Neuropsychological Rehabilitation最新文献

Cognitive challenges are common and often impede performing everyday tasks after acquired brain injury. Occupational therapists working with client groups with cognitive impairments seek evidence-based, occupation-based interventions to help individuals achieve independence in everyday activities. The aim of the study was to evaluate the effectiveness of the Perceive, Recall, Plan and Perform (PRPP) Intervention in increasing task mastery for individuals with cognitive challenges post-brain injury. This study is part of a systematic replication series and employed a multiple baseline design with intersubject replication across four participants with brain injury in a local inpatient rehabilitation context. Occupational therapists conducted nine PRPP Intervention sessions over three weeks during everyday tasks and collected data using the PRPP Assessment during baseline, intervention, post-intervention, and follow-up phases. Results were analyzed using systematic visual inspection, Tau-U, and descriptive methods. Different analytical methods yielded divergent results, with limited evidence of an immediate change. However, all four participants demonstrated improved task mastery after the intervention was completed, three with clinically significant improvements. The PRPP Intervention provides occupational therapists with a standardized and occupation-based approach to cognitive rehabilitation for individuals following brain injury. This study contributes to the existing knowledge base on the PRPP Intervention.Trial registration: NCT05148247.

There is considerable variability in return-to-work (RTW) outcomes for individuals with major traumatic injuries, including traumatic brain injury (TBI), spinal cord injury (SCI) and multi-trauma orthopaedic (MTO) injury. This study aimed to understand how injury-related, demographic and psychosocial factors and access to vocational rehabilitation interact to determine likelihood and time to RTW at one and two years post-injury. Participants were 170 adults employed pre-injury, enrolled in a trial of early vocational rehabilitation and followed up one- and/or two years post-injury. Of the 143 and 128 participants followed up, 53.8% and 59.4% were employed at one and two years post-injury. Employment was lowest for those with SCI. Factors associated with being employed at one and/or two years post-injury included being female, having more education, higher work skill level, no pre-injury psychological issues, and lower post-injury anxiety, depression, fatigue and pain. Mean time to RTW was 189 days for the one-year cohort and 247 days for the two-year cohort. Participants with less education and lower pre-injury work skills took longer to RTW. This study highlights the impact of demographic, pre-injury psychiatric issues, pre-injury employment and post-injury sequelae on return to employment after traumatic injury in addition to early vocational rehabilitation.Trial registration:Australian New Zealand Clinical Trials Registry identifier: ACTRN12619000521123.

In this qualitative study, we explored the views of stroke survivors and informal caregivers regarding three types of mental practice for upper limb recovery: (1) action observation (AO); (2) motor imagery (MI); and (3) combined action observation and motor imagery (AO + MI). Semi-structured interviews and focus groups were conducted between December 2021 and October 2022 with 23 participants (13 caregivers and 10 stroke survivors).Thematic analysis generated three higher-order themes: (1) Mental practice: understanding and recent experience. Although comprehension of AO, MI, and AO + MI varied, participants could provide clear, jargon-free explanations of these methods. (2) Feasibility of home-based training. Caregivers often felt overburdened, confused, and unsupported in home-based care but considered mental practice education useful for rehabilitation. (3) User perspectives on a digital prototype (Webapp). Participants viewed the WebApp interface as overly text-heavy and recommended a more visually engaging design. This study provides new insights into stroke survivors' and caregivers' understanding and perceptions of mental practice and highlights the potential of co-designed digital resources to enhance engagement and support home-based rehabilitation. These findings will inform the iterative refinement of mental practice materials for future feasibility and acceptability testing in chronic stroke survivors.

