Neuropsychological Rehabilitation最新文献

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.

Prospective memory (PM) is the ability to remember to perform an intended task. PM is often impaired in individuals with Korsakoff's syndrome (KS), a neuropsychiatric disorder caused by severe thiamine deficiency resulting from malnutrition, typically as a consequence of structural alcohol abuse. This study aimed to investigate whether smartwatch reminders were as effective as verbal in-person reminders in prompting individuals to perform time-based PM tasks. Twelve individuals with KS, residing in a long-term care facility, were asked to complete PM tasks that were already part of their daily routine. We analysed each participant's result individually and then performed a group case study analysis where we combined the p-values using Fisher's method to evaluate the overall significance across participants, which formed the basis of our conclusion. The results showed that smartwatches were as effective as verbal reminders to enhance PM performance. Overall cognitive functioning negatively influences timeliness of PM performance after a smartwatch reminder. Thus, for individuals with lower cognitive functioning, reminders should be delivered closer to the intended action time to improve effectiveness. Participants generally reported a pleasant experience with the smartwatch reminders, reinforcing its potential as a valuable external memory aid for increasing autonomy in individuals with KS.

ABSTRACTTo examine the impact of a healthy lifestyle intervention adapted for survivors of traumatic brain injury (TBI) classified as overweight or obese on cognition and habits. Setting is community-based intervention. Participants (n = 57) were adult survivors of moderate or severe TBI at least 6-month post-injury with a body mass index of ≥25 kg/m². We conducted secondary analysis of a 12-month randomized controlled trial of a healthy lifestyle intervention (GLB-TBI) compared to an attention control group (BHG); primary study analyses previously demonstrated statistically and clinically significant weight loss of 7.9%, enhanced blood pressure, improved lipids, and good attendance and self-monitoring. Primary outcomes included the Montreal Cognitive Assessment and the Self-Report Habit Index. Average cognitive function for the GLB-TBI group significantly improved, whereas the average score for BHG decreased (β = 1.8 [0.29, 3.31]; p = 0.02). There were no significant differences in perceived habit strength. Although both groups perceived improvement in healthy habits, only the GLB-TBI group focused on evidence-based dietary and physical activity changes, resulted in improved cognitive function. Healthcare providers should consider referrals for healthy lifestyle interventions for survivors of brain injury who are overweight/obese, particularly for those experiencing sustained cognitive deficits.

Being hospitalized at an intensive-care unit (ICU) is stressful and often accompanied by feelings of helplessness, loss of control, fear and traumatic memories. There is substantial influence on cognition and emotion. Relaxation interventions have proven to be effective for regulating affect and cognition for various patient groups. N = 30 patients currently hospitalized at the ICU ward of an early neurological rehabilitation department were exposed once to an audio recording of a self-recorded customized guided imagery intervention with basic mindfulness elements (GIME) and a fictional diagnostic dialogue (control), in randomized order. We recorded respiratory rate, heart rate, systolic and diastolic blood pressure and perfusion. Functionally interactive patients were asked for self-report measures of mood, arousal and pain. We conducted repeated measures ANOVAs with the factors CONDITION and TIME and t-tests for all of the physiological parameters and self-report measures. Analyses showed significant interaction effects for systolic, as well as for diastolic blood pressure indicating a decrease during listening to the GIME. There also was a significant decrease in self-reported arousal after listening to the GIME. Our results suggest that an adapted GIME may induce a beneficial relaxation response and is suitable for administration to neurological patients within early neurological rehabilitation.

The Wellbeing After Stroke (WAterS) study co-developed a nine-week, online, group-based intervention for stroke survivors, informed by Acceptance and Commitment Therapy (ACT), and trained third-sector practitioners to deliver it. This study explored practitioners' perceptions of the acceptability of the training they received and their views prior to delivering the intervention. Semi-structured interviews were completed with practitioners after training, but before intervention delivery had begun. The interview schedule was guided by the Theoretical Framework of Acceptability. Template Analysis was used to inductively and deductively interpret the data. All eight WAterS-trained practitioners were interviewed. Five main themes were generated. Practitioners were motivated to deliver a stroke-specific therapy. Practitioners reported that training was understandable and that experiencing ACT during training benefitted practitioners' own wellbeing and increased their preparedness for intervention delivery. Previous experience affected their confidence to deliver. Practitioners expected the therapy to be acceptable to many stroke survivors. The online group context was expected to be beneficial, although they foresaw challenges in remotely facilitating groups with diverse accessibility needs. In conclusion, it may be acceptable to upskill a third-sector workforce to deliver a protocolised ACT-informed intervention to stroke survivors, potentially enabling greater reach of much needed psychological support.

The use of single-case experimental design (SCED) methodology is growing across all domains of rehabilitation. SCED methodology may be used for several different purposes, which creates confusion about its ethical, legal and regulatory status. We will argue that aspects of SCED methodology can be helpful in clinical practice to determine the optimal treatment for a given person. Given the use of SCED methods in research, clinicians may assume that ethics committee approval is required, though this is not necessarily the case given that SCED methods may, under certain circumstances, be considered as evidence-based clinical practice, rather than generalizable research. In this paper, we aim to raise awareness of the principles and legal/ethical framework of SCEDs, and we propose a series of position points that could help researchers/ethics review boards to determine whether a SCED is "research" or "evidence-based person-specific clinical practice", based on its design and purpose. We aim to clarify how the features of SCED methodology - baseline length and content, repeated measurement, randomization, and blinding - impact SCED categorization. A secondary objective is to provide recommendations for universities and training institutes to help trainees undertaking SCED studies to use appropriate methodologies that comply with the proposed regulatory framework.

Sleep disturbance and fatigue are persistent, clinically significant problems for many with acquired brain injury (ABI). A recent randomized controlled trial (RCT) demonstrated that cognitive and behavioral therapy tailored for post-ABI sleep and fatigue (CBT-SF) produced larger and faster effects compared to an active health education (HE) control intervention. The current study aimed to qualitatively explore the perspectives of the six clinicians, all clinical neuropsychologists, who delivered the CBT-SF and HE interventions to 126 individuals with ABI in the RCT. One-on-one semi-structured interviews were conducted, and transcripts were analyzed using reflexive thematic analysis. Seven themes were generated, encompassing client-related factors (Client Awareness and Readiness as Precursors to Engagement and Navigating Client Differences Throughout Treatment) and clinician-related factors that influenced treatment delivery (Building on Pre-Existing Expertise and Strengths and Challenges of Delivering a Manualized Intervention), as well as other themes directly related to treatment delivery itself (Challenges and Successes Relating to Client Engagement, CBT Strategies That Work, and Navigating Practical Considerations in Treatment Delivery). The findings reinforce the value of psychoeducation and cognitive-behavioral strategies for managing sleep and fatigue problems after ABI. They also provide valuable insights to guide the translation of CBT-SF from an RCT to real-world clinical practice.