Neuropsychological Rehabilitation Program Research Articles

Evaluación neuropsicológica en adultos con discapacidad intelectual. Análisis de casos

La discapacidad intelectual consiste en alteraciones del funcionamiento de los procesos psi­cológicos básicos como resultado de disfunciones en el sistema nervioso. Pueden valorarse mediante evaluaciones neuropsicológicas. El diagnóstico neuropsicológico debe apoyarse en los resultados de las pruebas psicométricas y en observaciones conductuales. El estu­dio de casos permite explicar las bases de una problemática donde el investigador puede convertirse en un experto en el área de conocimiento planteada. Se da a conocer el análisis de la evaluación de dos casos clínicos con discapacidad intelectual. Los instrumentos em­pleados fueron: historia clínica, NEUROPSI breve en español. Se realizaron observaciones conductuales en sesiones de interacción y se hizo un electroencefalograma (EEG). Ambos casos presentaron dificultades en los procesos neuropsicológicos de orientación, atención, memoria, lenguaje, funciones ejecutivas y motricidad. La descripción y análisis de casos individuales permiten diseñar programas de rehabilitación neuropsicológica para la inter­vención clínica de los pacientes.

A Neuropsychological Rehabilitation Program for Cognitive Impairment in Psychiatric and Neurological Conditions: A Review That Supports Its Efficacy.

Neuropsychological rehabilitation has been the focus of much scientific research over the past decades due to its efficacy in different pathologies. Advances in the neuropsychology field have led to improvements and changes in neuropsychological interventions, which in turn have given rise to different approaches and rehabilitation programs. REHACOP is an integrative neuropsychological rehabilitation program designed by specialist neuropsychologists. With an integrated bottom-up and top-down approach, REHACOP includes neurocognition, social cognition, and daily living tasks hierarchically organized on an increasing level of difficulty. Task arrangement is addressed to maximize improvements and transfer effects into participant's daily living. To date, REHACOP has been implemented on different clinical samples such as patients with schizophrenia, multiple sclerosis (MS), and Parkinson's disease (PD). This manuscript presents the efficacy data of REHACOP across these three populations and discusses it in the context of the available literature. Overall, the magnitude of improvements obtained by means of REHACOP ranged from medium to high across samples. These changes were not restricted to specific neurocognitive domains since participants attending the REHACOP program also showed changes in social cognition and daily functioning variables by means of both direct and transfer effects. Results regarding REHACOP's efficacy in psychiatric and neurological conditions have contributed to expanding the existing evidence about the use of structured neuropsychological rehabilitation. In addition, the results obtained after its implementation highlighted the need and importance of designing and implementing integrative neuropsychological rehabilitation programs that are focused not only on cognition per se but also on participants' performance in daily living.

A neuropsychological rehabilitation program for mucopolysaccharidosis based on the eco-epidemiological and community model of the World Health Organization

The Psychology Program of the Corporación Universitaria Minuto de Dios, UNIMINUTO University (Main location), in agreement with the Colombian Association of Patients with Lysosomal Deposit Diseases (ACOPEL) in Spanish, develops neuropsychological research and intervention activities that contribute to overcoming the barriers that limit the access to prevention, care and health services for patients with Mucopolysaccharidosis since 2016. The answer to address this public health problem is based not only on assessment and neuropsychological diagnosis (n = 18 children, n = 3 adults), cognitive stimulation (n = 9 children) has been used in cognitive functions such as attention and memory, and currently neuropsychological rehabilitation (n = 2 children) taking into account the eco-epidemiological model in public health and the rehabilitation model based in the community of the World Health Organization (WHO), characterized by the overcoming of the traditional approach health-disease. In coherence with these models, the three phases of the research and two case studies are presented with a neuro-rehabilitation model of a biopsychosocial nature (systemic psychological intervention, interview in the family context and focus groups in the academic context). In conclusion, this line of research and intradisciplinary work in neurorehabilitation, is a new challenge in this Colombian population, which has allowed the improvement of the cognitive functioning of the participants, greater functionality in activities of daily life with their primary caregivers/family and inclusive education.

