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Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas M, Felicetti T, Laatsch L, Harley JP, Bergquist T, Azulay J, Cantor J, Ashman T. Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch Phys Med Rehabil 2011; 92:519-30. [PMID: 21440699 DOI: 10.1016/j.apmr.2010.11.015] [Citation(s) in RCA: 745] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 10/29/2010] [Accepted: 11/03/2010] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To update our clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 2003 through 2008. DATA SOURCES PubMed and Infotrieve literature searches were conducted using the terms attention, awareness, cognitive, communication, executive, language, memory, perception, problem solving, and/or reasoning combined with each of the following terms: rehabilitation, remediation, and training for articles published between 2003 and 2008. The task force initially identified citations for 198 published articles. STUDY SELECTION One hundred forty-one articles were selected for inclusion after our initial screening. Twenty-nine studies were excluded after further detailed review. Excluded articles included 4 descriptive studies without data, 6 nontreatment studies, 7 experimental manipulations, 6 reviews, 1 single case study not related to TBI or stroke, 2 articles where the intervention was provided to caretakers, 1 article redacted by the journal, and 2 reanalyses of prior publications. We fully reviewed and evaluated 112 studies. DATA EXTRACTION Articles were assigned to 1 of 6 categories reflecting the primary area of intervention: attention; vision and visuospatial functioning; language and communication skills; memory; executive functioning, problem solving and awareness; and comprehensive-holistic cognitive rehabilitation. Articles were abstracted and levels of evidence determined using specific criteria. DATA SYNTHESIS Of the 112 studies, 14 were rated as class I, 5 as class Ia, 11 as class II, and 82 as class III. Evidence within each area of intervention was synthesized and recommendations for Practice Standards, Practice Guidelines, and Practice Options were made. CONCLUSIONS There is substantial evidence to support interventions for attention, memory, social communication skills, executive function, and for comprehensive-holistic neuropsychologic rehabilitation after TBI. Evidence supports visuospatial rehabilitation after right hemisphere stroke, and interventions for aphasia and apraxia after left hemisphere stroke. Together with our prior reviews, we have evaluated a total of 370 interventions, including 65 class I or Ia studies. There is now sufficient information to support evidence-based protocols and implement empirically-supported treatments for cognitive disability after TBI and stroke.
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Affiliation(s)
- Keith D Cicerone
- Department of Physical Medicine and Rehabilitation, JFK-Johnson Rehabilitation Institute, Edison, NJ 08820, USA.
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Turner KJ, Gillespie A, McMichael LJ. Rigorous development of prompting dialogues. J Biomed Inform 2011; 44:713-27. [PMID: 21443968 DOI: 10.1016/j.jbi.2011.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 01/21/2011] [Accepted: 03/20/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim was to support people with cognitive impairment through speech-based dialogues that guide them through everyday tasks such as activities of daily living. The research objectives were to simplify the design of prompting dialogues, to automate the checking of prompting dialogues for syntactic and semantic errors, and to automate the translation of dialogue designs into a form that allows their ready deployment. APPROACH Prompting dialogues are described using CRESS (Communication Representation Employing Systematic Specification). This is a notation and toolset that allows the flow in a service (such as a dialogue) to be defined in an understandable and graphical way. A dialogue diagram is automatically translated into a formal specification for rigorous verification and validation. Once confidence has been built in the dialogue design, the dialogue diagram is automatically translated into VoiceXML and deployed on a voice platform. RESULTS All key objectives of the work have been achieved. A variety of significant dialogues have been successfully represented using the CRESS notation. These dialogues have been automatically analysed through formal verification and validation in order to detect anomalies. Finally, the dialogues have been automatically realised on a VoiceXML platform and have been evaluated with volunteer users.
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Affiliation(s)
- Kenneth J Turner
- Computing Science and Mathematics, University of Stirling, Stirling FK94LA, UK.
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Abstract
Cognitive impairment can be detected in a sizeable proportion of pediatric multiple sclerosis (MS) patients. It involves memory, complex attention, information processing speed, executive functions, linguistic abilities, and intelligent quotient. It has a great impact on school, everyday and social activities, and significantly progresses overtime in the great majority of the subjects. These findings highlight the importance of a comprehensive and systematic assessment of MS-related cognitive difficulties in pediatric cases. Moreover, despite the acknowledged relevance of cognitive impairment in this age range, specific interventions for pediatric MS are lacking. As for rehabilitative strategies, there is some evidence of efficacy in other diseases, in particular brain trauma, tumor, and stroke. The development of effective rehabilitative strategies tailored to the needs of young MS patients is a priority for future research in the field.
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104
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Boelen DHE, Spikman JM, Fasotti L. Rehabilitation of executive disorders after brain injury: Are interventions effective? J Neuropsychol 2011; 5:73-113. [DOI: 10.1348/174866410x516434] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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105
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Haslam C, Hodder KI, Yates PJ. Errorless learning and spaced retrieval: how do these methods fare in healthy and clinical populations? J Clin Exp Neuropsychol 2011; 33:432-47. [PMID: 21229436 DOI: 10.1080/13803395.2010.533155] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
While errorless learning and spaced retrieval have both proved effective in helping many patients with acquired brain injury (ABI) and dementia learn novel information, it is not clear which of these principles we should apply to target treatment most effectively. To address this issue we conducted a systematic comparison of these principles in three experiments, comparing their effectiveness in healthy controls (N = 60), patients with ABI (N = 30), and patients with dementia (N = 15). Participants were asked to learn face-name associations, and the relative effectiveness of the principles over and above trial-and-error learning was investigated. The results were remarkably consistent across experiments: Both errorless learning and spaced retrieval produced greater accuracy in name recall than did trial-and-error learning, but recall under conditions of spaced retrieval was significantly better than that under errorless learning. We discuss the implications of these findings and suggest that spaced retrieval may be the stronger memory rehabilitation principle when it comes to learning face-name associations in people with mild to moderate memory impairment.