Depression affects approximately 30% of stroke survivors. Behavioural activation (BA) is a depression intervention based on completing positively reinforcing activities. However, post-stroke cognitive changes, like episodic memory difficulties, could affect encoding, storing, and recollecting reinforcing activities. Mental imagery has high acceptability in post-stroke motor recovery interventions, and in depression and anxiety interventions outside of stroke. We evaluated whether augmenting BA with mental imagery improves mood and activity outcomes in stroke compared to BA alone. Randomized participants received positive activity scheduling ("standard" BA) with (1) mental imagery simulating the planned activity, or (2) an imagery active control unrelated to the planned activity. Depressive symptoms and activity measures were completed weekly over 3 sessions and between-group differences evaluated via mixed-effects modelling. Exploratory models covaried for baseline verbal episodic memory and subjective memory. N = 45 participants [M age = 69.29, M years post-stroke = 3.00, 60% male] took part. BA with mental imagery led to significantly greater reduction in depressive symptoms compared to standard BA (t₍79₎= -2.72, p = .008; Cohen's d = 0.65). Subjective, but not objective, memory correlated with depression severity and activity engagement. There were no between-group differences in activity measures. Mental imagery may enhance mood outcomes in BA post-stroke, potentially supporting positive activity reflections irrespective of activity completion.

Purpose: This scoping review aimed to synthesize evidence on the psychometric properties of measurement instruments used to assess people with aphasia (PWA) after stroke. In constructing support for PWA, a comprehensive assessment is vital, yet evidence on measurement accuracy is limited.

Materials and methods: Six databases (PubMed, MEDLINE, EMBASE, PsycINFO, Web of Science, and Ichushi-Web) were searched for studies up to 2023. Four authors independently screened studies examining the psychometric properties of instruments for PWA. Data were classified according to the Research Outcome Measurement in Aphasia (ROMA) Core Outcome Set (COS), focusing on language, communication, emotional well-being, and quality of life (QOL), and on four key instruments: Western Aphasia Battery-Revised (WAB-R), Scenario Test, GHQ-12, and SAQOL-39. Psychometric properties were appraised using the COSMIN criteria.

Results: From 12,150 records, 34 studies covering 37 instruments were included; participants were mostly ≥60 years and >6 months post-stroke. Fewer tools assessed communication, well-being, and QOL than language. Responsiveness and measurement error were rarely evaluated; ROMA instruments WAB-R and GHQ-12 were absent. Sufficient properties supported 2 languages, 5 communication, 1 well-being, and 3 QOL instruments.

Conclusions: Major gaps persist-limited validation, scant responsiveness/measurement error evidence, and weak support even for COS instruments.

Interventions targeting social cognition following moderate-to-severe Traumatic Brain Injury (TBI) have shown some benefit, however, there remains a need to systematically review, statistically synthesize, and evaluate these interventions to inform the development of Clinical Practice Guidelines. Six databases were searched from inception to May 2024. Eligible studies targeted adults with a moderate-to-severe TBI (P); evaluated interventions targeting social cognition (I); compared to a control, baseline performance, or phase without treatment (C); based on objective social-cognitive ability/performance (O). Studies were screened by two independent reviewers. A random effects model estimated treatment effects for RCTs (Hedge's g) and observational (pre-post) studies (SMD) separately. Risk of bias was assessed. Certainty of evidence was evaluated using GRADE. Twenty-five studies were eligible, including 478 participants. RCTs targeting emotion perception and ToM produced a small effect (g = 0.38 (95%CI, 0.17, 0.59), p < .001). Observational studies targeting emotion perception and ToM produced a small-medium effect (SMD = 0.42 (95% CI 0.22, 0.61), p < .001). Interventions targeting empathy or alexithymia were limited. Our review provides initial evidence for the effectiveness of social-cognitive interventions targeting emotion perception and/or ToM. More research is needed to develop and evaluate interventions for other social-cognitive domains, including empathy and alexithymia.

