NeuroRehabilitation - Volume 34, issue 1

Authors: Parente, Rick

Article Type: Editorial

DOI: 10.3233/NRE-131004

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 1-2, 2014

Authors: Malia, Kit

Article Type: Research Article

Abstract: This opinion paper provides a summary of some aspects of rehabilitation which seem to empower change and progress in people following brain injury according to the authors experience. It frames this within 3 factors: 1) What you do, 2) Who the brain injury survivor is, and 3) Who you are.

Keywords: Cognitive rehabilition, brain injury, insight, self concept

DOI: 10.3233/NRE-131018

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 3-13, 2014

Authors: van Schouwen-van Kranen, E.T.

Article Type: Research Article

Abstract: Background: Many who provide cognitive rehabilitation therapy (CRT) are unaware of the theoretical rationale that underlies their decisions concerning therapeutic intervention. Can the survivor form goals for treatment? When should treatment end? When should the therapist retrain skills, provide remedial cognitive treatments, or simply adapt surroundings because a survivor is too handicapped to be treated at all? Objective: This paper combines theory with the author's experience to provide therapists with a structure for clinical reasoning in their daily practice. Method: The discussion begins with a description of different models of recovery after brain injury. It goes …on to discuss similarities, commonalities, and general principles that can be derived from all of them. It ends with suggestions for treatment that serve as useful guidelines for therapists in their practices. Conclusion: Combining the clinician's clinical intuition with knowledge of the theory of CRT can greatly improve the quality of treatment the therapist provides. Show more

DOI: 10.3233/NRE-131014

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 15-21, 2014

Authors: Shaw, Dorothy R.

Article Type: Research Article

Abstract: Background: Many studies have investigated the impact of pediatric Cognitive Rehabilitation Therapy (CRT) upon intellectual functioning after traumatic brain injury; however, relatively few have identified efficacious treatment in a school setting. Objective: The purpose is to present a variety of CRT strategies that would be useful to a teacher or therapist working with students who are learning disabled or who have who have had a traumatic brain injury (TBI). Methods: This article investigates the particular challenges in learning which result from impaired cognition, and suggests techniques for improving memory and executive functioning. Results: Students …who are learning disabled or who have TBI face social and emotional issues that impact their learning. Special therapeutic interventions are necessary to assist with orienting to their setting, integrating with peers, and coping with distressing emotions. Conclusions: Students with TBI can adapt and flourish in a school based setting provided that therapies and learned strategies are targeted to their specific needs. Show more

Keywords: Emotion recognition, brain injury, nonverbal communication, cognitive rehabilitation

DOI: 10.3233/NRE-131005

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 23-28, 2014

Authors: Wheeler, Lisa | Nickerson, Sherry | Long, Kayla | Silver, Rebecca

Article Type: Research Article

Abstract: Background: There is a dearth of systematic studies of expressive writing disorder (EWD) in persons with Traumatic Brain Injury (TBI). It is unclear if TBI survivors' written expression differs significantly from that experienced by persons with learning disabilities. It is also unclear which cognitive or neuropsychological variables predict problems with expressive writing (EW) or the EWD. Objective: This study investigated the EW skill, and the EWD in adults with mild traumatic brain injuries (TBI) relative to those with learning disabilities (LD). It also determined which of several cognitive variables predicted EW and EWD. Methods: Principle Component …Analysis (PCA) of writing samples from 28 LD participants and 28 TBI survivors revealed four components of expressive writing skills: Reading Ease, Sentence Fluency, Grammar and Spelling, and Paragraph Fluency. Results: There were no significant differences between the LD and TBI groups on any of the expressive writing components. Several neuropsychological variables predicted skills of written expression. The best predictors included measures of spatial perception, verbal IQ, working memory, and visual memory. Conclusions: TBI survivors and persons with LD do not differ markedly in terms of expressive writing skill. Measures of spatial perception, visual memory, verbal intelligence, and working memory predict writing skill in both groups. Several therapeutic interventions are suggested that are specifically designed to improve deficits in expressive writing skills in individuals with TBI and LD. Show more