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106
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107
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Lemoncello R, Sohlberg MM, Fickas S, Albin R, Harn BE. Phase I evaluation of the television assisted prompting system to increase completion of home exercises among stroke survivors. Disabil Rehabil Assist Technol 2010; 6:440-52. [DOI: 10.3109/17483107.2010.542571] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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108
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Abstract
Cognitive rehabilitation interventions are theoretically based and empirically validated treatments designed to ameliorate the cognitive, behavioral, and emotional impairments commonly experienced by individuals with traumatic brain injury (TBI). Cognitive rehabilitation can play many roles in facilitating recovery after TBI, such as improving impaired cognitive functions, increasing awareness of injury-related deficits, improving mood, facilitating vocational and community involvement, and reducing the probability of secondary disability. The considerable evidence documenting the impact of cognitive rehabilitation on improving the day-to-day function of individuals with TBI is described.
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Affiliation(s)
- Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1240, New York, NY 10029-6574, USA. Kristen.dams-o'
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109
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Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, Billinger SA. Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient. Stroke 2010; 41:2402-48. [PMID: 20813995 DOI: 10.1161/str.0b013e3181e7512b] [Citation(s) in RCA: 458] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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110
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Svoboda E, Richards B, Polsinelli A, Guger S. A theory-driven training programme in the use of emerging commercial technology: Application to an adolescent with severe memory impairment. Neuropsychol Rehabil 2010; 20:562-86. [DOI: 10.1080/09602011003669918] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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111
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Ptak R, der Linden MV, Schnider A. Cognitive rehabilitation of episodic memory disorders: from theory to practice. Front Hum Neurosci 2010; 4:57. [PMID: 20700383 PMCID: PMC2914528 DOI: 10.3389/fnhum.2010.00057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 06/22/2010] [Indexed: 11/13/2022] Open
Abstract
Memory disorders are among the most frequent and most debilitating cognitive impairments following acquired brain damage. Cognitive remediation strategies attempt to restore lost memory capacity, provide compensatory techniques or teach the use of external memory aids. Memory rehabilitation has strongly been influenced by memory theory, and the interaction between both has stimulated the development of techniques such as spaced retrieval, vanishing cues or errorless learning. These techniques partly rely on implicit memory and therefore enable even patients with dense amnesia to acquire new information. However, knowledge acquired in this way is often strongly domain-specific and inflexible. In addition, individual patients with amnesia respond differently to distinct interventions. The factors underlying these differences have not yet been identified. Behavioral management of memory failures therefore often relies on a careful description of environmental factors and measurement of associated behavioral disorders such as unawareness of memory failures. The current evidence suggests that patients with less severe disorders benefit from self-management techniques and mnemonics whereas rehabilitation of severely amnesic patients should focus on behavior management, the transmission of domain-specific knowledge through implicit memory processes and the compensation for memory deficits with memory aids.
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Affiliation(s)
- Radek Ptak
- Department of Clinical Neurosciences, Division of Neurorehabilitation, University Hospitals GenevaGeneva, Switzerland
- Faculty of Medicine, University of GenevaGeneva, Switzerland
| | | | - Armin Schnider
- Department of Clinical Neurosciences, Division of Neurorehabilitation, University Hospitals GenevaGeneva, Switzerland
- Faculty of Medicine, University of GenevaGeneva, Switzerland
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112
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Boman IL, Bartfai A, Borell L, Tham K, Hemmingsson H. Support in everyday activities with a home-based electronic memory aid for persons with memory impairments. Disabil Rehabil Assist Technol 2010; 5:339-50. [DOI: 10.3109/17483100903131777] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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113
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de Joode E, van Heugten C, Verhey F, van Boxtel M. Efficacy and usability of assistive technology for patients with cognitive deficits: a systematic review. Clin Rehabil 2010; 24:701-14. [DOI: 10.1177/0269215510367551] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine the efficacy of portable electronic aids such as personal digital assistants (PDAs), pagers or mobile phones for patients with cognitive deficits by means of a systematic review. The usability of these aids is also briefly discussed. Data sources: PubMed, CINAHL, PsychINFO, EMBASE and MEDLINE were searched up to February 2009. The references of identified and relevant articles were scanned to find additional relevant titles. Review methods: Papers referring to ‘electronic aids’, ‘cognition’ and ‘brain injury’ were included. The population had to be adult and have cognitive impairments as a result of acquired brain injury. Outcome measures were change in cognitive or occupational performance or the level of participation in daily life. The criteria of Cicerone et al. were used to evaluate the quality of the retrieved studies. Results: Twenty-eight papers presenting 25 studies were reviewed. The total number of participants was 423. Most identified papers described case reports or non-randomized clinical trials. Only one randomized controlled trial was identified, in which the NeuroPage proved effective in supporting prospective memory. Other kinds of assistive technology such as PDAs and voice recorders showed positive results in supporting retrospective and prospective memory. Conclusion: The efficacy of assistive technology in general is not yet sufficiently studied in randomized controlled trials, although promising results has been reported. Furthermore, several survey studies established that both potential users and clinicians have optimistic expectations about the usability of assistive technology.
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Affiliation(s)
- Elsbeth de Joode
- School for Mental Health and Neuroscience, Division Cognitive Neuropsychiatry and Clinical Neuroscience, Maastricht University, The Netherlands,
| | - Caroline van Heugten
- School for Mental Health and Neuroscience, Division Cognitive Neuropsychiatry and Clinical Neuroscience, Maastricht University, The Netherlands
| | - Frans Verhey
- School for Mental Health and Neuroscience, Division Cognitive Neuropsychiatry and Clinical Neuroscience, Maastricht University, The Netherlands
| | - Martin van Boxtel
- School for Mental Health and Neuroscience, Division Cognitive Neuropsychiatry and Clinical Neuroscience, Maastricht University, The Netherlands
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114
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Wilson BA, Emslie H, Evans JJ, Quirk K, Watson P, Fish J. The NeuroPage system for children and adolescents with neurological deficits. Dev Neurorehabil 2010; 12:421-6. [PMID: 20205551 DOI: 10.3109/17518420903200573] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Several studies have demonstrated the effectiveness of a paging system, NeuroPage, in helping survivors of brain injury compensate for everyday memory and planning problems. This study examines the effectiveness of the paging system in the sub-group of 12 children and adolescents with neurological deficits who took part in a larger study. METHODS Twelve participants aged 8-17 years took part in a randomized controlled crossover trial in which their completion of everyday goals was monitored prior to and during use of the NeuroPage system, where participants were sent reminder messages regarding tasks they should complete. RESULTS All 12 young people showed significant improvements in carrying out everyday tasks between the baseline and treatment phases. CONCLUSIONS The NeuroPage system can be successfully used by children and adolescents with neurological deficits and can alleviate some of the everyday difficulties caused by their memory and planning difficulties.
