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Fortier CB, Kenna A, Katz D, Kim S, Hursh C, Beck B, Sablone CA, Currao A, Lebas A, Jorge RE, Fonda JR. STEP-Home transdiagnostic group reintegration workshop to improve mental health outcomes for post-9/11 Veterans: Design, methods, and rationale for a randomized controlled behavioral trial. Contemp Clin Trials 2024; 141:107536. [PMID: 38614448 DOI: 10.1016/j.cct.2024.107536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/17/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Many post-9/11 U.S. combat Veterans experience difficulty readjusting to civilian life after military service, including relationship problems, reduced work productivity, substance misuse, and increased anger control problems. Mental health problems are frequently cited as causing these difficulties, driven by unparalleled rates of mild traumatic brain injury, posttraumatic stress, and other co-occurring emotional and physical conditions. Given the high prevalence of multimorbidity in this cohort, acceptable, non-stigmatizing, transdiagnostic interventions targeting reintegration are needed. The STEP-Home reintegration workshop has the potential to significantly improve skills to foster civilian reintegration, increase engagement in VA services, and improve mental health outcomes in Veterans with and without diagnosed clinical conditions. METHODS/DESIGN Ongoing from 2019, a prospective, two-site, randomized trial of 206 post-9/11 U.S. military Veterans randomized to receive either 12 sessions of the STEP-Home transdiagnostic reintegration workshop (SH; Active Intervention) or Present Centered Reintegration Group Therapy (PCRGT; Active Control Intervention). Primary outcomes are reintegration, anger, and emotional regulation post-intervention and at 3-months post-intervention. Secondary outcomes include measures of mental health, functional and vocational status, and cognition. CONCLUSION This study addresses an important gap in transdiagnostic interventions to improve civilian reintegration in post-9/11 Veterans. STEP-Home is designed to promote treatment engagement and retention, opening the door to critically needed VA care, and ultimately reducing long-term healthcare burden of untreated mental health illness in U.S. Veterans. TRIAL REGISTRATION Clinicaltrials.gov: D2907-R.
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Affiliation(s)
- Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Alexandra Kenna
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Dylan Katz
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Sahra Kim
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Colleen Hursh
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Brigitta Beck
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Caroline A Sablone
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Alyssa Currao
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Adam Lebas
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Ricardo E Jorge
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Baylor College of Medicine, Houston, TX, United States of America
| | - Jennifer R Fonda
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Boston University Chobanian and Avedisian school of Medicine, Boston, MA, United States of America
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Chuaykarn U, Thato R, Crago EA. Nonpharmacological interventions to improve the cognitive function among persons with traumatic brain injury: A systematic review. J Nurs Scholarsh 2024. [PMID: 38798031 DOI: 10.1111/jnu.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE The systematic review aimed to evaluate the effectiveness of nonpharmacological interventions (NPIs) for improving cognitive function among persons with traumatic brain injury. DESIGN A systematic review. METHODS This systematic review was registered in PROSPERO and followed the PRISMA guideline. PubMed, ScienceDirect, Scopus, SpringerLink, Wiley Online Library, JSTOR, and Taylor & Francis were systematically searched for relevant articles of peer-reviewed studies published between 2008 and 2022. Two independent researchers conducted study selection, data extraction, and data quality assessment. FINDINGS Twenty-one studies met inclusion criteria, numbering a total of 757 participants. Six groups of NPIs were effective in improving cognitive functioning among persons with traumatic brain injury, including multimodal cognitive training, technology innovation, memory training, executive function training, physical activity, and sensory stimulation programs. Pooled evidence revealed that NPIs had a large effect on memory (d = 0.80, p < 0.05 to d = 2.03, p < 0.000), processing speed (d = 1.58, p < 0.05), and cognitive behavior (d = 1.63, p < 0.001 to d = 8.91, p 0.003). There was a medium effect on executive function (d = 0.5, p < 0.01 to d = 0.62, p < 0.05), attention (d = 0.5, p < 0.01), and intelligence (d = 0.57 to d = 0.59, p = 0.000). For visuospatial function and language, there was a significant increase post-intervention. CONCLUSION Evidence from this systematic review indicates that NPIs, specifically the use of multimodal cognitive training and sensory stimulation programs, were effective in improving cognitive function outcomes among persons with traumatic brain injury, with medium to large effect sizes. CLINICAL RELEVANCE Nonpharmacological interventions (NPIs) can enhance cognitive function in individuals with traumatic brain injury. These findings can guide healthcare professionals in clinical settings and support the development of technology applications for cognitive rehabilitation using NPIs.
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Affiliation(s)
- Uraporn Chuaykarn
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
- Boromarajonnani College of Nursing, Nakhon Si Thammarat, Faculty of Nursing, Praboromarajchanok Institute, Bangkok, Thailand
| | - Ratsiri Thato
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| | - Elizabeth A Crago
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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Baker W, Skillman M, Rocha L, Bayne A, Whitehouse S, Murphy E, Papanikolaou M, Caples M, Choudhary E. The impact of injury control research centers: Advancing the field of injury and violence prevention. JOURNAL OF SAFETY RESEARCH 2024; 88:56-67. [PMID: 38485385 PMCID: PMC10957095 DOI: 10.1016/j.jsr.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/14/2023] [Accepted: 10/16/2023] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control (NCIPC) funds Injury Control Research Centers (ICRCs). These centers study injury and violence prevention through three core areas: (1) Research conducts cutting-edge, multidisciplinary research in the injury and violence prevention field; (2) Outreach translates injury and violence prevention research into action; and (3) Training educates and trains the next generation of injury and violence prevention professionals. We examined ICRC work from 2012 to 2019 to determine whether they fulfilled their goal of furthering injury and violence prevention research and practice. METHODS We created a database of core area accomplishments reported through annual and interim progress reports. These reports track core area accomplishments by injury and violence prevention topic area, publications, partnerships, and trainings. RESULTS From 2012 to 2019, ten ICRCs from two funding cycles received approximately $49 million. ICRCs reported 703 research, 1,432 outreach, and 660 training accomplishments. There were also 342 accomplishments contributing to a special tool or resource. These accomplishments focused on preventing traumatic brain injury, suicide, adverse childhood experiences, and transportation safety. ICRCs produced over 3,500 peer-reviewed publications. ICRCs reported over 3,600 accomplishments partnered with academic institutions, public health agencies, healthcare, and non-profit organizations. ICRCs created resources for audiences such as students, law enforcement, and policy makers. ICRCs trained 3,131 students and faculty. PRACTICAL APPLICATIONS ICRCs are the hubs of modern research and practice in the injury and violence prevention field. They successfully bring together stakeholders from disparate disciplines, perspectives, and agencies to join forces and tackle critical public health problems. CONCLUSION ICRCs are an integral component of NCIPC's, CDC's and the Department of Health and Human Service's missions to protect and enhance the health of Americans. Research covered NCIPC research priorities over the funding period, furthering injury and violence prevention research and working as a foundation to practice and policy. Outreach and partnerships with an array of organizations put research into action. Trainings educated the new generation of injury and violence prevention professionals.
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Affiliation(s)
- Will Baker
- Program Implementation and Evaluation Branch, Division of Injury Prevention, National Center for Injury Control and Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | | | | | - Alycia Bayne
- NORC at the University of Chicago, United States
| | | | | | | | - Marvin Caples
- Program Implementation and Evaluation Branch, Division of Injury Prevention, National Center for Injury Control and Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ekta Choudhary
- Program Implementation and Evaluation Branch, Division of Injury Prevention, National Center for Injury Control and Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Davies A, Rogers JM, Baker K, Li L, Llerena J, das Nair R, Wong D. Combined Cognitive and Psychological Interventions Improve Meaningful Outcomes after Acquired Brain Injury: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2023:10.1007/s11065-023-09625-z. [PMID: 37955821 DOI: 10.1007/s11065-023-09625-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
Interventions addressing cognitive and emotional difficulties after acquired brain injury (ABI) often focus on specific impairments in cognition or mood. These interventions can be effective at addressing their specific target, but do not routinely translate to improved activity and participation outcomes. Approaches that combine cognitive and psychological rehabilitation are increasingly popular; however, to date, there have been no systematic evaluations of their efficacy. We conducted a systematic review of five databases, searching for randomised controlled trials of adults with diagnoses of non-progressive ABI at least 1-month post injury, in receipt of interventions that combined cognitive and psychological components compared to any control. Screening and data extraction were evaluated by two independent reviewers using a standardised protocol. Effect sizes were calculated using Hedge's g and estimated using a random-effects model. Risk of bias was assessed using the PEDro-P rating system, and quality of evidence evaluated using the grading of recommendation, assessment, development and evaluation (GRADE) approach. Thirteen studies were included in the meta-analysis (n = 684). There was an overall small-to-medium effect (g = 0.42) for combined interventions compared with controls, with gains maintained at 6-month follow-up. Improvements were observed at the level of impairment, activity, participation and quality of life. GRADE ratings and analyses investigating sensitivity, heterogeneity and publication bias indicated that these effects were robust. No a priori variables moderated these effects. Overall, this review provides strong evidence that combined cognitive and psychological interventions create meaningful change in the lives of people with ABI.
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Affiliation(s)
- Alexandra Davies
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Jeffrey M Rogers
- Faculty of Health Sciences, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Katharine Baker
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Lily Li
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Joshua Llerena
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Roshan das Nair
- School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- Health Research, SINTEF Digital, Dept. of Health Research, Torgaarden, P.O. Box 4760, Trondheim, NO-7465, Norway
| | - Dana Wong
- School of Psychology & Public Health, La Trobe University, Bundoora, VIC, 3086, Australia.
