After Acquired Brain Injury Research Articles

Self-Awareness After Brain Injury: Relation with Emotion Recognition and Effects of Treatment

Self-awareness is often impaired after acquired brain injury (ABI) and this hampers rehabilitation, in general: unrealistic reports by patients about their functioning and poor motivation and compliance with treatment. We evaluated a self-awareness treatment that was part of a treatment protocol on executive dysfunction (Spikman, Boelen, Lamberts, Brouwer, & Fasotti, 2010). A total of 63 patients were included, aged 17–70, suffering non-progressive ABI, and minimum time post-onset of 3 months. Self-awareness was measured by comparing the patient's Dysexecutive Questionnaire (Wilson, Alderman, Burgess, Emslie, & Evans, 1996) score with that of an independent other. As emotion recognition is associated with self-awareness and influences the effect of rehabilitation treatment, we assessed this function using the Facial Expressions of Emotion-Stimuli and Tests (Young, Perrett, Calder, Sprengelmeyer, & Ekman, 2002). Results showed that patients in the experimental treatment group (n= 29) had better self-awareness after training than control patients (n= 34). Moreover, our results confirmed that the level of self-awareness before treatment was related to emotion recognition. Hence, self-awareness can improve after neuropsychological treatment fostering self-monitoring. Since neuropsychological treatment involves social learning, impairments in social cognition should be taken into account before starting and during treatment.

Delayed voluntary exercise does not enhance cognitive performance after hippocampal injury: an investigation of differentially distributed exercise protocols.

Voluntary exercise has previously been shown to enhance cognitive recovery after acquired brain injury (ABI). The present study evaluated effects of two differentially distributed protocols of delayed, voluntary exercise on cognitive recovery using an allocentric place learning task in an 8-arm radial maze. Fifty-four Wistar rats were subjected to either bilateral transection of the fimbria-fornix (FF) or to sham surgery. Twenty-one days postinjury, the animals started exercising in running wheels either for 14 consecutive days (FF/exercise daily [ExD], sham/ExD) or every other day for 14 days (FF/exercise every second day [ExS], sham/ExS). Additional groups were given no exercise treatment (FF/not exercise [NE], sham/NE). Regardless of how exercise was distributed, we found no cognitively enhancing effects of exercise in the brain injured animals. Design and protocol factors possibly affecting the efficacy of post-ABI exercise are discussed.

Evidence of Big-Five personality changes following acquired brain injury from a prospective longitudinal investigation

ObjectiveMany studies using different assessment methods have reported personality changes after acquired brain injury (ABI). However, to our knowledge, no prospective study has yet been conducted to examine whether previous cross-sectional and retrospective results can be replicated in a longitudinal prospective design. Further, because clinical control groups were only rarely used, it remains debatable if the personality changes found are unique to patients with ABI or if they also affect patients with other disabilities. MethodsThis study examined personality change in 114 participants with different kinds of ABI, 1321 matched controls (general control, GC), and 746 matched participants with restrictive impairments other than brain injury (clinical control, CC) in a prospective longitudinal design using data from the panel survey Household, Income and Labour Dynamics in Australia (HILDA). ResultsParticipants with ABI showed significantly larger declines in Extraversion and Conscientiousness compared with the GC group. When the ABI participants were compared with the CC group, only the difference in Conscientiousness remained significant. ConclusionOur prospective data corroborate evidence from previous cross-sectional studies that patients with ABI experience larger declines in Extraversion and Conscientiousness than the general population. Whereas the effect on Conscientiousness was unique to patients with ABI, the decline in Extraversion was also observed in participants with other impairments.

A conceptual model for vision rehabilitation.

Vision impairments are highly prevalent after acquired brain injury (ABI). Conceptual models that focus on constructing intellectual frameworks greatly facilitate comprehension and implementation of practice guidelines in an interprofessional setting. The purpose of this article is to provide a review of the vision literature in ABI, describe a conceptual model for vision rehabilitation, explain its potential clinical inferences, and discuss its translation into rehabilitation across multiple practice settings and disciplines.

