Cognitive Rehabilitation Research Articles

Bibliometric Analysis of Research on Exercise Intervention for Cancer-Related Cognitive Impairments.

Introduction: Cancer treatments frequently lead to cognitive impairments, affecting a substantial global population. Among various approaches, exercise has emerged as a promising strategy for rehabilitation. However, a comprehensive bibliometric analysis of research in this field is lacking. Methods: We conducted a bibliometric analysis of 10,345 articles sourced from the Web of Science database using the R package "bibliometrix". Our analysis examined publication trends, leading countries, journals, authors, institutions, keywords, and prevalent themes. Results: Over the past two decades, research on exercise interventions for cancer-related cognitive impairments (CRCI) has advanced significantly. Nonetheless, challenges persist in elucidating underlying mechanisms, developing innovative strategies, and creating effective tools. Conclusions: The number of publications notably increased from 1998 to 2023, although there has been a recent decline in citations. The United States (US) leads in both publications and citations, while China is showing increasing influence. Using Lotka's Law in our bibliometric analysis, we identified 58 key authors in the field of exercise interventions for CRCI. Leading institutions such as the University of Toronto and Duke University are at the forefront of this research. Although the Journal of Clinical Oncology has fewer publications, it remains influential. Current research focuses on exercise interventions to enhance the quality of life for cancer patients, with particular emphasis on cognitive rehabilitation in breast cancer and the challenges faced by survivors. Future research should delve deeper into intervention mechanisms, behavioral strategies, telemedicine, and precise cognitive assessment tools.

A lifespan perspective on fetal alcohol syndrome: Developmental challenges and outcomes

Fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorder (FASD) result from alcohol exposure during the intrauterine life of the fetus and are the most common nonheritable, avoidable causes of intellectual disability and a wide range of neurobehavioral outcomes. Alcohol causes neurotoxicity in the developing brain. Children with FASD experience behavioral issues from an early age and progress to adulthood. The prevalence of alcohol consumption among women is increasing. Clinically, symptoms in children with FAS manifest in a wide range of ways, probably as a result of the quantity and timing of alcohol exposure, as well as maternal and genetic effects. All of these elements contribute to the mechanisms through which alcohol harms a growing brain, the specifics of which are still largely unknown. Neuroimaging reveals alterations in the structure of the brain, white matter structure, cortical development, and functional connections. However, recent advancements and ongoing research have yielded encouraging findings that could result in the use of FAS screening tools and therapy for individuals. Intervention aims to enhance development, address behavioural challenges, and ensure suitable educational programming. Prioritizing early childhood intervention is crucial to prevent secondary disabilities that may arise from delays in obtaining a definitive diagnosis of Fetal Alcohol Syndrome. Effective nutritional therapies as well as cognitive rehabilitation are now being tested. This disorder represents the intersection of complicated societal, community, family, and biological circumstances that increase the risk for intergenerational suffering, health disparity, and social injustice. This paper aims to guide healthcare professionals and policymaker in enhancing the quality of life for individuals with FAS through effective strategies.

Effect of tDCS combined with virtual reality for post-stroke cognitive impairment: a randomized controlled trial study protocol