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Wheeler S, Acord-Vira A. Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury. Am J Occup Ther 2023; 77:7704397010. [PMID: 37624997 DOI: 10.5014/ajot.2023.077401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
IMPORTANCE Occupational therapy practitioners are uniquely qualified to address the occupational needs of people with traumatic brain injury (TBI) and their caregivers to maximize participation, health, and well-being. OBJECTIVE These Practice Guidelines are informed by systematic reviews of the effectiveness of interventions that address impairments and skills to improve the occupational performance of people with TBI, as well as interventions for caregivers of people with TBI. The purpose of these guidelines is to summarize the current evidence available to assist clinicians' clinical decision-making in providing interventions for people with TBI and their caregivers. METHOD We reviewed six systematic reviews and synthesized the results into clinical recommendations to be used in occupational therapy clinical practice. RESULTS Sixty-two articles served as the basis for the clinical recommendations. CONCLUSIONS AND RECOMMENDATIONS Strong to moderate evidence supports multimodal sensory stimulation, unimodal auditory stimulation, physical activity, virtual reality, cognitive interventions, vision therapy, goal-focused interventions, individual and group training and education, and caregiver supports. Occupational therapy practitioners should incorporate these interventions into individual and group sessions to maximize recovery and promote occupational participation. Additional interventions are also available, based on emerging evidence and expert opinion, including prevention approaches, complexity of injury, and the use of occupation-based performance assessments. What This Article Adds: These Practice Guidelines provide a summary of evidence in clinical recommendations tables supporting occupational therapy interventions that address impairments resulting from and skills to improve occupational performance after TBI. The guidelines also include case study examples and evidence graphics for practitioners to use to support clinical reasoning when selecting interventions that address the goals of the person with TBI and their caregiver's needs.
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Affiliation(s)
- Steven Wheeler
- Steven Wheeler, PhD, OTR/L, FAOTA, CBIS, is Professor and Chair of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown;
| | - Amanda Acord-Vira
- Amanda Acord-Vira, EdD, OTR/L, FAOTA, CBIS, is Associate Professor of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown
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Schnell-Inderst P, Conrads-Frank A, Stojkov I, Krenn C, Kofler LM, Siebert U. Occupational therapy for persons with cognitive impairments. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2023; 21:Doc02. [PMID: 37260919 PMCID: PMC10227641 DOI: 10.3205/000316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Indexed: 06/02/2023]
Abstract
Background Damage to the central nervous system can occur in adulthood, for example, due to stroke, trauma, tumours, or chronic diseases. After damage to the central nervous system, cognitive impairments occur in addition to physical limitations. Occupational therapy is most often prescribed for neurological diagnoses, including stroke and traumatic brain injury. Methods The health technology assessment (HTA) report this HTA article is based on investigates the clinical effectiveness, cost-effectiveness, and patient-related, social and ethical aspects of occupational therapy for patients with cognitive impairments compared to no occupational therapy. In addition, the effects of different occupational therapy interventions with and without cognitive components were compared in an explorative overview. Patients with moderate or severe dementia are excluded from the assessment. Systematic overviews, that is, systematic reviews of systematic reviews, were conducted. Results For the evaluation of clinical effectiveness, a total of nine systematic reviews were included. No systematic review was identified for the assessment of costs or cost-effectiveness. Five systematic reviews were included for the assessment of patient and social aspects. For the assessment of clinical effectiveness compared with no occupational therapy, five systematic reviews comprising 20 randomised controlled trials with a total of 1,316 subjects reported small positive effects for the outcomes "global cognitive function" and "activities of daily living" as well as a non-quantified positive effect on the outcomes "health-related quality of life" and "behavioural control". No effect was found for individual components of cognition and measures of perception. The quality of the evidence for all outcomes is low due to a high risk of bias. In the supplementary presentations, no positive effects could be demonstrated on the basis of the available evidence. The quality of this evidence was not assessed. For the assessment of patient and social aspects, five systematic reviews on patients with a stroke or a traumatic brain injury - without specification regarding cognitive deficits or studies with their relatives - were included. It was reported that patients and family caregivers go through different phases of rehabilitation in which the discharge home is a decisive turning point. The discharge home represents a crucial breaking point. Regaining an active, self-determining role is a process that requires therapists to find the right level of support for patients and relatives. For the assessment of ethical aspects, nine documents were included. We identified ethical problem-solving models for occupational therapy and 16 ethical aspects in occupational therapy for cognitive deficits. The central theme of the analysis is the limited autonomy due to the consequences of the disease as well as the resulting tensions with those treating the patient. Conclusions Based on this systematic overview, it can neither be proven nor excluded with certainty that occupational therapy for cognitive impairment is an effective therapy for adult patients with central nervous system injuries compared to no occupational therapy. There is a lack of randomised trials with sufficient sample size, well-defined interventions, and comparable concomitant therapies in the control groups, but there is also a lack of well-designed observational studies in routine care and health economic studies. The identified systematic reviews on patient and social aspects provide information on the needs of patients after stroke or traumatic brain injury and their relatives, but there is a lack of studies on this aspect in German-speaking countries. For the ethical assessment, in addition to the identified theoretical models for solving ethical conflicts in occupational therapy, more empirical studies on ethical aspects with patients with cognitive deficits and their relatives as well as occupational therapists are needed.
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Affiliation(s)
- Petra Schnell-Inderst
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i.T., Austria
| | - Annette Conrads-Frank
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i.T., Austria
| | - Igor Stojkov
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i.T., Austria
| | - Cornelia Krenn
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Austria
| | - Lisa-Maria Kofler
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i.T., Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i.T., Austria
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Health Decision Science, Departments of Health Policy and Management and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Gartell R, Morris J, Wallace T. Feasibility of Using a Mobile App Supported Executive Function Intervention in Military Service Members and Veterans with mTBI and Co-Occurring Psychological Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2457. [PMID: 36767823 PMCID: PMC9915093 DOI: 10.3390/ijerph20032457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
This pilot study assessed the feasibility of using SwapMyMood, a smartphone application supporting evidence-based strategies for emotion regulation and problem-solving as a supplement to conventional care for military service members and veterans (SM/Vs) experiencing chronic symptoms of mild traumatic brain injury (mTBI) and co-occurring psychological conditions. Eight military SM/Vs were recruited from an intensive outpatient program. Participants were block randomized to an experimental group (conventional care plus use of the SwapMyMood app) or a conventional care only group for six weeks. Conventional care included instruction on problem-solving and emotion regulation strategies using traditional paper manuals and protocols. Effects on the knowledge and use of strategies and related goal attainment were measured. Patient-reported outcomes were measured via several validated problem-solving and emotion regulation scales. No differences were found between groups in goal attainment, global executive function, problem-solving, emotion regulation, and knowledge of how to use the problem-solving and emotion regulation strategies targeted. Experimental group participants rated the application positively, demonstrating feasibility of integration of the app into clinical care. The implementation of SwapMyMood is feasible in a clinical setting. SwapMyMood may be a clinically effective supplemental tool for supporting executive function in SM/Vs with mTBI and co-occurring psychological conditions.
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Affiliation(s)
- Rebecca Gartell
- SHARE Military Initiative, Shepherd Center, Atlanta, GA 30309, USA
| | - John Morris
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA
| | - Tracey Wallace
- SHARE Military Initiative, Shepherd Center, Atlanta, GA 30309, USA
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA
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INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part III: Executive Functions. J Head Trauma Rehabil 2023; 38:52-64. [PMID: 36594859 DOI: 10.1097/htr.0000000000000834] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Moderate-to-severe traumatic brain injury (MS-TBI) causes debilitating and enduring impairments of executive functioning and self-awareness, which clinicians often find challenging to address. Here, we provide an update to the INCOG 2014 guidelines for the clinical management of these impairments. METHODS An expert panel of clinicians/researchers (known as INCOG) reviewed evidence published from 2014 and developed updated recommendations for the management of executive functioning and self-awareness post-MS-TBI, as well as a decision-making algorithm, and an audit tool for review of clinical practice. RESULTS A total of 8 recommendations are provided regarding executive functioning and self-awareness. Since INCOG 2014, 4 new recommendations were made and 4 were modified and updated from previous recommendations. Six recommendations are based on level A evidence, and 2 are based on level C. Recommendations retained from the previous guidelines and updated, where new evidence was available, focus on enhancement of self-awareness (eg, feedback to increase self-monitoring; training with video-feedback), meta-cognitive strategy instruction (eg, goal management training), enhancement of reasoning skills, and group-based treatments. New recommendations addressing music therapy, virtual therapy, telerehabilitation-delivered metacognitive strategies, and caution regarding other group-based telerehabilitation (due to a lack of evidence) have been made. CONCLUSIONS Effective management of impairments in executive functioning can increase the success and well-being of individuals with MS-TBI in their day-to-day lives. These guidelines provide management recommendations based on the latest evidence, with support for their implementation, and encourage researchers to explore and validate additional factors such as predictors of treatment response.
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McAndrew LM, Quigley KS, Lu SE, Litke D, Rath JF, Lange G, Santos SL, Anastasides N, Petrakis BA, Greenberg L, Helmer DA, Pigeon WR. Effect of Problem-solving Treatment on Self-reported Disability Among Veterans With Gulf War Illness: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2245272. [PMID: 36472870 PMCID: PMC9856484 DOI: 10.1001/jamanetworkopen.2022.45272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Few evidence-based treatments are available for Gulf War illness (GWI). Behavioral treatments that target factors known to maintain the disability from GWI, such as problem-solving impairment, may be beneficial. Problem-solving treatment (PST) targets problem-solving impairment and is an evidence-based treatment for other conditions. OBJECTIVE To examine the efficacy of PST to reduce disability, problem-solving impairment, and physical symptoms in GWI. DESIGN, SETTING, AND PARTICIPANTS This multicenter randomized clinical trial conducted in the US Department of Veterans Affairs compared PST with health education in a volunteer sample of 511 Gulf War veterans with GWI and disability (January 1, 2015, to September 1, 2019); outcomes were assessed at 12 weeks and 6 months. Statistical analysis was conducted between January 1, 2019, and December 31, 2020. INTERVENTIONS Problem-solving treatment taught skills to improve problem-solving. Health education provided didactic health information. Both were delivered by telephone weekly for 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was reduction from baseline to 12 weeks in self-report of disability (World Health Organization Disability Assessment Schedule). Secondary outcomes were reductions in self-report of problem-solving impairment and objective problem-solving. Exploratory outcomes were reductions in pain, pain disability, and fatigue. RESULTS A total of 268 veterans (mean [SD] age, 52.9 [7.3] years; 88.4% male; 66.8% White) were randomized to PST (n = 135) or health education (n = 133). Most participants completed all 12 sessions of PST (114 of 135 [84.4%]) and health education (120 of 133 [90.2%]). No difference was found between groups in reductions in disability at the end of treatment. Results suggested that PST reduced problem-solving impairment (moderate effect, 0.42; P = .01) and disability at 6 months (moderate effect, 0.39; P = .06) compared with health education. CONCLUSIONS AND RELEVANCE In this randomized clinical trial of the efficacy of PST for GWI, no difference was found between groups in reduction in disability at 12 weeks. Problem-solving treatment had high adherence and reduced problem-solving impairment and potentially reduced disability at 6 months compared with health education. These findings should be confirmed in future studies. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02161133.