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115
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Sweeney S, Kersel D, Morris RG, Manly T, Evans JJ. The sensitivity of a virtual reality task to planning and prospective memory impairments: Group differences and the efficacy of periodic alerts on performance. Neuropsychol Rehabil 2010; 20:239-63. [DOI: 10.1080/09602010903080531] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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116
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Fish J, Wilson BA, Manly T. The assessment and rehabilitation of prospective memory problems in people with neurological disorders: a review. Neuropsychol Rehabil 2010; 20:161-79. [PMID: 20146135 PMCID: PMC2840878 DOI: 10.1080/09602010903126029] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
People with neurological disorders often report difficulty with prospective memory (PM), that is, remembering to do things they had intended to do. This paper briefly reviews the literature regarding the neuropsychology of PM function, concluding that from the clinical perspective, PM is best considered in terms of its separable but interacting mnemonic and executive components. Next, the strengths and limitations in the current clinical assessment of PM, including the assessment of component processes, desktop analogues of PM tasks, and naturalistic PM tasks, are outlined. The evidence base for the rehabilitation of PM is then considered, focusing on retraining PM, using retrospective memory strategies, problem-solving training, and finally, electronic memory aids. It is proposed that further research should focus on establishing the predictive validity of PM assessment, and refining promising rehabilitation techniques.
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Affiliation(s)
- Jessica Fish
- MRC Cognition and Brain Sciences Unit, Cambridge, UK.
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117
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O'Neill B, Moran K, Gillespie A. Scaffolding rehabilitation behaviour using a voice-mediated assistive technology for cognition. Neuropsychol Rehabil 2010; 20:509-27. [PMID: 20182951 DOI: 10.1080/09602010903519652] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A variety of cognitive deficits can lead to difficulties performing complex behavioural sequences and thus, disability in the performance of routine and rehabilitation behaviours. Interventions to date involve increasing support or providing behavioural training. Assistive technologies for cognition have the potential to augment cognitive capacity thus enabling the performance of behavioural sequences. Guide is an assistive technology for cognition that scaffolds task performance by providing verbal prompts and responding to verbal feedback. Guide was used to provide verbal support and guidance for eight amputees (mean age 64), with cognitive impairment of vascular origin, putting on their prosthetic limbs. Participants were referred to the research due to problems learning the correct behavioural sequence. The research used repeated trials with random assignment to intervention and baseline conditions. The voice-mediated assistive technology for cognition resulted in a significant reduction of safety critical errors and omitted steps. Discussion focuses upon the relation between voice-mediated cognitive support for memory and executive function, and suggestions are made for future research.
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Affiliation(s)
- Brian O'Neill
- Department of Psychology, University of Stirling, Stirling, UK.
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118
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Rehabilitation von Störungen der Exekutivfunktionen. NeuroRehabilitation 2010. [DOI: 10.1007/978-3-642-12915-5_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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119
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Gedächtnisstörungen. NeuroRehabilitation 2010. [DOI: 10.1007/978-3-642-12915-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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120
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121
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A Controlled Treatment Study of Internal Memory Strategies (I-MEMS) Following Traumatic Brain Injury. J Head Trauma Rehabil 2010; 25:43-51. [DOI: 10.1097/htr.0b013e3181bf24b1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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122
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Thöne-Otto A, George S, Hildebrandt H, Reuther P, Schoof-Tams K, Sturm W, Wallesch CW. Diagnostik und Therapie von Gedächtnisstörungen. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2010. [DOI: 10.1024/1016-264x/a000020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Die wichtigsten Empfehlungen auf einen Blick Diagnostik: Die Untersuchung von Gedächtnisstörungen erfordert mindestens ein Verfahren zur Erfassung der Gedächtnisspanne und des Arbeitsgedächtnisses sowie je ein Verfahren zur Untersuchung der unmittelbaren und verzögerten Reproduktion verbaler und figuraler Informationen. Darüber hinaus wird eine Untersuchung des Lernprozesses im Rahmen eines Lernparadigmas (z. B. Wortlisten-Lernen) empfohlen (A). Für die Untersuchung des für den Alltag so relevanten prospektiven Gedächtnisses sind vor allem die Verhaltensbeobachtung und die systematische Befragung z. B. mit Hilfe von Fragebögen von Bedeutung (B). Therapie: (1) Am Anfang der Therapie in der Frühphase steht häufig das Orientierungstraining. (2) Bei Patienten, bei denen die Diagnostik Hinweise auf eine erhaltene Konsolidierung gibt und bei denen der Rehabilitationsverlauf noch offen ist, wird empfohlen, internale Gedächtnisstrategien intensiv zu üben, um die Enkodierungsleistung zu verbessern (A). Für die Wirkung eines übenden Funktionstrainings, bei dem möglichst viele Informationen «auswendig gelernt» werden müssen, gibt es hingegen keine Evidenz. (3) Darüber hinaus ist die Behandlung der Gedächtnisstörung an den Alltagsanforderungen des Patienten zu orientieren und für spezifische gedächtnisrelevante Situationen sind Kompensationsstrategien zu erarbeiten (A). Ob die Patienten lediglich lernen können, auf externe Hilfen, die sie von Angehörigen oder Pflegepersonen erhalten, adäquat zu reagieren, oder ob sie diese selbstständig nutzen können, muss im Einzelfall im Therapieverlauf entschieden werden.