BackgroundPost-stroke cognitive impairment (PSCI) not only increases patient mortality and disability, but also adversely affects motor function and the ability to perform routine daily activities. Current therapeutic approaches for, PSCI lack specificity, primarily relying on and medication and traditional cognitive therapy supplemented by a limited array of tools. Both transcranial direct current stimulation (tDCS) and virtual reality (VR) training have demonstrated efficacy in improving cognitive performance among PSCI patients. Previous findings across various conditions suggest that implementing a therapeutic protocol combining tDCS and VR (tDCS - VR) may yield superior in isolation. Despite this, to our knowledge, no clinical investigation combining tDCS and VR for PSCI rehabilitation has been conducted. Thus, the purpose of this study is to explore the effects of tDCS - VR on PSCI rehabilitation.MethodsThis 4-week, single-center randomized clinical trial protocol will recruit 200 patients who were randomly assigned to one of four groups: Group A (tDCS + VR), Group B (tDCS + sham VR), Group C (sham tDCS + VR), Group D (sham tDCS + sham VR). All four groups will receive conventional cognitive rehabilitation training. The primary outcome measurement utilizes the Mini-Mental State Examination (MMSE). Secondary outcome measures include the Montreal Cognitive Assessment, Frontal Assessment Battery, Clock Drawing Test, Digital Span Test, Logic Memory Test, and Modified Barthel Index. Additionally, S-YYZ-01 apparatus for diagnosis and treating language disorders assesses subjects’ speech function. Pre- and post-four-week intervention assessments are conducted for all outcome measures. Functional near-infrared spectroscopy (fNIRS) is employed to observe changes in oxygenated hemoglobin (HbO), deoxy-hemoglobin (HbR), and total hemoglobin (HbT) in the cerebral cortex.DiscussionOur hypothesis posits that the tDCS - VR therapy, in opposed to individual tDCS or VR interventions, could enhance cognitive function, speech ability and daily living skills in PSCI patients while concurrently augmenting frontal cortical activity. This randomized study aims to provide a robust theoretical foundation supported by scientific evidence for the practical implementation of the tDCS - VR combination as a secure and efficient PSCI rehabilitation approach.Trial registrationChictr.org.cn Identifier: ChiCTR2300070580. Registered on 17th April 2023.

Pilot feasibility randomised controlled trial of cognitive–behavioural therapy for functional cognitive disorder after concussion

BackgroundFunctional cognitive disorder (FCD) may be common after a concussion, and no evidence-based treatment options are available. The current study evaluated the feasibility of a novel cognitive–behavioural therapy (CBT) protocol...

Remote delivered cognitive rehabilitation programs in Acquired Brain Injury: a systematic review of methods and outcomes

AbstractRemote delivered cognitive rehabilitation programs (r-CRP) are increasingly recognized as alternative and complementary intervention approaches to traditional cognitive rehabilitation (CR) in the context of several neurological conditions, including acquired brain injuries (ABI). This systematic review examines the methodological characteristics of currently available r-CRP for ABI patients and investigates their impact on cognitive and noncognitive outcomes. A systematic search was performed on EBSCOhost, PubMed, and Web of Science, complemented by a manual search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration Guidelines were followed. Out of 1624 studies, a total of 19 studies were included. The results demonstrate that most r-CRP were administered to middle-aged community-dwelling chronic stroke survivors and that there was no consensus regarding assessment and intervention protocols. Moreover, most r-CRP were delivered through information and communication technologies (ICTs), primarily relying on cognitive training (CT) interventions addressing multiple cognitive domains (e.g., attention, memory). These ICT-based CT programs included tasks with low ecological validity, i.e., tasks with limited real-world application (e.g., cancelation tasks with artificial stimuli), and were asynchronous, meaning that participants performed the sessions at their own pace, without real-time monitoring from a therapist. In terms of the impact of r-CRP, class I studies reported mixed and inconsistent results regarding the effect of this mode of delivery on cognitive and noncognitive outcomes of ABI patients while supporting its high feasibility and acceptability among patients. Specific recommendations for future research are provided to improve the methodological quality of clinical studies and establish the evidence base for r-CRP.

Comparing the Effects of Transcranial Direct Current Stimulation and Cognitive Rehabilitation on Language Skills and Attention in Elderly With Mild Alzheimer's Disease

Objectives Alzheimer’s disease (AD) is one of the most common problems in the elderly, which causes a decline in their cognitive function. This study aims to compare the effects of transcranial direct current stimulation (tDCS) and short-term cognitive rehabilitation on language skills and attention in older people with mild AD. Methods & Materials This is a quasi-experimental study with a pre-test/post-test/follow-up design. Participants were 60 people over 65 years of age with mild Alzheimer’s referred to a neurologist in 2022, who were selected by a convenience sampling method and were randomly assigned into two experimental groups and one control group (20 in each group). Then, the tDCS was applied in one experimental group at 10 sessions of 20 minutes once a week and the short-term cognitive rehabilitation program was provided to the second experimental group at 9 sessions of 90 minutes, once a week. No intervention was provided to the control group. Before, one week after (post-test) and one month after (follow-up) the end of the intervention, the assessments were conducted in all groups using Addenbrooke’s cognitive examination- revised (ACE-R). For data analysis, repeated measures analysis of variance test was used in SPSS software, version 23. Results Both methods improved the writing and naming domains of language skills, but they had no significant effect on the attention variable. Conclusion Both tDCS and short-term cognitive rehabilitation can be used to improve the language skills of older adults with mild AD.

