NeuroRehabilitation - Volume 49, issue 2

Authors: Mills, Ana | Dukarm, Paul | Klyce, Daniel

Article Type: Editorial

DOI: 10.3233/NRE-218018

Citation: NeuroRehabilitation, vol. 49, no. 2, pp. 165-167, 2021

Authors: Kanser, Robert J. | O’Rourke, Justin J.F. | Silva, Marc A.

Article Type: Research Article

Abstract: BACKGROUND: The COVID-19 pandemic has led to increased utilization of teleneuropsychology (TeleNP) services. Unfortunately, investigations of performance validity tests (PVT) delivered via TeleNP are sparse. OBJECTIVE: The purpose of this study was to examine the specificity of the Reliable Digit Span (RDS) and 21-item test administered via telephone. METHOD: Participants were 51 veterans with moderate-to-severe traumatic brain injury (TBI). All participants completed the RDS and 21-item test in the context of a larger TeleNP battery. Specificity rates were examined across multiple cutoffs for both PVTs. RESULTS: Consistent with research employing traditional face-to-face neuropsychological evaluations, …both PVTs maintained adequate specificity (i.e., > 90%) across previously established cutoffs. Specifically, defining performance invalidity as RDS < 7 or 21-item test forced choice total correct < 11 led to < 10%false positive classification errors. CONCLUSIONS: Findings add to the limited body of research examining and provide preliminary support for the use of the RDS and 21-item test in TeleNP via telephone. Both measures maintained adequate specificity in veterans with moderate-to-severe TBI. Future investigations including clinical or experimental “feigners” in a counter-balanced cross-over design (i.e., face-to-face vs. TeleNP) are recommended. Show more

Keywords: Brain injuries, traumatic, neuropsychological tests, performance validity, telemedicine, TBI

DOI: 10.3233/NRE-218019

Citation: NeuroRehabilitation, vol. 49, no. 2, pp. 169-177, 2021

Authors: Erdodi, Laszlo A.

Article Type: Research Article

Abstract: OBJECTIVE: This study was designed to empirically investigate the signal detection profile of various multivariate models of performance validity tests (MV-PVTs) and explore several contested assumptions underlying validity assessment in general and MV-PVTs specifically. METHOD: Archival data were collected from 167 patients (52.4%male; M Age  = 39.7) clinicially evaluated subsequent to a TBI. Performance validity was psychometrically defined using two free-standing PVTs and five composite measures, each based on five embedded PVTs. RESULTS: MV-PVTs had superior classification accuracy compared to univariate cutoffs. The similarity between predictor and criterion PVTs influenced signal detection profiles. False positive rates (FPR) …in MV-PVTs can be effectively controlled using more stringent multivariate cutoffs. In addition to Pass and Fail , Borderline is a legitimate third outcome of performance validity assessment. Failing memory-based PVTs was associated with elevated self-reported psychiatric symptoms. CONCLUSIONS: Concerns about elevated FPR in MV-PVTs are unsubstantiated. In fact, MV-PVTs are psychometrically superior to individual components. Instrumentation artifacts are endemic to PVTs, and represent both a threat and an opportunity during the interpretation of a given neurocognitive profile. There is no such thing as too much information in performance validity assessment. Psychometric issues should be evaluated based on empirical, not theoretical models. As the number/severity of embedded PVT failures accumulates, assessors must consider the possibility of non-credible presentation and its clinical implications to neurorehabilitation. Show more

Keywords: Performance validity, embedded validity indicators, multivariate models, Erdodi Index

DOI: 10.3233/NRE-218020

Citation: NeuroRehabilitation, vol. 49, no. 2, pp. 179-213, 2021

Authors: Costa, Silvana L. | Schwizer Ashkenazi, Simone | Strober, Lauren B. | Chiaravalloti, Nancy D. | Vakil, Eli