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Affiliation(s)
- Lisa M. McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
| | - Karen S. Quigley
- Bedford VA Medical Center, Bedford, Massachusetts
- Department of Psychology, Northeastern University, Boston, Massachusetts
| | - Shou-En Lu
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - David Litke
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
- Department of Rehabilitation Medicine, New York University School of Medicine, New York
| | - Joseph F. Rath
- Department of Rehabilitation Medicine, New York University School of Medicine, New York
| | - Gudrun Lange
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
| | - Susan L. Santos
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
| | - Nicole Anastasides
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
| | | | - Lauren Greenberg
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
- VA Palo Alto Health Care System, Palo Alto, California
| | - Drew A. Helmer
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
- Center for Innovations in Quality, Effectiveness and Safety at Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas
| | - Wilfred R. Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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Wallace TD, McCauley KL, Hodge AT, Moran TP, Porter ST, Whaley MC, Gore RK. Use of person-centered goals to direct interdisciplinary care for military service members and Veterans with chronic mTBI and co-occurring psychological conditions. Front Neurol 2022; 13:1015591. [PMID: 36523344 PMCID: PMC9746344 DOI: 10.3389/fneur.2022.1015591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/26/2022] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE To explore the use of person-centered goals (PCGs) to direct interdisciplinary care to support PCG attainment in military service members and Veterans (SM/Vs) with chronic mild traumatic brain injury (mTBI) and co-occurring psychological conditions. METHODS A retrospective chart review was completed for 146 United States military SM/Vs reporting chronic symptoms following mTBI and co-occurring psychological conditions who received care in the SHARE Military Initiative intensive outpatient program, a donor-funded program administered by a not-for-profit hospital, between April 1, 2015 and March 31, 2019. PCGs were used to direct care consisting of individual and group-based interventions and therapies delivered by an interdisciplinary, co-located team including behavioral health, case management, neurology or physiatry, nursing, occupational therapy, physical therapy, recreation therapy, speech-language pathology, and transition support. The primary outcome measure was PCG attainment measured via goal attainment scaling. RESULTS Increased PCG attainment was demonstrated at program discharge and throughout the first year following program discharge. Predictors of goal attainment at discharge included longer participation in treatment, greater reduction in depressive symptoms and greater improvement in adjustment at discharge, male gender, and higher cognitive and physical abilities on admission. CONCLUSIONS This sample of military SM/Vs with mTBI and co-occurring psychological conditions who received intensive, interdisciplinary, PCG directed care demonstrated increased PCG attainment at program discharge which further increased with transition support over the year post-discharge. Results suggest PGC goal directed care is a feasible, promising methodology of individualizing treatment in this population. This exploratory study lays a foundation for future prospective, controlled, comparative effectiveness research that will further understanding of the effectiveness of intensive, interdisciplinary, PCG directed care.
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Affiliation(s)
- Tracey D. Wallace
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, United States
| | | | - April T. Hodge
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, United States
| | - Tim P. Moran
- School of Medicine, Department of Emergency Medicine, Emory University, Atlanta, GA, United States
| | - Stephen T. Porter
- School of Medicine, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Maya C. Whaley
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, United States
| | - Russell K. Gore
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, United States
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
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11
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Brown J, Kaelin D, Mattingly E, Mello C, Miller ES, Mitchell G, Picon LM, Waldron-Perine B, Wolf TJ, Frymark T, Bowen R. American Speech-Language-Hearing Association Clinical Practice Guideline: Cognitive Rehabilitation for the Management of Cognitive Dysfunction Associated With Acquired Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2455-2526. [PMID: 36373898 DOI: 10.1044/2022_ajslp-21-00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive-communication impairments following acquired brain injury (ABI) can have devastating effects on a person's ability to participate in community, social, vocational, and academic preinjury roles and responsibilities. Guidelines for evidence-based practices are needed to assist speech-language pathologists (SLPs) and other rehabilitation specialists in the delivery of cognitive rehabilitation for the adult population. PURPOSE The American Speech-Language-Hearing Association, in conjunction with a multidisciplinary panel of subject matter experts, developed this guideline to identify best practice recommendations for the delivery of cognitive rehabilitation to adults with cognitive dysfunction associated with ABI. METHOD A multidisciplinary panel identified 19 critical questions to be addressed in the guideline. Literature published between 1980 and 2020 was identified based on a set of a priori inclusion/exclusion criteria, and main findings were pooled and organized into summary of findings tables. Following the principles of the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision Framework, the panel drafted recommendations, when appropriate, based on the findings, overall quality of the evidence, balance of benefits and harms, patient preferences, resource implications, and the feasibility and acceptability of cognitive rehabilitation. RECOMMENDATIONS This guideline includes one overarching evidence-based recommendation that addresses the management of cognitive dysfunction following ABI and 11 subsequent recommendations focusing on cognitive rehabilitation treatment approaches, methods, and manner of delivery. In addition, this guideline includes an overarching consensus-based recommendation and seven additional consensus recommendations highlighting the role of the SLP in the screening, assessment, and treatment of adults with cognitive dysfunction associated with ABI. Future research considerations are also discussed.
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Affiliation(s)
| | | | | | | | - E Sam Miller
- Maryland State Department of Education, Baltimore
| | | | | | | | | | - Tobi Frymark
- American Speech-Language-Hearing Association, Rockville, MD
| | - Rebecca Bowen
- American Speech-Language-Hearing Association, Rockville, MD
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12
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Radomski MV, Giles GM, Carroll G, Anheluk M, Yunek J. Cognitive Interventions to Improve a Specific Cognitive Impairment for Adults With TBI (June 2013-October 2020). Am J Occup Ther 2022; 76:23933. [PMID: 36166674 DOI: 10.5014/ajot.2022/76s2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on cognitive interventions to improve a specific cognitive impairment for adults with TBI.
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Affiliation(s)
- Mary Vining Radomski
- Mary Vining Radomski, PhD, OTR/L, FAOTA, is Director, Courage Kenny Research, Courage Kenny Research Center/Allina Health
| | - Gordon Muir Giles
- Gordon Muir Giles, PhD, OTR/L, is Professor, Samuel Merritt University
| | - Ginger Carroll
- Ginger Carroll, MS, OT/L, CPPM, Courage Kenny Research Center/Allina Health
| | - Mattie Anheluk
- Mattie Anheluk, MOT, OTR/L, Courage Kenny Rehabilitation Institute- Minneapolis/Allina Health
| | - Joe Yunek
- Joe Yunek, MS, OTR/L, Courage Kenny Rehabilitation Institute- Minneapolis/Allina Health
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13
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Fortier CB, Currao A, Kenna A, Kim S, Beck BM, Katz D, Hursh C, Fonda JR. Online Telehealth Delivery of Group Mental Health Treatment Is Safe, Feasible, and Increases Enrollment and Attendance in Post-9/11 U.S. Veterans. Behav Ther 2022; 53:469-480. [PMID: 35473650 PMCID: PMC8613935 DOI: 10.1016/j.beth.2021.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022]
Abstract
Post-9/11 U.S. veterans are clinically complex with multiple co-occurring health conditions that lead to increased morbidity and mortality, risk for suicide, and decreased quality of life, but underutilization and resistance to treatment remain significant problems. Increased isolation and decreased community and social support due to coronavirus disease (COVID-19) have exacerbated mental health risk. This study evaluated the safety and feasibility of home-based telemental health group workshops to improve reintegration and social connection in post-9/11 U.S. military personnel. Seventy-four (61 males/13 females) post-9/11 U.S. military veterans were randomized to receive 12 sessions of STEP-Home cognitive-behavioral group workshop or present-centered group therapy. Treatment was delivered either in person (traditional medical center setting, treatment as usual [TAU]), or via home-based synchronous videoconferencing (VC). The change to VC occurred due to social distancing guidelines during COVID-19. Mean age was 41.0 years (SD = 11.5, range 24-65). Forty-five (36 males/9 females) participated in VC and 29 (25 males/4 females) in TAU. Demographics were similar across treatment milieu. There were no differences in therapist treatment adherence for TAU versus VC. Therapist satisfaction was higher for TAU groups (q value < .05). Veterans showed higher enrollment, attendance, group cohesion, and veteran-to-veteran support for VC compared to TAU (q values < .05). Safety procedures were successfully implemented via VC. Results demonstrate the safety, feasibility, and high satisfaction of group telemental health in U.S. veterans. Higher enrollment and treatment adherence for telemental health delivery resulted in a greater likelihood of receiving an effective treatment dose than TAU. Strong group cohesion and veteran-to-veteran support were achievable via telehealth. Telemental health offers convenient, efficient, and cost-effective care options for veterans and may be particularly helpful for patients with high psychiatric burden.