Cognitive remediation of attention deficits following acquired brain injury: A systematic review and meta-analysis.

Attention deficits are common after acquired brain injury (ABI) and adversely impact academic, vocational and social outcomes. The role of cognitive interventions in post-ABI attention rehabilitation remains unclear. To evaluate effectiveness of cognitive interventions in treating attention deficits following ABI and to explore differences in treatment effect between ABI etiologies. MEDLINE, EMBASE, PsycINFO and CENTRAL databases were searched for randomized controlled trials (RCTs). Studies were selected by three reviewers. Study quality was assessed using Cochrane Collaboration tool for RCTs. Effect sizes (Hedge's g) for each attentional domain were meta-analyzed with subgroup analysis by ABI etiology. Twelve RCTs with 584 participants were included, representing individuals with stroke, traumatic brain injury (TBI) and CNS-impacting malignancy. Cognitive rehabilitation improved divided attention in stroke survivors (g 0.67; 95% confidence interval, 0.35-0.98; p < 0.0001) but not other ABI populations. Sustained, selective and alternating attention, and inhibition were not significantly improved in any ABI population. Follow-up data showed no evidence of long-term benefit. Cognitive rehabilitation resulted in short-term improvements in divided attention following stroke, but not after TBI or CNS-impacting malignancy. Cognitive interventions did not significantly improve other attentional domains in participants with stroke, TBI or CNS-impacting malignancy.

Participation after acquired brain injury: Associations with everyday technology and activities in daily life

Background: The development of the information society has led to increased use of everyday technology and changed the conditions for participation. Enabling participation in everyday life situations is an important rehabilitation goal after acquired brain injury (ABI). Identifying factors associated with individuals’ experienced participation and problems therein is therefore essential. Objective: This study aimed at exploring the relationship between perceived difficulty in everyday technology use, perceived ability in the activities of daily living (ADL), and perceived participation, and participation problems in persons with ABI. Methods: Eighty-one persons with ABI participated in the study and were assessed by the Impact on Participation and Autonomy questionnaire, the Everyday Technology Use Questionnaire, and the ADL taxonomy. Results: Findings showed that the combined model of difficulty in everyday technology (ET) use, ADL ability, and the interaction between them explained both participation in various domains of everyday life, and also overall level of perceived participation and the perceived problems. Conclusions: The findings underscore the importance of evaluating individuals’ ability in both ET use and ADL after ABI to increase the probability of explaining these persons’ participation in desired everyday life situations and, also, for rehabilitation design.

Associations between executive functioning, coping, and psychosocial functioning after acquired brain injury.

To examine the relationships between executive functioning, coping, depressive symptoms, and quality of life in individuals with neuropsychiatric symptoms after acquired brain injury (ABI). Cross-sectional study. Individuals (n = 93) in the post-acute and chronic phase (>3 months) after ABI and their significant others (N = 58) were recruited from outpatient clinics of four mental health centres in the Netherlands. Outcome measures were the Trail Making Test, Stroop Colour Word Test, Frontal Systems Behavioural Scale, Utrecht Coping List, Patient Health Questionnaire, and Life Satisfaction Questionnaire. Data were analysed with multiple regression analyses. Self-reported executive dysfunction was associated with greater use of passive coping styles (β = .37, p < .01), and passive coping, in turn, was associated with lower quality of life (β = -.57, p < .001) and more depressive symptoms (β = .65, p < .001). Problem-focused coping was associated with higher quality of life among individuals who reported better executive functioning (β = -.94, p < .05). Performances on executive functioning tests were not associated with coping, depressive symptoms, or quality of life. For clinicians, these data indicate that individuals who report greater difficulties with executive functioning after ABI are inclined to use maladaptive passive coping styles, which should be targeted in treatment. In comparison, individuals who report greater difficulties with executive functioning should not be prompted to use problem-focused coping styles. These individuals may benefit from other coping styles, such as the use of seeking social support or acceptance of problems. Coping influences the association between executive functioning and quality of life. Individuals who report difficulties with executive functioning after ABI may be inclined to use passive coping styles, which are maladaptive. Problem-focused coping strategies may be more useful for individuals who have strong executive abilities. This study was a cross-sectional study; thus, a cause-and-effect relationship could not be established between executive functioning, coping, and psychosocial functioning. As this research was part of standard clinical care, non-traditional tests for executive functioning were not administered.

