Neurocognitive Rehabilitation Research Articles

The co-occurrence between depressive symptoms and paranoid ideation: A population-based longitudinal study

BackgroundThe aim of this study was to examine longitudinally in the general population (a) whether depressive symptoms co-occur with paranoid ideation from late adolescence to middle age (b) whether depressive subsymptoms are differently linked with paranoid ideation (c) whether depressive symptoms are associated with state-level or trait-level paranoid ideation. MethodsAltogether 2109 subjects of the Young Finns study completed the Paranoid Ideation Scale of the Symptom Checklist-90 Revised and a modified version of the Beck Depression Inventory in 1992, 1997, 2001, 2007, and 2012, and the Beck Depression Inventory-II in 2007, 2011, and 2012. ResultsHigher self-rated depressive symptoms were associated with the course of more severe paranoid ideation over age, especially in late adolescence and early adulthood. Regarding depressive subsymptoms, the associations of negative attitude and performance difficulties with paranoid ideation were evident over age, whereas the influence of somatic symptoms (such as changes in sleep and appetite) was not significant until after early adulthood. Additionally, depressive symptoms were more evidently associated with the development of trait- than state-level paranoid ideation. LimitationsOur study mostly captured mild depressive and paranoid symptoms. The results cannot be directly generalized to clinical populations. ConclusionsDepressive symptoms were associated with the course of paranoid ideation from late adolescence to middle age. Patients with paranoid ideation might merit from evaluation of potential depressive symptoms, especially in late adolescence and early adulthood. Among patients with co-occurring depressive symptoms and paranoid ideation, there may be a substantial need for neurocognitive rehabilitation and community-based treatments.

Advances in neurocognitive rehabilitation research from 1992 to 2017: The ascension of neural plasticity.

The last 25 years have seen profound changes in neurocognitive rehabilitation that continue to motivate its evolution. Although the concept of nervous system plasticity was discussed by William James (1890), the foundation for experience-based plasticity had not reached the critical empirical mass to seriously impact rehabilitation research until after 1992. The objective of this review is to describe how the emergence of neural plasticity has changed neurocognitive rehabilitation research. The important developments included (a) introduction of a widely available tool that could measure brain plasticity (i.e., functional MRI); (b) development of new structural imaging techniques that could define limits of and opportunities for neural plasticity; (c) deployment of noninvasive brain stimulation to leverage neural plasticity for rehabilitation; (d) growth of a literature indicating that exercise has positively impacts neural plasticity, especially for older persons; and (e) enhancement of neural plasticity by creating interventions that generalize beyond the boundaries of treatment activities. Given the massive literature, each of these areas is developed by example. The expanding influence of neural plasticity has provided new models and tools for neurocognitive rehabilitation in neural injuries and disorders, as well as methods for measuring neural plasticity and predicting its limits and opportunities. Early clinical trials have provided very encouraging results. Now that neural plasticity has gained a firm foothold, it will continue to influence the evolution of neurocognitive rehabilitation research for the next 25 years and advance rehabilitation for neural injuries and disease. (PsycINFO Database Record

Building a psychosocial rehabilitation unit: The experience of centro hospitalar entre Douro e Vouga

IntroductionIn Portugal, the National Mental Health Plan sought to reform the mental health care system, decentralizing mental health care by promoting community based services. Guidelines point to treatment of Psychotic Disorders with collaborative, person directed and individualized approaches.ObjectiveThe authors propose to describe the development of a new psychosocial rehabilitation unit in a recently created psychiatric department.MethodsThe CHEDV's psychiatry department (2009) serves a population of around 340,000. The Psychosocial Rehabilitation Unit (2015) aims to ensure a multidisciplinary and integrated response to users with major psychiatric disorders. The Psychosocial Rehabilitation Unit structures 4 axes of response: detection and initial approach of the disease, intervention in crisis, psychosocial rehabilitation and management of difficult patients.ResultsCHEDV's psychosocial rehabilitation unit is responsible for the care of about 25 patients daily. Treatment activities range from specialized consultations, home visits, medication management and crisis telephone to social skills training, psycho-education, neurocognitive rehabilitation, occupational workshops and social intervention/orientation. The unit bases its work on constant communication within the team but also with all other carers of the patient (in or out of hospital).ConclusionsBringing to the population a set of previously unavailable responses is the most blatant success of this unit that is helping people getting a better and closer care. To improve our work we aim at integrating the quantitative and qualitative psychometric evaluation of the patients. The lack of resources, necessity of further training, insufficient funding, and low political priority remain as the main barriers to community based mental health care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Impact of an intervention of neuro-cognitive rehabilitation in treatment resistant schizophrenia (TRS) compared to schizophrenia responder patients

