Acquired Brain Damage Research Articles

Rehabilitation of people with cognitive problems: Findings from a field study

The aim of this study was to focus on the nursing rehabilitation of patients with cognitive problems following acquired brain damage. The objective of the study was to explore how actions of highly experienced nurses promoted and strengthened the complex content of the nursing rehabilitation. This article discusses a field study which used participant observations as well as ongoing solicited and unsolicited conversations with nurses. The work of five experienced nurses was followed for three months during the day in a specialized ward for patients with medium severe acquired brain damage at a Danish hospital. The nursing intervention in the rehabilitative process is a complex interaction between ‘what to do’ and ‘how to do’. The specific focus on the ‘patient's current cognitive capacity’ primarily emerged through field observations as nurses were reluctant to express their precise scientific knowledge. It is worth considering if an increase in nurses' use of scientific knowledge in the rehabilitation process of people with cognitive problems could strengthen nurses' position in a multi-disciplinary rehabilitation approach.

Methodological Issues in Interviews Involving People With Communication Impairments After Acquired Brain Damage

Qualitative research has made a significant contribution to the body of knowledge related to how people experience living with various chronic diseases and disabilities; however, the voices of certain vulnerable populations, particularly those with impairments that affect their ability to communicate, are commonly absent. In recent years, a few researchers have attempted to explore the most effective ways to ensure that the voices of people with communication impairments from acquired brain damages can be captured in qualitative research interviews; yet several methodological issues related to including this population in qualitative research remained unexamined. In this article, the authors draw on insights derived from their research on the experiences of adult survivors of stroke and traumatic brain injury to describe methodological issues related to sampling, informed consent, and fatigue in participant and researcher while also making some recommendations for conducting qualitative interviews with these populations.

The Meaning of the Present: Hope and Foreclosure in Narrations about People with Severe Brain Damage

In this article, I consider narratives told within a clinical setting. I argue that personnel in a day center for people with acquired brain damage are constantly involved in narrating about the disabled participants. The negotiation of who the participant is, and foremost will be, is in constant negotiation in regard to issues of hope. I further argue that hope is a meaning-making process and, as such, it has been defined as crucially connected to time. Hope has been said to enable a connection between the present and the future, because action taken in the present could bring about (positive) change in the future. However, I show that hope, in relation to narratives told about people with severe disabilities that are considered "incurable," must be understood within a realm of narrative foreclosure. Time seems to have lost the openness of its horizon for these people, and a narrative that tells of immediacy rather than chronology is created, resulting in hope being established within the present.

El papel del neuropsicólogo [The role of the neuropsychologist

Neuropsicology is the scientific discipline that studies the ties between the cognitive processes, emotions and their substrate in the central nervous system. The high prevalence of the neurological disorders (i.e. acquired brain damage, dementias, developmental impairments, etc.) does that the presence of the neuropsychologists in different welfare resources has been increased in the last few years. Among its main functions they are the one to evaluate patients and to design and to carry out programs of neuropsicological rehabilitation. Moreover, the neuropsychologist as a researcher receives a great importance, specially in a multidisciplinary context. In the present work some of these functions are reviewed.

Terapia ocupacional y daño cerebral adquirido [Occupational Therapy and acquired brain damage

Occupational therapy is the use of purposeful activity or interventions designed to achieve functional outcomes that promote health, prevent injury or disability, and that develop, improve, sustain, or restore the highest possible level of independence of any individual who has an injury, illnes, or other disorders or condition. This article has been designed to serve as a foundation for the general understanding of occupational therapy intervention with acquired brain damage survivors. The ultimate goal of occupational therapy is to enable individuals to perform the tasks that are essential for performing their unique roles. An occupational therapist assesss underlying motor, cognitive, perceptual, and interpersonal skills as well as task performance and valued roles. Depending on a person´s current potential for recovery impairments, the occupational therapist, and others health profesionals, facilites task performance by improving relevant performance skills, developing and teaching compensatory strategies to overcome lost performance skills, or combining both of these strategies.