Dutch Multifactor Fatigue Scale: A New Scale to Measure the Different Aspects of Fatigue After Acquired Brain Injury

ObjectivesTo develop the Dutch Multifactor Fatigue Scale (DMFS), a new scale to assess the nature and impact of fatigue and coping with fatigue in the chronic phase after acquired brain injury (ABI) and to analyze the psychometric properties of this scale in a mixed group of patients with ABI. DesignCross-sectional survey study. SettingAcademic rehabilitation center. ParticipantsA mixed sample of patients with ABI (N=134). For the development of the DMFS: community-dwelling adults with stroke (n=9) and traumatic brain injury (n=5). For analyses of the psychometric properties of the DMFS: community-dwelling adults with ischemic stroke (n=55), hemorrhagic stroke (n=22), traumatic brain injury (n=35), or other ABIs (n=22), all at least 6 months after brain injury. InterventionsNot applicable. Main Outcome MeasuresDMFS, Hospital Anxiety and Depression Scale, Checklist Individual Strength, and Dutch Personality Questionnaire. ResultsExploratory and confirmatory factor analyses on data of 134 patients showed that the final DMFS consisted of 5 factors (explaining 55% of the variance): Impact of fatigue, Mental fatigue, Signs and Direct consequences of fatigue, Physical fatigue, and Coping with fatigue. All subscales of the DMFS showed sufficient to good reliability, good convergent validity with an existing fatigue scale, and good divergent validity with measures of mood and self-esteem. ConclusionsThe DMFS is believed to improve the diagnostic process of fatigue in the chronic phase after ABI. As it measures several factors of fatigue after brain injury, therapeutic indications can be targeted to patients' needs.

Early vocational rehabilitation after acquired brain injury: A structured and interdisciplinary approach

BACKGROUND: There are indications that specialist vocational rehabilitation is beneficial when trying to return to work after acquired brain injury (ABI). OBJECTIVE: To give a description of the Early Vocational Rehabilitation (EVR) protocol and its development in order to make it available for implementation in rehabilitation institutes to strengthen the appearance of these institutes as relevant partners and supporters during the process of (sustaining) return to work of people with ABI. METHODS: The Early Vocational Rehabilitation (EVR) protocol is a process guideline to facilitate the interdisciplinary rehabilitation team to systematically focus on return to work during an early stage of (inpatient or outpatient) rehabilitation of people with ABI. The development was expert based. RESULTS: The EVR protocol consists of four stages: 1) orientation of the rehabilitation team towards the patient’s work; 2) investigating the gap between the patient’s abilities and work; 3) work training; and 4) finalizing EVR. Cooperation among all relevant partners from inside or outside the rehabilitation institute is important for maximally adapting the EVR treatment to the individual (work) situation of the person with ABI. CONCLUSION: The EVR protocol is available for implementation in other rehabilitation institutes. Performing a context analysis for each new context in which it is implemented is recommended.

The Effects of Exercise on Cognitive Recovery after Acquired Brain Injury in Animal Models: A Systematic Review.