Measuring Impairment-Specific Gains in Individual Cognitive Rehabilitation Through a Systematic Therapy Protocol.

This study investigated treatment-induced performance gains in memory function following therapy through the Intensive Cognitive Communication Rehabilitation (ICCR) program for young adults with acquired brain injury (ABI). We aimed to determine the utility of a novel approach to measuring memory performance improvement across semesters of therapy using (a) systematic treatment tasks called Individualized Quantitative Protocols (IQPs) as compared to (b) standardized measures of memory function. Retrospective IQP data spanning five consecutive ICCR semesters were collected from patients (N = 13) with ABI. Raw task-accuracy data were scaled to account for task difficulty gradation. Linear mixed-effects models (LMMs) were used to evaluate the degree of memory improvement-measured by scaled IQP scores-as a function of therapy duration, age, time postinjury, and aphasia; pre- to posttreatment effect sizes were also calculated. For comparison, similar LMMs were run using standardized metrics of memory abilities as the outcome measure. Results showed significant treatment-induced improvements, with gains at the session level (β = 2.76; t = 2.23; p = .047), when improvement was measured using IQP scaled scores. Standardized metrics did not show significant improvement as a function of therapy. Effect size analysis mirrored LMM results, with a large (d = 0.92, 95% confidence interval [0.35, 1.49]) pre- to posttreatment effect when change was measured using IQP scaled scores and a small effect for standardized measures. This preliminary study demonstrates the utility of a granular, individualized metric to index significant impairment-based performance gains following ICCR treatment. These results introduce promise for future analysis of complex treatment data. Additionally, they provide another lens with which to assess treatment progress and its significance. https://doi.org/10.23641/asha.27045937.

StrokeCog-R: Protocol for a Pilot Randomised Controlled Trial Of A Novel Cognitive Rehabilitation Intervention For Post-Stroke Cognitive Impairment

Abstract Background Post-stroke cognitive impairment (PSCI) affects 50% of patients six months post-stroke and is associated with increased disability, reduced quality of life, diminished independence, and a higher risk of long-term care and dementia. Addressing cognitive impairment is crucial to maximise patient recovery, facilitate the return to pre-stroke activities, and optimise secondary prevention efforts. However, cognitive rehabilitation is underrepresented in standard stroke rehabilitation protocols. This pilot randomised controlled trial (RCT) aims to evaluate a novel cognitive rehabilitation intervention, StrokeCog-R, designed to enhance cognitive function in stroke survivors with PSCI. The primary aims are to assess the feasibility of patient recruitment and retention and to determine the statistical power needed for a definitive trial. A secondary aim is to evaluate the efficacy and acceptability of the intervention for individuals with mild-to-moderate PSCI. Methods Sixty-four consecutive stroke patients with mild-to-moderate PSCI will be recruited and randomly assigned to either the intervention group (StrokeCog-R) or the control group (usual care). The intervention involves five weeks of group-based cognitive rehabilitation using “Rehearsal-Based” and “Compensatory-Based” strategies, supplemented with tailored home activities. Cognitive function, self-efficacy, and caregiver psychological wellbeing will be assessed pre- and post-intervention (or control) and at a four-month follow-up. Intervention acceptability will be documented through focus groups following each intervention. Recruitment is ongoing, and the first intervention group has concluded. Results Recruitment and retention rates, the feasibility of randomisation, patient acceptability, and resource utilisation will be evaluated. Additionally, the effectiveness of various communication techniques for retaining participants between the intervention period and the four-month follow-up will be assessed. These data will inform recruitment strategies and the determination of necessary effect sizes to power a definitive trial. Conclusion This study will provide critical insights for a definitive trial, potentially making a substantial contribution to the evidence base for cognitive rehabilitation in stroke patients.