Fluoxetine for Persistent Developmental Stuttering

Stuttering is a disturbance in the normal fluency and time patterning of speech. Developmental stuttering (DS), with or without associated psychiatric illness, is the most common form and includes all cases with gradual onset in childhood that are not the result of acquired brain damage. Persistent developmental stuttering (PDS) is DS that has not undergone spontaneous or speech therapy-induced remission. Adults in speech therapy behavioral programs will often show regression and even total relapse if they stop practicing. This case report deals with a patient of PDS who responded significantly to treatment with fluoxetine.

1215: Fetal brain and spinal cord by 3D/4D neuroimaging technology

Antenatal evaluation of the fetal central nervous system (CNS) plays an important role in the field of perinatology. Transvaginal sonography of the fetal brain opened a new field in medicine, neurosonography. Transvaginal approach to the normal fetal brain during the second and third trimester was introduced in the beginning of 1990s. Transvaginal observation of the fetal brain offers sagittal and coronal views of the brain from fetal parietal direction through the fontanelles and/or the sagittal suture as ultrasound windows. Serial oblique sections via the same ultrasound window reveal the intracranial morphology in detail. This method has contributed to the prenatal sonographic assessment of congenital CNS anomalies and acquired brain damage in utero, especially when compared with conventional transabdominal method. Combination of both transvaginal sonography and 3D ultrasound has been a great diagnostic tool for evaluation of 3D structure of fetal CNS. 3D transvaginal sonography demonstrates bony structure such as cranial os and vertebrae, multiplanar analysis of inside morphology from early till late pregnancy, sono-angiography and volume extraction and calculation of target organ, i.e., lateral ventricle and/or choroids plexus. Recent advanced 3D technology produced tomographic ultrasound imaging, which shows tomographic parallel slices of any cutting sections. Because tomographic images are produced from original 3D dataset, slice distance can be changed, and all tomographic images can be rotated around x, y and z axes. Those 3D technologies have contributed to the CNS neuroassessment during pregnancy. 4D ultrasound has furthermore added the information of fetal functional neurobehavior to static neuroimaging data. Fetal MRI has also produced whole CNS information of fetuses and compensated smartly for the weak points of ultrasound, such as detection of gyri and sulci in late pregnancy By the use of update imaging technologies, it has been possible to clarify natural history of normal development of the brain and spine from very early period, natural history and detailed structure of congenital CNS anomalies and rapid morphological changes of in utero brain damage such as intracranial bleeding. In referral cases with CNS abnormalities, main reasons for referral are enlarged ventricles or intracranial cystic area. However, there are many intracranial morphological changes without ventriculomegaly or cystic area, which might cause neurological deficits. New facts produced from advanced neuroimaging of fetal CNS might be clues for explaining the unknown neurological disorders. Antenatal evaluation of the fetal central nervous system (CNS) plays an important role in the field of perinatology. Transvaginal sonography of the fetal brain opened a new field in medicine, neurosonography. Transvaginal approach to the normal fetal brain during the second and third trimester was introduced in the beginning of 1990s. Transvaginal observation of the fetal brain offers sagittal and coronal views of the brain from fetal parietal direction through the fontanelles and/or the sagittal suture as ultrasound windows. Serial oblique sections via the same ultrasound window reveal the intracranial morphology in detail. This method has contributed to the prenatal sonographic assessment of congenital CNS anomalies and acquired brain damage in utero, especially when compared with conventional transabdominal method. Combination of both transvaginal sonography and 3D ultrasound has been a great diagnostic tool for evaluation of 3D structure of fetal CNS. 3D transvaginal sonography demonstrates bony structure such as cranial os and vertebrae, multiplanar analysis of inside morphology from early till late pregnancy, sono-angiography and volume extraction and calculation of target organ, i.e., lateral ventricle and/or choroids plexus. Recent advanced 3D technology produced tomographic ultrasound imaging, which shows tomographic parallel slices of any cutting sections. Because tomographic images are produced from original 3D dataset, slice distance can be changed, and all tomographic images can be rotated around x, y and z axes. Those 3D technologies have contributed to the CNS neuroassessment during pregnancy. 4D ultrasound has furthermore added the information of fetal functional neurobehavior to static neuroimaging data. Fetal MRI has also produced whole CNS information of fetuses and compensated smartly for the weak points of ultrasound, such as detection of gyri and sulci in late pregnancy By the use of update imaging technologies, it has been possible to clarify natural history of normal development of the brain and spine from very early period, natural history and detailed structure of congenital CNS anomalies and rapid morphological changes of in utero brain damage such as intracranial bleeding. In referral cases with CNS abnormalities, main reasons for referral are enlarged ventricles or intracranial cystic area. However, there are many intracranial morphological changes without ventriculomegaly or cystic area, which might cause neurological deficits. New facts produced from advanced neuroimaging of fetal CNS might be clues for explaining the unknown neurological disorders.