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Affiliation(s)
- Catherine B. Fortier
- Address correspondence to Catherine B. Fortier, Ph.D., TRACTS (182-JP), VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130
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14
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Wallace T, Morris JT, Glickstein R, Anderson RK, Gore RK. Implementation of a Mobile Technology-Supported Diaphragmatic Breathing Intervention in Military mTBI With PTSD. J Head Trauma Rehabil 2022; 37:152-161. [PMID: 35703895 PMCID: PMC9204778 DOI: 10.1097/htr.0000000000000774] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Diaphragmatic breathing is an evidence-based intervention for managing stress and anxiety; however, some military veterans with mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) report challenges to learning and practicing the technique. BreatheWell Wear assists performance of breathing exercises through reminders, biofeedback, and visual, tactile, and auditory guidance. OBJECTIVE To evaluate feasibility of implementing BreatheWell Wear, a mobile smartwatch application with companion smartphone app, as an intervention for stress management in military veterans with mTBI and PTSD. METHODS Thirty veterans with chronic symptoms of mTBI and PTSD recruited from an interdisciplinary, intensive outpatient program participated in this pilot pragmatic clinical trial. Participants were randomly assigned to the experimental (BreatheWell Wear and conventional care) and control (conventional care) groups for 4 weeks. Conventional care included instruction on relaxation breathing and participation in behavioral health therapy. Effects on goal attainment, treatment adherence, diaphragmatic breathing technique knowledge, and stress were measured through surveys and diaries. Changes in symptoms, mood, and well-being were measured pre/postintervention via the Posttraumatic Checklist for DSM-5, Beck Anxiety Inventory, Beck Depression Inventory, and Flourishing Scale. RESULTS Person-centered goal attainment (t = 4.009, P < .001), treatment adherence (t = 2.742, P = .001), diaphragmatic breathing technique knowledge (t = 1.637, P < .001), and reported ease of remembering to practice (t = -3.075, P = .005) were significantly greater in the experimental group. As expected, measures of PTSD, anxiety, depression, and psychological well-being showed clinically meaningful change in both groups, and both groups demonstrated reduced stress following diaphragmatic breathing. CONCLUSION These preliminary findings indicate that BreatheWell Wear may be a clinically feasible tool for supporting diaphragmatic breathing as an intervention in veterans with mTBI and PTSD, and a future effectiveness trial is warranted.
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Affiliation(s)
- Tracey Wallace
- SHARE Military Initiative (Ms Wallace, Mr Glickstein, and Dr Gore), Crawford Research Institute (Ms Wallace and Drs Morris and Anderson), Shepherd Center, Atlanta, Georgia; and Department of Sociology, Georgia State University, Atlanta, Georgia (Dr Anderson)
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15
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Gilmore N, Mirman D, Kiran S. Young Adults With Acquired Brain Injury Show Longitudinal Improvements in Cognition After Intensive Cognitive Rehabilitation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1494-1520. [PMID: 35290740 PMCID: PMC9499382 DOI: 10.1044/2021_jslhr-21-00324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE The aim of this study was to assess the effect of an intensive cognitive and communication rehabilitation (ICCR) program on language and other cognitive performance in young adults with acquired brain injury (ABI). METHOD Thirty young adults with chronic ABI participated in this study. Treatment participants (n = 22) attended ICCR 6 hours/day, 4 days/week for at least one 12-week semester. Deferred treatment/usual care control participants (n = 14) were evaluated before and after at least one 12-week semester. Pre- and postsemester standardized cognitive assessment items were assigned to subdomains. Between-groups and within-group generalized linear mixed-effects models assessed the effect of time point on overall item accuracy and differences by item subdomain. Subdomain analyses were adjusted for multiple comparisons. RESULTS Between-groups analyses revealed that treatment participants improved significantly faster over time than deferred treatment/usual care participants in overall item accuracy and specifically on items in the verbal expression subdomain. Investigating the three-way interaction between time point, group, and etiology revealed that the overall effects of the treatment were similar for individuals with nontraumatic and traumatic brain injuries. The treatment group showed an overall effect of treatment and significant gains over time in the verbal expression, written expression, memory, and problem solving subdomains. The control group did not significantly improve over time on overall item accuracy and showed significant subdomain-level gains in auditory comprehension, which did not survive correction. CONCLUSIONS Sustaining an ABI in young adulthood can significantly disrupt key developmental milestones, such as attending college and launching a career. This study provides strong evidence that integrating impairment-based retraining of language and other cognitive skills with "real-world" application in academically focused activities promotes gains in underlying cognitive processes that are important for academic success as measured by standardized assessment items. These findings may prompt a revision to the current continuum of rehabilitative care for young adults with ABI. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19320068.
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Affiliation(s)
- Natalie Gilmore
- Department of Speech, Language & Hearing Sciences, College of Health & Rehabilitation Sciences: Sargent College, Boston University, MA
| | - Daniel Mirman
- Department of Psychology, School of Philosophy, Psychology & Language Sciences, The University of Edinburgh, United Kingdom
| | - Swathi Kiran
- Department of Speech, Language & Hearing Sciences, College of Health & Rehabilitation Sciences: Sargent College, Boston University, MA
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16
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Kersey J, Hammel J, Baum C, Huebert K, Malagari E, Terhorst L, McCue M, Skidmore ER. Effect of interventions on activity and participation outcomes for adults with brain injury: a scoping review. Brain Inj 2022; 36:21-31. [DOI: 10.1080/02699052.2022.2034043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Jessica Kersey
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kelly Huebert
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Emily Malagari
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth R. Skidmore
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
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17
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Etchin AG, Corbo V, Brown E, Fortier CB, Fonda JR, Milberg WP, Currao A, McGlinchey RE. Associations Among Clinical Variables and Anger Differ by Early Life Adversity Among Post‐9/11 Veterans. Clin Psychol Psychother 2022; 29:1403-1415. [DOI: 10.1002/cpp.2722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Anna G. Etchin
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System Boston MA USA
| | - Vincent Corbo
- Department of Psychology Southern New Hampshire University Manchester NH USA
| | - Emma Brown
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System Boston MA USA
| | - Catherine B. Fortier
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Jennifer R. Fonda
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System Boston MA USA
- Department of Psychiatry Boston University Medical Campus Boston MA USA
| | - William P. Milberg
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
- Geriatric Research Education and Clinical Center, VA Boston Healthcare System Boston MA USA
| | - Alyssa Currao
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System Boston MA USA
| | - Regina E. McGlinchey
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
- Geriatric Research Education and Clinical Center, VA Boston Healthcare System Boston MA USA
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18
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The Effectiveness of the Short-Term Executive Plus Intervention on Problem Solving, Emotion Regulation and Selective attention in Traumatic Brain Injury Patients. JOURNAL OF COGNITIVE PSYCHOLOGY 2021. [DOI: 10.52547/jcp.9.3.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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19
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Voelbel GT, Lindsey HM, Mercuri G, Bushnik T, Rath J. The effects of neuroplasticity-based auditory information processing remediation in adults with chronic traumatic brain injury. NeuroRehabilitation 2021; 49:267-278. [PMID: 34420987 DOI: 10.3233/nre-218025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adults with chronic traumatic brain injury (TBI) may experience long-term deficits in multiple cognitive domains. Higher-order functions, such as verbal memory, are impacted by deficits in the ability to acquire verbal information. OBJECTIVE This study investigated the effects of a neuroplasticity-based computerized cognitive remediation program for auditory information processing in adults with a chronic TBI. METHODS Forty-eight adults with TBI were randomly assigned to an intervention or control group. Both groups underwent a neuropsychological assessment at baseline and post-training. The Intervention group received 40 one-hour cognitive training sessions with the Brain Fitness Program. RESULTS The intervention group improved in performance on measures of the Woodcock-Johnson-III Understanding Directions subtest and Trail Making Test Part-A. They also reported improvement on the cognitive domain of the Cognitive Self-Report Questionnaire. CONCLUSIONS The present study demonstrated that a neuroplasticity-based computerized cognitive remediation program may improve objective and subjective cognitive function in adults with TBI several years post-injury.
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Affiliation(s)
- Gerald T Voelbel
- Department of Occupational Therapy, New York University, New York, NY, USA.,Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
| | - Hannah M Lindsey
- Department of Psychology, New York University, New York, NY, USA.,Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Giulia Mercuri
- Department of Psychology, New York University, New York, NY, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Tamara Bushnik
- Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
| | - Joseph Rath
- Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
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20
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Kersey J, Terhorst L, Heinemann AW, Hammel J, Baum C, McCue M, Skidmore ER. Construct validity of the enfranchisement scale of the community participation indicators. Clin Rehabil 2021; 36:263-271. [PMID: 34414799 DOI: 10.1177/02692155211040930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examined the construct validity of the Enfranchisement scale of the Community Participation Indicators. DESIGN We conducted a secondary analysis of data collected in a cross-sectional study of rehabilitation outcomes. SUBJECTS The parent study included 604 community-dwelling adults with chronic traumatic brain injury, stroke, or spinal cord injury. The sample had a mean age of 64.1 years, was two-thirds male, and included a high proportion of racial minorities (n = 250, 41.4%). MAIN MEASURES The Enfranchisement scale contains two subscales: the Control subscale and the Importance subscale. We examined correlations between each Enfranchisement subscale and measures of participation, environment, and impairments. The current analyses included cases with at least 80% of items completed on each subscale (Control subscale: n = 391; Importance subscale: n = 219). Missing values were imputed using multiple imputation. RESULTS The sample demonstrated high scores, indicating poor enfranchisement (Control subscale: M = 51.7; Importance subscale: M = 43.0). Both subscales were most strongly associated with measures of participation (Control subscale: r = 0.56; Importance subscale: r = 0.52), and least strongly associated with measures of cognition (Control subscale: r = 0.03; Importance subscale: r = 0.03). The Importance subscale was closely associated with depression (r = 0.54), and systems, services, and policies (r = 0.50). Both subscales were associated with social attitudes (Control subscale: r = 0.44; Importance subscale: r = 0.44) and social support (Control subscale: r = 0.49; Importance subscale: r = 0.41). CONCLUSIONS We found evidence of convergent validity between the Enfranchisement scale and measures of participation, and discriminant validity between the Enfranchisement scale and measures of disability-related impairments. The analyses also revealed the importance of the environment to enfranchisement outcomes.