The objective of the present paper is to review the current status of exercise as a tool to promote cognitive rehabilitation after acquired brain injury (ABI) in animal model-based research. Searches were conducted on the PubMed, Scopus, and psycINFO databases in February 2014. Search strings used were: exercise (and) animal model (or) rodent (or) rat (and) traumatic brain injury (or) cerebral ischemia (or) brain irradiation. Studies were selected if they were (1) in English, (2) used adult animals subjected to acquired brain injury, (3) used exercise as an intervention tool after inflicted injury, (4) used exercise paradigms demanding movement of all extremities, (5) had exercise intervention effects that could be distinguished from other potential intervention effects, and (6) contained at least one measure of cognitive and/or emotional function. Out of 2308 hits, 22 publications fulfilled the criteria. The studies were examined relative to cognitive effects associated with three themes: exercise type (forced or voluntary), timing of exercise (early or late), and dose-related factors (intensity, duration, etc.). The studies indicate that exercise in many cases can promote cognitive recovery after brain injury. However, the optimal parameters to ensure cognitive rehabilitation efficacy still elude us, due to considerable methodological variations between studies.

Training of Attention in the Early Phase After Brain Injury

Attention can be successfully improved after acquired brain injury (ABI). The Attention Process Training (APT) is an evidence based method (chronic phase). Results in the acute phase are contradictory. A new method is applied describing patterns of recovery early after ABI. Statistical Process Control (SPC) is susceptible to process variations providing a closer indication of variability during recovery. We investigate the effects of targeted goal-driven rehabilitation in the early phase after ABI using both process method and end-point measures.

Treatment of Unawareness of Deficits in Patients With Acquired Brain Injury

To review and evaluate the effectiveness and methodological quality of available treatment methods for unawareness of deficits after acquired brain injury (ABI). Systematic literature search for treatment studies for unawareness of deficits after ABI. Information concerning study content and reported effectiveness was extracted. Quality of the study reports and methods were evaluated. A total of 471 articles were identified; 25 met inclusion criteria. 16 were uncontrolled or single-case studies. Nine were of higher quality: 2 randomized controlled trials, 5 single case experimental designs, 1 single-case design with pre- and posttreatment measurement, and 1 quasi-experimental controlled design. Overall, interventions consisted of multiple components including education and multimodal feedback on performance. Five of the 9 high-quality studies reported a positive effect of the intervention on unawareness in patients with some knowledge of their impairments. Effect sizes ranged from questionable to large. Patients with ABI may improve their awareness of their disabilities and possibly attain a level at which they personally experience problems when they occur. At present, because of lack of evidence, no recommendation can be made for treatment approaches for persons with severe impairment of self-awareness in the chronic phase of ABI. We recommended developing and evaluating theory-driven interventions specifically focused on disentangling the components of treatment that are successful in improving awareness. High-quality intervention studies are urgently needed using controlled designs (eg, single-case experimental designs, randomized controlled trials) based on a theoretic perspective with a detailed description of the content of the intervention and suitable outcome measures.

Are metacognitive processes associated with posttraumatic stress symptom severity following acquired brain injury?

Purpose: Although posttraumatic stress disorder (PTSD) after acquired brain injury (ABI) is relatively common, its causal mechanisms remain speculative and little research has considered psychological perspectives. The current study aimed to examine whether metacognitive variables were associated with posttraumatic stress symptom (PTSS) severity in individuals with an ABI. Methods: Participants who had a traumatic brain injury (n = 47) or subarachnoid haemorrhage (n = 93) completed questionnaires related to demographic, clinical, social support and metacognitive variables. Correlation analyses and a hierarchical multiple regression analysis, with total PTSS severity used as the outcome variable, were conducted. Results: Results demonstrated that metacognitive factors were correlated with PTSS severity and were able to explain an additional and significant amount of variance in PTSS severity within the regression analysis. Conclusions: The results provide preliminary support that metacognitive variables are associated with PTSS after ABI. Clinical implications within rehabilitative settings are discussed, as well as theoretical and research implications in the context of the study’s limitations.Implications for RehabilitationPosttraumatic stress disorder (PTSD) can impede quality of life after brain injury.Clinical, social and metacognitive processes all influence the development of PTSD after brain injury and should be considered within rehabilitative care plans.Rehabilitative care plans should incorporate interventions for PTSD when appropriate, and metacognitive interventions could prove beneficial.

