Use Of Cognitive Rehabilitation Research Articles

Cognitive Rehabilitation Approaches to Traumatic Brain Injury: A Review of Efficacy and Outcomes

Cognitive rehabilitation is a critical component of intervention for many individuals with both short- and long-term impairments associated with traumatic brain injury (TBI). By focusing on major cognitive domains, emotional processing, and behavioral strategies, clinicians use cognitive rehabilitation to improve cognitive related functional outcomes, quality of life, and social relationships. Cognitive rehabilitation is traditionally divided into restorative and compensatory approaches, though increasingly combined approaches within the larger medical, multidisciplinary team are being incorporated and explored. Literature related to cognitive rehabilitation within the TBI population continues to be needed in order to assist clinicians in developing evidence-based intervention protocols and therapy plans. This paper details current approaches to cognitive rehabilitation and provides an updated review of the literature associated with the efficacy of cognitive rehabilitation. Reviewed evidence supports the use of cognitive rehabilitation to improve multiple cognitive domains, including attention, memory, executive function, and metacognitive skills. The long-term outcomes of continued cognitive rehabilitation services post-TBI are not as comprehensively documented as the relative short-term outcomes. The efficacy of cognitive rehabilitation is impacted by patient-specific variables, timing and intensity of treatment. This paper concludes with noted information related to the limitations of the current evidence of cognitive rehabilitation, including study design concerns, and reduced generalizability of the relevant research.

Humanoid Robot Use in Cognitive Rehabilitation of Patients with Severe Brain Injury: A Pilot Study.

Severe acquired brain injury (SABI) is a major global public health problem and a source of disability. A major contributor to disability after SABI is limited access to multidisciplinary rehabilitation, despite evidence of sustained functional gains, improved quality of life, increased return to work, and reduced need for long-term care. Twelve patients with a diagnosis of SABI were enrolled and equally divided into two groups: experimental and control. Patients in both groups underwent intensive neurorehabilitation according to the severity of their disabilities (motor, psycho-cognitive, and sensory deficits). However, in the experimental group, the treatment was performed by using a humanoid robot. At baseline, the two groups differed significantly only in Severe Impairment Battery (SIB) scores. Results showed that the experimental treatment had a higher effect than the traditional one on quality of life and mood. In conclusion, this pilot study provides evidence of the possible effects of relational and cognitive stimulation in more severely brain-injured patients.

Postacute Cognitive Rehabilitation for Adult Brain Tumor Patients.

Intrinsic brain tumors often occur within functional neural networks, leading to neurological impairment and disability of varying degrees. Advances in our understanding of tumor-network integration, human cognition and language processing, and multiparametric imaging, combined with refined intraoperative tumor resection techniques, have enhanced surgical management of intrinsic brain tumors within eloquent areas. However, cognitive symptoms impacting health-related quality of life, particularly processing speed, attention, concentration, working memory, and executive function, often persist after the postoperative recovery period and treatment. Multidisciplinary cognitive rehabilitation is the standard of care for addressing cognitive impairments in many neurological diseases. There is promising research to support the use of cognitive rehabilitation in adult brain tumor patients. In this review, we summarize the history and usefulness of postacute cognitive rehabilitation for adult brain tumor patients.

Virtual supermarket shopping task for cognitive rehabilitation and assessment of psychiatric patients: Validation in chronic schizophrenia