The Inclusion of Children with a Disability in Child Care: The Influence of Experience, Training and Attitudes of Childcare Staff

Seventy-seven directors of childcare centres and 77 childcare staff were surveyed about their training to work with children with a disability, experience with these children, attitudes to disability, inclusive practices and barriers to inclusion. General support was expressed for the inclusion of children with a disability in child care, especially if the disability was mild. Some disabilities, e.g. speech and language problems, were viewed more favourably than others, e.g. acquired brain damage. Training for working with children who have a disability was associated with positive attitudes toward people with a disability. Directors currently including children with a disability in their program had significantly more training and experience with such children than other directors, although there was no difference in attitude to disability. Training and experience appeared to increase feelings of control over the provision of services for children with a disability.

The impact of levetiracetam on challenging behavior

An observational longitudinal design was employed to evaluate whether treatment with the antiepileptic drug levetiracetam (LEV) adversely impacts behavior in people with intellectual disabilities and/or acquired brain damage. Thirty-five adults were assessed once off the drug and once when on LEV therapy, with a 2-month interval between assessments. Behaviors were rated using an adaptation of the Yale–Brown Obsessive Compulsive Scale and the Challenging Behaviour Scale. Challenging behaviors were rated as more frequent and severe when individuals were taking LEV. Behavioral worsening was not related to better seizure control or increased levels of engagement in activities. Families and professionals need to be aware of the potential reversible adverse effects of this drug.

Reduced daytime activity in patients with acquired brain damage and apathy: A study with ambulatory actigraphy

Primary objective: Apathy is difficult to assess in clinical practice. Ambulatory actigraphy was used with the aim to measure locomotor activity during the daytime as a correlate of self-initiated action in brain-damaged patients with apathy.Research design: Twenty-four patients with acquired brain damage and high levels of apathy or low levels of apathy as well as 12 healthy controls were investigated using a parallel group design.Methods and procedures: Apathy was diagnosed after clinical observation and evaluated with the apathy evaluation scale. Locomotor activity was measured with a wrist-worn actigraph over 3 days.Results: High apathy patients showed significantly reduced locomotor activity and more episodes of inactivity (naps) during the daytime. Self-rated apathy correlated with daytime activity, nap frequency and cognitive (executive) deficits.Conclusions: Ambulatory actigraphy is a promising method to evaluate self-initiated action in patients with apathy.

The Collaboration of Music Therapy and Speech-Language Pathology in the Treatment of Neurogenic Communication Disorders: Part I--Diagnosis, Therapist Roles, and Rationale for Music