IntroductionSchizophrenia is a condition with high impact in terms of disability, also because between 30% and 60% affected individuals do not respond to treatment. It has been proposed that cognitive functioning is strongly impaired in schizophrenia and even more in TRS patients. Cognitive dysfunctions are regarded to worsen psychopathology, psychosocial functioning, and overall course of the illness.ObjectivesTo investigate the impact of Cognitive Remediation (CR) on psychopathology and psychosocial functioning in TRS vs. schizophrenia responder patients.AimsTo determine whether a CR intervention could improve functional outcomes in TRS patients.MethodsWe evaluated proximal and distal effects of CR on approximately 20 schizophrenia responders and 20 TRS patients. Patients in each group were randomized to receive CR or not. Patients were assessed in training task performance, neurocognition, functional capacity, symptoms and psychosocial functioning. Evaluations were conducted at baseline, at the end of the 4-month intervention, and at 6-month, 1 and 2 year-follow-ups. The study is still in active recruitment phase.ResultsBoth TRS and schizophrenia responder patients exposed to CR exhibited a significant improvement in specific neurocognitive domains, and in psychosocial functioning as assessed by either rating scales (SLOF and PSP) and performance-based measures (UPSA) at the 4-month time-point.ConclusionsCR improved psychosocial functioning in both group of patients, however, they were more pronounced in TRS patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effect of Computer-assisted Neurocognitive Rehabilitation on Inhibitory Control of the Students With Dyscalculia

Effect of Computer-assisted Neurocognitive Rehabilitation on Inhibitory Control of the Students With Dyscalculia

Significance of the Feuerstein approach in neurocognitive rehabilitation

The theory of Structural Cognitive Modifiability and Mediated Learning Experience of Reuven Feuerstein states that individuals with brain impairment, because of congenital or acquired origin, may substantially and structurally improve their cognitive functioning, by a systematic intervention based on a specific, criteria-based type of interaction ("mediated learning"). Three application systems are based on it: a dynamic-interactive assessment of learning capacity and processes of learning, the LPAD (Learning Propensity Assessment Device); a cognitive intervention program called "Instrumental Enrichment Program", which trains cognitive, metacognitive and executive functions; and a program, which is oriented at working in context, Shaping Modifying Environments. These programs have been applied in widely different target groups: from children and young adults with learning and developmental disabilities, at risk of school failure, or having failed at school, because of socio-economic disadvantage or congenital neurological impairment; disadvantaged youngsters and adults in vocational training, to elderly people at the beginning of a dementia process. Experience with cognitive rehabilitation of children and adults with acquired brain damage, has been relatively recent, first in the Feuerstein Institute's Brain Injury Unit in Jerusalem, later in other centers in different parts of the world; therefore scientific data are scarce. The purpose of this paper is to examine how the Feuerstein-approach fits into the goals and proposed approaches of cognitive rehabilitation, and to explore its relevance for assessment and intervention in individuals with congenital or acquired brain damage. The methodology of the Feuerstein approach consists of four pillars: dynamic assessment, cognitive activation, mediated learning and shaping a modifying environment. The criteria of mediated learning experience are explained with specific reference to people with acquired brain injury. The procedure of learning propensity assessment device uses visuo-spatial and verbal tasks known from neuropsychological assessment (such as Rey's complex figure drawing), as well as a in a pre-test - brief intervention - post-test format. Cognitive activation is done in various ways: a paper-and-pencil relatively content-free program called "instrumental enrichment", with transfer of learned principles into daily life situations, followed by metacognitive feedback. Four case histories of acquired brain damage are analyzed: a 19 year old man with extensive post-astrocytoma frontotemporal brain lesions; a 19 year old man with bilateral frontal and right temporal and parieto-occipital parenchymatous destruction after a traumatic brain injury; a 24 year old man with hemispherectomy for intractable epilepsy because of Sturge-Weber syndrome; and a 30-year old man with left porencephalic cyst after cerebral hemorrhage. Structural cognitive improvement could be demonstrated in positive change scores in visuo-spatial memory, associative and verbal memory, abstract thinking, and organizing tasks, even more than 10 years post-TBI. In some cases a rise in IQ has been documented. Improvement in daily life functioning and academic skills (re)learning has also been seen. Though impossible to claim scientific evidence, the case histories nevertheless suggest the importance of interactive assessment in designing intervention programs which have sufficient intensity, frequency, duration and consistency of mediation; furthermore, an essential ingredient is the ecological approach which requires working with the patient and the whole network around; a firm "belief system" or that modifiability is possible even with severe brain damage and many years after the injury; a cognitive, metacognitive and executive approach, and a quality of interaction according to criteria of mediated learning. They suggest that Feuerstein approach may offer interesting perspectives to cognitive rehabilitation. More extensive research is needed to provide a broader scientific evidence base.