Objectives. Schizophrenia has a debilitating impact on a patient's cognitive functioning and everyday activities. As a part of the treatment, schizophrenia patients attend sessions of cognitive remediation to restore impaired cognitive abilities. To combine cognitive and real life training, this study presents a virtual task to use in cognitive rehabilitation and assessment. Virtual Supermarket Shopping Task (VSST) simulates a shopping activity, in which participants have to memorize and collect items from a virtual supermarket. The aim of this study is to establish its validity for use in clinical practice. Sample and setting. Twenty patients suffering from chronic schizophrenia and twenty healthy controls were tested. Each participant completed the task and a battery of standard neuropsychological tests. Statistical analyses. Groups’ results were compared by Student’s t-tests. Validity of VSST was examined using correlations with standard neuropsychological measures. Several VSST metrics, such as trial difficulty, distances and times, and the effect the extraneous variables have on VSST measures were investigated using analyses of variance and mixed effect models. Results. The analyses demonstrate that patients perform worse in VSST than healthy controls and their performance corresponds to their mnemonic abilities measured by standard neuropsychological tests. VSST performance relates to the level of executive functioning only in patients. There was no effect of gaming experience on VSST performance. While potential gender effect has to be addressed in future studies, age seems to play a role in the additional VSST measures (trial time and distance). Study limitations. Subjects were tested only once and therefore long term benefits of using VSST in rehabilitation could not be investigated. Only schizophrenia patients were included in the sample, which reduces generalizability of results to other psychiatric and neurologic conditions.

Cancer-Related Cognitive Impairment: Retrospective Analyses of a Multidimensional, Psychoeducation-Based Cognitive Rehabilitation Intervention.

Managing cancer-related cognitive impairment (CRCI) is a vital component of optimal cancer survivorship care. Results from several small studies indicate growing support for the use of cognitive rehabilitation and training strategies. This study aimed to retrospectively analyze the effects of a six-week standardized, multidimensional, psychoeducation-based group cognitive rehabilitation intervention for CRCI. Retrospective analyses were conducted for data collected for 20 cohorts who received the intervention in groups of about six participants. Changes in cognitive function and health-related quality of life (HRQOL) were compared. 85 of 110 participants completed pre- and postintervention assessments. A significant improvement for self-reported cognitive function and HRQOL was demonstrated and sustained over time. Program satisfaction was high.

Effect of the Wii Sports Resort on the improvement in attention, processing speed and working memory in moderate stroke

BackgroundStroke is the most common neurological disease in the world. After the stroke, some people suffer a cognitive disability. Commercial videogames have been used after stroke for physical rehabilitation; however, their use in cognitive rehabilitation has hardly been studied. The objectives of this study were to analyze attention, processing speed, and working memory in patients with moderate stroke after an intervention with Wii Sports Resort and compared these results with a control group.MethodsA pre-post design study was conducted with 30 moderate stroke patients aged 65 ± 15. The study lasted eight weeks. 15 participated in the intervention group and 15 belong to the control group. They were assessed in attention and processing speed (TMT-A and B) and working memory (Digit Span of WAIS-III). Parametric and effect size tests were used to analyze the improvement of those outcomes and compared both groups.ResultsAt the baseline, there was no difference between TMT-A and B. A difference was found in the scalar score of TMT-B, as well as in Digit Backward Span and Total Digit Task. In TMT-A and B, the intervention group had better scores than the control group. The intervention group in the Digit Forward Span and the Total Digit obtained a moderate effect size and the control group also obtained a moderate effect size in Total Digit. In the Digit scalar scores, the control group achieved better results than the intervention group.ConclusionsThe results on attention, processing speed and working memory improved in both groups. However, according to the effect sizes, the intervention group achieved better results than the control group. In addition, the attention and processing speed improved more than the working memory after the intervention. Although more studies are needed in this area, the results are encouraging for cognitive rehabilitation after stroke.

Therapeutic synergism: How can psychopharmacology improve cognitive rehabilitation?

ABSTRACTDespite recent advances in cognitive rehabilitation of patients with cognitive disorders, there are many major obstacles to the optimized global use of this therapeutic resource.Objective:The authors outline the concept of ‘therapeutic synergism’, i.e. the concurrent use of pharmacological and cognitive rehabilitation therapies to maximize functional benefits, addressing the optimization of therapeutic approaches for cognitive disorders.Methods:Three psychopharmacological and rehabilitation interrelationship paradigms are presented in three different clinical settings.Results:Paradigm 1: Behavioral and cognitive symptoms that hinder a cognitive rehabilitation program, but can be improved with psychopharmacology. Paradigm 2: Cognitive symptoms that hinder cognitive rehabilitation, but can be improved with anticholinesterases. Paradigm 3: Behavioral symptoms that hamper the use of cognitive rehabilitation, but can be improved by psychotropic drugs.Conclusion:Judicious use of psychotropic drugs in cognitive disorders can benefit, directly or indirectly, cognitive functions, thereby favoring other treatment modalities for cognitive impairment, such as neuropsychological rehabilitation.