Keywords: Writing disorder, expressive writing skill, TBI, cognition

DOI: 10.3233/NRE-131007

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 29-37, 2014

Authors: Bird, Julie | Parente, Rick

Article Type: Research Article

Abstract: Background: Individuals who have had a traumatic brain injury (TBI) often have difficulty processing nonverbal communication (Ekman, 1976) The published research in this area has focused on a TBI patient's ability to recognize facial expression, vocal intonation, and postural expression (Croker, 2005; Hopkins, Dywan & Segalowitz, 2002). Objective: This study compared the non-verbal processing skills of brain-injured patients versus non-injured controls in all three domains. Methods: The stimuli were photographs of facial and postural expressions and audio recordings of intonational expressions. Results: The results indicated that persons with TBI have particular difficulty recognizing non-verbal …communication resulting from vocal intonations. Conclusions: The TBI patients had difficulty processing tonality, therefore, it is reasonable to suggest that clinicians, friends, and family members should emphasize the explicit verbal content of spoken language when speaking to a person with TBI. Show more

Keywords: Emotion recognition, brain injury, nonverbal communication, cognitive rehabilitation

DOI: 10.3233/NRE-131006

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 39-43, 2014

Authors: Long, Kayla | Rager, Bob | Adams, Greg

Article Type: Research Article

Abstract: Background: Anosognosia is commonly reported after acquired brain injury (ABI) or stroke and often hinders an ABI survivor's ability to perceive the social consequences of their behavior and to modify it. Objective: This study concerned the question of whether awareness discrepancy scores could predict cognitive performance with a focus on the acquired brain injured (ABI) population. It was hypothesized that lack of awareness would predict performance on cognitive tasks. Method: Archival data was assessed for a total of 21 patients; 10 learning disabled (LD) and 11 with a brain injury with each person having one “observer”. …Data consisted of patient and observer ratings on the Acquired Deficit Awareness Management System (ADAMS) profile, a 36-item survey that measured both patient self-report and observer assessment of awareness. These data yielded two discrepancy scores: deficit with awareness (DWA) and deficit without awareness (DWoA). The discrepancy scores were used to predict IQ scores from the Wechsler Adult Intelligence Scale, academic performance on the Woodcock-Johnson Psychoeducational Battery, memory functioning on the Wechsler Memory Scale, and a measure of fine motor skill. Results: The DWoA measure correlated significantly with several cognitive variables and with finger tapping speed on the non-dominant hand. These correlations were not apparent in the LD group. Conclusions: Measures of lack of awareness predicted cognitive performance in the ABI population. Therapeutic interventions are discussed that address lack of awareness after ABI. Show more

Keywords: Deficit awareness, cognitive performance, acquired brain injury

DOI: 10.3233/NRE-131009

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 45-53, 2014

Authors: Kegel, Jessica | Dux, Moira | Macko, Richard

Article Type: Research Article

Abstract: Background: Stroke is a leading cause of disability and sequelae may include physical, emotional, and cognitive impairments. The methods employed to cope with distress, both emotional and cognitive, have not been evaluated in individuals post-stroke. However, research in traumatic brain injury (TBI) suggests that executive function is positively correlated with adaptive coping and negatively correlated with maladaptive coping strategies (Krpan et al., 2007). Examination of these constructs post-stroke may assist with enriching our understanding of cognitive and emotional symptomatology and optimize rehabilitation strategies. Objective: The present study aimed to assess the association between executive function and coping strategies …in a sample of chronic stroke survivors. The researchers hypothesized that executive function would be positively correlated with adaptive coping strategies and negatively correlated with maladaptive coping strategies. Methods: Fifteen stroke survivors were administered a battery of cognitive tests assessing executive function and also completed the Ways of Coping Questionnaire (WAYS), a self-report coping measure. Results: Analyses indicated that executive function deficits were related to increased avoidant coping. Contrary to expectations, executive function was not significantly related to active coping. In addition, post hoc analyses revealed that executive function was a significant predictor of avoidant coping after controlling for demographics. Conclusions: Our data, in accordance with prior work in TBI, suggests that executive function and aspects of coping are associated. Rehabilitation strategies that improve executive function may also lead to utilization of adaptive coping strategies. Research has shown that aerobic exercise increases activation in the frontal lobe and improves executive function (Colcombe & Kramer, 2003; Colcombe et al., 2004). Future studies should examine whether aerobic exercise positively affects executive function and coping in stroke survivors. Show more