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Affiliation(s)
| | - Sabine George
- Deutscher Verband der Ergotherapeuten e. V., Karlsbad
| | - Helmut Hildebrandt
- Klinikum Bremen-Ost, Zentrum für Neurologie, und Universität Oldenburg, Institut für Psychologie, Oldenburg
| | - Paul Reuther
- Ambulantes Neurologisches Rehabilitationscenter Ahrweiler, Bad Neuenahr-Ahrweiler
| | | | - Walter Sturm
- Neurologische Klinik, Sektion Klinische Neuropsychologie, Universitätsklinikum der RWTH Aachen
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123
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Culley C, Evans JJ. SMS text messaging as a means of increasing recall of therapy goals in brain injury rehabilitation: A single-blind within-subjects trial. Neuropsychol Rehabil 2010; 20:103-19. [DOI: 10.1080/09602010902906926] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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124
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Wilson BA. Brain injury: recovery and rehabilitation. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2009; 1:108-118. [DOI: 10.1002/wcs.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Barbara A. Wilson
- MRC Cognition and Brain Sciences Unit, 15 Chaucer Rd, Cambridge, CB2 7EF, England, United Kingdom
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125
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Lefkowitz T, Flanagan S, Varlotta G. Rehabilitation of orthopaedic and neurologic boxing injuries. Clin Sports Med 2009; 28:623-39, vii. [PMID: 19819406 DOI: 10.1016/j.csm.2009.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical decision making for injured boxers follows the same therapeutic principles as the treatment plan for other injured athletes. Just as surgical techniques have improved, so has the scientific basis for implementing therapeutic exercises progressed to return the athletes to their former level of competition.
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Affiliation(s)
- Todd Lefkowitz
- Department of Rehabilitation Medicine, New York University School of Medicine, Rusk Institute of Rehabilitation Medicine, 317 East 34th Street, 5th Floor, NY 100016, USA
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126
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Pijnenborg GHM, Withaar FK, Brouwer WH, Timmerman ME, van den Bosch RJ, Evans JJ. The efficacy of SMS text messages to compensate for the effects of cognitive impairments in schizophrenia. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2009; 49:259-74. [PMID: 19735607 DOI: 10.1348/014466509x467828] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND AIMS Many people with schizophrenia have severe cognitive impairments that hamper their activities. The effect of pharmacological and behavioural interventions on cognitive functioning has been demonstrated, but even after successful intervention considerable impairments can remain. Therefore, we sought for alternative ways to help patients cope with the effects of their cognitive impairments. In the present study, we have evaluated the efficacy of short message service (SMS) text messages to compensate for the effects of cognitive impairments in schizophrenia in daily life. DESIGN A waiting list controlled trial was conducted: patients were quasi-randomly assigned to an A-B-A (baseline-intervention-follow-up) condition or an A-A-B-A condition that included an additional 7-week waiting list. The waiting list was included to control for the effect of time on relevant outcome. METHOD Sixty-two people with schizophrenia or related psychotic disorders were included in the study. All patients showed impaired goal-directed behaviour in daily life-situations. Patients were prompted with SMS text messages to improve their everyday functioning. The primary outcome measure was the percentage of goals achieved. RESULTS The overall percentage of goals achieved increased with prompting, while performance dropped to baseline level after withdrawing the prompts. Keeping appointments with mental health workers and carrying out leisure activities increased with prompting, while medication adherence and attendance at training sessions remained unchanged. A majority of the patients enjoyed receiving the SMS text messages. DISCUSSION Prompting can significantly improve achievement of a number of relevant goals. For other goals, combining prompting with interventions that enhance motivation seems indicated.
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Affiliation(s)
- G H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands.
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127
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Slomine B, Locascio G. Cognitive rehabilitation for children with acquired brain injury. ACTA ACUST UNITED AC 2009; 15:133-43. [PMID: 19489085 DOI: 10.1002/ddrr.56] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cognitive deficits are frequent consequences of acquired brain injury (ABI) and often require intervention. We review the theoretical and empirical literature on cognitive rehabilitation in a variety of treatment domains including attention, memory, unilateral neglect, speech and language, executive functioning, and family involvement/education. Because there are more well-designed studies examining the efficacy of cognitive rehabilitation in adults with brain injury, the major findings from this body of literature are also highlighted. In addition, given that similar cognitive and behavioral concerns are often apparent in children with certain neurodevelopmental disorders, selected literature focusing on interventions for these groups of children is included. Limitations and challenges inherent in examining cognitive interventions in children with ABI are also discussed. Overall, despite the growing body of literature examining the efficacy of cognitive rehabilitation in children with ABI, there continues to be a great need to develop well-designed studies to examine the efficacy of these interventions.
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Affiliation(s)
- Beth Slomine
- Department of Neuropsychology, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA.
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128
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Stip E. [Expert opinion on APAP (prolonged action atypical antipsychotic agents). Position of Canadian psychiatry]. Encephale 2009; Suppl 3:S115-8. [PMID: 19268180 DOI: 10.1016/s0013-7006(09)75547-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- E Stip
- Département de Psychiatrie, Université de Montréal
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129
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Catroppa C, Anderson V. Planning, problem-solving and organizational abilities in children following traumatic brain injury: Intervention techniques. ACTA ACUST UNITED AC 2009; 9:89-97. [PMID: 16449067 DOI: 10.1080/13638490500155458] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Due to the mechanisms involved in traumatic brain injury (TBI), the frontal lobes are often impacted. As the frontal regions of the brain are believed to subsume executive functioning, then it follows that post-TBI deficits may be seen in this domain. Executive functioning broadly refers to a set of inter-related skills necessary to maintain an appropriate problem-solving set for the attainment of a future goal and may include areas such as attentional control, planning, problem-solving, cognitive flexibility, abstraction and information processing. The literature available on interventions for executive difficulties following TBI is minimal, with that focused on the paediatric population even more limited. From the few evaluation studies available, results tend to suggest that specific types of intervention lead to positive outcomes. However, as the interventions are few and often based on case studies, there is much need for more evaluation studies to be conducted.
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Affiliation(s)
- C Catroppa
- Australian Centre for Child Neuropsychology Studies, Murdoch Children's Research Institute, Melbourne, Australia.
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130
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Rankin PM, Hood J. Designing clinical interventions for children with specific memory disorders. ACTA ACUST UNITED AC 2009; 8:283-97. [PMID: 16192103 DOI: 10.1080/13638490400022436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite increasing research into the severe effects of childhood memory disorders, there is currently a paucity of evidence available to inform the design of appropriate rehabilitation strategies. Indeed, within the paediatric literature there is no model that links specific memory disorders with hypotheses for appropriate rehabilitation strategies. This paper introduces a series of intervention hypotheses based on an examination of the strengths and weaknesses associated with each type of childhood memory disorder, including short-term phonological, visuo-spatial, central executive and long-term semantic and episodic memory. Guidance is provided for integrating the hypotheses within practical rehabilitation strategies and case studies are described to examine a number of the hypotheses.
