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Mehta S, Devito L, Patsakos EM, Devito J, Velikonja D, Bayley M, Teasell R, MacKenzie HM. Updated Canadian Clinical Practice Guideline for the Rehabilitation of Adults With Moderate to Severe Traumatic Brain Injury: Mental Health Recommendations. J Head Trauma Rehabil 2024; 39:359-368. [PMID: 39256157 DOI: 10.1097/htr.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE Objective: After sustaining a moderate to severe traumatic brain injury (MSTBI), individuals often experience comorbid mental health conditions that can impair the rehabilitation and recovery process. The objective of this initiative was to update recommendations on the assessment and management of mental health conditions for the Canadian Clinical Practice Guideline for the Rehabilitation of Adults with MSTBI (CAN-TBI 2023). OBJECTIVE Design: A systematic search was conducted by the Evidence-Based Review of Moderate to Severe Acquired Brain Injury to identify new and relevant articles. Expert Panel reviewed and discussed the new and existing evidence, evaluated its quality, and added, removed, or modified recommendations and tools as needed. A consensus process was followed to achieve agreement on recommendations. OBJECTIVE Results: CAN-TBI 2023 includes 20 recommendations regarding best practices for the assessment and management of mental health conditions post-MSTBI. About 17 recommendations were updated, 1 new recommendation was formed, and 2 recommendations remained unchanged. The Guideline emphasizes the importance of screening and assessment of mental health conditions throughout the rehabilitation continuum. The Expert Panel recommended incorporating multimodal treatments that include pharmacological and nonpharmacological approaches to manage mental health concerns. OBJECTIVE Conclusion: The CAN-TBI 2023 recommendations for the assessment and management of mental health conditions should be used to inform clinical practice. Additional high-quality research in this area is needed, as 13 recommendations are based on level C evidence, 4 on level B evidence, and 3 on level A evidence.
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Affiliation(s)
- Swati Mehta
- Author Affiliations: Parkwood Institute Research, Lawson Research Institute, London, Ontario, Canada (Drs Mehta and Teasell); Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (Drs Mehta, Teasell, and MacKenize); Parkwood Institute, St. Joseph's Health Care London, London, Canada (Drs Mehta, Teasell, and MacKenize); Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (Mss Lauren Devito and Julia Devito); Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada (Ms Patsakos and Dr Bayley); KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada (Ms Patsakos); Acquired Brain Injury Program, Hamilton Health Sciences, Hamilton, Ontario, Canada (Dr Velikonja); Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Velikonja); Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Dr Bayley); and University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada (Dr Bayley)
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Barua U, Ahrens J, Shao R, MacKenzie H, Wolfe D, Sequeira K, Teasell R, Loh E, Mehta S. Cognitive behavioral therapy for managing depressive and anxiety symptoms after brain injury: a meta-analysis. Brain Inj 2024; 38:227-240. [PMID: 38318855 DOI: 10.1080/02699052.2024.2309264] [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: 05/15/2022] [Accepted: 01/19/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Individuals with traumatic brain injury (TBI) are at increased risk of depression and anxiety, leading to impaired recovery. While cognitive-behavioral therapy (CBT) addresses anxiety and depression maintenance factors, its efficacy among those with TBI has not been clearly demonstrated. This review aims to bridge this gap in the literature. METHODS Several databases, including Medline, PsycInfo and EMBASE, were used to identify studies published between 1990 and 2021. Studies were included if: (1) trials were randomized controlled trials (RCT) involving CBT-based intervention targeting anxiety and/or depression; (2) participants experienced brain injury at least 3-months previous; (3) participants were ≥18 years old. An SMD ± SE, 95% CI and heterogeneity were calculated for each outcome. RESULTS Thirteen RCTs were included in this meta-analysis. The pooled-sample analyses suggest that CBT interventions had small immediate post-treatment effects on reducing depression (SMD ± SE: 0.391 ± 0.126, p < 0.005) and anxiety (SMD ± SE: 0.247 ± 0.081, p < 0.005). Effects were sustained at a 3-months follow-up for depression. A larger effect for CBT was seen when compared with supportive therapy than control. Another sub-analysis found that individualized CBT resulted in a slightly higher effect compared to group-based CBT. CONCLUSION This meta-analysis provides substantial evidence for CBT in managing anxiety and depression post-TBI.