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Affiliation(s)
- Jessica Kersey
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Carolyn Baum
- Program in Occupational Therapy and Departments of Neurology & Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
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21
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Maruyama BA, Abrams G, Kornblith E, Posecion LF, McQuaid JR, Neylan TC, Groberio J, Chen AJW, Novakovic-Agopian T. Improvement in executive functioning after Goal-Oriented Attentional Self-Regulation training is associated with reduction in PTSD hyperarousal symptoms among veterans with comorbid PTSD and mild TBI. APPLIED NEUROPSYCHOLOGY-ADULT 2021:1-9. [PMID: 34410839 DOI: 10.1080/23279095.2021.1960531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Goal-Oriented Attentional Self-Regulation (GOALS) is a cognitive rehabilitation training program that combines mindfulness-based attention regulation with individualized goal management strategies to improve functioning in daily life after traumatic brain injury (TBI). While not a specific target of GOALS training, previous research has indicated improvements in emotional functioning following GOALS training, specifically symptoms related to depression and posttraumatic stress disorder (PTSD). The current study is based on the hypothesis that improvements in cognitive control processes related to executive functioning and attention after GOALS training generalize to improvements in emotional functioning, thereby resulting in reductions in emotional distress. The current study analyzed archival data from 33 Veteran participants with a confirmed diagnosis of PTSD and a history of mild TBI who received either GOALS training or a psychoeducational intervention matched for time, therapist attention, and participation format. Regression analysis was used to assess the strength of the relationship between improvements in Overall Attention/Executive Functioning and decreases in hyperarousal symptoms associated with PTSD. Results from the regression analysis revealed that improvements in Overall Attention/Executive Functioning after GOALS was significantly associated with reductions in hyperarousal symptoms associated with PTSD (R2 = 0.26, F(1,15) = 5.01, β = -.51, p < .05). The current findings suggest that cognitive improvements after GOALS training may lead to changes in emotional functioning, resulting in decreased emotional distress. This is important, particularly in VA settings, because the results potentially highlight additional areas of research and focus on the treatment of comorbid mild TBI and PTSD among Veterans.
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Affiliation(s)
- Brian A Maruyama
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA
| | - Gary Abrams
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Erica Kornblith
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Lainie F Posecion
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA
| | - John R McQuaid
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Thomas C Neylan
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
| | - Jessica Groberio
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA
| | - Anthony J-W Chen
- University of California, San Francisco, CA, USA.,Department of Veterans Affairs, VA Northern California Health Care System, Martinez, CA, USA
| | - Tatjana Novakovic-Agopian
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, USA.,University of California, San Francisco, CA, USA
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22
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Assessment of Executive Function in Patients with Traumatic Brain Injury with the Wisconsin Card-Sorting Test. Brain Sci 2020; 10:brainsci10100699. [PMID: 33019772 PMCID: PMC7600451 DOI: 10.3390/brainsci10100699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
This review aimed at providing a brief and comprehensive summary of recent research regarding the use of the Wisconsin Card-Sorting Test (WCST) to assess executive function in patients with traumatic brain injury (TBI). A bibliographical search, performed in PubMed, Web of Science, Scopus, Cochrane Library, and PsycInfo, targeted publications from 2010 to 2020, in English or Spanish. Information regarding the studies’ designs, sample features and use of the WCST scores was recorded. An initial search eliciting 387 citations was reduced to 47 relevant papers. The highest proportion of publications came from the United States of America (34.0%) and included adult patients (95.7%). Observational designs were the most frequent (85.1%), the highest proportion being cross-sectional or case series studies. The average time after the occurrence of the TBI ranged from 4 to 62 years in single case studies, and from 6 weeks up to 23.5 years in the studies with more than one patient. Four studies compared groups of patients with TBI according to the severity (mild, moderate and/or severe), and in two cases, the studies compared TBI patients with healthy controls. Randomized control trials were seven in total. The noncomputerized WCST version including 128 cards was the most frequently used (78.7%). Characterization of the clinical profile of participants was the most frequent purpose (34.0%). The WCST is a common measure of executive function in patients with TBI. Although shorter and/or computerized versions are available, the original WCST with 128 cards is still used most often. The WCST is a useful tool for research and clinical purposes, yet a common practice is to report only one or a few of the possible scores, which prevents further valid comparisons across studies. Results might be useful to professionals in the clinical and research fields to guide them in assessment planning and proper interpretation of the WCST scores.
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Miesenberger K, Manduchi R, Covarrubias Rodriguez M, Peňáz P. SwapMyMood: User-Centered Design and Development of a Mobile App to Support Executive Function. LECTURE NOTES IN COMPUTER SCIENCE 2020. [PMCID: PMC7479790 DOI: 10.1007/978-3-030-58805-2_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AbstractThis paper describes the research and development of the SwapMyMood smartphone application designed to support use of evidence-based executive function strategies by people with traumatic brain injury. Executive dysfunction is a common sequela of traumatic brain injury (TBI) resulting in diminished cognitive-behavioral functioning. Problem-solving and emotion regulation are cognitive-behavioral functions that are often disrupted by changes in the executive control system. SwapMyMood is an electronic version of the Executive Plus/STEP program, a set of clinical techniques taught to people living with brain injury to help them 1) identify and implement solutions to problems encountered in daily life and 2) to utilize the emotion cycle to understand and regulate emotional responses to these problems. The Executive Plus/STEP program has until now relied on paper-based instruction and use. Input from target users – people with brain injury and clinical professionals who teach this program to their patients – has contributed to key refinements of features and functioning of the mobile app. Data gathered from target user participation in the user-centered design process are presented. Future directions for ongoing development of technologies to support executive function strategies are also discussed.
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Affiliation(s)
| | - Roberto Manduchi
- Jack Baskin School of Engineering, UC Santa Cruz, Santa Cruz, CA USA
| | | | - Petr Peňáz
- Support Centre for Students with Special Needs, Masaryk University Brno, Brno, Czech Republic
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Picon LM, Kaplan DA, Eshel I. Management and Rehabilitation of Cognitive Dysfunction. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Soendergaard PL, Wolffbrandt MM, Biering-Sørensen F, Nordin M, Schow T, Arango-Lasprilla JC, Norup A. A manual-based family intervention for families living with the consequences of traumatic injury to the brain or spinal cord: a study protocol of a randomized controlled trial. Trials 2019; 20:646. [PMID: 31775831 PMCID: PMC6880634 DOI: 10.1186/s13063-019-3794-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/10/2019] [Indexed: 01/07/2023] Open
Abstract
Background Acquiring a traumatic injury constitutes a severe life change for the survivor, but also for the surrounding family. The paradigm of helping the family has primarily been on psychosocial interventions targeting caregivers. However, interventions including both survivor and caregivers should be an essential part of treatment, as the whole family’s functional level and mental health can be affected. The current study protocol presents a manualized family intervention for families living with traumatic injury to the brain (TBI) or spinal cord (tSCI). The objectives are to investigate if the intervention improves quality of life (QoL) and decreases burden. It is hypothesized that the family intervention improves problem-solving strategies and family dynamics, which will reduce the burden. This may improve the caregivers’ mental health, which will improve the support to the survivor and QoL. Methods The study is an interventional, two-arm, randomized controlled trial. During a 2-year period, a total of 132 families will be included. Participants will be recruited from East-Denmark. Inclusion criteria are (1) TBI or tSCI, (2) ≥ 18 years of age, (3) ≥ 6 months to ≤ 2 years since discharge from hospital, (4) ability to understand and read Danish, (5) cognitive abilities that enable participation, and (6) a minimum of one family member actively involved in the survivor’s life. Exclusion criteria are (1) active substance abuse, (2) aphasia, (3) prior neurologic or psychiatric diagnose, and (4) history of violence. Within each disease group, families will be allocated randomly to participate in an intervention or a control group with a ratio 1:1. The intervention groups receive the family intervention consisting of eight sessions of 90 min duration. Families in the control groups receive 2 h of psychoeducation. All participants complete questionnaires on QoL, self-perceived burden, family dynamics, problem-solving strategies, mental health, and resilience at pre-intervention, post-intervention, and 6-month follow up. Conclusion If the intervention is found to have effect, the study will contribute with novel knowledge on the use of a manual-based intervention including the entire family. This would be of clinical interest and would help families living with the consequences of TBI or tSCI. Trials registration ClinicalTrials.gov, NCT03814876. Retrospectively registered on 24 January 2019.
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Affiliation(s)
- Pernille Langer Soendergaard
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, Kettegaard Allé 30, 2650, Hvidovre, Denmark. .,Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Mia Moth Wolffbrandt
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, Kettegaard Allé 30, 2650, Hvidovre, Denmark
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Havnevej 25, 3100, Hornbæk, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Malin Nordin
- Department of Neurosurgery, Karolinska University Hospital, Eugeniavägen 3, 171 76, Stockholm, Sweden
| | - Trine Schow
- Research and Development, Brain Injury Center BOMI, Maglegaardsvej 15, 4000, Roskilde, Denmark
| | - Juan Carlos Arango-Lasprilla
- BioCruces Vizcaya Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Department of Cell Biology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Anne Norup
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, Kettegaard Allé 30, 2650, Hvidovre, Denmark.,Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
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Smith EE, Smith JAD, Juengst SB. Cognitive process scores associated with self-reported behavioral dysfunction on the Frontal Systems Behavior Scale (FrSBe) in chronic traumatic brain injury. J Clin Exp Neuropsychol 2019; 42:90-100. [DOI: 10.1080/13803395.2019.1676882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Emily E. Smith
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jason A. D. Smith
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shannon B. Juengst
- Department of Physical Medicine & Rehabilitation, Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Cicerone KD, Goldin Y, Ganci K, Rosenbaum A, Wethe JV, Langenbahn DM, Malec JF, Bergquist TF, Kingsley K, Nagele D, Trexler L, Fraas M, Bogdanova Y, Harley JP. Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. Arch Phys Med Rehabil 2019; 100:1515-1533. [DOI: 10.1016/j.apmr.2019.02.011] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
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An Intensive Outpatient Program for Veterans With Posttraumatic Stress Disorder and Traumatic Brain Injury. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kim S, Zemon V, Lehrer P, McCraty R, Cavallo MM, Raghavan P, Ginsberg JJ, Foley FW. Emotion regulation after acquired brain injury: a study of heart rate variability, attentional control, and psychophysiology. Brain Inj 2019; 33:1012-1020. [PMID: 30907142 DOI: 10.1080/02699052.2019.1593506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Primary objective: To examine the efficacy of heart rate variability biofeedback (HRV-BF) to treat emotional dysregulation in persons with acquired brain injury. Design: A secondary analysis of a quasi-experimental study which enrolled 13 individuals with severe chronic acquired brain injury participating in a community-based programme. Response-to-treatment was measured with two HRV resonance indices (low frequency activity [LF] and low frequency/high frequency ratio [LF/HF]). Main outcome: Behavior Rating Inventory of Executive Function-informant report (emotional control subscale [EC]). Results: Results show significant correlation between LF and EC with higher LF activity associated with greater emotional control; the association between LF/HF pre-post-change score and EC is not statistically significant. A moderation model, however, demonstrates a significant influence of attention on the relation between LF/HF change and EC when attention level is high, with an increase in LF/HF activity associated with greater emotional control. Conclusions: HRV-BF is associated with large increases in HRV, and it appears to be useful for the treatment of emotional dysregulation in individuals with severe acquired brain injury. Attention training may enhance an individual's emotional control.