A Randomized Controlled Trial to Evaluate if Computerized Cognitive Rehabilitation Improves Neurocognition in Ugandan Children with HIV.

Clinically stable children with HIV can have neuromotor, attention, memory, visual-spatial, and executive function impairments. We evaluated neuropsychological and behavioral benefits of computerized cognitive rehabilitation training (CCRT) in Ugandan HIV children. One hundred fifty-nine rural Ugandan children with WHO Stage I or II HIV disease (6 to 12 years; 77 boys, 82 girls; M = 8.9, SD = 1.86 years) were randomized to one of three treatment arms over a 2-month period. The CCRT arm received 24 one-hour sessions over 2 months, using Captain's Log (BrainTrain Corporation) programmed for games targeting working memory, attention, and visual-spatial analysis. These games progressed in difficulty as the child's performance improved. The second arm was a "limited CCRT" with the same games rotated randomly from simple to moderate levels of training. The third arm was a passive control group receiving no training. All children were assessed at enrollment, 2 months (immediately following CCRT), and 3 months after CCRT completion. The CCRT group had significantly greater gains through 3 months of follow-up compared to passive controls on overall Kaufman Assessment Battery for Children-second edition (KABC-II) mental processing index (p < .01), planning (p = .04), and knowledge (p = .03). The limited CCRT group performed better than controls on learning (p = .05). Both CCRT arms had significant improvements on CogState Groton maze learning (p < .01); although not on CogState attention/memory, TOVA/impulsivity, or behavior rating inventory for executive function and child behavior checklist (psychiatric behavior/symptom problems) ratings by caregiver. CCRT intervention can be effective for neurocognitive rehabilitation in children with HIV in low-resource settings, especially in children who are clinically stable on ARV treatment.

Value and Efficacy of Transcranial Direct Current Stimulation in the Cognitive Rehabilitation: A Critical Review Since 2000.

Non-invasive brain stimulation techniques, including transcranial direct current stimulation (t-DCS) have been used in the rehabilitation of cognitive function in a spectrum of neurological disorders. The present review outlines methodological communalities and differences of t-DCS procedures in neurocognitive rehabilitation. We consider the efficacy of tDCS for the management of specific cognitive deficits in four main neurological disorders by providing a critical analysis of recent studies that have used t-DCS to improve cognition in patients with Parkinson's Disease, Alzheimer's Disease, Hemi-spatial Neglect, and Aphasia. The evidence from this innovative approach to cognitive rehabilitation suggests that tDCS can influence cognition. However, the results show a high variability between studies both in terms of the methodological approach adopted and the cognitive functions targeted. The review also focuses both on methodological issues such as technical aspects of the stimulation (electrode position and dimension; current intensity; duration of protocol) and on the inclusion of appropriate assessment tools for cognition. A further aspect considered is the optimal timing for administration of tDCS: before, during or after cognitive rehabilitation. We conclude that more studies using common methodology are needed to gain a better understanding of the efficacy of tDCS as a new tool for rehabilitation of cognitive disorders in a range of neurological disorders.

Neurocognitive Deficits and Neurocognitive Rehabilitation in Adult Brain Tumors.

