Conceptualizing functional cognition in traumatic brain injury rehabilitation

Assessments of Functional Cognition Used with Patients following Traumatic Brain Injury in Acute Care: A Survey of Australian Occupational Therapists

This study aimed to describe how occupational therapists working in acute care settings in Australia assess cognitive function in patients with TBI, the influences on assessment choice, and clinician perceptions of performance-based assessment. An online survey was completed by 81 occupational therapists. The most common method of cognitive assessment was reported as non-standardized observation of functional tasks (94.7%), followed by carer-report / self-report (93%). Despite their being positive perceptions of performance-based assessment there was limited use in practice. Assessment use was impacted by practical and organizational constraints including access to assessment resources, time and the built environment in acute care.

Patient-Reported Outcome of Functional Cognition for Traumatic Brain Injury: Item-Level Psychometrics

A patient-reported functional cognition measure that can bridge neuropsychological tests and ecological validity is lacking. The purpose of this study was to present the initial item-level psychometrics of a functional cognition item bank, the Functional Cognition-Patient-Reported Outcome (FC-PRO). Confirmatory factor analysis, Rasch analysis, and convergent validity were conducted to establish item-level psychometrics of the FC-PRO item bank. Four of the six domains met essential unidimensionality criteria; all domains met rating scale criteria; domains had relatively few misfitting items (3%-13%); person reliability (.8-.92), and person strata (2.97-4.29) were satisfactory; the domains showed convergent validity for five of six domains. The FC-PRO showed adequate initial item-level psychometrics for researchers/clinicians to measure specific functional cognitive domains in patients with traumatic brain injury (TBI). This study provides the foundation for the development of future short forms, computer adaptive tests, and keyform recovery maps of patient-reported functional cognition to facilitate clinical utilization.

From word list learning to successful shopping: The neuropsychological assessment continuum from cognitive tests to cognition in everyday life

Cognitive deficits are common after brain injury and can be measured in various ways. Many neuropsychological tests are designed to measure specific cognitive deficits, and self-report questionnaires capture cognitive complaints. Measuring cognition in daily life is important in rehabilitating the abilities required to undertake daily life activities and participate in society. However, assessment of cognition in daily life is often performed in a non-standardized manner. In this opinion paper we discuss the various types of assessment of cognitive functioning and their associated instruments. Drawing on existing literature and evidence from experts in the field, we propose a framework that includes seven dimensions of cognition measurement, reflecting a continuum ranging from controlled test situations through to measurement of cognition in daily life environments. We recommend multidimensional measurement of cognitive functioning in different categories of the continuum for the purpose of diagnostics, evaluation of cognitive rehabilitation treatment, and assessing capacity after brain injury.

Die Erhebung von kommunikativ-pragmatischen Fähigkeiten und Lebensqualität nach Schädel-Hirn-Trauma

Zusammenfassung. Hintergrund: Kommunikationsstörungen nach Schädel-Hirn-Trauma (SHT) können die Betroffenen langfristig in der sozialen Teilhabe und damit in der Lebensqualität (LQ) beeinträchtigen. Der Erfassung dieser Störungen liegt aktuell kein einheitliches Vorgehen zugrunde. Ziele: Ziel des vorliegenden Scoping Reviews war die Erfassung von Diagnostikverfahren, welche die kommunikativ-pragmatischen Kompetenzen und die Auswirkung möglicher kommunikativer Defizite auf soziale Teilhabe und LQ bei Menschen mit SHT überprüfen. Ergebnisse: Eine systematische Datenbankrecherche für den Veröffentlichungszeitraum 2010 bis 2020 identifizierte 14 relevante Testverfahren (6 auf Deutsch verfügbar). Eine inhaltliche und methodische Analyse stellte Verfahren zur Überprüfung der Kommunikationsfähigkeit (z. B. La Trobe Communication Questionnaire [LCQ]) und Verfahren zur Erfassung von Partizipation und LQ (z. B. Quality of Life after Brain Injury [QOLIBRI]) heraus. Zusammenfassung: Trotz der hohen Auftretenshäufigkeit und Persistenz kommunikativer Störungen nach SHT stehen im deutschsprachigen Raum bislang wenige geeignete Diagnostikverfahren zur Ermittlung von Kommunikationsfähigkeiten und LQ zur Verfügung. Eine weiterführende Entwicklung erscheint unerlässlich.

A retrospective study on the acceptability, feasibility, and effectiveness of LoveYourBrain Yoga for people with traumatic brain injury and caregivers

PURPOSE

To conduct a mixed methods, pre-post, retrospective study on the feasibility, acceptability, and effectiveness of the LoveYourBrain Yoga program.

MATERIALS AND METHODS

People were eligible if they were a traumatic brain injury survivor or caregiver, age 15-70, ambulatory, and capable of gentle exercise and group discussion. We analyzed attendance, satisfaction, and mean differences in scores on Quality of Life After Brain Injury Overall scale (QOLIBRI-OS) and four TBI-QOL/Neuro-QOL scales. Content analysis explored perceptions of benefits and areas of improvement.