Article Type: Research Article

Abstract: BACKGROUND: Information processing speed is often impaired in neurological disorders, as well as with healthy aging. Thus, being able to accurately assess information processing speed is of high importance. One of the most commonly used tests to examine information processing speed is the Symbol Digit Modalities Test (SDMT), which has been shown to have good psychometric properties. OBJECTIVES: The current study aims to examine differences between two response modalities, written and oral, on the performance of an adapted version of the Symbol Digit Modalities Test. METHODS: Ninety-nine individuals completed two alternate forms of the adapted version …of the SDMT (aSDMT). Participants were instructed to complete the five lines of the task as quickly and accurately as possible. On one form participants were instructed to provide their response in writing and on the other one, orally. Form and response modality (oral vs. written) were counterbalanced to control for practice effects. RESULTS: On average, there was a significant difference between response modalities, such that participants needed more time to respond when the response modality was written. For both response modalities, time to complete each line of stimuli decreased as the task progressed. While changes in response time on the first four lines of stimuli on the oral version were not found, there was a substantial improvement in response time on the fifth line. In contrast, on the written version a gradual learning effect was observed, in which response time was the slowest on the first two lines, an intermediate response time was noted on line 3, and the fastest response time was achieved on lines four and five. CONCLUSION: The current study demonstrates that response modality, oral versus written, can significantly impact performance efficiency (the length of time it takes to complete a task), but not accuracy (total correct responses), on a new adaptation of the SDMT, the aSDMT. Show more

Keywords: Adapted symbol digit modalities test, oral versus written version

DOI: 10.3233/NRE-218021

Citation: NeuroRehabilitation, vol. 49, no. 2, pp. 215-220, 2021

Authors: Venkatesan, Umesh M. | Rabinowitz, Amanda R. | Wolfert, Stephanie P. | Hillary, Frank G.

Article Type: Research Article

Abstract: BACKGROUND: Disrupted memory circuitry may contribute to post-traumatic amnesia (PTA) after traumatic brain injury (TBI). It is unclear whether duration of PTA (doPTA) uniquely impacts memory functioning in the chronic post-injury stage. OBJECTIVE: To examine the relationship between doPTA and memory functioning, independent of other cognitive abilities, in chronic moderate-to-severe TBI. METHODS: Participants were 82 individuals (median chronicity = 10.5 years) with available doPTA estimates and neuropsychological data. Composite memory, processing speed (PS), and executive functioning (EF) performance scores, as well as data on subjective memory (SM) beliefs, were extracted. DoPTA-memory associations were evaluated via linear modeling of …doPTA with memory performance and clinical memory status (impaired/unimpaired), controlling for PS, EF, and demographic covariates. Interrelationships between doPTA, objective memory functioning, and SM were assessed. RESULTS: DoPTA was significantly related to memory performance, even after covariate adjustment. Impairment in memory, but not PS or EF, was associated with a history of longer doPTA. SM was associated with memory performance, but unrelated to doPTA. CONCLUSIONS: Findings suggest a specific association between doPTA—an acute injury phenomenon—and chronic memory deficits after TBI. Prospective studies are needed to understand how underlying mechanisms of PTA shape distinct outcome trajectories, particularly functional abilities related to memory processing. Show more

Keywords: Traumatic brain injury, chronic TBI, post-traumatic amnesia, memory, subjective memory, cognition, neuropsychology, rehabilitation

DOI: 10.3233/NRE-218022

Citation: NeuroRehabilitation, vol. 49, no. 2, pp. 221-233, 2021

Authors: Bigler, Erin D. | Allder, Steven

Article Type: Research Article

Abstract: BACKGROUND: Quantitative neuroimaging analyses have the potential to provide additional information about the neuropathology of traumatic brain injury (TBI) that more thoroughly informs the neurorehabilitation clinician. OBJECTIVE: Quantitative neuroimaging is typically not covered in the standard radiological report, but often can be extracted via post-processing of clinical neuroimaging studies, provided that the proper volume acquisition sequences were originally obtained. METHODS: Research and commercially available quantitative neuroimaging methods provide region of interest (ROI) quantification metrics, lesion burden volumetrics and cortical thickness measures, degree of focal encephalomalacia, white matter (WM) abnormalities and residual hemorrhagic pathology. If present, diffusion …tensor imaging (DTI) provides a variety of techniques that aid in evaluating WM integrity. Using quantitatively identified structural and ROI neuropathological changes are most informative when done from a neural network approach. RESULTS: Viewing quantitatively identifiable damage from a neural network perspective provides the neurorehabilitation clinician with an additional tool for linking brain pathology to understand symptoms, problems and deficits as well as aid neuropsychological test interpretation. All of these analyses can be displayed in graphic form, including3-D image analysis. A case study approach is used to demonstrate the utility of quantitative neuroimaging and network analyses in TBI. CONCLUSIONS: Quantitative neuroimaging may provide additional useful information for the neurorehabilitation clinician. Show more

Keywords: Traumatic brain injury (TBI), white matter (WM), gray matter (GM), volumetrics, ‘cone of vulnerability’, neural networks, computed tomography (CT), magnetic resonance imaging (MRI)

DOI: 10.3233/NRE-218023

Citation: NeuroRehabilitation, vol. 49, no. 2, pp. 235-253, 2021

Authors: Prigatano, George P. | Braga, Lucia W. | Johnson, Spring Flores | Souza, Lígia M.N.