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Affiliation(s)
- Ujjoyinee Barua
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Jessica Ahrens
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
| | - Richard Shao
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
| | - Heather MacKenzie
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Dalton Wolfe
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Keith Sequeira
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Robert Teasell
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Eldon Loh
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Swati Mehta
- Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
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Boulos ME, Colella B, Meusel LA, Sharma B, Peter MK, Worthington T, Green REA. Feasibility of group telerehabilitation for individuals with chronic acquired brain injury: integrating clinical care and research. Disabil Rehabil 2024; 46:750-762. [PMID: 36855274 DOI: 10.1080/09638288.2023.2177357] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 02/02/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Acquired brain injury (ABI) is a leading cause of lifelong disability, but access to treatment in the chronic stages has significant barriers. Group-based, remotely delivered neurorehabilitation reduces costs, travel barriers, and infection risk; however, its feasibility for patients with ABI is not well-established. OBJECTIVES To investigate the feasibility of remotely group-based cognitive and mood therapies for persons with chronic ABI. METHODS Three hundred and eighty-eight adults with chronic ABI participated in group tele-neurorehabilitation modules comprising Cognitive Behavioral Therapy, Goal Management Training®, Relaxation and Mindfulness Skills Training, and/or a novel Concussion Education & Symptom Management program. Assessments comprised quantitative metrics, surveys, as well as qualitative semi-structured interviews in a subset of participants. RESULTS High retention, adherence, and satisfaction were observed. Facilitators of treatment included accessibility, cost-effectiveness, and convenience. Adoption of technology was high, but other people's technological interruptions were a barrier. Self-reported benefits specific to group-based format included improved mood, stress management, coping, interpersonal relationships, cognitive functioning, and present-mindedness. CONCLUSIONS The present study examined chronic ABI patients' perceptions of telerehabilitation. Patients found remotely delivered, group-based mood, and cognitive interventions feasible with easy technology adoption. Group format was considered a benefit. Recommendations are provided to inform design of remotely delivered ABI programs.
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Affiliation(s)
- Mary E Boulos
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Brenda Colella
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Liesel-Ann Meusel
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Bhanu Sharma
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Medical Sciences, McMaster University, Hamilton, Canada
| | - Marika K Peter
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Thomas Worthington
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Robin E A Green
- Cognitive Neurorehabilitation Sciences Lab, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Peacock WF, Kuehl D, Bazarian J, Singer AJ, Cannon C, Rafique Z, d'Etienne JP, Welch R, Clark C, Diaz-Arrastia R. Defining Acute Traumatic Encephalopathy: Methods of the "HEAD Injury Serum Markers and Multi-Modalities for Assessing Response to Trauma" (HeadSMART II) Study. Front Neurol 2021; 12:733712. [PMID: 34956041 PMCID: PMC8693379 DOI: 10.3389/fneur.2021.733712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Despite an estimated 2.8 million annual ED visits, traumatic brain injury (TBI) is a syndromic diagnosis largely based on report of loss of consciousness, post-traumatic amnesia, and/or confusion, without readily available objective diagnostic tests at the time of presentation, nor an ability to identify a patient's prognosis at the time of injury. The recognition that “mild” forms of TBI and even sub-clinical impacts can result in persistent neuropsychiatric consequences, particularly when repetitive, highlights the need for objective assessments that can complement the clinical diagnosis and provide prognostic information about long-term outcomes. Biomarkers and neurocognitive testing can identify brain injured patients and those likely to have post-concussive symptoms, regardless of imaging testing results, thus providing a physiologic basis for a diagnosis of acute traumatic encephalopathy (ATE). The goal of the HeadSMART II (HEAD injury Serum markers and Multi-modalities for Assessing Response to Trauma) clinical study is to develop an in-vitro diagnostic test for ATE. The BRAINBox TBI Test will be developed in the current clinical study to serve as an aid in evaluation of patients with ATE by incorporating blood protein biomarkers, clinical assessments, and tools to measure, identify, and define associated pathologic evidence and neurocognitive impairments. This protocol proposes to collect data on TBI subjects by a multi-modality approach that includes serum biomarkers, clinical assessments, neurocognitive performance, and neuropsychological characteristics, to determine the accuracy of the BRAINBox TBI test as an aid to the diagnosis of ATE, defined herein, and to objectively determine a patient's risk of developing post-concussive symptoms.