Neurocognitive deficits are common with brain tumors. If assessed at presentation using detailed neurocognitive tests, problems are detected in 80% of cases. Neurocognition may be affected by the tumor, its treatment, associated medication, mood, fatigue, and insomnia. Interpretation of neurocognitive problems should be considered in the context of these factors. Early post-operative neurocognitive rehabilitation for brain tumor patients will produce rehabilitation outcomes (e.g., quality of life, improved physical function, subjective neurocognition) equivalent to stroke, multiple sclerosis, and head injury, but the effect size and duration of benefit needs further research. In stable patients treated with radiotherapy +/- chemotherapy, the most frequent causes of distress include neurocognitive problems, psychological factors of anxiety, depression, fatigue, and sleep. Exercise, neurocognitive training, neurocognitive behavioral therapy, and medications to treat fatigue, behavior, memory, mood, and removal of drugs that may be associated with neurocognitive side effects (e.g., anti-epileptic drugs) all show promise in helping patients to manage the effects of their neurocognitive impairments better. As these are complex symptoms, multidisciplinary expertise is necessary to evaluate the influence of each variable to plan appropriate support and intervention. Neurocognitive rehabilitation should therefore occur in parallel with disease-centered, medical management from the outset. It should not occur in series, as a restricted phase in a patient's pathway. It should be considered in the pre- and post-operative period where there are good prospects of recovery, as one would for any brain-injured patient, so that the person may reach their optimal physical, sensory, intellectual, psychological, and social functional level. Yet the identification and selection of patients for early neurological rehabilitation and routine evaluation of cognition is uncommon in neurosurgical wards.

Application of Neuro-Cognitive Assessment and Rehabilitation (NCAR) Computerized Test in Working Memory Deficit in Parkinson

Patients with Parkinson have working memory changes, so they need rehabilitation and treatment is required for them. The purpose of current study is to determine the effect of neuro-cognitive rehabilitation computerized test on these impairments. The present cross-sectional study was conducted on 120 patients with Parkinson and neuro-cognitive rehabilitation computerized test were used for assessment (before) and rehabilitation (after) in patients in 15 minutes. Before and after neuro-cognitive rehabilitation, a significant difference was identified in neuro-cognitive rehabilitation computerized test’ scores (P<0.000). This technique can rehab in Parkinson with working memory disorders associated with neurological conditions to facilitate the acquisition.

New Perspectives in the Exploration of Korsakoff's Syndrome: The Usefulness of Neurophysiological Markers.

This perspective aims at underlining the usefulness of event-related potentials (ERP) to better understand the brain correlates of Korsakoff’s syndrome (KS), a neuropsychiatric disease characterized by severe memory impairment and most frequently resulting as a neurological complication of alcohol-dependence (AD). While ERP have been broadly used in AD, it has up to now been very little applied in KS or in the comparison of KS and AD. Within the framework of dual-process models, an influential theory postulating that addictive states result from an imbalance between under-activated reflective system and over-activated automatic-affective one, this paper proposes: (1) a brief synthesis of the main results of ERP studies in AD and KS, and (2) new research avenues using ERP to identify the electrophysiological correlates of cognitive and emotional dysfunction in KS. These experimental perspectives aim at exploring the continuity hypothesis, which postulates a gradient of impairments from AD to KS. We conclude on the possibility of developing neuropsychological strategies with electrophysiological follow-up to ensure KS diagnosis and test the efficacy of patient’s neurocognitive rehabilitation.

Neuropsychological benefits of computer-assisted cognitive rehabilitation (using FORAMENRehab program) in children with mild traumatic brain injury or partial epilepsy: A pilot study.

The number of children with different cognitive difficulties is constantly increasing. Still, too few evidence-based pediatric neurocognitive rehabilitation programs exist. The main aim of the study was to assess the efficiency and usability of computer-assisted FORAMENRehab program for training specific components of attention in children with mild traumatic brain injury (mTBI) and partial epilepsy (PE). The second aim was to specify short- and long-term effects of the intervention. Eight children between the ages of 9-12 years with attention impairment (3 with PE and 5 with mTBI) and 18 healthy controls participated. FORAMENRehab Attention software, adapted by the authors, was used for intervention. Strict intervention protocol consisting of patients completing 10 sessions over a 6-week-period to train four components of attention (sustaining, focusing, dividing, tracking) was designed and applied. Follow-up assessments were conducted after the end of the last training and 1.63 years later. After the intervention patients' sustained and complex attention improved. Long-term follow-up revealed continuing positive rehabilitation effects. 100% compliance suggested that the used method is attractive for children. These preliminary results of the pilot study give reason to presume that the method is effective in attention impairment remediation. However, more thorough research is needed.