Longitudinal investigation of optic chiasm in patients with traumatic brain injury

BackgroundTraumatic brain injury (TBI) often precipitates a cascade of neurophysiological alterations, impacting structures such as the optic nerve and ocular motor system. However, the literature lacks expansive investigations into the longitudinal changes in the optic chiasm and its relationship with the clinical recovery of visual processing. This study aimed to scrutinize longitudinal changes in optic chiasm volume (OCV) and establish the relationship of OCV with process speed index at 12 months post-injury. Process speed index is derived from Wechsler Adult Intelligence Scale IV.MethodsThorough cross-sectional and longitudinal analyses were executed, involving 42 patients with moderate to severe TBI and 35 healthy controls. OCV was acquired at 3, 6, and 12 months post-injury using T1-weighted images. OCV of healthy controls and that of patients with TBI at 3, 6, and 12 months post-injury were compared using a Mann-Whitney U test. A multiple linear regression model was constructed to assess the association between OCV and PSI and to predict PSI at 12 months post-injury using OCV at 3 months post-injury.ResultsOCV of patients with TBI was significantly larger compared to healthy controls, persisting from 3 to 12 months post-injury (p < 0.05). This increased OCV negatively correlated with PSI at 12 months post-injury, indicating that larger OCV sizes were associated with decreased PSI (p = 0.031). Furthermore, the multiple linear regression model was significant in predicting PSI at 12 months post-injury utilizing OCV at 3 months post-injury (p = 0.024).ConclusionFor the first time, this study elucidates the increased OCV and the significant association between OCV in sub-chronic stage and PSI at 12 months post-injury, potentially providing clinicians with a tool for anticipatory cognitive rehabilitation strategies following TBI.

Brain tumor patient perceptions toward repetitive transcranial magnetic stimulation for rehabilitation after surgery

Abstract Background Repetitive transcranial magnetic stimulation (rTMS) is established for depression and rehabilitation after stroke and is emerging for cognitive rehabilitation. We sought to evaluate patient and carer perceptions toward rTMS for rehabilitation after neurosurgery. Methods Two surveys were undertaken. Group 1: Patients who received 7 days of rTMS for motor or language rehabilitation for severe postoperative deficits following lesional resection were prospectively surveyed on the last day of their rTMS treatment, as well as their next of kin. Group 2: Patients who had previously been diagnosed with glioma but did not receive rTMS were retrospectively surveyed through two brain tumor charities, including next of kin. Results Group 1: Twenty-one responses. Eleven patients, 10 next of kin. The commonest pathology was WHO Grade 4 glioma (n = 3). Group 2: 24 responses. Sixteen patients, 8 next of kin. The commonest pathology was WHO Grade 2 glioma (n = 7). Most Group 1 respondents reported a positive experience of rTMS (15/21). Patients experienced subjective improvements in gross motor functions of arm and leg weakness and purposeful movement (9/11). Lack of subjective motor improvement was associated with adverse symptoms (e.g., headaches; p = .01). Group 2 respondents were supportive of rTMS. Key priorities included motor and cognitive rehabilitation. They were accepting of longer and more frequent rTMS sessions than Group 1 (p = .028 and &amp;lt;.001, respectively). Commonest concerns pertained to side effects are seizures and headaches. Conclusions rTMS for rehabilitation was well-tolerated by patients with side effects being commoner in those with no subjective motor improvements. Nontreated patients and their next of kin would find longer and more sessions acceptable but have concerns about potential side effects.

Cognitive Performance is Associated With 1-Year Participation and Life Satisfaction Outcomes: A Traumatic Brain Injury Model Systems Study.