ABSTRACT: This two-part article addresses collaboration of music therapists (MTs) and speech-language pathologists (SLPs), specifically in treatment of neurogenic communication disorders (NCDs). Part I of this article will include following: (a) definitions and descriptions of several NCDs relevant to music therapy practice; (b) brief overview of SLP treatment approaches and techniques for these disorders; and (c) rationale for applying music therapy methods with these disorders and discussion of several techniques commonly used. When language is impaired due to neurological damage, it is referred to as neurogenic communication disorder (NCD) (Brookshire, 2003). The term neurogenic is comprised of prefix neuro-, meaning to nerves or the nervous system, and suffix -genic, meaning or caused by; therefore, neurogenic communication disorders are disorders resulting from nervous system pathology (Brookshire, 2003, p. 1). Because communication is primary treatment area, patient with NCD is likely to be referred to speech-language pathologist (SLP) for assessment and/or subsequent habilitation or rehabilitation. Some of treatment goals may be effectively addressed in music therapy as well; however, role of music therapist (MT), at present time, may be less clearly defined within treatment team. Therefore, this two-part article will address defining NCDs, their treatment, rationale for use of music with NCDs, and role of SLPs and MTs respectively in collaborative treatment. Music therapists likely have general familiarity with role of SLPs: assessment, treatment, and referral services for individuals with communication and other related disorders, such as speech, language, voice, and swallowing disorders (ASHA, 20016; Brookshire, 2003). Beyond that, some MTs may lack comprehensive understanding of what SLPs actually do. Conversely, SLPs may be unfamiliar with possible applications of music therapy for persons with communication disorders or may harbor concerns regarding whether MTs are professionally prepared to address treatment objectives of this clientele. This lack of understanding can contribute to communication breakdown that can reduce provision of treatment options for clients who can benefit from collaborative treatment approach. An understanding of NCDs and their characteristics can provide an important foundation for effective collaboration. Neurogenic Communication Disorders Neurogenic communication disorders can be further categorized in terms or neurogenic language disorders, including various forms of aphasia or neurogenic motor speech disorders, such as apraxia of speech and various forms of dysarthria (Brookshire, 2003; Hegde, 1998). Neurogenic Language Disorders Aphasia is neurogenic language disorder resulting from acquired brain damage, such as cerebrovascular accidents (CVAs, i.e., strokes), brain trauma (e.g., brain injury from automobile accidents), brain tumors, or progressive neurological diseases (Brookshire, 2003; Hegde, 1998). Multiple definitions of aphasia can be found in literature due to various considerations of types of aphasia and varying definitions of language (Hegde, 1998); however, for purposes of this article, aphasia can be defined as a language impairment that crosses all input and output modalities (Brookshire, 2003, p. 569) or deficiency in ability to understand and/or create language (Brookshire, 2003; J. Gordon, personal communication, September 16, 2002; Hegde, 1998). Aphasia can affect different aspects of language, such as speaking, comprehension, reading, writing, and gesturing, for example. There are several kinds of aphasia and differential diagnosis is often controversial (Hegde, 1998). In broad terms, aphasia can be categorized in terms of fluency or prosodie (melodic) aspects of speech. Individuals with form of fluent aphasia speak naturally and with ease, incorporating more normal speech rate and emphasis, whereas individuals with form of nonfluent aphasia speak slowly and laboriously with frequent pauses (Brookshire, 2003). …

Everyday memory self-assessed by adult patients with acquired brain damage and their significant others

Self-assessment of everyday memory dysfunction was examined in a sample of 48 patients with acquired brain injury. A modified version of the Everyday Memory Questionnaire (EMQ20) was used as an interview. Patients were compared to 30 persons without brain injury. EMQ20 was completed by significant others (SOs) to both patients and controls. Patients reported a higher frequency of memory problems (days per week) and more distress due to memory deficits compared to controls. A high degree of consistency was found between patient and SO ratings on these measures. No difference was found on the total usage of memory aids, but patients asked other people more for a reminder and used loose notes less than controls. Implications for rehabilitation and future research are discussed. This research was supported by a grant from the research and development centre, municipality of Gävleborg, Sweden.

Selective preservation of memory for people in the context of semantic memory disorder: Patterns of association and dissociation

A number of single cases in the literature demonstrate that person-specific semantic knowledge can be selectively impaired after acquired brain damage compared with that of object categories. However, there has been little unequivocal evidence for the reverse dissociation, selective preservation of person-specific semantic knowledge. Recently, three case studies have been published which provide support for the claim that such knowledge can be selectively preserved [Kay, J., & Hanley, J. R. (2002). Preservation of memory for people in semantic memory disorder: Further category-specific semantic dissociation. Cognitive Neuropsychology, 19, 113–134; Lyons, F., Hanley, J. R., & Kay, J. (2002). Anomia for common names and geographical names with preserved retrieval of names of people: A semantic memory disorder. Cortex, 38, 23–35; Thompson, S. A, Graham, K. S., Williams, G., Patterson, K., Kapur, N., & Hodges, J. R. (2004). Dissociating person-specific from general semantic knowledge: Roles of the left and right temporal lobes. Neuropsychologia, 42, 359–370]. In this paper, we supply further evidence from a series of 18 patients with acquired language disorder. Of this set, a number were observed to be impaired on tests of semantic association and word-picture matching using names of object categories (e.g. objects, animals and foods), but preserved on similar tests using names of famous people. Careful methodology was applied to match object and person-specific categories for item difficulty. The study also examined whether preservation of person-specific semantic knowledge was associated with preservation of knowledge of ‘biological categories’ such as fruit and vegetables and animals, or with preservation of ‘token’ knowledge of singular categories such as countries. The findings are discussed in the context of a variety of accounts that examine whether semantic memory has a categorical structure.

