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Sargénius HL, Hypher RE, Finnanger TG, Brandt AE, Andersson S, Risnes K, Rø TB, Stubberud JE. Goal management training for improving fatigue in children and adolescents with acquired brain injuries: A 2-year follow-up of a randomised controlled trial. Neuropsychol Rehabil 2024:1-21. [PMID: 38848501 DOI: 10.1080/09602011.2024.2353395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 05/01/2024] [Indexed: 06/09/2024]
Abstract
To explore the long-term effectiveness of a paediatric adaptation of Goal Management Training (pGMT), relative to a psychoeducative program (pBHW), in reducing fatigue after pABI 2 years post-intervention. Thirty-eight youths and their parents completed the Paediatric Quality of Life - Multidimensional Fatigue Scale. Primary outcome measures were Total Fatigue Score, General fatigue, Cognitive fatigue, and Sleep/rest fatigue (parent-report). No significant differences in fatigue symptoms by the parental report was observed between the intervention groups at the 2-year follow-up (total score: F = .16, p = .69; general fatigue: F = .36, p = .55; sleep/rest: F = .48, p = .49; and cognitive fatigue: F = .09, p = .76), nor any time*group interactions (total score: F = .25, p = .86; general fatigue: F = .39, p = .76; sleep/rest: F = .20, p = .89; and cognitive fatigue: F = .08, p = .97). In total, 45% of the participants in the pGMT group and 25% in the pBHW group demonstrated a reliable positive clinical change. The significant improvements in fatigue symptoms that were demonstrated 6 months post-intervention could not be confirmed in this 2-year follow-up study. However, a continued positive tendency on most dimensions of fatigue for the participants in the pGMT group could be observed, suggesting that cognitive rehabilitation may help reduce fatigue.
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Affiliation(s)
| | - Ruth Elizabeth Hypher
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | | | - Anne Elisabeth Brandt
- Children's Clinic, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
| | - Stein Andersson
- Department of Psychology, University of Oslo, Oslo, Norway
- Psychosomatic Medicine and Clinical Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Kari Risnes
- Children's Clinic, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
| | - Torstein Baade Rø
- Children's Clinic, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
| | - Jan Egil Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
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Joosub N, Kruger G, Basson P. A neuropsychological rehabilitation service delivery model for South African adults with acquired brain injury (RSDM-SA). FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1175963. [PMID: 38681901 PMCID: PMC11045952 DOI: 10.3389/fresc.2023.1175963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/24/2023] [Indexed: 05/01/2024]
Abstract
In low- and- middle- income countries (LMICs) such as South Africa, a high number of Acquired Brain Injuries (ABIs) and a lack of accessibility to healthcare lead to many survivors of brain injury not receiving the level of healthcare and rehabilitation required. Further, in LMICs life-saving or acute care is prioritized with an inadequate focus on the lifelong effects of ABI. This study used Program Theory to develop a Rehabilitation Service Delivery Model for South African Adults with Acquired Brain Injury (RSDM-SA) that caters for the unique nuances of a resource-constrained and culturally diverse context. The RSDM-SA has four interdependent levels, namely (i) Integration of Relevant Aspects of Explanatory Frameworks (ii) South African Contextual Influences on the Model (iii) Systemic Role players Necessary for the Model and (iv) Evidence-Based Guidelines in a Holistic Rehabilitation Process. The Model is a valuable resource in guiding future research endeavors and its contribution lies in the Model's focus on quality, accessibility, relevance, and efficiency, all of which are needed in healthcare internationally.