External modulation of the sustained attention network in traumatic brain injury.

Traumatic brain injury (TBI) is associated with impairments in processing speed as well as higher-level cognitive functions that depend on distributed neural networks, such as regulating and sustaining attention. Although exogenous alerting cues have been shown to support patients in sustaining attentive, goal-directed behavior, the neural correlates of this rehabilitative effect are unclear. The purpose of this study was to explore the effects of moderate to severe TBI on activity and functional connectivity in the well-documented right-lateralized frontal-subcortical-parietal sustained attention network, and to assess the effects of alerting cues. Using multivariate analysis of fMRI data, TBI patients and matched neurologically healthy (NH) comparison participants were scanned as they performed the Sustained Attention to Response Task (SART) in 60-s blocks, with or without exogenous cueing through brief auditory alerting tones. Results documented inefficient voluntary control of attention in the TBI patients, with reduced functional connectivity in the sustained attention network relative to NH participants. When alerting cues were present during the SART, however, functional connectivity increased and became comparable to activity patterns seen in the NH group. These findings provide novel evidence of a neural mechanism for the facilitatory effects of alerting cues on goal-directed behavior in patients with damaged attentional brain systems, and support their use in cognitive rehabilitation. (PsycINFO Database Record

Nonmotor Symptoms and Natural History of Parkinson's Disease: Evidence From Cognitive Dysfunction and Role of Noninvasive Interventions.

Parkinson's disease (PD) is a common neurodegenerative disorder, characterized by motor and nonmotor symptoms (NMS). Several subsequent studies substantiate the great functional burden related to NMS, their progression, and negative effect on quality of life in PD. Additional evidence indicates interesting relationships between striatal dopaminergic function and NMS. The basal ganglia are implicated in the modulation and integration of sensory information and pain, bladder function is under control of both inhibitory (D1) and facilitatory (D2) dopaminergic inputs, finally reduced dopaminergic activity in the mesocortical and mesolimbic pathways is involved in the development of several NMS including mood, motivational, and cognitive alterations. Some NMS fluctuate in response to dopaminergic treatment and are relieved by dopamine replacement therapy, other are insensitive to current therapeutic strategies. The relation among the overall disease complications, perhaps the most important for PD patients and family members' well-being and functionality is dementia that affects most PD patients over the course of disease. Specific pharmacological treatment is lacking, and alternative approaches have been implemented to improve everyday functionality and quality of life. The state of the art suggests that cognitive rehabilitation in PD is possible and may either increase performance or preserve cognitive level over the time. However, it is also evident that cognitive abnormalities in PD are heterogeneous and we still do not have biomarkers to detect early patients at risk for dementia. Cognitive dysfunction is one the most prevalent NMS and is a clinically and functionally important disease milestone. Given the available clinical and imaging evidence it is possible to use cognition to model NMS progression and design nonpharmacological interventions. In this chapter we will address the use of cognitive rehabilitation and noninvasive brain stimulation techniques to modulate cognitive performance and rescue connectivity in affected brain circuitry.

Executive Dysfunction Following Critical Illness: Exploring Risk Factors and Management Options in Geriatric Populations.

Cognitive impairment is a common occurrence that has been shown to occur in over 50 % of patients following critical illness. This impairment occurs across a range of domains including attention, memory, processing speed, and executive dysfunction. In this article, we will discuss the pathophysiology behind cognitive impairment including hypoxemia and cytokines. Secondly, we will describe the risk factors for cognitive impairment including age, length of stay, and delirium. Lastly, we will review emerging data related to the use of cognitive rehabilitation, formation of postintensive care clinics in qualifying patients, and potential neuropharmacologic therapy. While our chapter focuses on cognitive impairment generally, it places a particular emphasis on executive dysfunction, not because impairment occurs solely in this domain but because impairments of an executive nature may be uniquely debilitating.