Keywords: Stroke, executive function, coping

DOI: 10.3233/NRE-131010

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 55-63, 2014

Authors: Pierini, Davide | Hoerold, Doreen

Article Type: Research Article

Abstract: Background: Individuals with Acquired Brain Injury (ABI) could benefit from further cognitive rehabilitation, after they have returned home. However, a lack of specialist services to provide such rehabilitation often prevents this. This leads to reduced reintegration of patients, increased social disadvantages and ultimately, higher economic costs. Method: 10 months post-stroke, a 69 year-old woman was discharged from an inpatient rehabilitation program and returned home with severe cognitive impairments. We describe a pilot project which provided an individualised, low cost rehabilitation program, supervised and trained by a neuropsychologist. Progress was monitored every 3 months in order to decide on …continuation of the program, based on the achieved results and predicted costs. Results: Post intervention, despite severe initial impairment, cognitive and most notably daily functioning had improved. Although the financial investment was moderately high for the family, the intervention was still considered cost-effective when compared with the required costs of care in a local non-specialist care home. Moreover, the pilot experience was used to build a “local expert team” available for other individuals requiring rehabilitation. Conclusions: These results encourage the development of similar local “low cost” teams in the community, to provide scientifically-grounded cognitive rehabilitation for ABI patients returning home. Show more

Keywords: Acquired brain injury, cognitive rehabilitation, home-based rehabilitation, rehabilitation team, post-acute rehabilitation, post-acute recovery

DOI: 10.3233/NRE-131023

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 65-80, 2014

Authors: Nordvik, Jan E. | Walle, Kjersti Mæhlum | Nyberg, Claudia K. | Fjell, Anders M. | Walhovd, Kristine B. | Westlye, Lars T. | Tornas, Sveinung

Article Type: Research Article

Abstract: Background: Magnetic resonance imaging (MRI) has brought about advances in the fields of brain plasticity and lifespan brain change, that might be of special interest for cognitive rehabilitation research and, eventually, in clinical practice. Parallel, intensive cognitive training studies show promising results for the prospect of retraining some of the impaired functioning following acquired brain injury. Objectives: However, cognitive training research is largely performed without concurrent assessments of brain structural change and reorganization, which could have addressed possible mechanisms of training-related neuroplasticity. Methods: Criticism of cognitive training studies is often focused on lack of ecologically valid, …daily-living assessments of treatment effect, and on whether the applied cognitive measures overlap too much with the training exercises. Yet, the present paper takes another point of view, where the relevance of recent MRI research of brain plasticity to the field of cognitive rehabilitation is examined. Results: Arguably, treatment ought to be measured at the same level of the International Classification of Functioning, Disability and Health model, as it is targeting. In the case of cognitive training that will be the “body structure” and “body function” levels. Conclusions: MRI has shown promise to detect macro- and microstructural activity-related changes in the brain following intensive training. Show more

Keywords: Cognitive training, cognitive rehabilitation, brain plasticity, magnetic resonance imaging, diffusion tensor imaging, brain morphometry

DOI: 10.3233/NRE-131017

Citation: NeuroRehabilitation, vol. 34, no. 1, pp. 81-85, 2014