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Affiliation(s)
- Noorjehan Joosub
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
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3
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Zhang J, He C. Evidence-based rehabilitation medicine: definition, foundation, practice and development. MEDICAL REVIEW (2021) 2024; 4:42-54. [PMID: 38515780 PMCID: PMC10954297 DOI: 10.1515/mr-2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/19/2023] [Indexed: 03/23/2024]
Abstract
To determine the definition, foundation, practice, and development of evidence-based rehabilitation medicine (EBRM) and point out the development direction for EBRM. Retrieve the database of PubMed, Cochrane Library, Embase, China national knowledge infrastructure (CNKI), Wanfang, and China science and technology journal database (CSTJ). The search was conducted from the establishment of the database to June 2023. The key words are "rehabilitation medicine and evidence based" in Chinese and English. After reading the abstract or full text of the literature, a summary analysis is conducted to determine the definition, foundation, practice, and development of EBRM. A total of 127 articles were included. The development of 14 sub majors in EBRM are not balanced, evidence-based musculoskeletal rehabilitation medicine (EBMRM) (31 articles, mainly focuses on osteoarthritis, osteoporosis and musculoskeletal pain), evidence-based neurorehabilitation medicine (EBNM) (34 articles, mainly concentrated in stroke, traumatic brain injury and spinal cord injury) and evidence-based education rehabilitation medicine (EBEDRM) (17 articles, mainly focuses on educational methodology), evidence-based nursing rehabilitation medicine (EBNRM) (2 articles), evidence-based engineering rehabilitation medicine (EBENRM) (7 articles), evidence-based traditional Chinese rehabilitation medicine (EBTCRM) (3 articles), evidence-based internal rehabilitation medicine (EBIRM) (11 articles), evidence-based intensive care rehabilitation medicine (EBICRM) (4 articles), evidence-based oncology rehabilitation medicine (EBORM) (6 articles), evidence-based physical therapy medicine (EBPTM) (3 articles), evidence-based cardiopulmonary rehabilitation medicine (EBCRM) (6 articles), evidence-based speech therapy medicine (EBSTM)/evidence-based occupation therapy medicine (EBOTM)/evidence-based geriatric rehabilitation medicine (EBGRM) (1 article). The EBMRM, EBNM and EBEDRM are relatively well developed. The development of EBNRM, EBENRM, EBTCRM, EBIRM, EBICRM, EBGRM, EBORM, EBCRM, EBPTM, EBSTM and EBOTM is relatively slow, indicating these eleven fields should be pay more attention in future.
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Affiliation(s)
- Jinlong Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Bartfai A, Elg M, Schult ML, Markovic G. Predicting Outcome for Early Attention Training After Acquired Brain Injury. Front Hum Neurosci 2022; 16:767276. [PMID: 35664351 PMCID: PMC9159897 DOI: 10.3389/fnhum.2022.767276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background The training of impaired attention after acquired brain injury is central for successful reintegration in daily living, social, and working life. Using statistical process control, we found different improvement trajectories following attention training in a group of relatively homogeneous patients early after acquired brain injury (ABI). Objective To examine the contribution of pre-injury factors and clinical characteristics to differences in outcome after early attention training. Materials and Methods Data collected in a clinical trial comparing systematic attention training (APT) with activity-based attention training (ABAT) early after brain injury were reanalyzed. Results Stroke patients (p = 0.004) with unifocal (p = 0.002) and right hemisphere lesions (p = 0.045), and those with higher mental flexibility (TMT 4) (p = 0.048) benefitted most from APT training. Cognitive reserve (p = 0.030) was associated with CHANGE and APT as the sole pre-injury factor. For TBI patients, there was no statistical difference between the two treatments. Conclusion Our study identifies indiscernible factors predicting improvement after early attention training. APT is beneficial for patients with right-hemispheric stroke in an early recovery phase. Knowledge of prognostic factors, including the level of attention deficit, diagnosis, and injury characteristics, is vital to maximizing the efficiency of resource allocation and the effectiveness of rehabilitative interventions to enhance outcomes following stroke and TBI.