Functional Neuroimaging Studies of Cognitive Recovery After Acquired Brain Damage in Adults

The first two decades of cognitive neuroimaging research have provided a constant increase of the knowledge about the neural organization of cognitive processes. Many cognitive functions (e.g.working memory) can now be associated with particular neural structures, and ongoing research promises to clarify this picture further, providing a new mapping between cognitive and neural function. The main goal of this paper is to outline conceptual issues that are particularly important in the context of imaging changes in neural function through recovery process. This review focuses primarily on studies made in stroke and traumatic brain injury patients, but most of the issues raised here are also relevant to studies using other acquired brain damages. Finally, we summarize a set of methodological issues related to functional neuroimaging that are relevant for the study of neural plasticity and recovery after rehabilitation.

A randomized control trial to evaluate a paging system for people with traumatic brain injury

Although memory problems following acquired brain damage are common, some people are able to compensate for these problems through external aids. It was recently demonstrated that a paging system could reduce the everyday memory and planning problems for people with non-progressive brain injury. The 143 patients who participated in the study comprised several diagnostic groups. This paper reports on the sub-group of people with TBI (n = 63). This sub-group was part of the larger sample of 143 already published in the 2001 study. A randomized control cross-over design randomly allocated people to group A (pager first) or group B (waiting list first). Each participant chose their own tasks for which they needed reminders. During a 2 week baseline, successful task achievement was documented. Group A achieved 47.14% of tasks and group B 47.88%. People in group A then received a pager for 7 weeks. During the last 2 weeks of this 7 week period, task achievement was documented again. Group A now achieved 71.80% of tasks and group B (on the waiting list) achieved 49.05% (no different from baseline). Group A then returned their pagers and group B received pagers. During the last 2 weeks of this stage participants were monitored once more. At this point, people in group A had dropped back slightly but were still statistically significantly better than during the baseline (67.23%). Group B, meanwhile, were now achieving 73.62% of tasks. This was statistically significantly better than baseline and significantly better than group A, now in the post-pager phase. It is concluded that this paging system significantly reduces the everyday memory and planning problems of people with TBI.

EFNS guidelines on cognitive rehabilitation: report of an EFNS task force

Disorders of language, spatial perception, attention, memory, calculation and praxis are a frequent consequence of acquired brain damage [in particular, stroke and traumatic brain injury (TBI)] and a major determinant of disability. The rehabilitation of aphasia and, more recently, of other cognitive disorders is an important area of neurological rehabilitation. We report here a review of the available evidence about effectiveness of cognitive rehabilitation. Given the limited number and generally low quality of randomized clinical trials (RCTs) in this area of therapeutic intervention, the Task Force considered, besides the available Cochrane reviews, evidence of lower classes which was critically analysed until a consensus was reached. In particular, we considered evidence from small group or single cases studies including an appropriate statistical evaluation of effect sizes. The general conclusion is that there is evidence to award a grade A, B or C recommendation to some forms of cognitive rehabilitation in patients with neuropsychological deficits in the post-acute stage after a focal brain lesion (stroke, TBI). These include aphasia therapy, rehabilitation of unilateral spatial neglect (ULN), attentional training in the post-acute stage after TBI, the use of electronic memory aids in memory disorders, and the treatment of apraxia with compensatory strategies. There is clearly a need for adequately designed studies in this area, which should take into account specific problems such as patient heterogeneity and treatment standardization.