Article Type: Research Article

Abstract: Initial brain imaging studies on recovery of motor functioning after stroke suggested their potential prognostic value in neurorehabilitation. However, the value of brain imaging in documenting brain changes associated with cognitive and behavioral treatment effects seem less likely. Also, neuroimaging studies at that time seem to have little, if any, value for treatment planning. Advances in neuroimaging technology are beginning to challenge these initial impressions. In this clinical commentary, we propose that advances in the field of neuroimaging have relevance for the future development of neuropsychological rehabilitation. Neuropsychological rehabilitation is entering a new era that involves collaboration with neuroimaging and …associated studies on neuroplasticity. We recognize that this may seem “aspirational” rather than practical in most rehabilitation settings. However, we provide examples of how this can be achieved as illustrated by collaborative efforts of clinicians and scientists in the SARAH Network of Rehabilitation Hospitals in Brazil. We also review selective papers on neuroplasticity, spontaneous recovery and diaschisis that have relevance for research which will expand and further develop the field of neuropsychological rehabilitation. Show more

Keywords: Neuropsychological rehabilitation, neuroplasticity, diaschisis, neuroimaging

DOI: 10.3233/NRE-218024

Citation: NeuroRehabilitation, vol. 49, no. 2, pp. 255-265, 2021

Authors: Voelbel, Gerald T. | Lindsey, Hannah M. | Mercuri, Giulia | Bushnik, Tamara | Rath, Joseph

Article Type: Research Article

Abstract: BACKGROUND: Adults with chronic traumatic brain injury (TBI) may experience long-term deficits in multiple cognitive domains. Higher-order functions, such as verbal memory, are impacted by deficits in the ability to acquire verbal information. OBJECTIVE: This study investigated the effects of a neuroplasticity-based computerized cognitive remediation program for auditory information processing in adults with a chronic TBI. METHODS: Forty-eight adults with TBI were randomly assigned to an intervention or control group. Both groups underwent a neuropsychological assessment at baseline and post-training. The Intervention group received 40 one-hour cognitive training sessions with the Brain Fitness Program. …RESULTS: The intervention group improved in performance on measures of the Woodcock-Johnson-III Understanding Directions subtest and Trail Making Test Part-A. They also reported improvement on the cognitive domain of the Cognitive Self-Report Questionnaire. CONCLUSIONS: The present study demonstrated that a neuroplasticity-based computerized cognitive remediation program may improve objective and subjective cognitive function in adults with TBI several years post-injury. Show more

Keywords: Traumatic brain injury, cognitive rehabilitation, neuropsychological assessment, neuroplasticity, attention, working memory

DOI: 10.3233/NRE-218025

Citation: NeuroRehabilitation, vol. 49, no. 2, pp. 267-278, 2021

Authors: Perna, Robert | Pundlik, Jyoti | Arenivas, Ana

Article Type: Research Article

Abstract: BACKGROUND: Return to driving after an acquired brain injury (ABI) has been positively associated with return to employment, maintenance of social relationships, and engagement in recreational and other community activities. Safe driving involves multiple cognitive abilities in a dynamic environment, and cognitive dysfunction resulting from ABI can negatively impact driving performance. OBJECTIVE: This manuscript examines the post-injury return-to-driving process, including performances on the in-office and on-road assessments, and the role of a rehabilitation neuropsychologist in helping patients resume driving. METHOD: In this study, 39 of 200 individuals (approximately 20%) treated at an outpatient neurorehabilitation facility, who …performed satisfactorily on a pre-driving cognitive screening, completed a behind-the-wheel driving test. RESULTS: Of the 200 individuals, 34 (87%) passed the road test. Among the remaining five individuals who did not pass the road test, primary reasons for their failure included inability to follow or retain examiner directions primarily about lane position, speed, and vehicle control. The errors were attributable to cognitive difficulties with information processing, memory, attention regulation, and dual tasking. CONCLUSION The rehabilitation neuropsychologist contributed to the process by assessing cognition, facilitating self-awareness and error minimization, providing education about driving regulations and safety standards, and preparing for the road test and its outcomes. Show more