Individualized Neuro-Cognitive Rehabilitation Can Reverse Cognitive and Memory Impairment Irrespective of Etiology: Prospective Pilot Study

To assess the efficacy of customized one-on-one neurocognitive rehabilitation training in patients with cognitive deficit from various etiologies.

Simultaneous Treatment of Neurocognitive and Psychiatric Symptoms in Veterans with Post-Traumatic Stress Disorder and History of Mild Traumatic Brain Injury: A Pilot Study of Mindfulness-Based Stress Reduction.

Treating patient populations with significant psychiatric and neurocognitive symptomatology can present a unique clinical dilemma: progress in psychotherapy can be significantly fettered by cognitive deficits, whereas neurocognitive rehabilitation efforts can be ineffective because of psychiatric overlay. Application of mindfulness-based interventions to address either cognitive or psychiatric symptoms in isolation appears efficacious in many contexts; however, it remains unclear whether this type of intervention might help address simultaneous neurocognitive and psychiatric symptomatology. In a pre-post mixed methods design pilot study, nine Veterans with post-traumatic stress disorder (PTSD) and a history of mild traumatic brain injury with chronic cognitive complaints participated in Mindfulness-Based Stress Reduction (MBSR). Clinical interview, questionnaires, and attention and PTSD measures were administered immediately before, immediately after, and 3 months after MBSR completion. Qualitative and quantitative findings suggest high levels of safety, feasibility, and acceptability. Measurement of attention revealed significant improvement immediately following MBSR (p < 0.05, d = 0.57) and largely sustained improvement 3 months after completion of MBSR (p < 0.10, d = 0.48). Significant reduction in PTSD symptoms was found immediately after MBSR (p < 0.05, d = -1.56), and was sustained 3 months following MBSR completion (p < 0.05, d = -0.93). These results warrant a randomized controlled trial follow-up. Potential mechanisms for the broad effects observed will be explored.

Combined social cognitive and neurocognitive rehabilitation strategies in schizophrenia: neuropsychological and psychopathological influences on Theory of Mind improvement.

Neurocognitive and social cognitive impairments represent important treatment targets in schizophrenia, as they are significant predictors of functional outcome. Different rehabilitative interventions have recently been developed, addressing both cognitive and psychosocial domains. Although promising, results are still heterogeneous and predictors of treatment outcome are not yet identified. In this study we evaluated the efficacy of two newly developed social cognitive interventions, respectively based on the use of videotaped material and comic strips, combined with domain-specific Cognitive Remediation Therapy (CRT). We also analysed possible predictors of training outcome, including basal neurocognitive performance, the degree of cognitive improvement after CRT and psychopathological variables. Seventy-five patients with schizophrenia treated with CRT, were randomly assigned to: social cognitive training (SCT) group, Theory of Mind Intervention (ToMI) group, and active control group (ACG). ANOVAs showed that SCT and ToMI groups improved significantly in ToM measures, whereas the ACG did not. We reported no influences of neuropsychological measures and improvement after CRT on changes in ToM. Both paranoid and non-paranoid subjects improved significantly after ToMI and SCT, without differences between groups, despite the better performance in basal ToM found among paranoid patients. In the ACG only non-paranoid patients showed an improvement in non-verbal ToM. Results showed that both ToMI and SCT are effective in improving ToM in schizophrenia with no influence of neuropsychological domains. Our data also suggest that paranoid symptoms may discriminate between different types of ToM difficulties in schizophrenia.

Experience of group conversations in rehabilitation medicine: methodological approach and pilot study.