To determine, in persons with traumatic brain injury (TBI), the association between cognitive change after inpatient rehabilitation discharge and 1-year participation and life satisfaction outcomes. Secondary analysis of prospectively collected TBI Model Systems (TBIMS) data. Inpatient rehabilitation and community. 499 individuals with TBI requiring inpatient rehabilitation who completed the Brief Test of Adult Cognition by Telephone (BTACT) at inpatient rehabilitation discharge (ie, baseline) and 1-year postinjury. Participation Assessment with Recombined Tools-Objective (PART-O) and Satisfaction with Life Scale (SWLS). Of 2,840 TBIMS participants with baseline BTACT, 499met inclusion criteria (mean [standard deviation] age=45 [19] years; 72% male). Change in BTACT executive function (EF) was not associated with 1-year participation (PART-O; β=0.087, 95% CI [-0.004, 0.178], P =.061) when it was the sole model predictor. Change in BTACT episodic memory (EM) was associated with 1-year participation (β=0.096, [0.007, 0.184], P =.035), but not after adjusting for demographic, clinical, and functional status covariates (β=0.067, 95% CI [-0.010, 0.145], P =.089). Change in BTACT EF was not associated with life satisfaction total scores (SWLS) when it was the sole model predictor (β=0.091, 95% CI [-0.001, 0.182], P =.0503). Change in BTACT EM was associated with 1-year life satisfaction before (β=0.114, 95% CI [0.025, 0.202], P =.012) and after adjusting for covariates (β=0.103, [0.014, 0.191], P =.023). In secondary analyses, change in BTACT EF was associated with PART-O Social Relations and Out and About subdomains before (Social Relations: β=0.127, 95% CI [0.036, 0.217], P =.006; Out and About: β=0.141, 95% CI [0.051, 0.232], P =.002) and after (Social Relations: β=0.168, 95% CI [0.072, 0.265], P <.002; Out and About: β=0.156, 95% CI [0.061, 0.252], P <.002) adjusting for functional status and further adjusting for covariates (Social Relations: β=0.127, 95% CI [0.040, 0.214], P =.004; Out and About: β=0.136, 95% CI [0.043, 0.229], P =.004). However, only the models adjusting for functional status remained significant after multiple comparison correction (ie, Bonferroni-adjusted alpha level=0.002). EF gains during the first year after TBI were related to 1-year social and community participation. Gains in EM were associated with 1-year life satisfaction. These results highlight the potential benefit of cognitive rehabilitation after inpatient rehabilitation discharge and the need for interventions targeting specific cognitive functions that may contribute to participation and life satisfaction after TBI.

Memory problems in elderly people with traumatic brain injury

AbstractThe aim of this study is to assess the effectiveness of various therapy methods in elderly individuals with traumatic brain injury (TBI), taking into account the degree of memory loss and the severity of the injury. The study was conducted in 2022 in Moscow, Russia, and Sofia, Bulgaria, involving six clinics. A total of 200 elderly patients with TBI participated in the study, with a mean age of 72 years. Patients were categorized into groups based on the degree of memory loss and severity of the injury. Standardized tests, including the Mini‐Mental State Examination (MMSE), Clock Drawing Test, Digit Symbol Substitution Test, and Free, and Cued Selective Reminding Test, were used to assess cognitive functions. The Progressive Learning Test evaluated patients' ability to memorize and reproduce information over time. Groups receiving physical therapy and cognitive rehabilitation showed statistically significant improvement in cognitive functions compared to other therapy methods. Specifically, the mean score of the MMSE in these groups increased by 7 points (p &lt; .001). Patients with more severe memory loss demonstrated more pronounced improvement in cognitive functions following the integrated therapy approach. The mean MMSE score increased by 10 points (p &lt; .001), whereas in patients with milder memory loss, the growth was less significant (mean increase of 5 points, p &lt; .05). Groups receiving physical therapy and cognitive rehabilitation consistently demonstrated significantly better results compared to speech therapy and psychological support throughout the study period.

AS CONTRIBUIÇÕES DA NEUROPSICOLOGIA NO TRATAMENTO NÃO MEDICAMENTOSO DAS DEMÊNCIAS EM IDOSOS

Dementia syndromes are a group of disorders characterized by a progressive and global decline in cognitive functions, such as memory, language, attention, reasoning, and judgment. These changes significantly interfere with a person’s ability to perform daily activities and interact socially. Although the use of drugs is the basis for the treatment of dementia syndromes, non-pharmacological and therapeutic treatment is an important ally in these cases. Neuropsychology presents itself as an essential resource for the implementation of non- pharmacological treatment, where it can monitor its progress and carry out cognitive rehabilitation. Neuropsychological rehabilitation presents strategies that help reduce cognitive deficits and is applied in the treatment of cognitive alterations of reasoning, attention, memory, communication, and others. This intervention aims to support individuals so that they can improve their functions in important areas of their lives. This article aims to analyze how Neuropsychology performs the treatment of dementias, presenting its interventions and therapeutic approaches. In addition, we aim to investigate how these interventions can bring benefits to the quality and independence in their activities of daily living.

