Neuropsychological Rehabilitation最新文献

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.

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.

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.

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.