THE AMELIORATION OF BEHAVIORAL DISTURBANCES IN TBI PATIENTS WITH CHRONIC FRONTAL SYNDROME AFTER TREATMENT IN DIFFERENT REHABILITATION PROGRAMS

We evaluated the effectiveness of three different rehabilitation programs for chronic behavioral disorders in traumatic brain injury (TBI) patients with orbito-frontal damage (OFC), incurred from 13 to 15 years prior to enrollment. From among 547 adult patients with severe TBIs treated neurosurgically from 1999 to 2003, 60 were selected for the study, divided into three groups of 20, matched for age and sex. Each group received one of three different rehabilitation protocols. Group A received a comprehensive program with two components: (1) a 6-month early neuropsychological rehabilitation program targeting cognitive deficits, beginning immediately post-injury, and (2) the “Academy of Life” program, with weekly meetings aimed at reducing behavioral disorders in social transactions. Group B received only cognitive rehabilitation, while Group C received only the “Academy of Life” progam. The Frontal Behavioral Inventory (FBInv) was used to assess behavioral disorders at baseline and again after completion of the study. At baseline, all 60 patients still displayed all or most of the common behavioral symptoms characteristic of frontal syndrome. The improvement achieved by group A (the comprehensive program) was significantly better upon completion of the study than that shown by the patients in groups B (cognitive only) and C (social skills only). A comprehensive program of rehabilitation, which combines early neuropsychological rehabilitation of cognitive deficits with the “Academy of Life” program, aimed at improving social skills, proved to be more effective than either of these two components administered without the other

Rehabilitation of unilateral spatial neglect: A combined behavioral and fMRI single-case study.

Symptoms of visuospatial neglect occur frequently after unilateral brain damage. Neglect hampers general rehabilitation progress and is associated with reduced quality of life. Some of the rehabilitation programs developed to treat neglect have demonstrated behavioral improvements. However, only a few of them have addressed specifically the anatomo-functional correlates associated behavioral improvement. Here we describe the case of a patient (GV) with a severe left neglect disorder as a consequence of a right hemisphere stroke. Eighteen weeks after the onset, he underwent a 10-week intensive neuropsychological rehabilitation program. Functional MRI (fMRI) during execution of a covert attention task, and a broad neuropsychological assessment were conducted before and after the training. The results show a significant improvement of the performance in neglect tasks after the rehabilitation program, although the remission of symptoms was not complete. fMRI data showed that the behavioral improvement was accompanied by an increase of activity in the dorsal premotor cortex and middle frontal gyrus bilaterally. Other activations were present only in the contralesional left hemisphere, including supplementary motor area and superior temporal gyrus. The implications of the results are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Participation and the Role of Neuropsychological Functioning in Myotonic Dystrophy Type 1.

Myotonic Dystrophy type 1 (DM1) is primarily a neuromuscular disease but can also have neuropsychological consequences (i.e.cognitive, emotional and behavioural) which can influence daily living and societal participation. Not much is known about the level of participation of DM1 patients and their relatives and the factors influencing participation. This information can guide the development of rehabilitation programs and identify those at risk of long-term participation problems. To investigate the level of participation of DM1 patients and their partners and the determinants. Cross-sectional study using the Utrecht Scale for Evaluation of Rehabilitation-Participation. Determinants were demographic, disease related, and neuropsychological characteristics. Spearman correlations and backward multiple regression analyses were performed. Of the 66 DM1 participants, 54% reported severe fatigue and 47% apathy. Experienced participation restrictions were most prevalent in housekeeping (74%), sports (68%) and outdoor activities (55%). Participants were relatively satisfied with their level of participation, but dissatisfaction occurred mostly in housekeeping (58%), outdoor activities (55%), and sports (54%). Age and apathy were significant predictors of frequency of (R2 = 10.4) and restrictions in participation in the multivariate model (R2 = 14.4). Emotional functioning was the only significant predictor of satisfaction with participation (R2 = 23.8). A considerable number of DM1 patients have Central Nervous System-related problems such as fatigue and apathy in addition to neuromuscular restrictions. Risk factors for lower participation are age, apathy, and emotional problems. Physical as well as neuropsychological rehabilitation programs are recommended.