Fifty percent of Acquired Brain Injury (ABI) survivors experience fatigue. Symptom management in post-acute rehabilitation, where rehabilitation adherence is essential, is lacking. Research suggests that music listening interventions could help by addressing related symptoms including pain, mood and arousal. Our objective was to explore how music listening has been used for post-ABI fatigue and whether findings, together with interview data from a post-acute ward, could inform on its use for this purpose. Synthesized data included: intervention characteristics, study design and outcomes. Joanna Briggs Institute guidelines and PRISMA checklist were applied. Nine-hundred and eighty-seven abstracts and 29 full texts were screened, with thirteen papers on nine studies included. Fatigue was reported only as a secondary outcome and not defined by type. Associated outcomes included: increased self-reported stamina, vitality, arousal, sleep and relaxation, better mood and pain management, verbal memory and attention. Interview data (patients: n = 6; staff: n = 4; caregivers: n = 2) suggest the need for time allocation for music listening, help with equipment setup, and trialling to determine duration and frequency. Future studies should screen for fatigue type and symptoms and establish with participants whether music interventions might be beneficial for energizing or relaxing, and if complimentary to cited strategies including exercise or meditation.

Experiences of loss and change following acquired brain injury (ABI) are frequent and multi-contextual, yet the long-term experiences of people with ABI are not well understood. This study explored the experiences of intrapersonal loss, grief and change in people with ABI, a decade after their injury. Twelve adults with ABI were interviewed 10-13 years post-injury. Using interpretative phenomenological analysis, we identified four overarching themes: a dawning realization of the impact of injury; loss of personhood; loss and liminality; and learning to live with loss and grief. Our findings indicate that in the decade following ABI, people continue to develop awareness of the impact of their injury and experience oscillating acceptance towards enforced changes. Participants reported a diminished sense of agency and autonomy in how they were perceived by and interacted with following injury. Additionally, identity may be lost, suspended, and renegotiated. Findings suggest dynamic, active, and flexible coping strategies that continue to be present over the long term. Considering the persistent nature of the injury and the evolving needs of the individual, a longer term view of rehabilitation outcomes may be required, contextualised by relational and intrapersonal challenges that may present over the longer term.

Stigma represents a major obstacle in rehabilitation and community reintegration after brain injury. However, appropriate tools to measure stigma in Spanish-speaking countries are lacking. This study examined the psychometric properties of the Spanish version of the Anticipated Stigma and Concealment Questionnaire (ASCQ). An observational cross-sectional study was conducted with 103 participants who completed the ASCQ and other measures. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed to assess the scale's structure. Associations between the ASCQ and other mental health measures were explored to establish its nomological validity. All ASCQ items loaded significantly onto a single factor, with factor loadings ranging from .7 to .84. While χ² (35) = 56.282, p < .05, some fit indices indicated excellent model fit (CFI = .997 and TLI = .996), while others suggested a good fit (RMSEA = .077, 90% CI [.036, .113], and SRMR = .060). Significant associations were found between the ASCQ and measures of loneliness, depressive symptoms, quality of life, and self-esteem. The ASCQ is a valid and reliable tool for assessing anticipated stigma and the motivation to conceal information after acquired brain injury. It can aid rehabilitation professionals in identifying individuals with interpersonal difficulties during community reintegration.

Mental health difficulties are common post-stroke and developing support for psychological adjustment is a research priority. Wellbeing After Stroke (WAterS) is a nine-week, online, group-based Acceptance and Commitment Therapy (ACT)-informed intervention, delivered by trained third-sector practitioners, supervised by a clinical neuropsychologist. This study aimed to explore the acceptability of WAterS from the stroke survivors' perspective.Semi-structured interviews were conducted with twelve stroke survivors who received WAterS. The interview schedule was informed by theorised components of acceptability, including understanding, burden and perception of effectiveness. The data were analysed inductively and deductively using Template Analysis.Six qualitative themes were generated. Results indicate the intervention was mostly understandable and participants were able to engage with ACT and apply it to life. Online delivery reduced burden in accessing the intervention, and was acceptable when supported by live facilitation and a physical handbook. Group cohesion and understanding was facilitated by practitioners. The social aspect of the group was beneficial. Attending WAterS supported some participants to seek further support; others were left feeling unsupported when the intervention ended.Stroke survivors valued attending an online, group ACT-informed intervention, delivered by practitioners. This is a promising avenue in increasing the reach of interventions to support wellbeing.