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Affiliation(s)
| | - Damon Kuehl
- Carillion Clinic, Roanoke, VA, United States
| | - Jeff Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, NY, United States
| | - Adam J Singer
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Chad Cannon
- University of Kansas Medical Center, Kansas City, MO, United States
| | | | - James P d'Etienne
- Integrative Emergency Service/John Peter Smith Health System, Fort Worth, TX, United States
| | - Robert Welch
- Detroit Medical Center, Detroit, MI, United States
| | - Carol Clark
- William Beaumont Hospital, Royal Oak, MI, United States
| | - Ramon Diaz-Arrastia
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
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McIntyre A, Mehta S, Janzen S, Rice D, Harnett A, MacKenzie HM, Vanderlaan D, Teasell R. Coping strategies and personality traits among individuals with brain injury and depressive symptoms. NeuroRehabilitation 2020; 47:25-34. [DOI: 10.3233/nre-203081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Amanda McIntyre
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Swati Mehta
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Shannon Janzen
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Danielle Rice
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Amber Harnett
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Heather M. MacKenzie
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
- St. Joseph’s Health Care, Parkwood Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Danielle Vanderlaan
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Robert Teasell
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
- St. Joseph’s Health Care, Parkwood Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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McIntyre A, Rice D, Janzen S, Mehta S, Harnett A, Caughlin S, Sequeira K, Teasell R. Anxiety, depression, and quality of life among subgroups of individuals with acquired brain injury: The role of anxiety sensitivity and experiential avoidance. NeuroRehabilitation 2020; 47:45-53. [DOI: 10.3233/nre-203080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Amanda McIntyre
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Danielle Rice
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Shannon Janzen
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Swati Mehta
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Amber Harnett
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Sarah Caughlin
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Keith Sequeira
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
- St. Joseph’s Health Care, Parkwood Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Robert Teasell
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
- St. Joseph’s Health Care, Parkwood Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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Unique Features of the INESSS-ONF Rehabilitation Guidelines for Moderate to Severe Traumatic Brain Injury: Responding to Users' Needs. J Head Trauma Rehabil 2019; 33:296-305. [PMID: 30188459 DOI: 10.1097/htr.0000000000000428] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) clinical practice guidelines are a potential solution to rapidly expanding literature. The project objective was to convene experts to develop a unique set of TBI rehabilitation recommendations incorporating users' priorities for format and implementation tools including indicators of adherence. METHODS The Guidelines Adaptation & Development Cycle informed recommendation development. Published TBI recommendations were identified and tabulated. Experts convened to adapt or, where appropriate, develop new evidence-based recommendations. These draft recommendations were validated by systematically reviewing relevant literature. Surveys of experts and target users were triangulated with strength of evidence to identify priority topics. RESULTS The final recommendation set included a rationale, implementation tools (algorithms/adherence indicators), key process indicators, and evidence summaries, and were divided in 2 sections: Section I: Components of the Optimal TBI Rehabilitation System (71 recommendations) and Section II: Assessment and Rehabilitation of Brain Injury Sequelae (195 recommendations). The recommendations address top priorities for the TBI rehabilitation system: (1) intensity/frequency of interventions; (2) rehabilitation models; (3) duration of interventions; and (4) continuity-of-care mechanisms. Key sequelae addressed (1) behavioral disorders; (2) cognitive dysfunction; (3) fatigue and sleep disturbances; and (4) mental health. CONCLUSION This TBI rehabilitation guideline used a robust development process to address users' priorities.
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Psychological Intervention in Traumatic Brain Injury Patients. Behav Neurol 2019; 2019:6937832. [PMID: 31191738 PMCID: PMC6525953 DOI: 10.1155/2019/6937832] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/20/2018] [Accepted: 03/19/2019] [Indexed: 01/25/2023] Open
Abstract
Objective To provide a brief and comprehensive summary of recent research regarding psychological interventions for patients surviving a traumatic brain injury. Methods A bibliographical search was performed in PubMed, Cochrane Library, PsycNET, Scopus, ResearchGate, and Google Scholar online databases. Analysis included distribution by year of publication, age stage of participants (paediatric, adult), location of the research team, study design, type of intervention, and main outcome variables. Results The initial search eliciting 1541 citations was reduced to 62 relevant papers. Most publications had adult samples (88.7%). The United States outstands as the country with more research (58.1%); Latin America countries provided no results. Cognitive behavioural therapy (CBT) was the most widely used approach for treatment of (sub)clinical mental disturbances (41.9%). Neuropsychological interventions were scarce (4.8%). Outcome measures included psychiatric disorders (e.g., posttraumatic stress disorder (PTSD), depression, and anxiety) (37.1%), postconcussive symptoms (16.1%), cognitive and functional deficits (48.1%), and social and psychological dimensions (62.9%). Conclusions CBT outstands as the preferred therapeutic approach for treating behavioural and emotional disturbances. Also, other related therapies such as dialectical behaviour, mindfulness, and acceptance and commitment therapies have been proposed, and probably in the years to come, more literature regarding their effectiveness will be available. On the other hand, evidence showed that interventions from the field of neuropsychology are minimal if compared with its contribution to assessment. Future research should be aimed at performing studies on more diverse populations (e.g., nonmilitary communities and paediatric and Latin American populations) and at controlling designs to examine the therapeutic efficacy of psychotherapeutic and neurocognitive rehabilitation interventions and compare amelioration by injury severity, age of patients, and clinical profile, in the hopes of creating better guidelines for practitioners.