The Possibilities and Limits of the Rehabilitation of Cognitive Functions in Patients with Multiple Sclerosis Using a Computer Program

Objectives: The purpose of the current study was to evaluate whether a 12-week neuropsychological rehabilitation program has a positive effect on the improvement of cognitive functions and what methods can be used to measure this effect. Furthermore, this study intended to verify the effect of the chosen training plan on the resulting state of cognitive functions, in particular with regard to the frequency and duration of the plan. Methodology: Fifty-eight patients diagnosed with MS were randomized into an experimental condition or the control group, 15 patients were excluded from the study. The experimental condition included 26 patients (22 women and 4 men), whole the control group consisted of 17 patients (12 women and 5 men). All of these patients had a cognitive defect that was assessed at the beginning of the study and monitored using the neuropsychological tests after the participation in the training program. Participants in the experimental group received their rehabilitation of cognitive functions using a PC training program, which they completed in their home environments (30 mins/4 times per week, for 8 consecutive weeks). Overall, there were 32 training sessions on predetermined days with a specific detailed training plan. The control group received no training. The neuropsychological tests used at the beginning and the conclusion of the study showed a positive effect of the training program, while the greatest improvement was seen in the areas of immediate memory and attention. Results: The results showed a positive effect related to neuropsychological rehabilitation in MS patients that received regular training four times per week for eight consecutive weeks.

Program of neuropsychological stimulation of cognition in students: Emphasis on executive functions - development and evidence of content validity.

ObjectiveThe goal of this study was to describe the construction process and content validity evidence of an early and preventive intervention program for stimulating executive functions (EF) in Elementary School children within the school environment.MethodsThe process has followed the recommended steps for creating neuropsychological instruments: internal phase of program organization, with literature search and analyses of available materials in the classroom; program construction; analysis by expert judges; data integration and program finalization. To determine the level of agreement among the judges, a Content Validity Index (CVI) was calculated.ResultsContent validity was evidenced by the agreement among the experts with regards to the program, both in general and for each activity. All steps taken were deemed necessary because they contributed to the identification of positive aspects and possible flaws in the process.ConclusionThe steps also helped to adapt stimuli and improve program tasks and activities. Methodological procedures implemented in this study can be adopted by other researchers to create or adapt neuropsychological stimulation and rehabilitation programs. Furthermore, the methodological approach allows the reader to understand, in detail, the technical and scientific rigor adopted in devising this program.

Development of a Neuropsychological Rehabilitation Program for Executive Functions in Students with Developmental Dyslexia

Neuropsychological rehabilitation and self-regulated learning models are commonly used in intervention programs for students with learning disorders. However, systematic programs with this same objective are scant. Here we describe the development and evaluation of a neuropsychological rehabilitation program for the executive functions of students with dyslexia. The program is separated in stages comprising: theoretical basis foundation, definition of session structures and development of support material, evaluation by three expert judges, revision, and elaboration of the final version. The final program consists of thirty sessions divided into four modules, including (1) psychoeducation; (2) orientation for parents and teachers; (3) executive functions applied to study competencies; and (4) executive functions applied to reading comprehension. Judges evaluated 53 items associated with theoretical basis, clinical principles, support material and modules. The items were distributed on the Likert scale as inadequate (0), partially adequate (1), and adequate (2). Five items had an agreement index of 67%, the rest had 100%. The Kappa coefficients were “excellent” (theoretical basis, clinical principles and orientation module) or “satisfactory” (support materials, psycho-education modules, competencies and reading). Suggestions from the judges were incorporated into the program’s final version. A discussion of our results sheds light on the possible implications of the program for the stimulation of executive functioning in developmental dyslexia.