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Affiliation(s)
- Peter M Rankin
- Paediatric Neuropsychology, Newcomen Centre, Guy's Hospital, London, UK.
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131
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Todis B, Sohlberg MM, Hood D, Fickas S. Making electronic mail accessible: Perspectives of people with acquired cognitive impairments, caregivers and professionals. Brain Inj 2009; 19:389-401. [PMID: 16101262 DOI: 10.1080/02699050400003957] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The primary objective of this study was to better understand the technology needs, barriers and strategies of individuals with acquired cognitive impairments (ACI) in order to design and modify technologies with potential for alleviating the diminished independence and social isolation common in this population. The authors hypothesized that (1) higher rates of computer use would be reported by younger, more highly educated individuals with ACI, those with less severe injuries and those with previous computer experience; (2) A low percentage of survey respondents would own their own computers; and (3) People with ACI would experience social isolation and report low frequency of connecting with important people who live far away. A total of 133 individuals with ACI, professionals and care providers completed the survey. To gain more specific information, seven focus groups were conducted with 66 individuals with ACI and 20 care providers. Finally, 10 current email users participated in structured conversations, detailing their strategies for using email. The survey revealed that 80% of subjects with ACI reported owning a computer. Age and education were not predictors of computer use, but individuals whose ACI was the result of more severe injuries were less likely to use computers. As expected, respondents reported that maintaining contact with distant loved ones is problematic. The focus groups and conversations provided more detail about the communication needs of the population and the relative advantages and disadvantages of email compared with telephone and mail. Participants also identified barriers to email use they had encountered or feared they would encounter when using email. A number of accommodations to overcome these barriers were suggested. The results of the survey, focus groups and conversations confirmed the utility of email and other technologies for people with ACI and the need to make these technologies more accessible. The results and suggestions provided by the focus groups and interviews are being used in the design of Think and Link, an email interface for use by individuals with ACI.
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Affiliation(s)
- B Todis
- Teaching Research, Western Oregon University, Oregon 97401, USA.
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132
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Fleming JM, Shum D, Strong J, Lightbody S. Prospective memory rehabilitation for adults with traumatic brain injury: A compensatory training programme. Brain Inj 2009; 19:1-10. [PMID: 15762096 DOI: 10.1080/02699050410001720059] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PRIMARY OBJECTIVE To describe a prospective memory rehabilitation programme based on a compensatory training approach and report the results of three case studies. RESEARCH DESIGN Programme evaluation using pre- and post-intervention assessments and telephone follow-up. METHODS AND PROCEDURES Three participants with traumatic brain injury completed 8 weeks of training with 1-2 hour individual sessions. Assessments were formal prospective memory assessment, self-report and measures of diary use. EXPERIMENTAL INTERVENTIONS Intervention aimed to identify potential barriers, establish self-awareness of memory deficits, introduce a customized compensatory tool, a cueing system and organizational strategies. A significant other was involved in training to assist generalization. MAIN OUTCOMES AND RESULTS All three participants improved on formal prospective memory assessment and demonstrated successful diary use after the programme. Self-report of prospective memory failure fluctuated and may reflect increased self-awareness. CONCLUSION A compensatory approach may be useful in improving prospective memory performance following TBI.
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133
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Wilson BA, Emslie H, Quirk K, Evans J, Watson P. A randomized control trial to evaluate a paging system for people with traumatic brain injury. Brain Inj 2009; 19:891-4. [PMID: 16296571 DOI: 10.1080/02699050400002363] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although memory problems following acquired brain damage are common, some people are able to compensate for these problems through external aids. It was recently demonstrated that a paging system could reduce the everyday memory and planning problems for people with non-progressive brain injury. The 143 patients who participated in the study comprised several diagnostic groups. This paper reports on the sub-group of people with TBI (n=63). This sub-group was part of the larger sample of 143 already published in the 2001 study. A randomized control cross-over design randomly allocated people to group A (pager first) or group B (waiting list first). Each participant chose their own tasks for which they needed reminders. During a 2 week baseline, successful task achievement was documented. Group A achieved 47.14% of tasks and group B 47.88%. People in group A then received a pager for 7 weeks. During the last 2 weeks of this 7 week period, task achievement was documented again. Group A now achieved 71.80% of tasks and group B (on the waiting list) achieved 49.05% (no different from baseline). Group A then returned their pagers and group B received pagers. During the last 2 weeks of this stage participants were monitored once more. At this point, people in group A had dropped back slightly but were still statistically significantly better than during the baseline (67.23%). Group B, meanwhile, were now achieving 73.62% of tasks. This was statistically significantly better than baseline and significantly better than group A, now in the post-pager phase. It is concluded that this paging system significantly reduces the everyday memory and planning problems of people with TBI.
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Affiliation(s)
- Barbara A Wilson
- MRC Cognition and Brain Sciences Unit, Addenbrooke's Hospital, Cambridge, UK
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134
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Sohlberg MM, Fickas S, Hung PF, Fortier A. A comparison of four prompt modes for route finding for community travellers with severe cognitive impairments. Brain Inj 2009; 21:531-8. [PMID: 17522993 DOI: 10.1080/02699050701311000] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PRIMARY OBJECTIVE Navigational skills are fundamental to community travel and, hence, personal independence and are often disrupted in people with cognitive impairments. Navigation devices are being developed that can support community navigation by delivering directional information. Selecting an effective mode to provide route-prompts is a critical design issue. This study evaluated the differential effects on pedestrian route finding using different modes of prompting delivered via a handheld electronic device for travellers with severe cognitive impairments. RESEARCH DESIGN A within-subject comparison study was used to evaluate potential differences in route navigation performance when travellers received directions using four different prompt modes: (1) aerial map image, (2) point of view map image, (3) text based instructions/no image and (4) audio direction/no image. METHODS AND PROCEDURES Twenty travellers with severe cognitive impairments due to acquired brain injury walked four equivalent routes using four different prompting modes delivered via a wrist-worn navigation device. Navigation scores were computed that captured accuracy and confidence during navigation. MAIN OUTCOME Results of the repeated measures Analysis of Variance suggested that participants performed best when given prompts via speech-based audio directions. The majority of the participants also preferred this prompting mode. Findings are interpreted in the context of cognitive resource allocation theory.