Progression of posturographic findings after acquired brain injury

Objective: To study the characteristics of balance performance in a sample of patients with increasing postural instability after acquired brain injury (ABI) and to establish the clinical utility of a new computerized posturographic system (NedSVE/IBV).Methods: This study included 108 patients with ABI divided into five groups from minimal to severe postural impairment. All patients were assessed with the NedSVE/IBV system and with traditional balance measures. Posturographic analyses included the modified clinical test of sensory interaction on balance, the limits of stability and the weight-shifting test. Sensitivity to detect changes and reproducibility were evaluated in 63 patients who were followed-up for 6 months and in 20 patients who were evaluated on two separate occasions during the same week, respectively.Results: The patients showed reduced stability limits, abnormal postural responses and an increased reliance on visual input with differences in intensity directly related to their degree of balance impairment. Posturographic study showed excellent convergent validity, reproducibility and sensitivity to detect changes.Conclusion: The data suggests that, regardless of the intensity of postural instability, there is a common mechanism of sensory processing to maintain balance after ABI. The NedSVE-IBV system is a valid tool to quantify balance after ABI.

Deficit awareness and cognitive performance in individuals with acquired brain injury

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. 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. 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. 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. Measures of lack of awareness predicted cognitive performance in the ABI population. Therapeutic interventions are discussed that address lack of awareness after ABI.

Anxiety as a primary predictor of functional impairment after acquired brain injury: A brief report.

Cognitive and emotional symptoms are primary causes of long-term functional impairment after acquired brain injury (ABI). Although the occurrence of post-ABI emotional difficulties is well-documented, most investigators have focused on the impact of depression on functioning after ABI, with few examining the role of anxiety. Knowledge of the latter's impact is essential for optimal treatment planning in neurorehabilitation settings. The purpose of the present study is therefore to examine the predictive relationships between cognition, anxiety, and functional impairment in an ABI sample. Multiple regression analyses were conducted with a sample of 54 outpatients with ABI. Predictors selected from an archival data set included standardized neuropsychological measures and Beck Anxiety Inventory scores. Dependent variables were caregiver ratings of functional impairments in the Affective/Behavioral, Cognitive, and Physical/Dependency domains. Anxiety predicted a significant proportion of the variance in caregiver-assessed real-life affective/behavioral and cognitive functioning. In contrast, objective neuropsychological test scores did not contribute to the variance in functional impairment. Neither anxiety nor neuropsychological test scores significantly predicted impairment in everyday physical/dependency function. These findings support the role of anxiety in influencing functional outcome post-ABI and suggest the necessity of addressing symptoms of anxiety as an essential component of treatment in outpatient neurorehabilitation.

Psychometric Properties and Feasibility of Instruments Used to Assess Awareness of Deficits After Acquired Brain Injury

Unawareness of deficits after acquired brain injury (ABI) is often reported in the clinic. Several methods have been developed to measure a patient's awareness of deficits after ABI; however, no criterion standard currently exists to measure this phenomenon. To review all instruments for measuring awareness of deficits and evaluate their psychometric and conceptual properties as well as their feasibility. Systematic literature search for available awareness measurement instruments used in experimental ABI studies. Instruments were divided into the following 4 assessment methods: clinician ratings, structured interviews, performance-based discrepancy, and self-other rating discrepancy methods. The quality of the instruments was evaluated. The literature search identified 39 instruments and 8 of these were selected. The following 3 instruments stood out in terms of quality: Self-Awareness of Deficits Interview, Patient Competency Rating Scale, and Awareness Questionnaire. Although these quantitative instruments are useful tools in research, they have limited utility in the clinic because they only measure intellectual awareness. Therefore, in addition to these instruments, qualitative tools should also be used to gain a complete view of a patient's awareness problem.

Evaluación de las necesidades de los familiares de personas afectadas de Daño Cerebral Adquirido mediante el Cuestionario de Necesidades Familiares.

