offering insights underexplored in clinical research. We conducted a cross-sectional analysis of 2,024 Reddit posts from r/TBI and r/Concussion between January 2020 and May 2025. Posts were analysed using natural language processing (NLP) to identify themes related to symptoms, treatment experiences, healthcare interactions, and follow-up challenges. Statistical analyses examined discussion patterns and symptom co-occurrences. Information gaps were noted in 47.7% of posts, most often involving symptom interpretation (34.6%) and recovery timeline confusion (23.5%). Red flag symptoms, including worsening neurological deficits, were frequently reported without appropriate clinical guidance. Persistent symptoms such as mood changes (41.2%), memory issues (30.4%), and headaches (19.3%) often extended beyond the acute phase. Patients frequently described difficulty accessing appropriate care or specialist consultations. Reddit narratives reveal substantial unmet needs in post-TBI care. Leveraging social media content through NLP offers valuable insights into patient concerns, highlighting the need for improved education, follow-up, and patient centered communication in neurotrauma care.

Increasing evidence suggests that transcranial direct current stimulation (tDCS) can enhance language outcomes in people with post-stroke aphasia. However, the neurophysiological mechanisms underlying these behavioral improvements remain insufficiently characterized.This crossover feasibility study examined the clinical and technical viability of integrating transcranial magnetic stimulation with electroencephalography (TMS-EEG) to characterize cortical excitability and network dynamics before and after real and sham tDCS in individuals with chronic post-stroke non-fluent aphasia.Eight participants were enrolled; four completed the full protocol, while four discontinued due to scheduling or technical constraints. The completers underwent eight weeks of anodal tDCS and language exercises. They tolerated the combined procedures well, with full adherence, no adverse events, and good-quality TMS-EEG recordings, confirming the protocol's feasibility.Cortical responses were quantified using global and local mean field power (GMFP, LMFP) and a regional complexity index. Behaviorally, modest language improvements were observed in two participants with Broca's aphasia. Neurophysiologically, heterogeneous modulations of cortical reactivity were observed across cases.These findings indicate that this multimodal protocol can be practically and safely implemented, with no adverse effects observed, while also underscoring logistical, technical, and clinical considerations for larger-scale studies designed to elucidate the neurophysiological mechanisms supporting tDCS-driven language recovery.

People with Huntington's disease (HD) commonly experience anxiety, yet access to psychological interventions remains limited. Guided self-help is a low-cost, scalable, evidence-based approach with the potential to improve access to psychological support. This qualitative study aimed to explore participants' experience of GUIDE-HD, a remote guided self-help intervention designed to address anxiety in people with HD based on cognitive behavioural therapy and acceptance and commitment therapy, by examining: (i) the acceptability of the intervention, (ii) any perceived benefits or challenges, and (iii) ways to enhance its relevance and accessibility for people with HD (pwHD). Qualitative individual semi-structured interviews were conducted with nine pwHD and three carers and analysed using framework analysis. Three overarching themes emerged: (1) A therapeutic journey for people with and affected by HD; (2) Mechanisms of benefit; (3) Experiencing various gains. Participants valued the intervention's relevance, structure, accessibility, personalization and facilitation. Reported gains extended beyond reduced anxiety to increased acceptance of the realities of living with and managing the condition and better relationships. While a number of limitations should be considered, such as the sample size and its predominant female representation, the GUIDE-HD intervention was acceptable and showed promise as a tailored psychological approach for pwHD.