DOI: 10.3233/NRE-218026

Citation: NeuroRehabilitation, vol. 49, no. 2, pp. 279-292, 2021

Authors: Waldron-Perrine, Brigid | Rai, Jaspreet K. | Chao, Dominique

Article Type: Research Article

Abstract: BACKGROUND: Therapeutic assessment involves the integration of evidence-based approaches and humanistic principles, and there is empirical support for the use of this approach in the context of neuropsychological assessment broadly. OBJECTIVE: We propose that therapeutic assessment (TA) and collaborative therapeutic neuropsychological assessment (CTNA) principles are appropriate and effective for application within a neurological rehabilitation population specifically. METHODS: We review TA and CTNA principles and propose a model for their application to a neurological rehabilitation population, with an emphasis on describing the strengths of the collaborative approach, guidelines and principles for maximizing the efficacy of feedback, and …transitioning the patient into psychotherapy services to further address their personal goals. A case example of a neurologically injured individual engaged in CTNA and subsequent intervention is shared to highlight the principles discussed. RESULTS AND CONCLUSION: The proposed model and case study demonstrate the clinical utility of TA and CTNA principles with a neurological rehabilitation population. Show more

Keywords: Therapeutic assessment, feedback, collaborative care, patient-centered practice

DOI: 10.3233/NRE-218027

Citation: NeuroRehabilitation, vol. 49, no. 2, pp. 293-306, 2021

Authors: Pedrotty, Mark | Wong, Tiffanie S. | Wilde, Elisabeth A. | Bigler, Erin D. | Laatsch, Linda K.

Article Type: Research Article

Abstract: BACKGROUND: An early approach to cognitive rehabilitation therapy (CRT) was developed based on A. R. Luria’s theory of brain function. Expanding upon this approach, the Integrative Cognitive Rehabilitation Psychotherapy model (ICRP) was advanced. OBJECTIVE: To describe the ICRP approach to treatment of clients post brain injury and provide a comprehensive list of evaluation tools to determine the client’s abilities and needs. Finally, to provide a link between CRT and functional imaging studies designed to improve rehabilitation efforts. METHODS: History of cognitive rehabilitation and neuropsychological testing is reviewed and description of cognitive, academic, psychiatric, and substance abuse …tools are provided. Cognitive and emotional treatment techniques are fully described. Additionally, a method of determining the client’s stage of recovery and pertinent functional imaging studies is detailed. RESULTS: Authors have been able to provide a set of tools and techniques to use in comprehensive treatment of clients with brain injury. CONCLUSIONS: Inclusive treatment which is outlined in the ICRP model is optimal for the client’s recovery and return to a full and satisfying life post brain injury. The model provides a framework for neuropsychologists to integrate issues that tend to co-occur in clients living with brain injury into a unified treatment plan. Show more

Keywords: Brain injury, cognitive rehabilitation, neuropsychological assessment, integrative cognitive rehabilitation, psychotherapy, substance use, imaging

DOI: 10.3233/NRE-218028

Citation: NeuroRehabilitation, vol. 49, no. 2, pp. 307-327, 2021

Authors: Sen, Ekin Ilke

Article Type: Other

Abstract: BACKGROUND: Motor imagery (MI) is a promising therapeutic technique for stroke rehabilitation. OBJECTIVE: To assess the effects of MI on gait rehabilitation after stroke. METHODS: To summarize the “Cochrane Review” by Silva et al. RESULTS: Twenty-one studies with 762 participants were included in the Cochrane review. Very low level of certainty evidence pointed to some beneficial effects of MI alone or combined with action observation or physical practice on walking speed compared to other therapies. There is uncertainty about the effect of MI compared to other therapies in terms of motor function or functional …mobility. CONCLUSIONS: High-quality adequately powered studies investigating the effects of MI in individuals with stroke should be encouraged. Show more

Keywords: Motor imagery, rehabilitation, stroke, gait

DOI: 10.3233/NRE-218004

Citation: NeuroRehabilitation, vol. 49, no. 2, pp. 329-331, 2021