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Evaluating the Psychometric Properties of 3 Depression Measures in a Sample of Persons With Traumatic Brain Injury and Major Depressive Disorder. J Head Trauma Rehabil 2018; 31:225-32. [PMID: 26291629 DOI: 10.1097/htr.0000000000000177] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore the psychometric properties of 3 widely used measures of depression in a sample of individuals with traumatic brain injury (TBI) and major depressive disorder and refine them to maximize efficiency. DESIGN Secondary analysis of data from a randomized controlled trial of cognitive-behavioral therapy for depression after TBI. SETTING Nationwide recruitment from community and clinical settings. PARTICIPANTS One hundred adults within 10 years of complicated mild to severe TBI. INTERVENTION Telephone and in-person cognitive-behavioral therapy. MAIN MEASURES Patient Health Questionnaire-9 (PHQ-9), Symptom Checklist-20, and Hamilton Depression Rating Scale. RESULTS We used Rasch rating scale analysis and multilevel modeling to investigate the 3 measures. Measurement properties of each of the depression measures were strong. We explored modifications to the rating scales to improve efficiency while retaining strong psychometric characteristics. Correlations among these revised measures were high. Treatment effects of each revised depression measure were compared using a multilevel model, and effect size estimates were comparable among the revised PHQ-9, Symptom Checklist-20, and Hamilton Depression Rating Scale. CONCLUSIONS Although each of the 3 measures demonstrated adequate reliability, the efficiency of all 3 instruments was improved with rating scale analysis. The PHQ-9 required the fewest modifications and functions well as a measure of depression among those with TBI.
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Mueller C, Wesenberg S, Nestmann F, Stubbs B, Bebbington P, Raymont V. Interventions to enhance coping after traumatic brain injury: A systematic review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.3.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: The aim of this study was to identify effective psychosocial interventions to enhance coping in people who have experienced a traumatic brain injury, in order to inform clinical practice and articulate future research directions. Methods: Five electronic databases (CINAHL, Medline, EMBASE, PsycINFO, and Cochrane Library) were searched. Titles and abstracts were independently screened by two of the authors and selected for inclusion. The full text of all potentially relevant studies were retrieved and assessed for eligibility, reporting and methodological quality, and risk of bias. Findings: Eight included studies were very heterogeneous in terms of study design, type of intervention, the population studied and instruments used to evaluate coping. All studies were judged to have a moderately high risk of bias. Six studies used cognitive behavioural therapy-based interventions. Two interventions (a peer-mentoring programme and cognitive behavioural therapy combined with motivational interviewing) showed significant treatment effects on maladaptive coping. Two cognitive behavioural therapy-based group programmes improved adaptive coping, but increases were either not sustained over time or no longer significant when compared to an active control. Conclusions: There is insufficient evidence to support practice recommendations strongly. Targeting specific subgroups of people who have experienced traumatic brain injury might allow the development of more effective coping interventions. Further, a more unified concept of coping in traumatic brain injury needs to be articulated allowing larger scale evaluations.
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Affiliation(s)
- Christoph Mueller
- Academic clinical lecturer, Department of Old Age Psychiatry, King's College London, London, UK
| | - Sandra Wesenberg
- Research associate, Faculty of Education, Technische Universität Dresden, Germany
| | - Frank Nestmann
- Emeritus professor of counselling and rehabilitation, Faculty of Education, Technische Universität Dresden, Germany
| | - Brendon Stubbs
- Post-doctoral research physiotherapist, King's College London and Head of Physiotherapy at South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul Bebbington
- Emeritus professor of social and community psychiatry, Division of Psychiatry, University College London, London, UK
| | - Vanessa Raymont
- Senior clinical researcher, Department of Psychiatry, University of Oxford, Oxford, UK
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11
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Verberne DPJ, Spauwen PJJ, van Heugten CM. Psychological interventions for treating neuropsychiatric consequences of acquired brain injury: A systematic review. Neuropsychol Rehabil 2018; 29:1509-1542. [DOI: 10.1080/09602011.2018.1433049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Daan P. J. Verberne
- Department of Acquired Brain Injury, GGZ Oost Brabant, Boekel, the Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
| | - Peggy J. J. Spauwen
- Department of Acquired Brain Injury, GGZ Oost Brabant, Boekel, the Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Caroline M. van Heugten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School of Mental Health and Neurosciences (MHeNS), Maastricht University Medical Centre, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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12
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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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Juengst SB, Kumar RG, Wagner AK. A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges. Psychol Res Behav Manag 2017; 10:175-186. [PMID: 28652833 PMCID: PMC5476717 DOI: 10.2147/prbm.s113264] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Depression is one of the most common conditions to emerge after traumatic brain injury (TBI), and despite its potentially serious consequences it remains undertreated. Treatment for post-traumatic depression (PTD) is complicated due to the multifactorial etiology of PTD, ranging from biological pathways to psychosocial adjustment. Identifying the unique, personalized factors contributing to the development of PTD could improve long-term treatment and management for individuals with TBI. The purpose of this narrative literature review was to summarize the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management. Overall, PTD has an estimated point prevalence of 30%, with 50% of individuals with moderate to severe TBI experiencing an episode of PTD in the first year after injury alone. PTD has significant implications for health, leading to more hospitalizations and greater caregiver burden, for participation, reducing rates of return to work and affecting social relationships, and for quality of life. PTD may develop directly or indirectly as a result of biological changes after injury, most notably post-injury inflammation, or through psychological and psychosocial factors, including pre injury personal characteristics and post-injury adjustment to disability. Current evidence for effective treatments is limited, although the strongest evidence supports antidepressants and cognitive behavioral interventions. More personalized approaches to treatment and further research into unique therapy combinations may improve the management of PTD and improve the health, functioning, and quality of life for individuals with TBI.