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Affiliation(s)
- Aniko Bartfai
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
- Division of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
- *Correspondence: Aniko Bartfai,
| | - Mattias Elg
- Department of Management and Engineering, IEI, Linköping University, Linköping, Sweden
| | - Marie-Louise Schult
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
- Division of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Gabriela Markovic
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
- Division of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
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Stubberud J, Holthe IL, Løvstad M, Schanke AK, Brandt A, Finnanger T. The feasibility and acceptability of goal management training of executive functions in children with spina bifida and acquired brain injury. Neuropsychol Rehabil 2020; 31:601-620. [PMID: 32065032 DOI: 10.1080/09602011.2020.1723649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Executive dysfunction causes significant real-life disability for children with spina bifida (SB) and acquired brain injury (ABI), and efficient interventions are needed. Goal Management Training (GMT) is a cognitive rehabilitation intervention for improving executive function (EF) that has received empirical support in studies of adults with SB and ABI. The purpose of this study was to determine the feasibility and acceptability of a newly developed pediatric GMT protocol (pGMT). Thirteen children (7 boys, 10-16 years) with SB (n = 4), traumatic brain injury (n = 8), and encephalitis (n = 1) were included, based upon the presence of EF problems as described by parents. The participants received 21 h of pGMT, using inpatient intervention periods, followed by 4 h of pGMT outpatient guidance over 8 weeks. Notably, pGMT was found to be both feasible and acceptable, with satisfactory compliance for the children, parents and teachers, in addition to being considered acceptable by all participants. Furthermore, a reliable change in daily life EF was reported by the parents for 2 children. And, some children obtained scores below clinical cut-off on a measure of parent reported real-life EF after intervention. Hence, findings suggest that a randomized controlled trial of pGMT, with a larger sample size, should be conducted.
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Affiliation(s)
- Jan Stubberud
- TRS National Resource Centre for Rare Disorders, Nesoddtangen, Norway.,Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ingvil L Holthe
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Marianne Løvstad
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Anne-Kristine Schanke
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Anne Brandt
- Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torun Finnanger
- Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Markovic G, Bartfai A, Ekholm J, Nilsson C, Schult ML, Löfgren M. Daily management of attention dysfunction two–four years after brain injury and early cognitive rehabilitation with attention process training: a qualitative study. Neuropsychol Rehabil 2018; 30:523-544. [DOI: 10.1080/09602011.2018.1482770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gabriela Markovic
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Aniko Bartfai
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Jan Ekholm
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Charlotte Nilsson
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Marie-Louise Schult
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Monika Löfgren
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
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Li H, Zhang M, Wang X, Ding X, Si J. The Central Executive Mediates the Relationship Between Children's Approximate Number System Acuity and Arithmetic Strategy Utilization in Computational Estimation. Front Psychol 2018; 9:943. [PMID: 30013492 PMCID: PMC6036804 DOI: 10.3389/fpsyg.2018.00943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/23/2018] [Indexed: 01/29/2023] Open
Abstract
Studies investigating the relationship between working memory (WM) and approximate number system (ANS) acuity in the area of arithmetic strategy utilization are scarce. The choice/no choice method paradigm was used in the present study to determine whether and how ANS acuity and WM components affected strategy utilization. The results showed that the central executive (CE) mediated the relationship between ANS acuity and strategy utilization. Furthermore, quantile regression analyses revealed that the association between CE and strategy choice was robust from the first to highest quantile. Notably, the relationship between ANS acuity and strategy choice was significant at the median and higher quantiles (i.e., 0.5, 0.75, and 0.85 quantiles), but not significant at lower quantiles (i.e., 0.15 and 0.25 quantiles). These results suggest that domain-general skills play a crucial role in the relationship between children's ANS acuity and mathematical ability. The impact of ANS acuity and CE on strategy choice was dependent on the distribution of the strategy utilization level. These results provide a further understanding of the utilization of cognitive strategies.