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Affiliation(s)
- Sonya Kim
- a Department of Neurology and Department of Rehabilitation Medicine , NYU School of Medicine , New York , NY , USA
| | - Vance Zemon
- b Ferkauf Graduate School of Psychology , Albert Einstein College of Medicine Yeshiva University , New York , NY , USA
| | - Paul Lehrer
- c Rutgers- Robert Wood Johnson Medical School , Piscataway , NJ , USA
| | | | | | - Preeti Raghavan
- f Rusk Institute of Rehabilitation Medicine NYU Langone Medical Center , New York , NY , USA
| | | | - Frederick W Foley
- b Ferkauf Graduate School of Psychology , Albert Einstein College of Medicine Yeshiva University , New York , NY , USA.,h Multiple Sclerosis Comprehensive Care Multiple Sclerosis Center , Holy Name Hospital , New York , NY , USA
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Howe EI, Løvstad M, Langlo KPS, Hellstrøm T, Spjelkavik Ø, Ugelstad H, Twamley EW, Andelic N. Feasibility of a cognitive rehabilitation program for individuals with mild-to-moderate traumatic brain injury: Participants’ engagement and satisfaction. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1565614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Knut-Petter S. Langlo
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | - Helene Ugelstad
- Department of Vocational Rehabilitation, Norwegian Labour and Welfare Administration, Oslo, Norway
| | - Elizabeth W. Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
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Emmanouel A, Kontrafouri E, Nikolaos P, Kessels RPC, Fasotti L. Incorporation of a working memory strategy in GMT to facilitate serial-order behaviour in brain-injured patients. Neuropsychol Rehabil 2018; 30:888-914. [PMID: 30272538 DOI: 10.1080/09602011.2018.1517369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Goal Management Training (GMT) is an effective method for improving disorganised behaviour in multistep real-life tasks after brain damage. In the present study we incorporated Working Memory Training (WMT) in GMT to explore their combined efficacy in facilitating the serial-order maintenance of the steps that had to be learned. GMT+WMT was compared to a control WMT designed for other purposes. For this purpose 18 brain-injured patients (aged 20-54), who were at least 4 months post-onset, were randomly assigned to either the GMT+WMT or the WMT treatment. Inclusion was based on a baseline score of less than six correct steps on each of two multistep everyday tasks. Alternative versions of these tasks were used as primary outcome tasks. Pre-treatment and post-treatment comparisons of scores on these primary tasks and on several secondary neuropsychological measures were collected. The results show that post-treatment the GMT+WMT group performed significantly better than the WMT group on the primary outcome measures and on several ecologically valid executive tests that demanded a step-by-step maintenance of multiple actions. Time effects were found for both groups on the secondary measures. Other measures showed no significant differences. We conclude that our results support the efficacy of the combined GMT+WMT in facilitating performance in everyday multistep tasks.
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Affiliation(s)
- Anna Emmanouel
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands.,Department of Psychology, City College, International Faculty of the University of Sheffield, Thessaloniki, Greece
| | - Ellisavet Kontrafouri
- MSc International Medicine, Management of Health Crises, Medical School of Athens, Athens, Greece
| | - Psarras Nikolaos
- Neurosurgical Department, General Hospital of Papanikolaou, Thessaloniki, Greece.,Neurosurgical Department, Clinic of Saint Loukas, Thessaloniki, Greece
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands.,Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
| | - Luciano Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands.,Rehabilitation Center Klimmendaal, Arnhem, The Netherlands
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Cognitive Rehabilitation With Mobile Technology and Social Support for Veterans With TBI and PTSD: A Randomized Clinical Trial. J Head Trauma Rehabil 2018; 34:1-10. [PMID: 30169439 DOI: 10.1097/htr.0000000000000435] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate effects of cognitive rehabilitation with mobile technology and social support on veterans with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). PARTICIPANTS There were 112 dyads, comprised by a veteran and a family member or friend (224 participants in total). DESIGN Dyads were randomized to the following: (1) a novel intervention, Cognitive Applications for Life Management (CALM), involving goal management training plus mobile devices for cueing and training attentional control; or (2) Brain Health Training, involving psychoeducation plus mobile devices to train visual memory. MAIN MEASURES Executive dysfunction (disinhibition, impulsivity) and emotional dysregulation (anger, maladaptive interpersonal behaviors) collected prior to randomization and following intervention completion at 6 months. RESULTS The clinical trial yielded negative findings regarding executive dysfunction but positive findings on measures of emotion dysregulation. Veterans randomized to CALM reported a 25% decrease in anger over 6 months compared with 8% reduction in the control (B = -5.27, P = .008). Family/friends reported that veterans randomized to CALM engaged in 26% fewer maladaptive interpersonal behaviors (eg, aggression) over 6 months compared with 6% reduction in the control (B = -2.08, P = .016). An unanticipated result was clinically meaningful change in reduced PTSD symptoms among veterans randomized to CALM (P < .001). CONCLUSION This preliminary study demonstrated effectiveness of CALM for reducing emotional dysregulation in veterans with TBI and PTSD.
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Neumann D, Malec JF, Hammond FM. Reductions in Alexithymia and Emotion Dysregulation After Training Emotional Self-Awareness Following Traumatic Brain Injury: A Phase I Trial. J Head Trauma Rehabil 2018; 32:286-295. [PMID: 28060205 PMCID: PMC5498277 DOI: 10.1097/htr.0000000000000277] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the acceptability and initial efficacy of an emotional self-awareness treatment at reducing alexithymia and emotion dysregulation in participants with traumatic brain injury (TBI). SETTING An outpatient rehabilitation hospital. PARTICIPANTS Seventeen adults with moderate to severe TBI and alexithymia. Time postinjury ranged 1 to 33 years. DESIGN Within subject design, with 3 assessment times: baseline, posttest, and 2-month follow-up. INTERVENTION Eight lessons incorporated psychoeducational information and skill-building exercises teaching emotional vocabulary, labeling, and differentiating self-emotions; interoceptive awareness; and distinguishing emotions from thoughts, actions, and sensations. MEASURES Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Trait Anxiety Inventory (TAI); Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI); Difficulty With Emotion Regulation Scale (DERS); and Positive and Negative Affect Scale (PANAS). RESULTS Thirteen participants completed the treatment. Repeated-measures analysis of variance revealed changes on the TAS-20 (P = .003), LEAS (P < .001), TAI (P = .014), STAXI (P = .015), DERS (P = .020), and positive affect (P < .005). Paired t tests indicated significant baseline to posttest improvements on these measures. Gains were maintained at follow-up for the TAS, LEAS, and positive affect. Treatment satisfaction was high. CONCLUSION This is the first study published on treating alexithymia post-TBI. Positive changes were identified for emotional self-awareness and emotion regulation; some changes were maintained several months posttreatment. Findings justify advancing to the next investigational phase for this novel intervention.
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Affiliation(s)
- Dawn Neumann
- Indiana University School of Medicine, Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital of Indiana, 4141 Shore Drive, Indianapolis, IN 46254, , Phone: 317-329-2188
| | - James F. Malec
- Indiana University School of Medicine, Department of Physical, Medicine and Rehabilitation, Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Flora M. Hammond
- Indiana University School of Medicine, Department of Physical, Medicine and Rehabilitation, Chief of Medical Affairs, Rehabilitation Hospital of Indiana, Indianapolis, IN
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Winter L, Moriarty HJ, Short TH. Beyond anger: emotion regulation and social connectedness in veterans with traumatic brain injury. Brain Inj 2018; 32:593-599. [DOI: 10.1080/02699052.2018.1432895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Laraine Winter
- Philadelphia Research and Education Foundation, Corporal Michael C. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Nursing Service, Corporal Michael C. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Helene J Moriarty
- Nursing Service, Corporal Michael C. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Villanova University College of Nursing, Villanova, PA, USA
| | - Thomas H Short
- Department of Mathematics, West Chester University of Pennsylvania, West Chester, PA, USA
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Feasibility of a Skills-Based Group Reintegration Workshop for OEF/OIF Veterans: STEP-Home. J Head Trauma Rehabil 2017; 33:E17-E23. [PMID: 29194181 DOI: 10.1097/htr.0000000000000362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the feasibility of a newly developed reintegration workshop for Operation Iraqi Freedom/Operation Enduring Freedom (OEF/OIF) Veterans that is based on an evidence-based rehabilitation program shown to be effective in treating mild traumatic brain injury-related symptoms in civilians. Underutilization and resistance to mental health treatment remain a significant problem for OEF/OIF Veterans. Innovative, integrative, transdiagnostic, and acceptable interventions are needed, particularly for this heterogeneous group. PARTICIPANTS Eighty-four OEF/OIF/Operation New Dawn Veterans (74 male and 10 female)-mean age = 35; standard deviation = 7.4. SETTING VA Healthcare System. INTERVENTION A 12-week, 2-hour/wk, group skills-based workshop with individual skill building to assist all OEF/OIF Veterans (with and without psychiatric and/or traumatic brain injury) in reintegration after military service. MAIN MEASURES Primary outcomes were feasibility measures including treatment fidelity, acceptability, tolerability/adherence, and treatment-related skill acquisition. Secondary outcomes were interest and engagement in future treatment and reintegration status. RESULTS Veterans' enrollment, adherence, and attrition data indicated that Short-Term Executive Plus adapted for Veteran civilian reintegration (STEP-Home) was acceptable and tolerable. Pre-/postintervention differences in attention, problem-solving, and emotional regulation skills demonstrated treatment-related skills acquisition. Secondary outcome data demonstrated Veterans who were hesitant to participate in mental health treatments before enrollment were more open to treatment engagement after STEP-Home, and reintegration status improved. CONCLUSIONS This study demonstrated that the STEP-Home workshop is feasible in OEF/OIF Veterans and changes in treatment-related skill acquisition and reintegration status were observed. STEP-Home has potential to facilitate readjustment and serves as a gateway to additional, critically needed Veterans Administration services.
