Neuropsychological Rehabilitation最新文献

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.

Informal caregiving comprises a core part of stroke survivors' rehabilitation. It can encompass positive elements, yet adopting and sustaining this role can affect carers' physical and mental health. Understanding carers' experiences is important for clinical psychologists, to highlight potential roles in supporting unmet needs. Theories of stroke informal carers' experiences exist, yet no previous attempt has been made to identify, organise and describe them, and synthesize key themes. This PRISMA-ScR guided scoping review aimed to identify theories and generate new knowledge of the experience and psychological impact of caregiving. Six databases were systematically searched, identifying relevant theoretical and empirical papers. Seventeen papers, presenting 13 distinct theories, were included and theories thematically synthesized. Two overarching themes were developed - "Systemic and Cultural factors" and "A staged process" - containing three main themes - "Adjustment to aspects of post-stroke life", "Emotional and psychological aspects of caregiving", "Carer Needs" - and four subthemes constituting relevant stroke pathway stages. Substantial theoretical knowledge exists that was useful in generating key themes of experiences and psychological impact of caregiving across the stroke pathway, to guide clinical practice and future research. Findings indicate that changes to carers' self-identity as they adjust to the role are not sufficiently captured by existing theories.

Auditory motion stimulation is a promising new therapeutical approach for visual neglect, whereby patients listen to music which repeatedly moves from the ipsi - to the contralateral hemispace. In this study, we investigated the feasibility, enjoyability, and efficacy of auditory motion simulation in an inpatient neurorehabilitation setting. 30 patients with left-sided visual neglect due to a right-hemispheric subacute stroke participated in the study. 15 patients were included prospectively and received 45 minutes of auditory motion stimulation per day for three weeks in addition to best possible standard neglect therapy. 15 further patients - who were matched based on neglect severity at admission, time since stroke, rehabilitation duration, and age - received best possible standard neglect therapy alone and served as a control group. Feasibility was assessed using remote time tracking, whereas enjoyability was measured with the Flow State Scale for Rehabilitation Tasks (FSSRT). Efficacy was evaluated using video-oculography during free visual exploration (FVE) at admission, discharge, and after three months. Our findings indicate that auditory motion stimulation is feasible and enjoyed by patients. Auditory motion stimulation significantly improved visual neglect at discharge. Randomized controlled studies are needed to confirm that auditory motion stimulation represents a valuable add-on therapy for visual neglect.

It has been argued that Working Memory Training (WMT) has the potential to improve emotional regulation. In this study, we investigated whether 20 days of WMT improved general emotion regulation in healthy participants using resting high-frequency heart rate variability (HF-HRV) as a physiological indicator of general emotion regulation, and examined its maintenance effect three months later. The analysis of the linear mixed-effects (LME) model revealed that after completing 20 days of WMT, there was a significant improvement in the individual's resting HF-HRV. This improvement was observed to be stable even after 3 months, and the resting HF-HRV of the training group was significantly better than that of the control group. In addition, there was a positive correlation between the gain in resting HF-HRV and the gain in working memory in the training group, which persisted from post-test to follow-up, suggesting that the greater the gain in working memory, the greater the gain in emotional regulation. Our study provides the first evidence that WMT can effectively improve general emotional regulation ability, and this improvement can last for at least three months.

ABSTRACTThe benefits of assistive technology (AT) have been well established to positively support participation within disability. Clinicians have an important role in guiding clients to choose goal-centred AT. This study aims to explore (i) the frequency and types of AT prescribed by clinicians and (ii) real-world implementation of AT by clinicians, employing the ISO 9999 framework, and the challenges involved with AT prescription. An online survey was circulated to brain injury clinicians within New South Wales (NSW). Data were exported into IBM SPSS Statistics v.27 for analysis. Free text responses were analysed using a mixed-methods content analysis. A total of 31 AT products were reported 131 times by clinicians. The most frequently reported AT category was mainstream technology (n = 81), used amongst all professions. Using the ISO 9999 framework, the most reported class use of AT was "communication and information management" (n = 77/131). Challenges around AT implementation were funding acquisition, customizability of AT and time constraints with training. NSW clinicians have demonstrated varied use of AT to support cognitive, physical and communication functions. However, with the rapidly advancing nature of AT, there needs to be quicker approaches to generate high-quality evidence to support its use.

Trial registration: ACTRN12619001243101.