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Affiliation(s)
- McKay Moore Sohlberg
- Communication Disorders & Sciences, University of Oregon, Eugene, OR 97403, USA.
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135
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Stapleton S, Adams M, Atterton L. A mobile phone as a memory aid for individuals with traumatic brain injury: A preliminary investigation. Brain Inj 2009; 21:401-11. [PMID: 17487638 DOI: 10.1080/02699050701252030] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PRIMARY OBJECTIVE To investigate the use of a 'reminders' function on a mobile phone as a compensatory memory aid for five individuals with traumatic brain injury (TBI). RESEARCH DESIGN A series of five single case ABAB reversal design. METHODS AND PROCEDURE A mobile phone was given to each participant during two intervention phases. Target behaviours were recorded for the length of the study. EXPERIMENTAL INTERVENTION The phone was programmed to prompt a number of identified target behaviours. MAIN OUTCOMES AND RESULTS For two participants, there was an increase in the target behaviours achieved when the phone was used, with percentages rising from 51% to 95% for Participant 1 (P1) and 58% to 88% for Participant 5 (P5). The percentage of target behaviours achieved did not return to initial baseline levels when the phone was removed, indicating that the intervention may have facilitated P1 and, in particular, P5 in the learning of their routines. The participants who did not benefit from the mobile phone differed from P1 and P5 as they fell in the category of 'severe memory impairment' on the RBMT, were significantly impaired on an assessment of executive functioning (Tower Test) and required 24-hour care. CONCLUSIONS The preliminary investigation with five participants suggests that this system may be of best use with individuals who do not require 24-hour care and do not experience severe memory and executive functioning difficulties. However, further research with a larger sample is highly recommended.
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136
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Gentry T, Wallace J, Kvarfordt C, Lynch KB. Personal digital assistants as cognitive aids for individuals with severe traumatic brain injury: A community-based trial. Brain Inj 2009; 22:19-24. [DOI: 10.1080/02699050701810688] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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137
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O'Neil-Pirozzi TM, Kendrick H, Goldstein R, Glenn M. Clinician influences on use of portable electronic memory devices in traumatic brain injury rehabilitation. Brain Inj 2009; 18:179-89. [PMID: 14660229 DOI: 10.1080/0269905031000149560] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PRIMARY OBJECTIVE To explore the relationship between a group of clinicians' own experience, training and confidence with portable electronic memory devices and their use of the same in traumatic brain injury (TBI) rehabilitation. RESEARCH DESIGN Survey study. METHODS AND PROCEDURES Eighty-one TBI clinicians from various disciplines and work settings completed a survey distributed in person or by mail. MAIN OUTCOMES AND RESULTS Twenty-nine respondents (36%) reported using portable electronic memory devices with patients with TBI. Using regression analysis, respondent device training and confidence teaching patients device use were statistically associated with respondents' use of such devices in TBI rehabilitation. CONCLUSIONS Portable electronic memory device use with persons following TBI may be under-utilized. The importance of ongoing clinician training and of maximizing clinician confidence utilizing these devices in TBI rehabilitation is emphasized. The representativeness of the respondent sample is discussed. Specific training strategies and continued research needs are presented.
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Affiliation(s)
- Therese M O'Neil-Pirozzi
- Professional Development Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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138
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Kirsch NL, Shenton M, Rowan J. A generic, ‘in-house’, alphanumeric paging system for prospective activity impairments after traumatic brain injury. Brain Inj 2009; 18:725-34. [PMID: 15204332 DOI: 10.1080/02699050310001646161] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE For settings having suitable infrastructure, generic, 'in-house' alphanumeric paging systems can be constructed that are fully under clinician control. Development of such a system for therapeutic application is described and a single-case study presented that assessed whether the system could improve repetitive, prospective use of a daily planner. DESIGN ABA' single case. METHODS The participant was male, in his mid-30s, having cognitive impairments subsequent to recent TBI superimposed on remote neurological changes. The pager reminded him to record therapeutic information in a daily planner, for discussion with a family member each evening. RESULTS During intervention (B) trials, reliable memory log usage was noted. By trial five of return-to-baseline (A') trials, there was decreased memory log use. CONCLUSIONS Alphanumeric paging facilitated reliable use of a memory log compensation technique. The 'in-house' paging system proved particularly suitable for intervention development. Limits of the study are discussed and other therapeutically useful wireless technologies are noted.
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Affiliation(s)
- Ned L Kirsch
- Department of Physical Medicine and Rehabilitation, University of Michigan Health Systems, Ann Arbor, MI 48108, USA.
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139
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Compensating for anterograde amnesia: a new training method that capitalizes on emerging smartphone technologies. J Int Neuropsychol Soc 2009; 15:629-38. [PMID: 19588540 DOI: 10.1017/s1355617709090791] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Following a neuropathological event, individuals left with moderate-to-severe memory impairment are unable to reliably form new memories. The most common challenges involve the capacity to perform a task in the future and to consciously recall a recent event. Disruption of these memory processes leaves the individual trapped in the present, unable to stay on track, and alienated from ongoing events. Memory research has demonstrated that implicit memory is often preserved despite severe explicit memory impairment and that preserved memory systems can provide avenues for acquiring new skills and knowledge. A within-subject single-case A1-B1-A2-B2 experimental design was used to introduce an established theory-driven training program of technology use for individuals with moderate-to-severe memory impairment. We describe its application to enabling RR, an individual with memory impairment postcolloid cyst removal, to independently support her memory using a commercial smartphone. RR showed successful outcome on both objective and qualitative measures of memory functioning. Moreover, she demonstrated consistent and creative generalization of acquired smartphone skills across a broad range of real-life memory-demanding circumstances. Our findings suggest that individuals with moderate-to-severe memory impairment are able to capitalize on emerging commercial technology to support their memory.