The present study aimed to adapt the Family Needs Questionnaire (FNQ; Kreutzer, 1988) to the Spanish population. This instrument was developed to assess perceptions of the families of their own needs after Acquired Brain Injury (ABI) of a relative. The questionnaire includes 6 factors: Need for Health Information, Need for Emotional Support, Need for Instrumental Support, Need for Professional Support, Need for a Support Network and Need for Involvement with Care. 223 family members of persons with ABI participated in this study. Factor analysis confirmed the original 6 factor structure and internal consistency coefficients were good. The results also show that information needs are considered as the most important and satisfied. In contrast, the needs of professional and emotional support are the least satisfied.

Clinical Assessment of Hand Motor Performance After Acquired Brain Injury With Dynamic Computerized Hand Dynamometry: Construct, Concurrent, and Predictive Validity

Barden HL, Nott MT, Heard R, Chapparo C, Baguley IJ. Clinical assessment of hand motor performance after acquired brain injury with dynamic computerized hand dynamometry: construct, concurrent, and predictive validity. ObjectiveTo assess the construct, concurrent, and predictive validity of dynamic computerized hand dynamometry. DesignProspective correlational study between dynamometry and functional upper limb performance. SettingHospital outpatient spasticity clinics. ParticipantsAdults with upper motor neuron syndrome affecting the upper limb after acquired brain injury (ABI) (n=38; median age, 50y; range, 18–81y) and healthy adult control participants (n=27; median age, 37y; range, 22–62y). InterventionNot applicable. Main Outcome MeasuresDynamic computerized dynamometry elements of hand performance (isometric force, force velocity, isometric grip work, contraction and relaxation duration) and the Action Research Arm Test. ResultsMotor elements of hand performance objectively measured by the dynamic computerized dynamometry protocol achieved moderate to good validity when correlated with standardized measures of functional hand performance. Dynamic computerized dynamometry identified clear differences in hand performance between participants with and without ABI. Within the ABI group, dynamic computerized hand dynamometry achieved fair to moderate predictive validity with regards to whether a participant would be referred for botulinum toxin A injections. ConclusionsThis study provides support for the construct, concurrent, and predictive validity of the dynamic computerized dynamometry protocol.

Point of Entry and Functional Outcomes After Comprehensive Day Treatment Participation

Micklewright JL, Yutsis M, Smigielski JS, Brown AW, Bergquist TF. Point of entry and functional outcomes after comprehensive day treatment participation. Objectives To explore the relationship between point of entry into a comprehensive day treatment (CDT) program and outcomes after acquired brain injury (ABI). We hypothesized that participants entering our program 0 to 6 months postinjury would demonstrate greater declines in neurobehavioral sequelae and improvements in residential/vocational independence than those entering >6 to 12 and >12 to 24 months postinjury. Design Retrospective examination of admission, discharge, and 1-year follow-up data from a CDT program. Setting A large Midwestern academic medical center. Participants Adult CDT participants with traumatic brain injuries (TBI) (n=54) or cerebrovascular accidents (CVAs) (n=29). Interventions A CDT rehabilitation program. Main Outcome Measures Portland Adaptability Inventory/Mayo-Portland Adaptability Inventory (percent change scores between admission and discharge) and the Independent Living and Vocational Independence Scales. Results Time since injury was categorically coded into the 3 aforementioned point of entry groups. A 2 (injury type) × 3 (point of entry) between subjects analysis of covariance revealed a significant main effect for the point of entry ( P<.001). Post hoc tests indicated that individuals entering the program 0 to 6 months postinjury demonstrated significantly greater treatment gains than those entering 6 to 12 or 12 to 24 months postinjury. Within group chi-square analyses revealed that a significantly higher percentage of the early entry participants were living and working independently at discharge and 1-year follow-up. Conclusions Entry into a CDT program (0–6mo postinjury) is associated with significantly greater declines in neurobehavioral sequelae and improvements in residential and vocational independence in participants with TBI or CVA. Sustainable modest treatment gains were also observed in the late entry groups, suggesting that these individuals also benefit significantly from CDT program participation.