A pilot randomised controlled trial examined the feasibility (i.e., intervention demand, acceptability and initial efficacy) of a single-session (T1) and two-week follow-up (T2) values-based versus standard goal-setting intervention for ABI community dwellers. Twenty four participants (12 in each group) with ABI were recruited, 14 of whom were male (age: M = 61, SD = 9.3). Retention rate was at 92%, and both interventions were rated as acceptable (mean ratings ≥ 80%). Improvements in the primary outcome of wellbeing were greater in the values group (d_ppc2 = 0.30), while no differences between groups were found for goal attainment or memory of goals. Regarding attitudes towards goals measured at T1, motivation was higher for the values group with a small-to-medium effect size (d = -0.31), whereas confidence and anticipated pleasure from working on the goal were higher for the standard goal-setting group with small-to-medium (d = 0.28) and small (d = 0.17) effect sizes, respectively. The study found a modest improvement for the wellbeing of ABI community dwellers when their goals were embedded in values, while memory of goals and goal achievement was similar across both groups. Study limitations and future recommendations are discussed, and replication is required.

This psychometric study aimed to evaluate the psychometric properties of the Dysexecutive Questionnaire (DEX) following a cardiac event, and to examine the relationship between self- and informant-ratings. Approximately 7 months post-cardiac event, 196 participants and their informants (N = 179) completed the DEX. Reliability was assessed by confirmatory factor analysis and internal consistency estimates. Construct validity was evaluated using two performance-based neuropsychological tests, the Colour-Word Interference Test and the Trail Making Test (TMT), along with the Hospital Anxiety and Depression Scale (HADS). A one-factor model showed acceptable fit for the self-assessed DEX (RMSEA = 0.062) with excellent internal consistency (ω > 0.90). Slight positive associations were found between the DEX and the performance-based executive function measures, while strong positive associations emerged between the self-assessed DEX and the HADS. Overall, self-assessed and informant-reported scores did not differ significantly (self-assessed DEX median = 11, Q₁-Q₃ = 5.75-20; informant-reported DEX median = 11, Q₁-Q₃ = 4-19, p = 0.924). However, participants with severe executive dysfunction (TMT-B z-scores ≤-2) rated their own symptoms as less severe than informants (p = .001), indicating impaired self-awareness in a subgroup of participants. In conclusion, the DEX provides a useful perspective into general executive dysfunction in daily life but should be complemented with performance-based measures.Trial registration: ClinicalTrials.gov identifier: NCT03543371.

Everyday life demands handling multiple tasks that need attention simultaneously, which may be challenging for children with ADHD. In this study we tested dual-tasks in a cognitive-motor and motor-motor condition in children with and without ADHD. Sixty-six children (42 children with ADHD; 24 typically developing) participated and were tested on a primary Wii Fit balance task, and two secondary tasks: a cognitive task (counting specific sounds) and a motor task (crossing fingers (CF)), performed in single-task and dual-task conditions. In addition, attentional and motor abilities were measured independently. Children with ADHD presented poorer motor performance (Wii-Fit game, finger crossings) in the single task with large effect sizes, but performed equally on cognitive performance compared with their peers. Dual-task interference was not present in the primary Wii-Fit scores, but clearly and similarly present in the cognitive and CF tasks in both groups. The impact of divided attention on Wii Fit dual-task performance was 6-11%, and on dual-task CF performance 28.8% when combined with motor abilities. Children with ADHD are disproportionately impaired in dual-task situations where they must perform two motor tasks, but not when they perform a motor and a cognitive task.

Acquired brain injury (ABI) often limits daily activities and participation. Comprehensive neuropsychological rehabilitation (CNR) aims to address these issues. This review examines research on predictors and moderators of improved activity, participation, and quality of life (QoL) after CNR, and updates its effectiveness. A comprehensive search of five databases (PubMed, MEDLINE, CINAHL, PsycINFO, CENTRAL) from 2002 to 2025 identified 12,174 studies. Ninety-five were screened, and 25 met the inclusion criteria. The included studies evaluated CNR for adults with ABI in outpatient or community settings, incorporating cognitive and psychological interventions with repeated assessments of activity, participation, and QoL. We found no clinical trials reporting predictors or moderators of CNR outcomes. However, four observational studies suggested that earlier admission to CNR may serve as a potential predictor of improved outcomes. Most controlled studies demonstrated that CNR significantly improved activity, participation, or QoL compared to control groups. These effects were substantiated by 13 observational studies, with improvements sustained in 89% of studies with follow-up beyond three months. Overall, while CNR improves levels of activity, participation, and QoL post-ABI, research on predictors and moderators of CNR effectiveness is still lacking. Future research should focus on identifying these factors to optimize CNR effectiveness for individual patients.