Rehabilitación neuropsicológica infantil: de la teoría a la práctica clínica

Alrededor del mundo existe una gran cantidad de niños con dificultades cognitivas producto de daño cerebral o trastornos del neurodesarrollo. Estas dificultades traen consigo dificultades de tipo escolar, social, familiar y conductual, entre otras, disminuyendo así la calidad de vida del niño y su familia. Consecuentemente han aumentado en la literatura los artículos que evalúan la utilidad de diferentes programas de rehabilitación neuropsicológica. El objetivo de esta revisión fue (1) determinar cuáles son las modalidades teóricas de rehabilitación neuropsicológica más utilizadas, (2) establecer si se reportan ganancias funcionales posteriores a cada intervención y, (3) establecer si durante la intervención se incluyó a los familiares. Los resultados mostraron que la principal modalidad de rehabilitación utilizada fue la restauración. Además, la mayoría de estudios no reportaban de manera clara ganancias funcionales ni incluían a la familia en el proceso terapéutico. Es necesario la realización de estudios que incluyan en su diseño diferentes modalidades de rehabilitación, apoyo familiar y evaluación de las ganancias funcionales.

Effects of intensive neuropsychological rehabilitation for acquired brain injury

ABSTRACTThe objective of the study was to examine the effects of a comprehensive neuropsychological rehabilitation programme (Intensive NeuroRehabilitation, INR) on the emotional and behavioural consequences of acquired brain injury (ABI). The participants were 75 adult patients suffering from ABI (33 traumatic brain injury, 14 stroke, 10 tumour, 6 hypoxia, 12 other), all of whom were admitted to the INR treatment programme. The main outcome measures were: general psychological well-being (Symptom-Checklist-90), depression and anxiety (Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, State Trait Anxiety Inventory), and quality of life (Quality of Life in Brain Injury). The study was a non-blinded, waiting-list controlled trial. During the waiting-list period no or minimal care was provided. Multivariate analysis of the main outcome measures showed large effect sizes for psychological well-being (partial η2 = .191, p < .001), depression (partial η2 = .168, p < .001), and anxiety (partial η2 = .182, p < .001), and a moderate effect size for quality of life (partial η2 = .130, p = .001). Changes on neuropsychological tests did not differ between the groups. It was concluded that the INR programme improved general psychological well-being, depressive symptoms, anxiety, and quality of life. The programme does not affect cognitive functioning.

Selection and visualisation of outcome measures for complex post-acute acquired brain injury rehabilitation interventions.

Outcome measurement challenges rehabilitation services to select tools that promote stakeholder engagement in measuring complex interventions. To examine the suitability of outcome measures for complex post-acute acquired brain injury (ABI) rehabilitation interventions, report outcomes of a holistic, neuropsychological ABI rehabilitation program and propose a simple way of visualizing complex outcomes. Patient/carer reported outcome measures (PROMS), experience measures (PREMS) and staff-rated measures were collected for consecutive admissions over 1 year to an 18-week holistic, neuropsychological rehabilitation programme at baseline, 18 weeks and 3- and 6-month follow-up. Engagement with outcome measurement was poorest for carers and at follow-up for all stakeholders. Dependence, abilities, adjustment, unmet needs, symptomatology including executive dysfunction, and self-reassurance showed improvements at 18 weeks. Adjustment, social participation, perceived health, symptomatology including dysexecutive difficulties, and anxiety were worse at baseline for those who did not complete rehabilitation, than those who did. A radar plot facilitated outcome visualization. Engagement with outcome measurement was best when time and support were provided. Supplementing patient- with staff-rated and attendance measures may explain missing data and help quantify healthcare needs. The MPAI4, EBIQ and DEX-R appeared suitable measures to evaluate outcomes and distinguish those completing and not completing neuropsychological rehabilitation.

Dysexecutive symptoms and carer strain following acquired brain injury: Changes measured before and after holistic neuropsychological rehabilitation.

Following acquired brain injury (ABI), deficits in executive functioning (EF) are common. As a result many brain-injured patients encounter problems in every-day functioning, and their families experience significant strain. Previous research has documented the benefits of cognitive rehabilitation for executive dysfunction, and rehabilitation programmes designed to ameliorate functional problems associated with ABI. This study primarily aims to evaluate whether a neuropsychological rehabilitation programme reduces reported symptoms of everyday dysexecutive behaviour and carer strain. In this study 66 ABI outpatients attended comprehensive holistic neuropsychological rehabilitation programme. A repeated-measures design was employed to determine the effect of rehabilitation on EF and carer strain, as part of a service evaluation. Outcome measures comprised the dysexecutive questionnaire (DEX/DEX-I) and carer strain index (CSI), applied pre- and post-rehabilitation. Results indicate rehabilitation benefited clients and carers in 5 of 6 DEX/DEX-I subscales, and 2 of 3 CSI subscales, (p < 0.05). An effect of aetiology on rehabilitation was found on the metacognitive scale of the DEX-I. Therefore, this study supports a comprehensive holistic neuropsychological rehabilitation programme as effective in reducing reported symptoms of dysexecutive behaviour and carer strain following ABI.