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140
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Remédiation cognitive et assistants cognitifs numériques dans la schizophrénie. Encephale 2009; 35:160-7. [DOI: 10.1016/j.encep.2008.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 02/21/2008] [Indexed: 11/18/2022]
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141
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Boman IL, Tham K, Granqvist A, Bartfai A, Hemmingsson H. Using electronic aids to daily living after acquired brain injury: a study of the learning process and the usability. Disabil Rehabil Assist Technol 2009; 2:23-33. [PMID: 19263551 DOI: 10.1080/17483100600856213] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose was to study the ability of persons with memory impairments after acquired brain injury to learn how to and use electronic aids to daily living (EADL) and to describe changes in function and quality of life. METHOD Eight participants stayed in two apartments equipped with a set of basic and advanced EADL for either 4 or 6 months during an intervention time of 2 years. The teaching and learning method was influenced by certain principles of errorless learning. Ability to learn to use EADL was measured by structured observations. Function and quality of life were assessed with self-rating questionnaires. RESULTS Results indicate that the participants learned to use EADL in their everyday activities. They perceived that EADL were very useful and easy to learn. Occupational performance and satisfaction with occupational performance and quality of life was improved. CONCLUSION The results indicate that EADL may play an important role in facilitating everyday activities and improve satisfaction with occupational performance and quality of life for people with memory impairments. The study indicates the importance of adjusting technology to the user's needs and calls for more consideration for human-technology interaction factors.
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Affiliation(s)
- I L Boman
- Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden.
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142
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Abstract
OBJECTIVE The aims of this review were to: (i) briefly outline common sequelae following childhood traumatic brain injury (TBI); (ii) provide a summary of models and research in the area of intervention; (iii) discuss issues and obstacles in the evaluation of research in the area of intervention; (vi) discuss integrative and translational aspects of research in this area; (v) provide an example of intervention studies being conducted in the laboratory; and (vii) highlight the need for continued and collaborative work in the paediatric intervention field. CONCLUSIONS When reviewing the literature, it is clear that while challenging, the development and evaluation of intervention programs for children post traumatic brain injury, must be encourage and pursued. This in turn will lead to improved quality of life for these children and their families.
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Affiliation(s)
- Cathy Catroppa
- Australian Centre for Child Neuropsychology Studies, Melbourne, Australia.
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143
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Flanagan SR, Cantor JB, Ashman TA. Traumatic brain injury: future assessment tools and treatment prospects. Neuropsychiatr Dis Treat 2008; 4:877-92. [PMID: 19183780 PMCID: PMC2626927 DOI: 10.2147/ndt.s1985] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Traumatic brain injury (TBI) is widespread and leads to death and disability in millions of individuals around the world each year. Overall incidence and prevalence of TBI are likely to increase in absolute terms in the future. Tackling the problem of treating TBI successfully will require improvements in the understanding of normal cerebral anatomy, physiology, and function throughout the lifespan, as well as the pathological and recuperative responses that result from trauma. New treatment approaches and combinations will need to be targeted to the heterogeneous needs of TBI populations. This article explores and evaluates the research evidence in areas that will likely lead to a reduction in TBI-related morbidity and improved outcomes. These include emerging assessment instruments and techniques in areas of structural/chemical and functional neuroimaging and neuropsychology, advances in the realms of cell-based therapies and genetics, promising cognitive rehabilitation techniques including cognitive remediation and the use of electronic technologies including assistive devices and virtual reality, and the emerging field of complementary and alternative medicine.
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Affiliation(s)
- Steven R Flanagan
- New York University School of Medicine, The Rusk Institute of Rehabilitation, New York, NY, USA.
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144
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Abstract
Neuropsychological rehabilitation (NR) is concerned with the amelioration of cognitive, emotional, psychosocial, and behavioral deficits caused by an insult to the brain. Major changes in NR have occurred over the past decade or so. NR is now mostly centered on a goal-planning approach in a partnership of survivors of brain injury, their families, and professional staff who negotiate and select goals to be achieved. There is widespread recognition that cognition, emotion, and psychosocial functioning are interlinked, and all should be targeted in rehabilitation. This is the basis of the holistic approach. Technology is increasingly used to compensate for cognitive deficits, and some technological aids are discussed. Evidence for effective treatment of cognitive, emotional, and psychosocial difficulties is presented, models that have been most influential in NR are described, and the review concludes with guidelines for good practice.
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Affiliation(s)
- Barbara A Wilson
- Cognition and Brain Sciences Unit, Medical Research Council, Addenbrooke's Hospital, Cambridge CB2 2QQ, United Kingdom.
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145
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O'Neill B, Gillespie A. Simulating naturalistic instruction: the case for a voice mediated interface for assistive technology for cognition. ACTA ACUST UNITED AC 2008. [DOI: 10.1108/17549450200800015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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146
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Serruya MD, Kahana MJ. Techniques and devices to restore cognition. Behav Brain Res 2008; 192:149-65. [PMID: 18539345 DOI: 10.1016/j.bbr.2008.04.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2007] [Revised: 03/03/2008] [Accepted: 04/09/2008] [Indexed: 12/18/2022]
Abstract
Executive planning, the ability to direct and sustain attention, language and several types of memory may be compromised by conditions such as stroke, traumatic brain injury, cancer, autism, cerebral palsy and Alzheimer's disease. No medical devices are currently available to help restore these cognitive functions. Recent findings about the neurophysiology of these conditions in humans coupled with progress in engineering devices to treat refractory neurological conditions imply that the time has arrived to consider the design and evaluation of a new class of devices. Like their neuromotor counterparts, neurocognitive prostheses might sense or modulate neural function in a non-invasive manner or by means of implanted electrodes. In order to paint a vision for future device development, it is essential to first review what can be achieved using behavioral and external modulatory techniques. While non-invasive approaches might strengthen a patient's remaining intact cognitive abilities, neurocognitive prosthetics comprised of direct brain-computer interfaces could in theory physically reconstitute and augment the substrate of cognition itself.
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Affiliation(s)
- Mijail Demian Serruya
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Gates 3 HUP, Philadelphia, PA 19104-4283, United States.