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Affiliation(s)
- Shannon B Juengst
- Department of Physical Medicine and Rehabilitation
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, TX
| | - Raj G Kumar
- Department of Physical Medicine and Rehabilitation
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation
- Department of Neuroscience
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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14
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Sharma B, Tomaszczyk JC, Dawson D, Turner GR, Colella B, Green REA. Feasibility of online self-administered cognitive training in moderate-severe brain injury. Disabil Rehabil 2016; 39:1380-1390. [PMID: 27414703 DOI: 10.1080/09638288.2016.1195453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Cognitive environmental enrichment (C-EE) offers promise for offsetting neural decline that is observed in chronic moderate-severe traumatic brain injury (TBI). Brain games are a delivery modality for C-EE that can be self-administered over the Internet without therapist oversight. To date, only one study has examined the feasibility of self-administered brain games in TBI, and the study focused predominantly on mild TBI. Therefore, the primary purpose of the current study was to examine the feasibility of self-administered brain games in moderate-severe TBI. A secondary and related purpose was to examine the feasibility of remote monitoring of any C-EE-induced adverse symptoms with a self-administered evaluation tool. METHOD Ten patients with moderate-severe TBI were asked to complete 12 weeks (60 min/day, five days/week) of online brain games with bi-weekly self-evaluation, intended to measure any adverse consequences of cognitive training (e.g., fatigue, eye strain). RESULTS There was modest weekly adherence (42.6% ± 4.4%, averaged across patients and weeks) and 70% patient retention; of the seven retained patients, six completed the self-evaluation questionnaire at least once/week for each week of the study. CONCLUSIONS Even patients with moderate-severe TBI can complete a demanding, online C-EE intervention and a self-administered symptom evaluation tool with limited therapist oversight, though at daily rate closer to 30 than 60 min per day. Further self-administered C-EE research is underway in our lab, with more extensive environmental support. Implications for Rehabilitation Online brain games (which may serve as a rehabilitation paradigm that can help offset the neurodegeneration observed in chronic TBI) can be feasibly self-administered by moderate-to-severe TBI patients. Brain games are a promising therapy modality, as they can be accessed by all moderate-to-severe TBI patients irrespective of geographic location, clinic and/or therapist availability, or impairments that limit mobility and access to rehabilitation services. Future efficacy trials that examine the effect of brain games for offsetting neurodegeneration in moderate-to-severe TBI patients are warranted.
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Affiliation(s)
- Bhanu Sharma
- a Rehabilitation Sciences Institute (Formerly Graduate Department of Rehabilitation Science) , University of Toronto , Toronto , Ontario , Canada.,b Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada
| | - Jennifer C Tomaszczyk
- b Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada
| | - Deirdre Dawson
- a Rehabilitation Sciences Institute (Formerly Graduate Department of Rehabilitation Science) , University of Toronto , Toronto , Ontario , Canada.,b Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada.,c Rotman Research Institute, Baycrest , Toronto , Ontario , Canada.,d Department of Occupational Science & Occupational Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Gary R Turner
- e Department of Psychology , York University , Toronto , Ontario , Canada
| | - Brenda Colella
- b Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada
| | - Robin E A Green
- a Rehabilitation Sciences Institute (Formerly Graduate Department of Rehabilitation Science) , University of Toronto , Toronto , Ontario , Canada.,b Toronto Rehabilitation Institute , University Health Network , Toronto , Ontario , Canada
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Wheeler S, Acord-Vira A, Davis D. Effectiveness of Interventions to Improve Occupational Performance for People With Psychosocial, Behavioral, and Emotional Impairments After Brain Injury: A Systematic Review. Am J Occup Ther 2016; 70:7003180060p1-9. [PMID: 27089290 DOI: 10.5014/ajot.115.020677] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This systematic review evaluates the effectiveness of interventions to improve occupational performance for people with psychosocial, behavioral, or emotional impairments after traumatic brain injury (TBI). METHOD Medline, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were searched. Of the 1,512 articles initially identified, 35 met the inclusion criteria. RESULTS Six types of interventions were identified: (1) education, (2) peer mentoring, (3) goal-directed therapy, (4) physical activity, (5) skills training, and (6) cognitive-behavioral therapy (CBT). Strong evidence from well-conducted research supports the use of CBT in individual and group settings. Moderate evidence supports goal-directed interventions, aquatic exercise, and functional skills training. Limited evidence supports peer mentoring, aerobic exercise, educational interventions, and various skills training. CONCLUSION An increasing body of evidence supports specific interventions to improve occupational performance and participation for people with psychosocial, behavioral, or emotional impairments after TBI.