A neuropsychological group rehabilitation program with institutionalized elderly

IntroductionElderly institutionalization involves an emotional adaptation and the research shows that the risk of depression increases.ObjectivesEvaluate the impact of a neuropsychological group rehabilitation program (NGRP) on depressive symptomatology of institutionalized elderly.AimsNGRP influences the decrease of depressive symptoms.MethodsElderly were assessed pre- and post-intervention with the Geriatric Depression Scale (GDS) and divided into a Rehabilitated Group (RG), a Waiting List Group (WLG), and a Neutral Task Group (NTG).ResultsIn this randomized study, before rehabilitation, 60 elderly people (RG; 80.31 ± 8.98 years of age; 74.2% women) had a mean GDS score of 13.33 (SD = 9.21). Five elderly included in the NTG (80.13 ± 10.84 years; 75.0% women) had a mean GDS score of 10.60 (SD = 4.72). Finally, 29 elderly in the WLG (81.32 ± 6.68 years; 69.0% women) had a mean GDS score of 14.93 (SD = 6.02). The groups were not different in GDS baseline scores (F = 0.74; P = 0.478). ANCOVA has shown significant differences (P &lt; 0.05) in GDS scores between the three groups after 10 weeks. Sidak adjustment for multiple comparisons revealed that elderly in the WLG got worse scores in GDS, comparing with elderly in RG (P &lt; 0.01), and with elderly in NTG (P &lt; 0.05).ConclusionsElderly that are not involved in a task get worse in depressive symptomatology. Being involved in a structured group task means lower depressive symptoms and being in a NGRP means even greater results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The syndromic approach to the rehabilitation of the higher mental functions (HMF) of patients with progressive cognitive disorders in L.S. Vygotsky–A.R. Luria School

BackgroundThe method of “rehabilitation training”, developed in the Soviet psychology, based on the idea that the human HMF are realized in complex functional systems, developed during cultural- and ontogenesis.AimsTo show the importance of the development of approaches to the rehabilitation of HMF in Luria's neuropsychology.MethodsThe disturbances in brain activity leads to the neuropsychological syndrome appearance that could be called self-developing system. According to the systemic principles, each neuropsychological syndrome HMF disorders in accordance with brain injury localisation has the common “cause” – destroyed neuropsychological factor. In the case of patients with dementia several neuropsychological factors are usually included. So the rehabilitation processes should be aimed at the maximum preserved and strengthened stereotypes and behavior strategies in past experiences.ResultsThe binary syndrome structure (set of symptoms of destroyed neuropsychological HMF and abnormal neuropsychological factor itself) allows us to define two strategies of neuropsychological rehabilitation programs. The first strategy involves choice as a “target” of the most destroyed mental function. The second strategy could be directed to the rehabilitation of abnormal neuropsychological factor that should be accompanied by the rehabilitation of several systemic interrelated mental functions. Recourse to past knowledge, interests and emotionally important topics is assisting and supporting the rehabilitation processes.ConclusionsUse of both strategies ensures targeted restoration of cognitive functions within Vygotsky-Luria approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ADHD Rehabilitation through Video Gaming: A Systematic Review Using PRISMA Guidelines of the Current Findings and the Associated Risk of Bias.