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Affiliation(s)
- Hongxia Li
- School of Psychology, Shandong Normal University, Jinan, China
| | - Mingliang Zhang
- School of Psychology, Shandong Normal University, Jinan, China
- Shandong Academy of Governance, Jinan, China
| | - Xiangyan Wang
- School of Psychology, Shandong Normal University, Jinan, China
| | - Xiao Ding
- School of Psychology, Shandong Normal University, Jinan, China
| | - Jiwei Si
- School of Psychology, Shandong Normal University, Jinan, China
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Iran-Nejad A, Bordbar F. Biofunctional Understanding and Conceptual Control: Searching for Systematic Consensus in Systemic Cohesion. Front Psychol 2017; 8:1702. [PMID: 29114235 PMCID: PMC5660850 DOI: 10.3389/fpsyg.2017.01702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/15/2017] [Indexed: 11/13/2022] Open
Abstract
For first generation scientists after the cognitive revolution, knowers were in active control over all (stages of) information processing. Then, following a decade of transition shaped by intense controversy, embodied cognition emerged and suggested sources of control other than those implied by metaphysical information processing. With a thematic focus on embodiment science and an eye toward systematic consensus in systemic cohesion, the present study explores the roles of biofunctional and conceptual control processes in the wholetheme spiral of biofunctional understanding (see Iran-Nejad and Irannejad, 2017b, Figure 1). According to this spiral, each of the two kinds of understanding has its own unique set of knower control processes. For conceptual understanding (CU), knowers have deliberate attention-allocation control over their first-person "knowthat" and "knowhow" content combined as mutually coherent corequisites. For biofunctional understanding (BU), knowers have attention-allocation control only over their knowthat content but knowhow control content is ordinarily conspicuously absent. To test the hypothesis of differences in the manner of control between CU and BU, participants in two experiments read identical-format statements for internal consistency, as response time was recorded. The results of Experiment 1 supported the hypothesis of differences in the manner of control between the two types of control processes; and Experiment 2 confirmed the results of Experiment 1. These findings are discussed in terms of the predicted differences between BU and CU control processes, their roles in regulating the physically unobservable flow of systemic cohesion in the wholetheme spiral, and a proposal for systematic consensus in systemic cohesion to serve as the second guiding principle in biofunctional embodiment science next to physical science's first guiding principle of systematic observation.
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Affiliation(s)
- Asghar Iran-Nejad
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, The University of Alabama, Tuscaloosa, AL, United States
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Stubberud J, Edvardsen E, Schanke AK, Lerdal A, Kjeverud A, Schillinger A, Løvstad M. Description of a multifaceted intervention programme for fatigue after acquired brain injury: a pilot study. Neuropsychol Rehabil 2017; 29:946-968. [DOI: 10.1080/09602011.2017.1344132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jan Stubberud
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Espen Edvardsen
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Anne-Kristine Schanke
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Anners Lerdal
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Nursing Science, University of Oslo, Oslo, Norway
| | | | - Andreas Schillinger
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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Tornås S, Stubberud J, Solbakk AK, Evans J, Schanke AK, Løvstad M. Moderators, mediators and nonspecific predictors of outcome after cognitive rehabilitation of executive functions in a randomised controlled trial. Neuropsychol Rehabil 2017. [PMID: 28651477 DOI: 10.1080/09602011.2017.1338587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Moderators, mediators and nonspecific predictors of treatment after cognitive rehabilitation of executive functions in a randomised controlled trial Objective: To explore moderators, mediators and nonspecific predictors of executive functioning after cognitive rehabilitation in a randomised controlled trial, comparing Goal Management Training (GMT) with an active psycho-educative control-intervention, in patients with chronic acquired brain injury. METHODS Seventy patients with executive dysfunction were randomly allocated to GMT (n = 33) or control (n = 37). Outcome measures were established by factor-analysis and included cognitive executive complaints, emotional dysregulation and psychological distress. RESULTS Higher age and IQ emerged as nonspecific predictors. Verbal memory and planning ability at baseline moderated cognitive executive complaints, while planning ability at six-month follow-up mediated all three outcome measures. Inhibitory cognitive control emerged as a unique GMT specific mediator. A general pattern regardless of intervention was identified; higher levels of self-reported cognitive-and executive-symptoms of emotional dysregulation and psychological distress at six-month follow-up mediated less improvement across outcome factors. CONCLUSIONS The majority of treatment effects were nonspecific to intervention, probably underscoring the variables' general contribution to outcome of cognitive rehabilitation interventions. Interventions targeting specific cognitive domains, such as attention or working memory, need to take into account the patients' overall cognitive and emotional self-perceived functioning. Future studies should investigate the identified predictors further, and also consider other predictor candidates.