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MacDonald S. Introducing the model of cognitive-communication competence: A model to guide evidence-based communication interventions after brain injury. Brain Inj 2017; 31:1760-1780. [DOI: 10.1080/02699052.2017.1379613] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Sheila MacDonald
- Adjunct Lecturer, Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Owner, Sheila MacDonald & Associates, Guelph, Ontario, Canada
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Hurstak E, Johnson JK, Tieu L, Guzman D, Ponath C, Lee CT, Jamora CW, Kushel M. Factors associated with cognitive impairment in a cohort of older homeless adults: Results from the HOPE HOME study. Drug Alcohol Depend 2017; 178:562-570. [PMID: 28738314 PMCID: PMC5568464 DOI: 10.1016/j.drugalcdep.2017.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/27/2017] [Accepted: 06/01/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND We evaluated cognitive function and factors associated with cognitive impairment in a cohort of older homeless adults. We hypothesized that substance use and a history of traumatic brain injury would be associated with cognitive impairment. METHODS We recruited 350 homeless individuals aged ≥50 years using population-based sampling and conducted structured interviews and neuropsychological testing. We evaluated alcohol use with the Alcohol Use Disorder Identification Test, defining high-severity alcohol use as a total score ≥16 or ≥4 on the alcohol dependency sub-scale. We assessed global cognition with the Modified Mini-Mental State Test (3MS) and processing speed and executive function with the Trail Making Test (TMTB), defining impairment as performing 1.5 standard deviations below the standardized mean. We used multivariable logistic regression to examine the association between alcohol use and cognition. RESULTS Participants had a median age of 58 years [IQR 54-61], 76.7% were men, and 79.9% were African American. A quarter (25.1%) of participants met criteria for impairment on the 3MS; 32.9% met criteria for impairment on TMTB. In models adjusted for sociodemographic variables and health conditions, high-severity alcohol use was associated with global cognitive impairment (AOR 2.39, CI 1.19-4.79) and executive dysfunction (AOR 3.09, CI 1.61-5.92). CONCLUSIONS Older homeless adults displayed a prevalence of cognitive impairment 3-4 times higher than has been observed in general population adults aged 70 and older. Impaired cognition in older homeless adults could impact access to housing programs and the treatment of health conditions, including the treatment of alcohol use disorders.
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Affiliation(s)
- Emily Hurstak
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
| | - Julene K Johnson
- Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, USA; Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco, CA, USA
| | - Lina Tieu
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA; Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - David Guzman
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA; Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Claudia Ponath
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Christopher T Lee
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA; Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Christina Weyer Jamora
- Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Margot Kushel
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA; Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA.
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Improving Emotion Regulation Following Web-Based Group Intervention for Individuals With Traumatic Brain Injury. J Head Trauma Rehabil 2017; 32:354-365. [DOI: 10.1097/htr.0000000000000345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Prince C, Bruhns ME. Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology. Brain Sci 2017; 7:brainsci7080105. [PMID: 28817065 PMCID: PMC5575625 DOI: 10.3390/brainsci7080105] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/04/2022] Open
Abstract
Awareness of mild traumatic brain injury (mTBI) and persisting post-concussive syndrome (PCS) has increased substantially in the past few decades, with a corresponding increase in research on diagnosis, management, and treatment of patients with mTBI. The purpose of this article is to provide a narrative review of the current literature on behavioral assessment and management of patients presenting with mTBI/PCS, and to detail the potential role of neuropsychologists and rehabilitation psychologists in interdisciplinary care for this population during the acute, subacute, and chronic phases of recovery.
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Affiliation(s)
- Carolyn Prince
- JFK Johnson Rehabilitation Institute, Center for Brain Injuries, Edison, NJ 08820, USA.
| | - Maya E Bruhns
- Alta Bates Summit Medical Center, Oakland, CA 94609, USA.
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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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Kumar KS, Samuelkamaleshkumar S, Viswanathan A, Macaden AS. Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes. Cochrane Database Syst Rev 2017; 6:CD007935. [PMID: 28631816 PMCID: PMC6481568 DOI: 10.1002/14651858.cd007935.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cognitive impairment in people with traumatic brain injury (TBI) could affect multiple facets of their daily functioning. Cognitive rehabilitation brings about clinically significant improvement in certain cognitive skills. However, it is uncertain if these improved cognitive skills lead to betterments in other key aspects of daily living. We evaluated whether cognitive rehabilitation for people with TBI improves return to work, independence in daily activities, community integration and quality of life. OBJECTIVES To evaluate the effects of cognitive rehabilitation on return to work, independence in daily activities, community integration (occupational outcomes) and quality of life in people with traumatic brain injury, and to determine which cognitive rehabilitation strategy better achieves these outcomes. SEARCH METHODS We searched CENTRAL (the Cochrane Library; 2017, Issue 3), MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), and clinical trials registries up to 30 March 2017. SELECTION CRITERIA We identified all available randomized controlled trials of cognitive rehabilitation compared with any other non-pharmacological intervention for people with TBI. We included studies that reported at least one outcome related to : return to work, independence in activities of daily living (ADL), community integration and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials. We used standard methodological procedures expected by Cochrane. We evaluated heterogeneity among the included studies and performed meta-analysis only when we could include more than one study in a comparison. We used the online computer programme GRADEpro to assess the quality of evidence, and generate 'Summary of findings' tables. MAIN RESULTS We included nine studies with 790 participants. Three trials (160 participants) compared cognitive rehabilitation versus no treatment, four trials (144 participants) compared cognitive rehabilitation versus conventional treatment, one trial (120 participants) compared hospital-based cognitive rehabilitation versus home programme and one trial (366 participants) compared one cognitive strategy versus another. Among the included studies, we judged three to be of low risk of bias.There was no difference between cognitive rehabilitation and no intervention in return to work (risk ratio (RR) 1.80, 95% confidence interval (CI) 0.74 to 4.39, 1 study; very low-quality evidence). There was no difference between biweekly cognitive rehabilitation for eight weeks and no treatment in community integration (Sydney Psychosocial Reintegration Scale): mean difference (MD) -2.90, 95% CI -12.57 to 6.77, 1 study; low-quality evidence). There was no difference in quality of life between cognitive rehabilitation and no intervention immediately following the 12-week intervention(MD 0.30, 95% CI -0.18 to 0.78, 1 study; low-quality evidence). No study reported effects on independence in ADL.There was no difference between cognitive rehabilitation and conventional treatment in return to work status at six months' follow-up in one study (RR 1.43, 95% CI 0.87 to 2.33; low-quality evidence); independence in ADL at three to four weeks' follow-up in two studies (standardized mean difference (SMD) -0.01, 95% CI -0.62 to 0.61; very low-quality evidence); community integration at three weeks' to six months' follow-up in three studies (Community Integration Questionnaire: MD 0.05, 95% CI -1.51 to 1.62; low-quality evidence) and quality of life at six months' follow-up in one study (Perceived Quality of Life scale: MD 6.50, 95% CI -2.57 to 15.57; moderate-quality evidence).For active duty military personnel with moderate-to-severe closed head injury, there was no difference between eight weeks of cognitive rehabilitation administered as a home programme and hospital-based cognitive rehabilitation in achieving return to work at one year' follow-up in one study (RR 0.95, 95% CI 0.85 to 1.05; moderate-quality evidence). The study did not report effects on independence in ADL, community integration or quality of life.There was no difference between one cognitive rehabilitation strategy (cognitive didactic) and another (functional experiential) for adult veterans or active duty military service personnel with moderate-to-severe TBI (one study with 366 participants and one year' follow-up) on return to work (RR 1.10, 95% CI 0.83 to 1.46; moderate-quality evidence), or on independence in ADL (RR 0.90, 95% CI 0.75 to 1.08; low-quality evidence). The study did not report effects on community integration or quality of life.None of the studies reported adverse effects of cognitive rehabilitation. AUTHORS' CONCLUSIONS There is insufficient good-quality evidence to support the role of cognitive rehabilitation when compared to no intervention or conventional rehabilitation in improving return to work, independence in ADL, community integration or quality of life in adults with TBI. There is moderate-quality evidence that cognitive rehabilitation provided as a home programme is similar to hospital-based cognitive rehabilitation in improving return to work status among active duty military personnel with moderate-to-severe TBI. Moderate-quality evidence suggests that one cognitive rehabilitation strategy (cognitive didactic) is no better than another (functional experiential) in achieving return to work in veterans or military personnel with TBI.
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Affiliation(s)
- K Suresh Kumar
- London School of Hygiene and Tropical MedicineClinical Research DepartmentKeppel StreetLondonUKWC1E 7HT
| | | | - Anand Viswanathan
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Center for Evidence‐Informed Health Care and Health PolicyBagayamVelloreTamil NaduIndia632002
| | - Ashish S Macaden
- Raigmore Hospital (NHS Highland)Stroke and Rehabilitation MedicineInvernessUKIV2 3UJ
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The Relations of Self-Reported Aggression to Alexithymia, Depression, and Anxiety After Traumatic Brain Injury. J Head Trauma Rehabil 2017; 32:205-213. [DOI: 10.1097/htr.0000000000000261] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hart T, Vaccaro MJ. Goal intention reminding in traumatic brain injury: A feasibility study using implementation intentions and text messaging. Brain Inj 2017; 31:297-303. [PMID: 28102697 DOI: 10.1080/02699052.2016.1251612] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine feasibility of participant-created implementation intentions, delivered as text message reminders, to enhance goal-related activity in persons with chronic, moderate/severe traumatic brain injury (TBI). DESIGN Pilot randomized controlled trial on effects of 8 weeks receiving goal-related implementation intentions (GI) compared to control condition, educational review regarding goals (GR). PARTICIPANTS Eight persons with moderate/severe TBI nearing discharge from intensive outpatient brain injury treatment. MEASURES Neuropsychological tests to characterize cognitive status; Participation with Recombined Tools-Objective (PART-O) assessing community activity, social relations and productivity; Brief Symptom Inventory-18 (BSI-18) assessing depression, anxiety and overall distress; Goal Attainment Scales (GAS). PART-O, BSI-18 and GAS were completed at baseline and 8 weeks; significant others provided ratings on PART-O and GAS. RESULTS Participants replied to SMS messages at high rates. Statistically significant group × time interactions with medium-to-large effect sizes favouring the GI group were observed on PART-O community activity and social relations. Neither BSI-18 nor GAS revealed differences or trends by group. Qualitative results suggested overall acceptance and success of SMS reminders. CONCLUSIONS Given positive preliminary findings, implementation intentions delivered by text holds promise as a simple, low-cost intervention to help people with moderate/severe TBI to implement goal-relevant behaviours.