Empirical research studies have highlighted the need to investigate whether video game can be useful as a tool within a neuropsychological rehabilitation program for attention deficit hyperactivity disorder (ADHD) patients. However, little is known about the possible gains that this kind of video game-based interventions can produce and even if these gains can be transferred to real life abilities. The present paper aims to uncover key information related to the use of video game in ADHD neuropsychological rehabilitation/intervention by focusing on its gains and its capability to transfer/generalize these gains to real life situation via a systematic review of the empirical literature. The PRISMA guidelines were adopted. Internet-based bibliographic searches were conducted via seven major electronic databases (i.e., PsycARTICLES, PsycINFO, Web of Science, Core Collection BIOSIS Citation Index, MEDLINE, SciELO Citation Index, and PubMed) to access studies examining the association between video game interventions in ADHD patients and behavioral and cognitive outcomes. A total of 14 empirical studies meeting the inclusion criteria were identified. The studies reported the attention, working memory, and the behavioral aspects as the main target of the intervention. Cognitive and behavioral gains were reported after the video game training (VGT). However, many bias related to the choice of outcome instruments, sampling and blindness of assessors, weaken the results power. Additional researches are important to clarify the effects and stability of the VGT programs, and an important effort should be made to construct better methods to assess improvements on everyday cognitive abilities and real world functioning.

Changes in impaired self-awareness after acquired brain injury in patients following intensive neuropsychological rehabilitation

The objective of this study was to investigate changes in self-awareness impairments in outpatients with acquired brain injury (ABI) and the effects these changes have on rehabilitation. Participants were 78 patients with ABI (8.3 years post-injury) who followed an intensive outpatient neuropsychological rehabilitation programme. This longitudinal study comprised pre (T1) and post (T2) measurements and a one-year follow-up (T3). Thirty-eight patients completed the study. The main outcome domains were self-awareness, depressive symptoms, psychological and physical dysfunction, and health-related quality of life (HRQoL). Patients were divided into three awareness groups: underestimation, accurate estimation, and overestimation of competencies. Most patients who underestimated their competencies at the start of treatment accurately estimated their competencies directly after treatment (9 out of 11 patients). These patients also exhibited the largest treatment effects regarding depressive symptoms, psychological and physical dysfunction, and HRQoL. Most patients with impaired self-awareness (i.e., overestimation of competencies) at the start of treatment continued to overestimate their competencies after treatment (10 out of 14 patients). These patients exhibited a significant decrease in depressive symptoms but no other treatment effects. The results indicate that changes in outcome are related to changes in awareness, which underline the importance of taking into account different awareness groups with respect to treatment effects.

Neuropsychological rehabilitation program for promoting executive functioning in students with developmental dyslexia

Neuropsychological rehabilitation program for promoting executive functioning in students with developmental dyslexia

A neuropsychological rehabilitation program for patients with Multiple Sclerosis based on the model of the ICF.

Forty to sixty percent of MS patients suffer from cognitive impairments. Cognitive deficits are a great burden for patients affected. In particular they may lead to a reduced quality of life, loss of work and problems with the social environment. The aim of this study was to evaluate a specific neuropsychological rehabilitation program for MS patients according to the ICF to be able to meet more properly individual requirements on the therapy level of function as well as of activities and participation. Forty patients with MS were randomised in an intervention (IG) - and a control group (CG). The outcome measure of the IG, who started an intensive computer based home training of attention and attended psychological counselling was compared to the untrained CG. In specific domains of attention (simple and cued alertness and divided attention) significant group differences between CG and IG could be found. The IG reported an improvement of mental fatigue and retardation. These findings support the idea that a neuropsychological rehabilitation program, which based on the model of ICF, could improve cognitive impairment and could also have a positive influence of activities and participation.

Rehabilitación neuropsicológica en pacientes con tumores cerebrales

Cognitive deficits are one of the most common symptoms in patients with brain tumors, especially in attention, memory and executive functions. These changes impact negatively on the quality of life of patients and their return to their daily activities. In recent years, they are developing Neuropsychological Rehabilitation programs in adult patients with brain tumors, with positive results.The authors recommend that interventions include psychoeducation techniques, recovery strategies of different attentional and executive processes (planning and organization) and compensatory techniques for memory. The studies published to date show improvement immediately after surgery in attention and memory. However, there are not data exist on the impact of these programs on performance rehabilitation of these patients in the medium and long term (over six months). The future studies need to evaluate the effectiveness of this intervention in elderly patients with brain tumors, and the results differ depending on the type of tumor and cancer treatments applied, as these two features can significantly affect the data obtained.