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Affiliation(s)
- Sveinung Tornås
- a Department of Research, Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway
| | - Jan Stubberud
- a Department of Research, Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway
| | - Anne-Kristin Solbakk
- b Department of Neurosurgery, Division of Clinical Neuroscience , Oslo University Hospital - Rikshospitalet , Oslo , Norway.,c Department of Psychology , University of Oslo , Oslo , Norway.,e Department of Neuropsychology , Helgeland Hospital , Mosjøen , Norway
| | - Jonathan Evans
- d Department of Mental Health and Wellbeing , Institute of Health & Wellbeing, University of Glasgow, Gartnavel Royal Hospital , Glasgow , Scotland , UK
| | - Anne-Kristine Schanke
- a Department of Research, Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway.,c Department of Psychology , University of Oslo , Oslo , Norway
| | - Marianne Løvstad
- a Department of Research, Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway.,c Department of Psychology , University of Oslo , Oslo , Norway
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Tornås S, Løvstad M, Solbakk AK, Schanke AK, Stubberud J. Goal Management Training Combined With External Cuing as a Means to Improve Emotional Regulation, Psychological Functioning, and Quality of Life in Patients With Acquired Brain Injury: A Randomized Controlled Trial. Arch Phys Med Rehabil 2016; 97:1841-1852.e3. [PMID: 27424292 DOI: 10.1016/j.apmr.2016.06.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/13/2016] [Accepted: 06/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate whether goal management training (GMT) expanded to include external cuing and an emotional regulation module is associated with improved emotional regulation, psychological functioning, and quality of life (QOL) after chronic acquired brain injury (ABI). DESIGN Randomized controlled trial with blinded outcome assessment at baseline, posttraining, and 6-month follow-up. SETTING Outpatient. PARTICIPANTS Persons with ABI and executive dysfunction (N=70; 64% traumatic brain injury; 52% men; mean age ± SD, 43±13y; mean time since injury ± SD, 8.1±9.4y). INTERVENTION Eight sessions of GMT in groups, including a new module addressing emotional regulation, and external cuing. A psychoeducative control condition (Brain Health Workshop) was matched on amount of training, therapist contact, and homework. MAIN OUTCOME MEASURES Emotional regulation was assessed with the Brain Injury Rehabilitation Trust Regulation of Emotions Questionnaire, the Emotional Control subscale and the Emotion Regulation factor (Behavior Rating Inventory of Executive Function-Adult Version), and the Positive and Negative Affect subscales from the Dysexecutive Questionnaire. Secondary outcome measures included psychological distress (Hopkins Symptom Checklist-25) and QOL (Quality of Life After Brain Injury Scale). RESULTS Findings indicated beneficial effects of GMT on emotional regulation skills in everyday life and in QOL 6 months posttreatment. No intervention effects on measures of psychological distress were registered. CONCLUSIONS GMT is a promising intervention for improving emotional regulation after ABI, even in the chronic phase. More research using objective measures of emotional regulation is needed to investigate the efficacy of this type of training.
