Towards validation of a new computerised test of goal neglect: preliminary evidence from clinical and neuroimaging pilot studies

Objective: Goal neglect is a significant problem following brain injury, and is a target for rehabilitation. It is not yet known how neural activation might change to reflect rehabilitation gains. We developed a computerised multiple elements test (CMET), suitable for use in neuroimaging paradigms. Design: Pilot correlational study and event-related fMRI study. Methods: In Study 1, 18 adults with acquired brain injury were assessed using the CMET, other tests of goal neglect (Hotel Test; Modified Six Elements Test) and tests of reasoning. In Study 2, 12 healthy adults underwent fMRI, during which the CMET was administered under two conditions: self-generated switching and experimenter-prompted switching. Results: Among the clinical sample, CMET performance was positively correlated with both the Hotel Test (r = 0.675, p = 0.003) and the Modified Six Elements Test (r = 0.568, p = 0.014), but not with other clinical or demographic measures. In the healthy sample, fMRI demonstrated significant activation in rostro-lateral prefrontal cortex in the self-generated condition compared with the prompted condition (peak 40, 44, 4; ZE = 4.25, p(FWEcorr) = 0.026). Conclusions: These pilot studies provide preliminary evidence towards the validation of the CMET as a measure of goal neglect. Future studies will aim to further establish its psychometric properties, and determine optimum pre- and post-rehabilitation fMRI paradigms

Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014

Objective To conduct an updated, systematic review of the clinical literature, classify studies based on the strength of research design, and derive consensual, evidence-based clinical recommendations for cognitive rehabilitation of people with TBI or stroke. Data Sources Online Pubmed and print journal searches identified citations for 250 articles published from 2009 through 2014. Study Selection 186 articles were selected for inclusion after initial screening. 50 articles were initially excluded (24 healthy, pediatric or other neurologic diagnoses, 10 non-cognitive interventions, 13 descriptive protocols or studies, 3 non-treatment studies). 15 articles were excluded after complete review (1 other neurologic diagnosis, 2 non-treatment studies, 1 qualitative study, 4 descriptive papers, 7 secondary analyses). 121 studies were fully reviewed. Data Extraction Articles were reviewed by CRTF members according to specific criteria for study design and quality, and classified as providing Class I, Class II, or Class III evidence. Articles were assigned to 1 of 6 possible categories (based on interventions for attention, vision and neglect, language and communication skills, memory, executive function, or comprehensive-integrated interventions). Data Synthesis Of 121 studies, 41 were rated as Class I, 3 as Class Ia, 14 as Class II, and 63 as Class III. Recommendations were derived by CRTF consensus from the relative strengths of the evidence, based on the decision rules applied in prior reviews. Conclusions CRTF has now evaluated 491 papers (109 Class I or Ia, 68 Class II, and 314 Class III) and makes 29 recommendations for evidence-based practice of cognitive rehabilitation (9 Practice Standards, 9 Practice Guidelines and 11 Practice Options). Evidence supports Practice Standards for attention deficits after TBI or stroke; visual scanning for neglect after right hemisphere stroke; compensatory strategies for mild memory deficits; language deficits after left hemisphere stroke; social communication deficits after TBI; metacognitive strategy training for deficits in executive functioning; and comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability after TBI or stroke

Kitchen-related tasks used in occupational therapy during rehabilitation of adults with acquired brain injury : a systematic review

Introduction Kitchen-related tasks are widely used in occupational therapy for adults with acquired brain injury. This study aimed to investigate the effectiveness of kitchen-related, task-based occupational therapy interventions for improving clinical and functional outcomes in the rehabilitation of adults with acquired brain injury. Method A systematic review of the literature was conducted with narrative synthesis (PROSPERO registration CRD42019141898), by searching relevant electronic databases (BNI, CINAHL Plus, MEDLINE, DORIS, OT Seeker etc.), registries of ongoing studies (ISRCTN, PROSPERO, etc.), and grey literature (OpenGrey, etc.). English-language studies that evaluated kitchen-related tasks in the rehabilitation of adults with acquired brain injury were included and independently appraised for their methodological quality by two reviewers. Results Seventeen primary studies met the eligibility criteria. Studies were heterogeneous in methods, methodological quality, setting, sample size, purpose, and design of kitchen-related tasks. Fifteen studies evaluated kitchen-related, task-based treatments for improving function, and two studies examined kitchen-related task assessments for safety and task performance. This provides very limited evidence for the effectiveness of kitchen-related, task-based interventions compared to interventions not based on kitchen-related tasks. Conclusion While kitchen-related, task-based occupational therapy interventions in acquired brain injury rehabilitation are common practice, there is currently limited research evidence to support this. Further studies are warranted to strengthen the evidence base

Rehabilitation of executive function deficits following acquired brain injury: a randomised controlled trial using Goal Management Training and Implementation Intentions to improve prospective memory

Introduction: Deficits in executive function (e.g. planning, problem-solving, prospective memory) following brain injury are associated with significant negative social and occupational outcomes. Prospective memory (PM) is particularly susceptible to the effects of brain injury, as it relies on controlled attentional resources to establish and recall intentions. Implementation intentions (II) have been shown to improve performance on prospective memory tasks across a variety of durations, by circumventing controlled attention and establishing strong cue-action associations using imagery and declarative statements. Aims: To determine the efficacy of a theory-based training intervention for prospective memory deficits following acquired brain injury. Methods: A single-blind, randomised trial was used to assess the efficacy of implementation intentions as compared to a control intervention for individuals with acquired brain injury. A within-between repeated measures designs was used. Participants were assessed using an ecologically valid measure of executive function. Results: No significant differences in interaction effects were found according to treatment allocation. Use of baseline performance, estimated premorbid intelligence, depression, fluid intelligence and processing speed as covariates did not result in significant changes to the effectiveness of interventions. Discussion: The lack of treatment effect may be attributable to several factors, including the interaction of severity of impairments, length of training, and complexity of the outcome measure. The appropriateness of group designs when assessing neuropsychological rehabilitation is also discussed