Association between widowhood and cognitive function among Chinese older adults with hearing impairment: the moderating effect of social support and participation

BackgroundOlder adults with hearing impairments are vulnerable to cognitive impairment. Although previous reports suggest a correlation between widowhood and cognitive impairment, further investigation is needed to elucidate the effect of widowhood on cognitive function and the moderating effects of social support and participation on widowhood-related cognitive impairment in this vulnerable demographic.MethodsThe study’s data were sourced from the nationally representative Chinese Longitudinal Healthy Longevity Survey (CLHLS) for the years 2011, 2014, and 2018. Multiple linear regression was used to analyze the association between widowhood and cognitive function among older adults. Multivariate logistic regression examined the effect of widowhood on the likelihood of experiencing various levels of cognitive impairment in older adults with hearing impairments. A moderating effect model explored the roles of social support and participation in mitigating widowhood-related cognitive impairment.ResultsThe cognitive function of older adults with hearing impairment was found to be lower than that of those without hearing impairment. Widowhood was significantly negatively correlated with Mini-Mental State Examination (MMSE) scores in older adults, both with (Coef. = -0.898) and without (Coef.: = -0.680) hearing impairments. A stronger association was observed between widowhood and declining cognitive function among older adults with hearing impairment. Specifically, widowhood may be more likely to significantly increase the likelihood of moderate and severe cognitive impairment (RRR = 1.326, 1.538) among older adults with hearing impairments. Social support and social participation significantly moderated the cognitive impairment associated with widowhood among hearing-impaired older adults. These forms of support and engagement are buffers against the risk of widowhood-related cognitive impairment among this demographic.ConclusionsOur findings indicate that widowhood is significantly associated with cognitive impairment in older adults with hearing impairment. Social support and participation help mitigate this risk. Strategies should prioritize early screening, specialized cognitive rehabilitation, comprehensive care, and enhancing social support and participation to maintain cognitive health in this vulnerable population following widowhood.

Comparative Analysis of LORETA Z Score Neurofeedback and Cognitive Rehabilitation on Quality of Life and Response Inhibition in Individuals with Opioid Addiction.

Background. Previous studies has shown that conventional neurofeedback and cognitive rehabilitation can improve psychological outcomes in people with opioid use disorders. However, the effectiveness of LORETA Z-score neurofeedback (LZNFB) and attention bias modification training on quality of life and inhibitory control of these people has not been investigated yet. LZNFB targets deeper brain structures with higher precision, compared to conventional neurofeedback that typically focuses on surface EEG activity. The present study aims to compare the effect of these two methods on quality of life and response inhibition in men with opioid use disorders under methadone maintenance therapy (MMT). Methods. In this randomized controlled clinical trial with a pre-test, post-test, follow-up design, 30 men with opioid use disorders under MMT were randomly assigned into three groups of LZNFB, attention bias modification training, and control (MMT alone). The LZNFB and Cognitive Rehabilitation groups received 20 and 15 sessions of treatment, respectively. The Persian versions WHO Quality of Life-BREEF questionnaire and the Go/No-Go test were completed by the participants before, immediately after, and one month after interventions. The collected data were analyzed in SPSS v.22 software. Results. Both intervention groups showed a significant improvement in quality-of-life score and a significant reduction in response time at the post-test phase (P < .05), where LZNFB group showed more improvement in quality of life and more reduction in response inhibition. After one month, the increase in quality of life continued in both groups, while the decrease in response time continued only in the LZNFB group. Conclusion. Both LZNFB and attention bias modification training are effective in improving quality of life and response inhibition of men with OUD under MMT, however, LZNFB is more effective.