RESULTS

1563 people (82.0%) participated ≥1 class in 156 programs across 18 states and 3 Canadian provinces. Mean satisfaction was 9.3 out of 10 (SD 1.0). Mixed effects linear regression found significant improvements in QOLIBRI-OS (B 9.70, 95% CI: 8.51, 10.90), Resilience (B 1.30, 95% CI: 0.60, 2.06), Positive Affect and Well-being (B 1.49, 95% CI: 1.14, 1.84), and Cognition (B 1.48, 95% CI: 0.78, 2.18) among traumatic brain injury survivors (n = 705). No improvement was found in Emotional and Behavioral Dysregulation, however, content analysis revealed better ability to regulate anxiety, anger, stress, and impulsivity. Caregivers perceived improvements in physical and psychological health.

CONCLUSIONS

LoveYourBrain Yoga is feasible and acceptable and may be an effective mode of community-based rehabilitation.IMPLICATIONS FOR REHABILITATIONPeople with traumatic brain injury and their caregivers often experience poor quality of life and difficulty accessing community-based rehabilitation services.Yoga is a holistic, mind-body therapy with many benefits to quality of life, yet is largely inaccessible to people affected by traumatic brain injury in community settings.Participants in LoveYourBrain Yoga, a six-session, community-based yoga with psychoeducation program in 18 states and 3 Canadian provinces, experienced significant improvements in quality of life, resilience, cognition, and positive affect.LoveYourBrain Yoga is feasible and acceptable when implemented on a large scale and may be an effective mode of, or adjunct to, community-based rehabilitation.

Naturalistic Assessment using a Simulated Environment: Cognitive Correlates and Relationship to Functional Status in Individuals with Neurologic Conditions

Objective

Research has shown that neurologic conditions, such as traumatic brain injury and multiple sclerosis, result in a number of cognitive and functional deficits. However, little is known about the relationship between various cognitive domains and ability to perform everyday activities. The Community Shopping Task (CST), a naturalistic assessment task conducted in a simulated environment, was used to examine functional abilities and cognitive correlates of everyday functioning in individuals with neurologic conditions.

Method

Thirty-four participants with neurologic conditions and 34 healthy controls completed the CST as well as traditional paper-pencil measures of cognition. In addition, all participants completed a questionnaire assessing instrumental activities of daily living (IADLs).

Results

The results indicated that participants with neurologic conditions required significantly more cues and time to complete the CST compared to control participants and that immediate memory and executive functioning were important predictors of CST performance. Furthermore, time to complete the CST accounted for a significant amount of variance in IADL performance, over and beyond the traditional measures of cognition.

Conclusions

These results provide evidence that a naturalistic task completed in an everyday environment can enhance our understanding of how daily functioning is impacted in individuals with neurologic conditions and subsequently inform rehabilitation strategies.

Risk taking in hospitalized patients with acute and severe traumatic brain injury

Rehabilitation can improve cognitive deficits observed in patients with traumatic brain injury (TBI). However, despite rehabilitation, the ability of making a choice often remains impaired. Risk taking is a daily activity involving numerous cognitive processes subserved by a complex neural network. In this work we investigated risk taking using the Balloon Analogue Risk Task (BART) in patients with acute TBI and healthy controls. We hypothesized that individuals with TBI will take less risk at the BART as compared to healthy individuals. We also predicted that within the TBI group factors such as the number of days since the injury, severity of the injury, and sites of the lesion will play a role in risk taking as assessed with the BART. Main findings revealed that participants with TBI displayed abnormally cautious risk taking at the BART as compared to healthy subjects. Moreover, healthy individuals showed increased risk taking throughout the task which is in line with previous work. However, individuals with TBI did not show this increased risk taking during the task. We also investigated the influence of three patients’ characteristics on their performance at the BART: Number of days post injury, Severity of the head injury, and Status of the frontal lobe. Results indicate that performance at the BART was influenced by the number of days post injury and the status of the frontal lobe, but not by the severity of the head injury. Reported findings are encouraging for risk taking seems to naturally improve with time postinjury. They support the need of conducting longitudinal prospective studies to ultimately identify impaired and intact cognitive skills that should be trained postinjury.

Ecological assessment of cognitive functions in children with acquired brain injury: a systematic review

BACKGROUND

Childhood acquired brain injury (ABI) often leads to impairment in cognitive functioning, resulting in disabilities in both the home and school environment. Assessing the impact of these cognitive deficits in everyday life using traditional neuropsychological tests has been challenging. This study systematically reviewed ecological measures of cognitive abilities available for children with ABI.

METHOD

Eight databases were searched (until October 2011) for scales: (1) focused on ecological assessment of cognitive functioning; (2) with published data in an ABI population; (3) applicable to children up to 17;11 years of age; and (4) in English. The title and abstract of all papers were reviewed independently by two reviewers.

RESULTS

Database searches yielded a total of 12 504 references, of which 17 scales met the inclusion criteria for the review, focusing on executive functions (n = 9), memory (n = 3), general cognitive abilities (n = 2), visuo-spatial skills (n = 2) and attention (n = 1). Four tasks used observation of actual performance in a natural environment, five were proxy-reports and six were functional paper and pencil type tasks, performed in an office.

CONCLUSION

Overall, few measures were found; eight were still experimental tasks which did not provide norms. Executive functions were better represented in ecological assessment, with relatively more standardized scales available.