Virtual reality for cognitive rehabilitation: from new use of computers to better knowledge of brain black box?

Virtual reality (VR)-based technologies are one of the emerging tools that appear to have great potential for use in cognitive rehabilitation. However, it still is unclear how brain capacities are involved and what is the best approach to such training. Quantitative aspects are encouraging because some improvements have been shown after few training sessions. By contrast, qualitative design of VR tools is more questionable. Choice of errorless or error-full designs may depend on the severity of disturbances. Most VR tools emphasize the explicit component of tasks; even procedural aspects comprise the main strength of VR retraining programs. VR and augmented reality tools give various stimuli and indicators, but their best modalities stay unclear, given that most data are coming from learning studies in normal subjects more than rehabilitation studies in brain-injured patients. Specific studies to explore the impact of sensorial transmodal effects and emotional involvement in VR tasks are required. Rehabilitation protocols utilizing virtual environments are moving from single applications to cognitive impairment (i.e., alertness, memory, neglect, language, executive functions) to comprehensive rehabilitation programs, with the aim of achieving efficient improvement in autonomy and transfer of benefits in real life conditions. A core issue that presents challenges to rehabilitation is decreased ability of persons with brain injury to transfer learning from one situation or context to another. The multi-context approach to cognitive rehabilitation proposes treatment methods for teaching the use of strategies across a wide range of meaningful activities, which can promote generalization and enhance functional performance.

Sintomatología prefrontal y trastornos de la personalidad en adictos a sustancias

Neuroimaging findings associate personality traits and their disorders with an altered functioning of certain areas of the brain, especially in the frontal lobe. There is a need for instruments that can be applied in clinical practice to explore these relations based on their behavioural manifestations. The sample was composed of 371 subjects with substance abuse/dependence. The Prefrontal Symptoms Inventory (PSI) and the Millon Clinical Multiaxial Inventory II (MCMI-II) were administered and diagnostic interviews were carried out to determine the existence of disorders affecting axis II (personality disorders). Criteria satisfying a diagnosis of some personality disorder were present in 43.9% of the sample. The results show a broad correlational pattern between the prefrontal symptoms scales and those of personality disorders. The variance in up to eight of the 13 scales of the MCMI-II is predicted in over 20%, based on the combination of scales from the PSI. The personality disorders diagnosed by means of a clinical interview present differential prefrontal symptomatological profiles that were consistent with what was expected. The results support the hypothesis of a relationship between the diagnosis of personality disorders and frontal malfunctioning, thus suggesting new lines for studying and approaching them in clinical practice. Such new paths could involve the use of cognitive rehabilitation to improve day-to-day functioning and modify the neurological substrates underlying personality disorders.

The use of standard calendar software by individuals with acquired brain injury and cognitive complaints: a mixed methods study

Purpose: To explore the actual use of standard calendar software by people with acquired brain injury (ABI) and healthy individuals. Method: Mixed methods design with qualitative and quantitative analyses of the respondents’ use of calendar software. Fifteen individuals with ABI and 15 healthy participants were enrolled. Participants were asked to execute five consecutive tasks using standard calendar software, which resembled everyday use of an electronic calendar. Results: The core processes “task execution” and “information processing” were influenced by internal factors (cognitive and emotional processes and fatigue) as well as environmental factors (software features and distractions). Results obtained by qualitative and quantitative methods showed similar reaction patterns in both groups. However, ABI patients had more cognitive problems and showed stronger emotions during task performance than healthy participants. Healthy participants were more successful and needed less time and mental effort to perform a task. Conclusions: Although ABI patients were able to use standard calendar software, they became upset more easily, needed more effort, became tired sooner and more suddenly. Strategies to support ABI patients in the use of calendar software are suggested from multi-disciplinary perspectives.Implications for RehabilitationA user-centred approach is necessary when designing dedicated calendar software for acquired brain injury (ABI) patients with cognitive deficits.Training ABI patients in the use of assistive technology should focus on the influence of person-related factors such as cognitive and emotional processes and fatigue and environmental factors such as software features and distractions.In order to conceive and realize user-centred solutions for AT use in cognitive rehabilitation, a strong multi-disciplinary input is necessary.