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Affiliation(s)
- Tessa Hart
- a Moss Rehabilitation Research Institute , Elkins Park , PA , USA
| | - Monica J Vaccaro
- a Moss Rehabilitation Research Institute , Elkins Park , PA , USA
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Woon FL, Farrer TJ, Braman CR, Mabey JK, Hedges DW. A meta-analysis of the relationship between symptom severity of Posttraumatic Stress Disorder and executive function. Cogn Neuropsychiatry 2017; 22:1-16. [PMID: 27875926 DOI: 10.1080/13546805.2016.1255603] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Some studies of Posttraumatic Stress Disorder (PTSD) find executive dysfunction, whereas others do not. We meta-analytically examined the association between executive function and PTSD and used meta-regression to examine the potential moderating effect of PTSD severity on executive function. METHODS We conducted a meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified published peer-reviewed articles containing measures of executive function and PTSD symptom severity in subjects with PTSD compared to trauma-unexposed controls or trauma-exposed controls without PTSD, or both. We calculated an effect size for each study containing at least one measure of executive function and PTSD symptom severity. RESULTS PTSD subjects for whom the Clinician-Administered PTSD Scale (CAPS) score was available had worse executive function compared to both trauma-unexposed controls (g = 0.464, p < .001) and to trauma-exposed controls without PTSD (g = 0.414, p = .001), as did PTSD subjects for whom the Mississippi Scale for Combat-Related PTSD (M-PTSD) score was available (g = 0.390, p < .001). Neither CAPS nor M-PTSD scores significantly moderated the effect size of executive function. CONCLUSIONS PTSD is associated with executive dysfunction, but this association was not moderated by PTSD symptom severity, suggesting that once PTSD occurs, executive dysfunction may occur regardless of PTSD severity.
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Affiliation(s)
- Fu L Woon
- a Seton Brain & Spine Institute, Department of Neurology , Dell Medical School, University of Texas , Austin , TX , USA
| | - Thomas J Farrer
- b Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
| | - Colin R Braman
- c Department of Psychology , Brigham Young University , Provo , UT , USA
| | - Jennifer K Mabey
- d Department of Physiology and Developmental Biology , Brigham Young University , Provo , UT , USA
| | - Dawson W Hedges
- c Department of Psychology , Brigham Young University , Provo , UT , USA
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Hallock H, Collins D, Lampit A, Deol K, Fleming J, Valenzuela M. Cognitive Training for Post-Acute Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2016; 10:537. [PMID: 27833541 PMCID: PMC5081379 DOI: 10.3389/fnhum.2016.00537] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/11/2016] [Indexed: 12/15/2022] Open
Abstract
Objective: To quantitatively aggregate effects of cognitive training (CT) on cognitive and functional outcome measures in patients with traumatic brain injury (TBI) more than 12-months post-injury. Design: We systematically searched six databases for non-randomized and randomized controlled trials of CT in TBI patients at least 12-months post-injury reporting cognitive and/or functional outcomes. Main Measures: Efficacy was measured as standardized mean difference (Hedges’ g) of post-training change. We investigated heterogeneity across studies using subgroup analyses and meta-regressions. Results: Fourteen studies encompassing 575 patients were included. The effect of CT on overall cognition was small and statistically significant (g = 0.22, 95%CI 0.05 to 0.38; p = 0.01), with low heterogeneity (I2 = 11.71%) and no evidence of publication bias. A moderate effect size was found for overall functional outcomes (g = 0.32, 95%CI 0.08 to 0.57, p = 0.01) with low heterogeneity (I2 = 14.27%) and possible publication bias. Statistically significant effects were also found only for executive function (g = 0.20, 95%CI 0.02 to 0.39, p = 0.03) and verbal memory (g = 0.32, 95%CI 0.14 to 0.50, p < 0.01). Conclusion: Despite limited studies in this field, this meta-analysis indicates that CT is modestly effective in improving cognitive and functional outcomes in patients with post-acute TBI and should therefore play a more significant role in TBI rehabilitation.
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Affiliation(s)
- Harry Hallock
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney Sydney, NSW, Australia
| | - Daniel Collins
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney Sydney, NSW, Australia
| | - Amit Lampit
- Regenerative Neuroscience Group, Brain and Mind Centre, University of SydneySydney, NSW, Australia; School of Psychology, University of SydneySydney, NSW, Australia
| | - Kiran Deol
- Sydney Medical School, University of Sydney Sydney, NSW, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of QueenslandBrisbane, QLD, Australia; Occupational Therapy Department, Princess Alexandra HospitalBrisbane, QLD, Australia; Centre for Functioning and Health Research, Metro South Hospital and Health ServiceBrisbane, QLD, Australia
| | - Michael Valenzuela
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney Sydney, NSW, Australia
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Haller CS, Bosma CM, Kapur K, Zafonte R, Langer EJ. Mindful creativity matters: trajectories of reported functioning after severe traumatic brain injury as a function of mindful creativity in patients’ relatives: a multilevel analysis. Qual Life Res 2016; 26:893-902. [DOI: 10.1007/s11136-016-1416-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 10/21/2022]
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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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Cooper DB, Bunner AE, Kennedy JE, Balldin V, Tate DF, Eapen BC, Jaramillo CA. Treatment of persistent post-concussive symptoms after mild traumatic brain injury: a systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans. Brain Imaging Behav 2016; 9:403-20. [PMID: 26330376 DOI: 10.1007/s11682-015-9440-2] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increased prevalence of traumatic brain injury (TBI) has been associated with service members and veterans who completed combat deployments in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Management of persistent post-concussive symptoms (PCS) has been a challenge to healthcare providers throughout the Military and Veterans Healthcare Systems, as well as civilian healthcare providers, due in part to the chronic nature of symptoms, co-occurrence of behavioral health disorders such as depression, Posttraumatic Stress Disorder (PTSD), and substance use disorders, and fear of a potential stigma associated with psychiatric diagnoses and behavioral health treatment(s). This systematic review examined non-pharmacologic behavioral health interventions and cognitive rehabilitation interventions for PCS in military service members and veterans with a history of mild TBI (mTBI). Six electronic databases were searched with specific term limitations, identifying 121 citations. Ultimately, 19 articles met criteria for inclusion in this systematic review. Studies were broadly categorized into four subtypes: psychoeducational interventions, cognitive rehabilitation, psychotherapeutic approaches, and integrated behavioral health interventions for PCS and PTSD. The review provides an update of the empirical evidence for these four types of interventions for PCS in active duty service members and veterans. Recommendations for future research are discussed, including the need to expand and improve the limited evidence basis on how to manage persistent post-concussive symptoms in this population.
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Affiliation(s)
- Douglas B Cooper
- Defense and Veteran's Brain Injury Center, San Antonio Military Medical Center MCHE MDU (DVBIC), 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234-6200, USA.
- Department of Neurology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
| | - Anne E Bunner
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA
| | - Jan E Kennedy
- Defense and Veteran's Brain Injury Center, San Antonio Military Medical Center MCHE MDU (DVBIC), 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234-6200, USA
- Department of Neurology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA
| | - Valerie Balldin
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - David F Tate
- Missouri Institute of Mental Health, University of Missouri at St. Louis, St. Louis, MO, USA
| | - Blessen C Eapen
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Carlos A Jaramillo
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, USA
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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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Radomski MV, Anheluk M, Bartzen MP, Zola J. Effectiveness of Interventions to Address Cognitive Impairments and Improve Occupational Performance After Traumatic Brain Injury: A Systematic Review. Am J Occup Ther 2016; 70:7003180050p1-9. [DOI: 10.5014/ajot.2016.020776] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. To determine the effectiveness of interventions addressing cognitive impairments to improve occupational performance for people with traumatic brain injury.
METHOD. A total of 37 studies met inclusion criteria: 9 Level I systematic reviews, 14 Level I studies, 5 Level II studies, and 9 Level III studies.
RESULTS. Strong evidence supports use of direct attention training, dual-task training, and strategy training to optimize executive functioning, encoding, and use of memory compensations, including assistive technology. However, in most studies, occupational performance was a secondary outcome, if it was evaluated at all.
CONCLUSION. Although evidence supports many intervention approaches used by occupational therapy practitioners to address cognitive impairments of adults with traumatic brain injury, more studies are needed in which occupational performance is the primary outcome of cognitive intervention.
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Affiliation(s)
- Mary Vining Radomski
- Mary Vining Radomski, PhD, OTR/L, FAOTA, is Senior Scientific Adviser, Courage Kenny Research Center, Minneapolis, MN;
| | - Mattie Anheluk
- Mattie Anheluk, MAOT, OTR/L, is Occupational Therapist, Courage Kenny Rehabilitation Institute–Abbott Northwestern Hospital, Minneapolis, MN
| | - M. Penny Bartzen
- M. Penny Bartzen, OTD, OTR/L, is Occupational Therapist, Courage Kenny Rehabilitation Institute–Buffalo Hospital, Buffalo, MN
| | - Joette Zola
- Joette Zola, BS, OTR/L, is Occupational Therapist, Courage Kenny Rehabilitation Institute–Abbott Northwestern Hospital, Minneapolis, MN
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