The fusiform face area is not sufficient for face recognition: Evidence from a patient with dense prosopagnosia and no occipital face area

We tested functional activation for faces in patient D.F., who following acquired brain damage has a profound deficit in object recognition based on form (visual form agnosia) and also prosopagnosia that is undocumented to date. Functional imaging demonstrated that like our control observers, D.F. shows significantly more activation when passively viewing face compared to scene images in an area that is consistent with the fusiform face area (FFA) ( p < 0.01). Control observers also show occipital face area (OFA) activation; however, whereas D.F.'s lesions appear to overlap the OFA bilaterally. We asked, given that D.F. shows FFA activation for faces, to what extent is she able to recognize faces? D.F. demonstrated a severe impairment in higher level face processing—she could not recognize face identity, gender or emotional expression. In contrast, she performed relatively normally on many face categorization tasks. D.F. can differentiate faces from non-faces given sufficient texture information and processing time, and she can do this is independent of color and illumination information. D.F. can use configural information for categorizing faces when they are presented in an upright but not a sideways orientation and given that she also cannot discriminate half-faces she may rely on a spatially symmetric feature arrangement. Faces appear to be a unique category, which she can classify even when she has no advance knowledge that she will be shown face images. Together, these imaging and behavioral data support the importance of the integrity of a complex network of regions for face identification, including more than just the FFA—in particular the OFA, a region believed to be associated with low-level processing.

Assessing Decision-Making and Capacity in Minimally-Aware Patients

The assessment of decision-making by minimally-aware patients represents an important challenge for medicine, science and the law. This paper seeks to assist the dialogue between these disciplines by discussing three aspects: the difficulties inherent in establishing a reliable means of communication with the patient; the difficulty of exploring understanding and decision-making once a means of communication has been determined; and the legal implications including problems that may arise with the 'balance of probabilities' legal standard of proof. These aspects are discussed using the example of patients who have very severe acquired brain damage or are in states which verge on the 'persistent vegetative state'. The discussion is informed by existing case law and by reference to clinical method and scientific theory including binomial theory.

Postnatal changes in cerebral oxygen extraction in the preterm infant are associated with intraventricular hemorrhage and hemorrhagic parenchymal infarction but not periventricular leukomalacia.

Fluctuations in cerebral hemodynamics have been implicated in the pathogenesis of acquired brain damage in babies born prematurely. This study examined the changes in cerebral fractional oxygen extraction (FOE) over the first 3 d after birth in 25 very-low-birth-weight preterm infants. Twelve infants had no major cerebral injury and 13 had acquired brain injury; cystic periventricular leukomalacia (PVL) was present in 4 and intraventricular hemorrhage (IVH) in 9, of whom 2 also had hemorrhagic parenchymal infarction (HPI). Normal values (median, 5(th)-95(th) centiles) for cerebral FOE in very-low-birth-weight infants with no cerebral injury were 0.38 (0.23-0.53) on d 1, 0.31 (0.18-0.45) on d 2, and 0.28 (0.17-0.38) on d 3. Infants who developed cystic PVL had no significant change in cerebral FOE during the first 3 d after birth. By contrast, cerebral FOE fluctuated in infants with IVH over the 3 d of measurement, decreasing from d 1 to d 2 (p = 0.03) and increasing from d 2 to d 3 (p = 0.02). The highest cerebral FOE values were seen in the two infants with HPI. The different patterns of change in cerebral FOE with HPI and cystic PVL provide additional evidence that the pathogenesis of these two conditions is different. Because high cerebral FOE is likely to be a consequence of low cerebral oxygen delivery, probably because of low cerebral blood flow, our results indicate that fluctuations in cerebral blood flow may occur when there is IVH or HPI.

A training apartment with electronic aids to daily living: lived experiences of persons with brain damage.

The objective of this study was to investigate how persons with acquired brain damage experienced their 1-week stay in an apartment fitted with electronic aids to daily living (EADL). The study focused on how the individuals adapted to this artificial environment in their performance of daily activities and how their occupational experiences influenced their view of the future. The 11 participants were interviewed on the last day of their rehabilitation period in an EADL-equipped training apartment. The data were collected and analyzed using the Empirical Phenomenological Psychological (EPP) method. The findings revealed four main characteristics that described an adaptation process that occurred during the week in the EADL-equipped training apartment: plunging into an EADL-equipped environment, "landing" and feeling comfortable with the new environment, incorporating the "new" in daily activities, and "taking-off" for the future. In a short time, the combination of the EADL and the aesthetically attractive environment gave the participants experiences that contributed to a "taking off" for their future life. Findings from this study suggest that, in clinical practice, clients may need initial guidance from the therapists to "land" and feel comfortable in a new environment, like a training apartment, before they can learn how to incorporate new electronic aids in their every day activities.