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory

Introduction: Memory impairments affecting encoding, acquisition, and retrieval of information after moderate-to-severe traumatic brain injury (TBI) have debilitating and enduring functional consequences. The interventional research reviewed primarily focused on mild to severe memory impairments in episodic and prospective memory. As memory is a common focus of cognitive rehabilitation, clinicians should understand and use the latest evidence. Therefore, the INCOG (“International Cognitive”) 2014 clinical practice guidelines were updated. Methods: An expert panel of clinicians/researchers reviewed evidence published since 2014 and developed updated recommendations for intervention for memory impairments post-TBI, a decision-making algorithm, and an audit tool for review of clinical practice. Results: The interventional research approaches for episodic and prospective memory from 2014 are synthesized into 8 recommendations (6 updated and 2 new). Six recommendations are based on level A evidence and 2 on level B. In summary, they include the efficacy of choosing individual or multiple internal compensatory strategies, which can be delivered in a structured or individualized program. Of the external compensatory strategies, which should be the primary strategy for severe memory impairment, electronic reminder systems such as smartphone technology are preferred, with technological advances increasing their viability over traditional systems. Furthermore, microprompting personal digital assistant technology is recommended to cue completion of complex tasks. Memory strategies should be taught using instruction that considers the individual\u27s functional and contextual needs while constraining errors. Memory rehabilitation programs can be delivered in an individualized or mixed format using group instruction. Computer cognitive training should be conducted with therapist guidance. Limited evidence exists to suggest that acetylcholinesterase inhibitors improve memory, so trials should include measures to assess impact. The use of transcranial direct current stimulation (tDCS) is not recommended for memory rehabilitation. Conclusion: These recommendations for memory rehabilitation post-TBI reflect the current evidence and highlight the limitations of group instruction with heterogeneous populations of TBI. Further research is needed on the role of medications and tDCS to enhance memory

Investigating the Comprehensive Inventory of Thriving (CIT) as a rehabilitation outcome measure

Reliable and valid outcome measures are needed in community rehabilitation settings following acquired neurological injury. The Comprehensive Inventory of Thriving (CIT) (Su, Tay and Diener, 2013) was investigated for this purpose. The CIT is a 54 item self-report measure that provides 18 subscales and seven main scales of thriving: Relationships, Engagement, Mastery, Autonomy, Meaning, Optimism and Subjective Well-being. Participants (n=76) were administered the CIT on admission to a community rehabilitation service. The mean age of participants was 54.8 (SD = 17.7), with 43% being male. The main diagnostic groups were cerebrovascular disease (28%), traumatic brain injury (17%) and Parkinson's disease (12%). Internal consistency was moderate to high (α =.6 to .9) for all subscales with the exception of Support (Relationships) and Skills (Mastery); and high (α=.79-.93) for all indexes with the exception of Subjective Wellbeing. Correlational analyses supported the scale groupings. However, the subscales of Support (Relationships) and Skills (Mastery) did not correlate significantly with any subscales. Additionally the Subjective Well-being scale should not be calculated, but instead its three subscales (Negative Feelings, Life Satisfaction, Positive Feelings) used individually. In terms of demographic variables, there were no significant gender differences on CIT scales. Age had low correlations with two Relationships subscales only (Trust r=.23, p=.04; Loneliness r=-.25, p=.03). Diagnostic group minimally influenced CIT scores. Significant between-group differences were only found for Accomplishment (Mastery), with post-hoc analyses indicating higher levels for the cerebrovascular group. The CIT shows considerable promise in rehabilitation outcomes as a reliable and valid multi-component measure of wellbeing

The Occupational Therapy Guide for Enabling Meaningful Social Participation Post-TBI

Introduction: The purpose of this scholarly project was to create a guide for occupational therapists to enable meaningful social participation throughout the rehabilitation phases with adults who have sustained a moderate or severe traumatic brain injury (TBI). The Guide discusses and presents assessments and interventions recommended for each phase of the rehabilitation process

Immersive Virtual Reality Training Improved Upper Extremity Function in Patients with Spinal Cord Injuries: A Case Series

Virtual reality (VR) is an emerging treatment tool to engage people in environments that appear and feel similar to real-world objects and events.1 There are various levels of evidence that VR can potentially promote functional activity and neuroplasticity in patients with neurological disorders like spinal cord injury (SCI).2,3 In this case series, we explored the feasibility of using commercially available immersive VR technology as an augmented treatment in the SCI population and compare participant’s suitability for this intervention. Three male SCI participants were recruited in a subacute inpatient rehabilitation facility and participated in VR intervention twice a week in addition to their conventional therapies. Manual strength and functional testing were recorded biweekly until participants discharged. Training includes reaching activities, wrist rotation, gripping, and thumb movement to simulate real-life activities. A questionnaire regarding their experience with VR training was administered at the end. All participants had improvement in strength and functional tests. 9-hole peg test demonstrated clinically meaningful change in two of three participants. Manual muscle test changes were 2, 4.5 and 13.5 points individually. Participants with lower manual muscle test scores at baseline showed more potential to change compared to those who had high scores, which would possibly due to plateau effect. Pinch and grip strength demonstrated small changes which were not clinically important. Participants also rated VR technology of high reality level and great enjoyment in the questionnaire. This case series suggests that immersive VR with head mount display may be viable to provide safe and effective treatment for patients with SCI. VR training appears to be a possible adjunct to physical and occupational therapy as a method of muscle strengthening, improving upper extremity function and improving motivation during subacute rehabilitation