B - 43 Utility of the Activity Measure for Post-Acute Care (AM-PAC) as a Measure of Functional Recovery across the TBI Rehabilitation Continuum

Abstract Objective To evaluate the utility of the AM-PAC (Activity Measure for Post-Acute Care) for functional assessment of patients with Traumatic Brain Injury (TBI) across inpatient and outpatient rehabilitation settings. We evaluated (1) Longitudinal changes (1-year) in cognitive and physical recovery patterns across the rehabilitation continuum (2) Concurrent validity of AM-PAC as compared to traditional measures. Method A prospective repeated measures cohort study of adults with TBI (n = 186), where 87 participants received inpatient rehabilitation (IR), and 99 participants received outpatient cognitive rehabilitation (CR). Functional recovery was assessed at IR admission, discharge, 6 months and 1 year, and at admission/discharge from CR for post-acute participants. Functional measures included AM-PAC-Basic Mobility (BM), Daily Activities (DA), and Applied Cognitive (AC) domains, Neuropsychological Assessment Battery (NAB), Texas Functional Living Scale (TFLS), Functional Independence Measure (FIM), Participation Assessment with Recombined Tools-Objective (PART-O), and Mayo-Portland Adaptability Inventory (MPAI-4: self-awareness). Results The AMPAC was sensitive to changes throughout the care continuum, demonstrating medium effect sizes across all three functional domains. Notably, AMPAC scores showed greater change compared to traditional tools (90% and 68% confidence levels). Additionally, analysis of Minimum Detectable Change thresholds demonstrated significant improvements, across settings and within moderate/severe TBI (p &amp;lt; 0.05), followed by predictably smaller gains in the mild TBI population (p &amp;lt; 0.05), underscoring the clinical relevance of these findings. Conclusions Results demonstrate that the AM-PAC is a practical, valid and sensitive scale responsive to longitudinal ecological and functional change in TBI. Analysis confirms the effectiveness of functional assessments, particularly emphasizing strengths of the AMPAC.

A - 29 Support for Use of Cognitive Rehabilitation Strategies to Enhance Accessibility of Medications for Opioid Use Disorder Treatment: a Qualitative Secondary Data Analysis

Abstract Objective Despite cognitive rehabilitation paradigms gaining support as adjunctive interventions to opioid use disorder treatments, limited research details strategies that medical providers who prescribe medications for opioid use disorder (MOUD) employ to attend to patient cognitive limitations. We conducted a secondary data analysis to explore this gap in the literature. Method The parent study included individual interviews with 23 MOUD treatment providers from New Mexico and Washington state, and the interview guide centered barriers and facilitators to equitable implementation. A deductive thematic analysis was utilized to identify sources, solutions, and strategies that MOUD providers identified for patients experiencing cognitive impairments. Results Regarding sources of cognitive dysfunction, history of stroke, overdose, severe mental illness, and traumatic brain injury were emphasized. Low health literacy was also identified as a justification to modify approach. Strategies providers utilized fell under five subthemes: visual aids; communication (e.g., repetition; open questions); engaging caregivers; leveraging peer support; and increasing visit frequency. Though less common, some providers emphasized only focusing on substance use and safety. Conclusions There have been calls to better attend to cognitive functioning as a potential moderator of MOUD treatment outcomes; however, existing personalized care guidelines do not address this adequately. The present study revealed variability in clinical decision-making that may exacerbate health inequities among individuals seeking MOUD treatment –a population disproportionately impacted by social determinants of health (e.g., housing; access to healthcare; quality of education). Greater focus on equitable MOUD implementation is needed to explore methods of personalizing care for individuals seeking MOUD treatment presenting with cognitive dysfunction.

How Interaction Techniques Affect Workload in a Virtual Environment During Multitasking

Abstract Virtual environments (VEs) can be modulated and adapted to the needs of each user, but in the case of patients, performance can be affected by several factors that are difficult to expertise. The objective of the study is to explore the relationship between workload and the interaction techniques used during selection in a virtual apartment. Fifty-six participants performed tasks in a VE with 2D or, more immersive, 3D interaction techniques. The VE used was the Virtual Multitasking Test (Banville et al., 2018) where participants realized several everyday tasks in a virtual apartment. Workload and variables describing how individuals felt in the VE were measured using questionnaires, and performance in VE has been assessed. Results showed that 2D selection techniques have a better usability than 3D ones. The performance (success in task realization) on the virtual tasks was not impacted by the interaction techniques. Our results suggest that the easier it is to use an interaction technique, the less workload is associated with it. Sense of presence and cybersickness were affected by 3D interaction techniques. Thus, future VEs for cognitive assessment and rehabilitation, based on instrumental activities of daily living, will have to adapt their interaction techniques to different users.