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Affiliation(s)
- Steven Wheeler
- Steven Wheeler, PhD, OTR/L, CBIS, is Associate Professor and Associate Chair, Division of Occupational Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown;
| | - Amanda Acord-Vira
- Amanda Acord-Vira, MOT, OTR/L, CBIS, is Assistant Professor, Division of Occupational Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown
| | - Diana Davis
- Diana Davis, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown
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Patterson F, Fleming J, Doig E. Group-based delivery of interventions in traumatic brain injury rehabilitation: a scoping review. Disabil Rehabil 2016; 38:1961-86. [DOI: 10.3109/09638288.2015.1111436] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Freyr Patterson
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Jennifer Fleming
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health District, Queensland Health, Brisbane, Australia
| | - Emmah Doig
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health District, Queensland Health, Brisbane, Australia
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17
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A Framework to Support Cognitive Behavior Therapy for Emotional Disorder After Stroke. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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How TV, Hwang AS, Green REA, Mihailidis A. Envisioning future cognitive telerehabilitation technologies: a co-design process with clinicians. Disabil Rehabil Assist Technol 2016; 12:244-261. [DOI: 10.3109/17483107.2015.1129457] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Tuck-Voon How
- Intelligent Assistive Technology & Systems Lab (IATSL), University of Toronto, Toronto, Canada
| | - Amy S. Hwang
- Intelligent Assistive Technology & Systems Lab (IATSL), University of Toronto, Toronto, Canada
| | - Robin E. A. Green
- Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Alex Mihailidis
- Intelligent Assistive Technology & Systems Lab (IATSL), University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
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19
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Gall C, Brösel D, Franke GH. Mental distress in patients with cerebral visual injury assessed with the german brief symptom inventory. Front Aging Neurosci 2015; 7:51. [PMID: 25999848 PMCID: PMC4418273 DOI: 10.3389/fnagi.2015.00051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/28/2015] [Indexed: 11/13/2022] Open
Abstract
Background While there are reports on vision-related quality of life in patients with vision impairment caused by both ophthalmic and brain diseases, little is known about mental distress. In fact, mental distress after cerebral visual injury has been widely ignored. Methods Mental health symptoms were assessed in 122 participants with visual field defects after brain damage (72 male, mean age 58.1 ± 15.6 years), who completed the German Brief Symptom Inventory (BSI) at their homes after they had been asked by phone for their participation. Results Clinically relevant mental distress was present in 25.4% of participants with cerebral visual injury. In case of multisensory impairment, an increased amount and intensity of mental distress symptoms was observed compared to the subsample with only visual impairment. Conclusion Assessment of comorbid mental health symptoms appears to be clinically meaningful in brain-damaged patients with visual sensory impairment. In case of clinically relevant mental distress, psychological supportive therapies are advisable especially in subjects with cerebral visual injury and comorbidities affecting other sensory modalities as well.
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Affiliation(s)
- Carolin Gall
- Department of Rehabilitation Psychology, AHW, Magdeburg-Stendal University of Applied Sciences , Stendal , Germany ; Department of Psychiatry, AMEOS Hospital , Haldensleben , Germany
| | - Doreen Brösel
- Department of Psychiatry, AMEOS Hospital , Haldensleben , Germany
| | - Gabriele Helga Franke
- Department of Rehabilitation Psychology, AHW, Magdeburg-Stendal University of Applied Sciences , Stendal , Germany
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20
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Schmidt J, Fleming J, Ownsworth T, Lannin NA. Maintenance of treatment effects of an occupation-based intervention with video feedback for adults with TBI. NeuroRehabilitation 2015; 36:175-86. [PMID: 25882200 DOI: 10.3233/nre-151205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Video feedback interventions have been found to improve self-awareness and occupational performance to a greater extent than other feedback interventions after traumatic brain injury (TBI). However, it is unclear whether the effects of video feedback are maintained over time. OBJECTIVE To evaluate the maintenance of gains in self-awareness achieved with a video feedback intervention in people with TBI. METHODS There were 32 participants with TBI and impaired self-awareness who had completed a randomized controlled trial with three feedback conditions (video plus verbal, verbal and experiential). Eight to ten weeks after the final feedback intervention session, a follow-up assessment was conducted. The primary outcome was maintenance of gains in online awareness measured by the number of errors made during a meal preparation task. Group outcomes were compared using an unstructured linear mixed regression model. RESULTS The video plus verbal feedback group continued to demonstrate significantly greater gains in online awareness compared to the verbal feedback group (mean difference 20.6, 95% CI 8.8 to 32.3) and the experiential feedback group (mean difference 14.4, 95% CI 3.1 to 25.6). There was no significant impact of the interventions on participants' emotional status at the 8 to 10 week follow-up. CONCLUSIONS A combination of video plus verbal feedback is an effective technique for achieving maintained gains in self-awareness in people with TBI.