The restoring of equilibrium after a traumatic event makes it possible to give a new significance to patients’ existence, and healthcare professionals simultaneously find themselves very close to questions of pain and disability. For these reasons, we introduced weekly group meetings of healthcare professionals and patients suffering from vascular, traumatic or neurological accidents, and meetings of professionals only at the Neurocognitive Rehabilitation Day Hospital of the University of Milan Bicocca. The aim of this paper is to identify possible indicators of changes in patients’ existence through a conversational analysis, describing the experience at the light of methodological approach and reporting the results of a pilot observational study. The patient meetings began in October 2011 and led to a process of greater closeness and trust that was expressed by means of words, gestures, emotional participation, and non-verbal communication. The pilot considers the evolution of indicators in a sample of 14 patients for a period of 9 months and a timeframe of 3 months. Supportive interventions decreased while elements of sharing progressively increased, leading to progressive increased consciousness of both self and the disease. The group of professionals found that being together allowed them to distinguish performance as the use of their technical skills from understanding the other and his/her experience as part of their own, and not only linked to the disease. The professionals’ reflections on their experiences led to the emergence of two possible ways of looking at a patient: as somebody other than me or somebody other like me.

OP39 – 2489: Improving the fundamentals of learning: Cognitive neurorehabilitation for children with partial epilepsy

Objective Attention and visuospatial impairments occur in children with partial epilepsy (PE). Attention impairment interrupts the development of other cognitive functions, eg. working memory and executive functions. Visuospatial impairment for one has been associated with difficulties in mathematics. Few systematically controlled neurocognitive rehabilitation techniques for children exist. Our aim was to examine the intervention effect with a computer-based attention and visuospatial rehabilitation modules for children. Methods 27 children with PE: 16 in study group (mean age=10.07 yrs, SD=1.149) and 11 in waiting-list group (mean age = 10.51 yrs, SD=1.766) with same profiles of cognitive impairment participated. Study group received individual supervised rehabilitation twice a week during 6 weeks with FORAMENRehab software (Sarajuuri et al, 2000; adapted for children by authors), while waiting-list group received no training. Intervention effect for study group and control performance for waiting-list group was evaluated comparing baseline tasks after 6-week-period. Results were analyzed with Mann-Whitney U test. Results Significant improvement was seen for study group after intervention. In complex attention tasks they gave more correct responses (p Conclusion Neurorehabilitation with FORAMENRehab is effective for children with PE. Children significantly improved in two more complicated attention components: complex and tracking; and in three main visuospatial components: visual organization, attention and perception. Modern computer-assisted neurocognitive intervention could improve the fundamentals of learning in children with cognitive impairment.

Individualized neuro-cognitive rehabilitation can reverse cognitive and memory impairment irrespective of etiology: Prospective pilot study (P6.189)

Individualized neuro-cognitive rehabilitation can reverse cognitive and memory impairment irrespective of etiology: Prospective pilot study (P6.189)

Neurocognitive rehabilitation in Parkinson's disease with motor imagery: a rehabilitative experience in a case report.

A 50-year-old female with Parkinson's disease underwent a neurocognitive rehabilitation program consisting of one-hour-lasting sessions attended twice a week for three months. The balance and the risk of falls were determined using the Tinetti Balance and Gait Evaluation Scale. The pain was determined using the Visual Analog Scale and the course of the disease was examined using the Unified Parkinson's Disease Rating Scale (UPDRS). Endpoints were before the treatment, at the end of the treatment, and at a 12-week follow-up. The aim of this study is to evaluate the efficacy of neurocognitive rehabilitation in PD with motor imagery. Primary outcome is the improvement in balance and the falls risk reduction; secondary outcome is lower limb pain reduction.

EARLY NEUROCOGNITIVE REHABILITATION IN CRITICALLY ILL PATIENTS DURING ICU STAY: A SAFETY STUDY

Critical illness result in significant long-term neurocognitive impairments that may persist for years after hospital discharge [1, 2]. These sequelae impact negatively in relatives' and patients' quality of life [3]. However, neurocognitive rehabilitation rarely occurs after critical illness. The Early Neurocognitive Rehabilitation in Intensive Care-ENRIC protocol (ClinicalTrial: NCT02078206)- has been develop to apply neurocognitive stimulation in patients during ICU stay. This intervention includes neurocognitive stimulation exercises that can be performed from the patient's bed through Kinect technology and it is targeted to ameliorate neurocognitive outcomes at short-and long-term.