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Affiliation(s)
| | - Marianne Løvstad
- Sunnaas Rehabilitation Hospital, Nesodden, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Anne-Kristin Solbakk
- Department of Psychology, University of Oslo, Oslo, Norway; Division of Surgery and Clinical Neuroscience, Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway
| | - Anne-Kristine Schanke
- Sunnaas Rehabilitation Hospital, Nesodden, Norway; Department of Psychology, University of Oslo, Oslo, Norway
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Rehabilitation of Executive Functions in Patients with Chronic Acquired Brain Injury with Goal Management Training, External Cuing, and Emotional Regulation: A Randomized Controlled Trial. J Int Neuropsychol Soc 2016; 22:436-52. [PMID: 26812574 DOI: 10.1017/s1355617715001344] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Executive dysfunction is a common consequence of acquired brain injury (ABI), causing significant disability in daily life. This randomized controlled trial investigated the efficacy of Goal Management Training (GMT) in improving executive functioning in patients with chronic ABI. Seventy patients with a verified ABI and executive dysfunction were randomly allocated to GMT (n=33) or a psycho-educative active control condition, Brain Health Workshop (BHW) (n=37). In addition, all participants received external cueing by text messages. Neuropsychological tests and self-reported questionnaires of executive functioning were administered pre-intervention, immediately after intervention, and at 6 months follow-up. Assessors were blinded to group allocation. Questionnaire measures indicated significant improvement of everyday executive functioning in the GMT group, with effects lasting at least 6 months post-treatment. Both groups improved on the majority of the applied neuropsychological tests. However, improved performance on tests demanding executive attention was most prominent in the GMT group. The results indicate that GMT combined with external cueing is an effective metacognitive strategy training method, ameliorating executive dysfunction in daily life for patients with chronic ABI. The strongest effects were seen on self-report measures of executive functions 6 months post-treatment, suggesting that strategies learned in GMT were applied and consolidated in everyday life after the end of training. Furthermore, these findings show that executive dysfunction can be improved years after the ABI.
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Sigmundsdottir L, Longley WA, Tate RL. Computerised cognitive training in acquired brain injury: A systematic review of outcomes using the International Classification of Functioning (ICF). Neuropsychol Rehabil 2016; 26:673-741. [PMID: 26965034 DOI: 10.1080/09602011.2016.1140657] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Computerised cognitive training (CCT) is an increasingly popular intervention for people experiencing cognitive symptoms. This systematic review evaluated the evidence for CCT in adults with acquired brain injury (ABI), focusing on how outcome measures used reflect efficacy across components of the International Classification of Functioning, Disability and Health. Database searches were conducted of studies investigating CCT to treat cognitive symptoms in adult ABI. Scientific quality was rated using the PEDro-P and RoBiNT Scales. Ninety-six studies met the criteria. Most studies examined outcomes using measures of mental functions (93/96, 97%); fewer studies included measures of activities/participation (41/96, 43%) or body structures (8/96, 8%). Only 14 studies (15%) provided Level 1 evidence (randomised controlled trials with a PEDro-P score ≥ 6/10), with these studies suggesting strong evidence for CCT improving processing speed in multiple sclerosis (MS) and moderate evidence for improving memory in MS and brain tumour populations. There is a large body of research examining the efficacy of CCT, but relatively few Level 1 studies and evidence is largely limited to body function outcomes. The routine use of outcome measures of activities/participation would provide more meaningful evidence for the efficacy of CCT. The use of body structure outcome measures (e.g., neuroimaging) is a newly emerging area, with potential to increase understanding of mechanisms of action for CCT.