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Affiliation(s)
- Julia Schmidt
- School of Allied Health, Australian Catholic University, North Sydney, NSW, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, QLD, Australia.,Royal Rehabilitation Centre Sydney, Sydney, NSW, Australia.,Centre for Functioning and Health Research, Metro South Hospital Health Service, Brisbane, QLD, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, QLD, Australia.,Centre for Functioning and Health Research, Metro South Hospital Health Service, Brisbane, QLD, Australia.,Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Griffith University, QLD, Australia
| | - Natasha A Lannin
- Occupational Therapy, La Trobe University, Melbourne, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Australia.,John Walsh Centre for Rehabilitation Research, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Abstract
Chronic traumatic encephalopathy (CTE) formerly known as dementia pugilistica is a long-term neurodegenerative disorder associated with repeated subconcussive head injuries in high-contact sports. We reviewed the existing literature on CTE and examined epidemiological trends, risk factors, and its temporal progression, and proposed the underlying pathophysiological mechanisms that may provide unique insights to clinicians with an in-depth understanding of the disease to aid in the diagnosis and prevention, and provide future perspectives for research via search of Medline and Cochrane databases as well as manual review of bibliographies from selected articles and monographs. The prevalence of CTE in recent years is on the rise and almost exclusively affects men, with pathologic signs characterized by progressive memory loss, behavioral changes, and violent tendencies with some patients demonstrating Parkinsonian-like symptoms and signs. Many patients with CTE die following suicide, accident, or complications of drug or alcohol use. Postmortem pathologic analysis is characterized by neurofibrillary tangles and Aβ plaques in 50 % of cases. Currently, there are no ante-mortem diagnostic criteria, but modern imaging techniques such as functional magnetic resonance (MR) imaging, MR spectroscopy, and diffusion tension imaging hold promise for delineating the future diagnostic criteria. Further long-term longitudinal studies are warranted to investigate risk factors that will enhance understanding of the disease progression and its pathogenesis.
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Tomaszczyk JC, Green NL, Frasca D, Colella B, Turner GR, Christensen BK, Green REA. Negative neuroplasticity in chronic traumatic brain injury and implications for neurorehabilitation. Neuropsychol Rev 2014; 24:409-27. [PMID: 25421811 PMCID: PMC4250564 DOI: 10.1007/s11065-014-9273-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/29/2014] [Indexed: 02/04/2023]
Abstract
Based on growing findings of brain volume loss and deleterious white matter alterations during the chronic stages of injury, researchers posit that moderate-severe traumatic brain injury (TBI) may act to “age” the brain by reducing reserve capacity and inducing neurodegeneration. Evidence that these changes correlate with poorer cognitive and functional outcomes corroborates this progressive characterization of chronic TBI. Borrowing from a framework developed to explain cognitive aging (Mahncke et al., Progress in Brain Research, 157, 81–109, 2006a; Mahncke et al., Proceedings of the National Academy of Sciences of the United States of America, 103(33), 12523–12528, 2006b), we suggest here that environmental factors (specifically environmental impoverishment and cognitive disuse) contribute to a downward spiral of negative neuroplastic change that may modulate the brain changes described above. In this context, we review new literature supporting the original aging framework, and its extrapolation to chronic TBI. We conclude that negative neuroplasticity may be one of the mechanisms underlying cognitive and neural decline in chronic TBI, but that there are a number of points of intervention that would permit mitigation of this decline and better long-term clinical outcomes.
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Affiliation(s)
- Jennifer C Tomaszczyk
- Research Department, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
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Tsaousides T, D'Antonio E, Varbanova V, Spielman L. Delivering group treatment via videoconference to individuals with traumatic brain injury: a feasibility study. Neuropsychol Rehabil 2014; 24:784-803. [PMID: 24810148 DOI: 10.1080/09602011.2014.907186] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective was to assess the feasibility of delivering a group treatment to improve emotional regulation via videoconferencing to individuals with traumatic brain injury (TBI). A pre-post feasibility study was undertaken. Seven individuals with TBI were recruited at a brain injury research centre in an urban medical centre. The main measures were therapist assessment of session-by-session progress and feasibility, Difficulties in Emotion Regulation Scale (DERS), Brain Injury Rehabilitation Trust Regulation of Emotions Questionnaire (BREQ), Satisfaction with Therapy and Therapist Scale (STTS), and exit interview. Attendance across sessions and participants was over 90%. Adequate skill acquisition and ease of use of the technology were demonstrated. Self-reported satisfaction with treatment was high. Participants noted several benefits in terms of the treatment delivery modality. There was no change is self-reported emotional dysregulation. This is the first study to report the use of videoconferencing for the delivery of group treatment to individuals with TBI. The exceptional compliance and self-reported satisfaction suggest that this treatment delivery option could be a viable alternative for increasing access to healthcare in this population. The findings of the study supported the development of a large clinical trial to assess treatment effectiveness.
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Affiliation(s)
- Theodore Tsaousides
- a Department of Rehabilitation Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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24
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Access all areas: creative adaptations for CBT with people with cognitive impairments – illustrations and issues. COGNITIVE BEHAVIOUR THERAPIST 2013. [DOI: 10.1017/s1754470x13000135] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPolicy and legislation requires clinicians and services to address diversity and equalities including disability. Currently, practice, training and research do not do this adequately. This paper outlines why adapted CBT is important and presents some evidence to increase accessibility for people who have cognitive impairments, learning disabilities and/or neurodevelopmental disorders. It demonstrates how CBT can be made accessible through clinical examples using traditional, adapted and personalized assessment and intervention materials. Implications and recommendations are identified.