Explicit memory training leads to improved memory for face–name pairs in patients with mild cognitive impairment: Results of a pilot investigation

Relatively few studies have examined the use of cognitive rehabilitation in patients with mild cognitive impairment (MCI), largely due to the assumption that training will not improve functioning in patients with progressive conditions. Face-name association, an ecologically valid task, is both dependent on the explicit memory system and difficult for MCI patients. During three hour-long sessions, eight patients diagnosed with MCI were trained in the use of explicit memory strategies with 45 face-name pairs. For each pair, they were taught to visually identify a facial feature, link a phonological cue to that feature, and recall the associated name. There was significant improvement in recognition accuracy, along with faster reaction times, for trained face-name pairs. Improved accuracy persisted when tested one month after training. Significant, but less, improvement was also found on untrained stimuli, raising the possibility of generalization of training strategies. Preliminary results suggest strategy-based cognitive rehabilitation may be beneficial in patients with MCI, though these results must be replicated with a control group to rule out practice effects.

New Wine in Old Bottles: The Transdiagnostic Model in the Case of Geoffrey

This reaction to the “Case of Geoffrey” by Dr. Jan Mohlman et al. (2008) highlights its use of a state-of-the-art, clinical combination of the transdiagnostic model and empirically supported, cognitive-behavioral therapies in the treatment of an older adult with multiple problems. I comment on Dr. Mohlman et al.’s creative use of cognitive rehabilitation, as a necessary adjunct to both anxiety and depression in the elderly, and, more generally, on Dr. Mohlman’s et al.’s unerring use of tactics, strategies, and interventions with Geoffrey. More specifically, I comment on: (1) the context of aging, both as it applies and serves as background to treatment in later life; (2) evidence-based practice of psychological and psychiatric treatments, as necessary for psychotherapy for older adults; (3) common factors of treatment in Dr. Mohlman et al.’s case that address aging-related issues in therapy which require case-specific alterations that they creatively considered, applied and monitored; and (4) a discussion of what was missing or lacking in Dr. Mohlman et al.’s approach. Their case of Geoffrey should serve as a model for graduate teaching in psychotherapy for older adults.

Perspectives on rehabilitation of individuals with cognitive impairment after brain injury: rationale for reconsideration of theoretical paradigms.

The frequency of cognitive impairment associated with traumatic brain injury (TBI) has led to the widespread use of cognitive rehabilitation as a discrete rehabilitative service. This service has become controversial in part because of disagreements regarding its theoretical base and implementation procedures, and in part because of insufficient experimental support. We outline two paradigms for cognitive rehabilitation that are interestingly different, both theoretically and procedurally. These paradigms are defined in relation to the goals of intervention, orientation to assessment, modalities of treatment, organization of treatment, and logistics of service delivery (setting, content, and provider). A rationale for each paradigm is described. We conclude with a call for (a) additional research into the effectiveness of interventions for individuals with cognitive impairment after TBI and (b) clinicians' thoughtful reflection on the foundations of their service.

Cognitive rehabilitation for attention deficits following stroke.

Attention problems occur following stroke and are treated using computerised activities or paper and pencil tasks. To determine the effects of cognitive rehabilitation for attention deficits following stroke. We searched the Cochrane Stroke Group Trials Register, Medline, EMBASE, CINHAL and CLIN PSYCH databases and reference lists from relevant articles. Date of most recent searches: December 1998 Controlled trials of attention training in stroke. Studies with mixed aetiology groups were excluded unless they included more than 75% of stroke patients or separate data were available for the stroke patients. Two reviewers extracted trial data and assessed trial quality. Reviewers contacted investigators for further details of trials. Two trials were identified with 56 participants. The two trials showed a benefit of training on measures of alertness and sustained attention. Only one trial included a measure of functional independence and this showed no significant effect of training. There is some indication that training improves alertness and sustained attention but no evidence to support or refute the use of cognitive rehabilitation for attention deficits to improve functional independence following stroke.