Postoperative Delirium and Neurocognitive Disorders: A Comprehensive Review of Pathophysiology, Risk Factors, and Management Strategies.

Postoperative delirium (POD) and neurocognitive disorders (NCDs) are common and serious complications that can occur after surgery, particularly in older adults and those with preexisting cognitive impairments. These conditions are associated with significant morbidity, increased healthcare costs, and reduced quality of life. Understanding the underlying mechanisms, risk factors, and effective management strategies for POD and NCDs is critical for improving patient outcomes and reducing the burden on healthcare systems. This comprehensive review aims to synthesize current knowledge on the pathophysiology, risk factors, and management strategies for POD and NCDs. It explores the neurobiological and molecular mechanisms contributing to these conditions, identifies the patient-related, surgical, and environmental factors that increase risk, and evaluates pharmacological and non-pharmacological approaches to prevention and treatment. A thorough literature review was conducted using recent studies, clinical guidelines, and expert consensus to provide a detailed overview of the pathophysiology, risk factors, clinical presentation, prevention, and management of POD and NCDs. The pathophysiology of POD and NCDs involves complex interactions between neuroinflammatory processes, neurotransmitter imbalances, and brain network disruptions. Risk factors include advanced age, preexisting cognitive impairment, type and duration of surgery, and perioperative complications. Management strategies emphasize a multidisciplinary approach, incorporating preoperative optimization, careful intraoperative management, and postoperative interventions. Pharmacological treatments, such as antipsychotics, and non-pharmacological approaches, including environmental modifications and cognitive rehabilitation, play crucial roles in management. Postoperative delirium and NCDs are multifactorial conditions with significant impacts on surgical outcomes. Effective management requires a comprehensive understanding of their pathophysiology and risk factors and the implementation of targeted prevention and treatment strategies. Future research should focus on personalized approaches to prevention and treatment, further elucidation of mechanisms, and developing predictive models to enhance care for patients at risk of these neurocognitive complications.

Prevalence of post-intensive care syndrome: Observations from a tertiary care hospital in Eastern India

ABSTRACT Background: Post-intensive care syndrome (PICS) refers to physical, cognitive and psychological symptoms that occur after a patient is discharged from the intensive care unit (ICU). Aims: The present study aimed to explore the prevalence of PICS among ICU survivors of a tertiary care setup in Eastern India. Methods: A single-centre prospective cohort study was conducted amongst patients admitted to the ICU. A predefined, structured interview in 1st month, 3rd month, 6th month after ICU admission was done. Baseline characteristics were noted. Physical and cognitive impairment, psychological distress and general health were assessed using the Barthel Index (BI), mini-mental state examination (MMSE) tool, Hospital Anxiety and Depression Scale (HADS) and EuroQoL Visual Analogue Scale. Results: Of the 150 patients included in the study, the mean Acute Physiology and Chronic Health Evaluation II score was 20.87. The leading cause of ICU admission was sepsis (40.7%), followed by acute exacerbation of chronic obstructive pulmonary disease and pneumonia (14%). The median stay in the ICU was 8 days. Mean BI significantly decreased from 79.20 at baseline to 60.17 and 64.33 in the 3rd and 6th months, respectively. The mean HADS-Depression score increased from 3.79 at baseline to 7.08 at 3rd and 5.92 at 6th month. Similarly, the mean HADS-Anxiety score increased from 4.37 at baseline to 7.44 at 3rd and 6.31 at 6th month. The mean MMSE score decreased from 24.61 at baseline to 22.26 at the 3rd and 6th months, respectively. Thus, PICS was recorded in 90% of cases in the 3rd month and 89.3% in the 6th month. Conclusion: The management of PICS involves a multidisciplinary approach, including physical rehabilitation, cognitive rehabilitation and psychological support.