Do informal caregivers of people with dementia mirror the cognitive deficits of their demented patients?:A pilot study

Recent research suggests that informal caregivers of people with dementia (ICs) experience more cognitive deficits than noncaregivers. The reason for this is not yet clear. Objective: to test the hypothesis that ICs ‘mirror' the cognitive deficits of the demented people they care for. Participants and methods: 105 adult ICs were asked to complete three neuropsychological tests: letter fluency, category fluency, and the logical memory test from the WMS-III. The ICs were grouped according to the diagnosis of their demented patients. One-sample ttests were conducted to investigate if the standardized mean scores (t-scores) of the ICs were different from normative data. A Bonferroni correction was used to correct for multiple comparisons. Results: 82 ICs cared for people with Alzheimer's dementia and 23 ICs cared for people with vascular dementia. Mean letter fluency score of the ICs of people with Alzheimer's dementia was significantly lower than the normative mean letter fluency score, p = .002. The other tests yielded no significant results. Conclusion: our data shows that ICs of Alzheimer patients have cognitive deficits on the letter fluency test. This test primarily measures executive functioning and it has been found to be sensitive to mild cognitive impairment in recent research. Our data tentatively suggests that ICs who care for Alzheimer patients also show signs of cognitive impairment but that it is too early to tell if this is cause for concern or not

Telerehabilitation Versus Standard Care for Improving Cognitive Function and Quality of Life for Adults with Traumatic Brain Injury: a Systematic Review

ABSTRACT Traumatic brain injury (TBI) is the most significant cause of death and severe disability following major trauma within Australia. Populations at risk include young adults aged 15 to 34, older adults, and military personnel. The main form of intervention following traumatic brain injury is rehabilitation, which places a large demand on the healthcare system. Telerehabilitation involves interventions delivered via telecommunication, which can improve accessibility and reduce this burden. There have been no systematic reviews conducted on the effectiveness of telerehabilitation in treating traumatic brain injury. Purpose: To examine the effectiveness of telerehabilitation for adults with traumatic brain injury. Methods: A systematic search of Medline, Embase, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, The Cochrane Library, OTSeeker and Google Scholar was conducted. Studies were included with participants aged 18 to 64 with traumatic brain injury and receiving telerehabilitation interventions. Methodological quality was assessed using the critical appraisal tools: Critical Appraisal Skills Programme (CASP) checklist for randomised controlled trials, and McMaster Critical Review for Quantitative Studies for non-randomised studies. Results: Three randomised controlled trials, one pseudo-randomised controlled trial, one case-control trial and one pre-post case series were included in this systematic review. Critical appraisal of the included studies revealed overall methodological quality to be moderate. A range of interventions with differing parameters were used as part of telerehabilitation. Collectively, there is some consistent evidence to indicate that telerehabilitation may be equally effective as other forms of care in the delivery of cognitive and psychological interventions, in addressing memory and depressive symptoms for adults with mild to severe traumatic brain injury. However, it is unclear if it is superior to other forms of care. Conclusions: A small number of studies have investigated the effect of telerehabilitation for adults with traumatic brain injury. The current evidence base is limited due to lack of standardised intervention parameters, outcomes measures and robust sample size. Despite these limitations, telerehabilitation may offer a complementary model of care for adults with traumatic brain injury, especially in instances where traditional models of care may not be readily accessible (such as those in rural and remote areas)

The Audiologist’s Role in Assessment and Management of Mild Traumatic Brain Injuries

Mild Traumatic Brain Injuries (mTBI) are caused by a blow to the head and have many severe consequences from amnesia and loss of consciousness to cognitive symptoms such as fatigue, pain, dizziness, light and sound sensitivity, blurry vision, and may even have vestibular symptoms like vertigo secondary to the injury. The purpose of this doctoral scholarly project is to investigate the overlap of mTBIs and vestibular disorders to understand and emphasize how audiologists can be a valuable member of a multidisciplinary team to help assess and manage patients who experience traumatic brain injuries. Audiologists can play a key role in diagnosing vestibular disorders that may otherwise be overlooked due to overlap in mTBI symptoms. Audiologists may also be the best professional to help provide treatment options such as vestibular therapy to help patients heal from a mTBI. Recommendations for future directions are included for integrating audiologists into a multidisciplinary team for managing patients with mTBIs

Understanding, Assessing and Treating Prospective Memory Dysfunctions in Traumatic Brain Injury Patients

Our capacity to shape and direct our future behaviour is of fundamental importance in the development, pursuit, and maintenance of independence and autonomy from early childhood to late adulthood. A cognitive ability required for those functions is prospective memory (PM), which is the ability to form and remember to prospectively perform the intended action. Researchers have extensively focused on PM impairment in patients with traumatic brain injury (TBI). However, there has been limited research into the assessment and treatment of PM impairment in TBI patients. Reliable and valid tests with normative data are necessary for health professionals working with people with PM impairments. This chapter reviews the principal findings on PM impairment in TBI patients, and the main procedures used to assess and rehabilitate PM

Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review

Background: Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience. Objective: This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation. Methods: This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies. Results: In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor. Conclusions: There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area

The investigation of treatment outcomes for adults with chronic brain injury following intensive multidisciplinary treatment

Although communication sciences and disorders (COMD) research supports intensive treatment for individuals with chronic brain injury, funding to provide these services is limited. This study explored the use of interdepartmental university resources to provide an intensive, multidisciplinary chronic brain injury program. Methodologically, treatment regimes were designed with clinical faculty as practicum experiences for COMD master’s degree students. Subjects with a single onset head injury or cerebral vascular accident greater than one year were recruited to participate in the Intensive Treatment, Weekly Treatment or Control Groups. Pre, Post, and Post-Post Testing were used to measure cognitive-linguistic, quality of life and physical function. Additionally, treatment groups participated in electronic Experience Sampling Method (ESM) probes which queried their perception of happiness, tiredness, stress, and communication satisfaction throughout treatment using a Palm Zire 31 Personal Data Assistant. Both treatment programs were contextually-oriented, stressing functional multi-modality communication and compensatory techniques. Three hours of small and medium group COMD treatment were administered to the Weekly Group once weekly. The six subjects in the Intensive Group received a 35 hour weekly program including: COMD (12 hours), modified Tai Chi (3 hours), and psychological support for them and caregivers (4 ¼ hours). One-way repeated measures analysis of variance with partial eta squared effect size was used to analyze measures in the standardized battery. Intensive Group cognitive linguistic function appeared to significantly differ from the other groups on the Communication Activities of Daily Living-2 and Aphasia Diagnostic Profile Writing subtest suggestive of functional communication gains. Results of the ESM probes indicate that the Intensive Group was reportedly more happy and satisfied with their communication than the Weekly Group. The participants of the Intensive Group appeared to physically benefit from 3 weeks of modified Tai Chi in rate of ambulation. Limitations of the study, including self selection of treatment condition and differing severity across treatment groups, must be addressed by expanding the subject pool in follow-up research