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Kneebone II, Jeffries FW. Treating anxiety after stroke using cognitive-behaviour therapy: two cases. Neuropsychol Rehabil 2013; 23:798-810. [PMID: 23889561 PMCID: PMC3856474 DOI: 10.1080/09602011.2013.820135] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Anxiety disorders are common after stroke. However, information on how to treat them with psychotherapy in this population is highly limited. Modified cognitive-behaviour therapy (CBT) has the potential to assist. Two cases of individuals treated with modified CBT for anxiety after stroke are presented. The modification was required in light of deficits in executive and memory function in one individual and in the context of communication difficulties in the other. The anxiety symptoms were treated over seven and nine sessions, respectively. Both participants improved following the intervention, and these improvements were maintained at 3 month follow-ups. Further case-series and randomised controlled designs are required to support and develop modified CBT for those with anxiety after stroke.
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Affiliation(s)
- Ian I Kneebone
- a Virgin Care, Department of Psychology , Farnham , Surrey , UK
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26
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Rehabilitation Approaches to the Management of Aggressive Behaviour Disorders after Acquired Brain Injury. BRAIN IMPAIR 2013. [DOI: 10.1017/brimp.2013.7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Symptoms of neurobehavioural disability acquired through brain injury, especially aggression, are associated with severe social handicap. Differences in terminology have resulted in varying estimates, but aggressive behaviour disorder appears to be characteristic of survivors at some point in their recovery journey. This paper provides a brief review regarding the prevalence, development and causes of aggression associated with acquired brain injury (ABI), and what can be done to help manage them. The advantages of using standardised measures conceptualised for ABI in the assessment and formulation of aggressive behaviour disorders are especially highlighted. A range of treatment methods and the evidence base relating to these are described. The contribution of pharmacological therapies, cognitive behavioural therapy and behavioural interventions are explored. It is argued that the strongest evidence base is associated with behaviour therapy, especially when carried out in the context of neurobehavioural rehabilitation, and two case studies are described to illustrate the clinical advantages of interventions derived from operant theory. Comparative lack of ABI experts trained in the management of post-acute behaviour disorders remains a limiting factor.
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27
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Waldron B, Casserly LM, O'Sullivan C. Cognitive behavioural therapy for depression and anxiety in adults with acquired brain injury. What works for whom? Neuropsychol Rehabil 2013; 23:64-101. [DOI: 10.1080/09602011.2012.724196] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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Current world literature. Curr Opin Psychiatry 2012; 25:565-73. [PMID: 23037966 DOI: 10.1097/yco.0b013e328359edae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chen AY, Zagorski B, Parsons D, Vander Laan R, Chan V, Colantonio A. Factors associated with discharge destination from acute care after acquired brain injury in Ontario, Canada. BMC Neurol 2012; 12:16. [PMID: 22443681 PMCID: PMC3402989 DOI: 10.1186/1471-2377-12-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 03/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this paper is to examine factors associated with discharge destination after acquired brain injury in a publicly insured population using the Anderson Behavioral Model as a framework. METHODS We utilized a retrospective cohort design. Inpatient data from provincial acute care records from fiscal years 2003/4 to 2006/7 with a diagnostic code of traumatic brain injury (TBI) and non-traumatic brain injury (nTBI) in Ontario, Canada were obtained for the study. Using multinomial logistic regression models, we examined predisposing, need and enabling factors from inpatient records in relation to major discharge outcomes such as discharge to home, inpatient rehabilitation and other institutionalized care. RESULTS Multinomial logistic regression revealed that need factors were strongly correlated with discharge destinations overall. Higher scores on the Charlson Comorbidity Index were associated with discharge to other institutionalized care in the nTBI population. Length of stay and special care days were identified as markers for severity and were both strongly positively correlated with discharge to other institutionalized care and inpatient rehabilitation, compared to discharge home, in both nTBI and TBI populations. Injury by motor vehicle collisions was found to be positively correlated with discharge to inpatient rehabilitation and other institutionalized care for patients with TBI. Controlling for need factors, rural location was associated with discharge to home versus inpatient rehabilitation. CONCLUSIONS These findings show that need factors (Charlson Comorbidity Index, length of stay, and number of special care days) are most significant in terms of discharge destination. However, there is evidence that other factors such as rural location and access to supplemental insurance (e.g., through motor vehicle insurance) may influence discharge destination outcomes as well. These findings should be considered in creating more equitable access to healthcare services across the continuum of care.
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Affiliation(s)
- Amy Y Chen
- Toronto Rehabilitation Institute, 550 University Ave, Toronto, ON M5G 2A2, Canada
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