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Affiliation(s)
- Linda Sigmundsdottir
- a John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School - Northern, University of Sydney , St Leonards , NSW , Australia.,b Brain Injury Rehabilitation Unit , Liverpool Hospital , Sydney , Australia
| | - Wendy A Longley
- a John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School - Northern, University of Sydney , St Leonards , NSW , Australia
| | - Robyn L Tate
- a John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School - Northern, University of Sydney , St Leonards , NSW , Australia
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Alverson R. A Biofunctional Perspective on Learning Environments. Front Psychol 2016; 6:1973. [PMID: 26779048 PMCID: PMC4688337 DOI: 10.3389/fpsyg.2015.01973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 12/09/2015] [Indexed: 11/13/2022] Open
Abstract
This paper proposes that the principles of learning, as highlighted by Bransford and colleagues, require biological grounding. This process essentially amounts to the facilitation of, and development of, an enriched capacity for ongoing biofunctional activity (OBA)—physical biology in action. The learning sciences’ principles of active learning, i.e., accessing prior understanding, organizing knowledge through schemas, and self-monitoring are psychological-understanding vehicles that work only in the ground of biofunctional (deep) understanding. Biofunctional understanding is a form of understanding that rises out of OBA. In this sense, biofunctional understanding juxtaposes and inherently complements psychological understanding. Without biofunctional understanding, psychological understanding becomes synonymous with superficial understanding. By contrast, in the illuminating context of biofunctional understanding, psychological understanding enables accomplishments of the kind enjoyed by experts in the rich and deep, metaphorically speaking, experiences of their respective fields of specialization. In this perspective article, I show how and why the psychological principles of active learning are ready for grounding in biofunctional understanding.
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Affiliation(s)
- Ryan Alverson
- Department of Teacher Education, College of Education and Human Services, Northern Kentucky University, Highland Heights KY, USA
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Tatla SK, Jarus T, Virji-Babul N, Holsti L. The development of the Pediatric Motivation Scale for rehabilitation. The Canadian Journal of Occupational Therapy 2014; 82:93-105. [DOI: 10.1177/0008417414556884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Clinicians recognize that client motivation is key to optimizing rehabilitation; however, they are limited in its assessment by a paucity of motivation measures. Purpose. This paper presents the preliminary psychometrics of the Pediatric Motivation Scale (PMOT) designed to measure motivation from a child’s perspective. Method. Content validity of the PMOT was measured through expert feedback ( n = 12), and field testing ocurred with 41 children, 21 in rehabilitation and 20 healthy. Pearson product-moment correlations were used to analyze subscale correlations, test-retest reliability, and convergent validity with the Pediatric Volitional Questionnaire (PVQ). Internal consistency was measured using Cronbach’s alpha. Findings. Preliminary psychometric evaluation indicates strong internal consistency for PMOT total (α = .96) and subscales (α = .79–.91). The PMOT and PVQ moderately correlated in the rehabilitation subsample ( r = .71, p < .01); no correlation was found in the healthy subsample ( p > .05). Test-retest reliability was excellent ( r = .97). Implications. This study provides preliminary psychometric evidence of the PMOT for children undergoing rehabilitation. These pilot findings warrant ongoing scale development.
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Stubberud J, Langenbahn D, Levine B, Stanghelle J, Schanke AK. Goal Management Training improves everyday executive functioning for persons with spina bifida: self-and informant reports six months post-training. Neuropsychol Rehabil 2013; 24:26-60. [PMID: 24168074 DOI: 10.1080/09602011.2013.847847] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Executive dysfunction accounts for significant disability for many patients with spina bifida (SB), thus indicating the need for effective interventions aimed at improving executive functioning in this population. Goal Management Training™ (GMT) is a cognitive rehabilitation approach that targets disorganised behaviour resulting from executive dysfunction, and has received empirical support in studies of other patient groups. The purpose of this study was to determine if GMT would lead to perceived improved executive functioning in the daily lives of patients with SB, as evidenced by reduced report of dysexecutive problems in daily life on self- and informant questionnaires. Thirty-eight adults with SB were included in this randomised controlled trial (RCT). Inclusion was based upon the presence of executive functioning complaints. Experimental subjects (n = 24) received 21 hours of GMT, with efficacy of GMT being compared to results of subjects in a wait-list condition (n = 14). All subjects were assessed at baseline, post-intervention, and at six-month follow-up. Self-report measures indicated that the GMT group's everyday executive functioning improved significantly after training, lasting at least 6 months post-treatment. There were no significant effects on informant-report questionnaires. Overall, these findings indicate that executive difficulties in everyday life can be ameliorated for individuals with congenital brain dysfunction.
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Affiliation(s)
- Jan Stubberud
- a Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway
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