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147
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Sablier J, Stip E, Franck N, Giroux S, Pigot H, Moreau JF, Paccoud B. Étude de convivialité de l’utilisation d’un agenda électronique par des personnes souffrant de schizophrénie. SANTE MENTALE AU QUEBEC 2008. [DOI: 10.7202/017807ar] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Résumé
La schizophrénie est associée à des troubles du fonctionnement mnésique et exécutif qui altèrent la capacité des patients à organiser leurs Activités de la Vie Quotidienne (AVQ). Afin d’améliorer leur autonomie et d’alléger la charge de leurs aidants, nous proposons de programmer des organiseurs en fonction des besoins spécifiques de chaque patient. Ces agendas électroniques permettent de rappeler au patient ses AVQ, et d’augmenter la communication avec l’aidant. Cette étude de convivialité vérifie que l’organiseur pressenti est fonctionnel. Malgré les problèmes techniques rencontrés, tous les participants ont été séduits par l’utilisation des organiseurs. Les aidants ont été convaincus que ces outils amélioreraient la qualité de vie des patients et constitueraient un complément de travail précieux. Les agendas seront améliorés d’après les commentaires des participants et testés dans une étude ultérieure.
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Affiliation(s)
- Juliette Sablier
- Étudiante en cotutelle de thèse Sciences Biomédicales et Sciences Cognitives ; Département de Psychiatrie, Faculté de Médecine, Centre de Recherche Fernand Seguin, Université de Montréal, Montréal, Canada, Institut des Sciences Cognitives, Université Lumière Lyon 2, Lyon, France
| | - Emmanuel Stip
- Psychiatre, chercheur, La chaire Eli Lilly de recherche en schizophrénie de l’Université de Montréal ; Centre de Recherche Fernand-Seguin, Département de Psychiatrie, Faculté de Médecine, Hôpital Sacré-Coeur de Montréal, Université de Montréal
| | - Nicolas Franck
- Institut des Sciences Cognitives, Hôpital Le Vinatier, Université Claude Bernard Lyon 1, Lyon, France
| | - Sylvain Giroux
- Professeur, Laboratoire DOMUS, Département d’informatique, Faculté des Sciences, Université de Sherbrooke
| | - Hélène Pigot
- Professeur, Laboratoire DOMUS, Département d’informatique, Faculté des Sciences, Université de Sherbrooke
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148
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Hart T, Fann JR, Novack TA. The dilemma of the control condition in experience-based cognitive and behavioural treatment research. Neuropsychol Rehabil 2008; 18:1-21. [PMID: 17852761 DOI: 10.1080/09602010601082359] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Rehabilitation using cognitive and behavioural treatment methods (i.e., experience-based interventions) faces particular challenges in improving its evidence base through rigorous studies such as randomised controlled trials (RCTs). Experience-based treatments are often complex, with multiple "active ingredients" that may be difficult to characterise. In addition to the difficulty in specifying treatment ingredients, experience-based rehabilitation researchers face challenges in designing or selecting appropriate control or comparison conditions to test the efficacy of complex treatments. Based on lessons learned in designing a cognitive-behavioural intervention for anger self-management for people with traumatic brain injury (TBI) for the National Institutes of Health (NIH)-funded TBI Clinical Trials Network, we review the advantages, disadvantages and applications of a variety of control conditions for experience-based interventions. We discuss controls in which active treatments are withheld (no-treatment controls, waitlist controls, and placebo-analogue designs); controls that involve comparison to naturally occurring or devised usual care treatments; and conditions that compare active treatments (dismantling designs, dose controls, and equivalence trials). Recommendations for selecting and developing control groups that maximise both equipoise and participant enrolment/retention are discussed.
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Affiliation(s)
- Tessa Hart
- Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA, USA.
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149
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Long-term compensatory treatment of organizational deficits in a patient with bilateral frontal lobe damage. J Int Neuropsychol Soc 2008; 14:154-63. [PMID: 18078543 DOI: 10.1017/s1355617708080120] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 07/18/2007] [Accepted: 07/18/2007] [Indexed: 11/06/2022]
Abstract
Evans et al. (1998) described compensatory strategy use in R.P., a patient with executive dysfunction following bilateral frontal lobe damage who had difficulty acting upon her intentions. A pager was used to remind R.P. of regularly scheduled activities, along with a checklist that aimed to moderate a perseverative routine. Although successful, 10 years after the original intervention, the strategies were no longer used, and considerable everyday problems were evident. In the current study, we conducted a follow-up assessment to examine potential reasons for this deterioration. No change in neuropsychological functioning was evident. Whereas the previous study introduced the two strategies together, and examined effects upon separate goals, in the current study we reintroduced the two strategies separately, and examined effects on three common goals. In addition to prompting specific activities, we aimed to support completion of more general goals (those that could be enacted within a wider window of time). The paging intervention had a dramatic effect on all three measured behaviors, at a much more consistent level than the checklist. We suggest that, in addition to direct reminders, the pager can cue a process of goal monitoring that bridges the gap between intention and action.
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150
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Rowland TJ, Cooke DM, Gustafsson LA. Role of occupational therapy after stroke. Ann Indian Acad Neurol 2008; 11:S99-S107. [PMID: 35721442 PMCID: PMC9204113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 03/20/2008] [Accepted: 04/29/2008] [Indexed: 11/25/2022] Open
Abstract
Internationally recognized best practice care in the early management and rehabilitation of individuals following stroke includes multidisciplinary assessment and treatment by a coordinated team of health care professionals that includes occupational therapists. Occupational therapists assess the impact of changes in motor function, sensation, coordination, visual perception, and cognition on a person's capacity to manage daily life tasks. Intervention improves participation in meaningful roles, tasks, and activities; remediates deficits; minimizes secondary complications; and provides education and support to the patient and caregivers. Occupational therapists' focus on independence and function, individual goal-setting, and their specialist skills in task adaptation and environmental modification underpin the profession's contribution to the multidisciplinary stroke rehabilitation team. The aim of this paper is to provide an overview of occupational therapy practice in stroke patients.
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Affiliation(s)
- Tennille J. Rowland
- Department of Occupational Therapy / Acute Stroke Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Deirdre M. Cooke
- Mater Private Rehabilitation Unit, Brisbane, Queensland, Australia
| | - Louise A. Gustafsson
- Division of Occupational Therapy, University of Queensland, Brisbane,Queensland, Australia
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