Neuropsychological Rehabilitation最新文献

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.

Depression in multiple sclerosis (MS) is under-detected and undertreated, impacting quality of life. This study explored perspectives, practices, barriers, and facilitators to improve mental health care for people with MS. In the current study, participants, including 176 people with MS (M age = 48.4, 86.9% female) and 51 healthcare professionals (neurologists, MS nurses, allied health) from Australia, completed a 15-20-minute online survey on depression detection and management. Nearly half of participants with MS reported moderate-to-severe depressive symptoms, yet many had not been informed about depression in MS or assessed by their MS healthcare team. Clinicians acknowledged depression is common in MS and reported providing education routinely (51.0%) or sometimes (39.2%). While clinicians acknowledged a need for routine screening through MS healthcare services, this was rare (9.1%) and often deferred to general practitioners. Participants with MS and clinicians identified barriers, such as service access, limited time, role definition, stigma and need for brief clinician training and resources. This study highlights significant gaps in depression identification and management among people with multiple sclerosis (MS) emphasizing the need for integrated mental health support within MS healthcare services, including systematic assessment, monitoring and treatment procedures.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12622000543785.

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.