|
1
|
McCabe C, Sica A, Doody N, Fortune DG. Self-awareness and quality of relationships after acquired brain injury: Systematic review without meta-analysis (SWiM). Neuropsychol Rehabil 2024; 34:335-361. [PMID: 36908086 DOI: 10.1080/09602011.2023.2186437] [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: 08/22/2022] [Accepted: 02/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Relational aspects of self-awareness following Acquired Brain Injury (ABI) are increasingly being recognized. However, research underpinning the nature of the association between self-awareness and quality of relationships has yet to be synthesized. METHOD Searches, which were completed between February 2022 and February 2023, consisted of combining terms related to ABI, self-awareness, and quality of relationships. Data were analyzed using the Synthesis Without Meta-Analysis (SWiM) approach. RESULTS Associations between self-awareness and relationship quality across eight studies identified for this review differed in direction and significance. A more consistent pattern emerged, however, when studies assessing the quality of specific types of relationships i.e., spousal (N = 1) and therapeutic (N = 3), were compared to studies assessing the quality of a person's broader network of relationships (N = 4). In particular, good awareness was positively associated with the quality of specific relationships (r = 0.66) whereas it was negatively associated with the quality of a person's broader network of relationships (r = -0.35). CONCLUSION Results are discussed with consideration given to measures assessing the quality of specific relationships. In particular, such measures may tap into important patterns of interaction between two individuals, such as those related to attunement or communication, which may be valuable preconditions for improving awareness.
Collapse
Affiliation(s)
- Corinne McCabe
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
| | - Andrea Sica
- Acquired Brain Injury Ireland, Dublin, Ireland
| | - Niamh Doody
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
- HSE CHO 3 Mid West, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
|
2
|
Basagni B, Malloggi S, Polito C, Pellicciari L, Campagnini S, Pancani S, Mannini A, Gemignani P, Salvadori E, Marignani S, Giovannelli F, Viggiano MP, Hakiki B, Grippo A, Macchi C, Cecchi F. MoCA Domain-Specific Pattern of Cognitive Impairment in Stroke Patients Attending Intensive Inpatient Rehabilitation: A Prospective Study. Behav Sci (Basel) 2024; 14:42. [PMID: 38247694 PMCID: PMC10813017 DOI: 10.3390/bs14010042] [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: 10/31/2023] [Revised: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
A domain-specific perspective to cognitive functioning in stroke patients may predict their cognitive recovery over time and target stroke rehabilitation intervention. However, data about domain-specific cognitive impairment after stroke are still scarce. This study prospectively investigated the domain-specific pattern of cognitive impairments, using the classification proposed by the Montreal Cognitive Assessment (MoCA), in a cohort of 49 stroke patients at admission (T0), discharge (T1), and six-month follow-up (T2) from subacute intensive rehabilitation. The predictive value of T0 cognitive domains cognitive impairment at T1 and T2 was also investigated. Patients' cognitive functioning at T0, T1, and T2 was assessed through the MoCA domains for executive functioning, attention, language, visuospatial, orientation, and memory. Different evolutionary trends of cognitive domain impairments emerged across time-points. Patients' impairments in all domains decreased from T0 to T1. Attention and executive impairments decreased from T0 to T2 (42.9% and 26.5% to 10.2% and 18.4%, respectively). Conversely, altered visuospatial, language, and orientation increased between T1 and T2 (16.3%, 36.7%, and 40.8%, respectively). Additionally, patients' global cognitive functioning at T1 was predicted by the language and executive domains in a subacute phase (p = 0.031 and p = 0.001, respectively), while in the long term, only attention (p = 0.043) and executive (p = 0.019) domains intervened. Overall, these results confirm the importance of a domain-specific approach to target cognitive recovery across time in stroke patients.
Collapse
Affiliation(s)
- Benedetta Basagni
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Serena Malloggi
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Cristina Polito
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Leonardo Pellicciari
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Paola Gemignani
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Emilia Salvadori
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Sara Marignani
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Fabio Giovannelli
- Department of NEUROFARBA, University of Florence, 50143 Firenze, Italy; (F.G.); (M.P.V.)
| | - Maria Pia Viggiano
- Department of NEUROFARBA, University of Florence, 50143 Firenze, Italy; (F.G.); (M.P.V.)
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
- Department of Experimental and Clinical Medicine, University of Florence, 50143 Firenze, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
- Department of Experimental and Clinical Medicine, University of Florence, 50143 Firenze, Italy
| |
Collapse
|
|
3
|
Alder G, Taylor D, Rashid U, Olsen S, Brooks T, Terry G, Niazi IK, Signal N. A Brain Computer Interface Neuromodulatory Device for Stroke Rehabilitation: Iterative User-Centered Design Approach. JMIR Rehabil Assist Technol 2023; 10:e49702. [PMID: 38079202 PMCID: PMC10750233 DOI: 10.2196/49702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/03/2023] [Accepted: 09/27/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Rehabilitation technologies for people with stroke are rapidly evolving. These technologies have the potential to support higher volumes of rehabilitation to improve outcomes for people with stroke. Despite growing evidence of their efficacy, there is a lack of uptake and sustained use in stroke rehabilitation and a call for user-centered design approaches during technology design and development. This study focuses on a novel rehabilitation technology called exciteBCI, a complex neuromodulatory wearable technology in the prototype stage that augments locomotor rehabilitation for people with stroke. The exciteBCI consists of a brain computer interface, a muscle electrical stimulator, and a mobile app. OBJECTIVE This study presents the evaluation phase of an iterative user-centered design approach supported by a qualitative descriptive methodology that sought to (1) explore users' perspectives and experiences of exciteBCI and how well it fits with rehabilitation, and (2) facilitate modifications to exciteBCI design features. METHODS The iterative usability evaluation of exciteBCI was conducted in 2 phases. Phase 1 consisted of 3 sprint cycles consisting of single usability sessions with people with stroke (n=4) and physiotherapists (n=4). During their interactions with exciteBCI, participants used a "think-aloud" approach, followed by a semistructured interview. At the end of each sprint cycle, device requirements were gathered and the device was modified in preparation for the next cycle. Phase 2 focused on a "near-live" approach in which 2 people with stroke and 1 physiotherapist participated in a 3-week program of rehabilitation augmented by exciteBCI (n=3). Participants completed a semistructured interview at the end of the program. Data were analyzed from both phases using conventional content analysis. RESULTS Overall, participants perceived and experienced exciteBCI positively, while providing guidance for iterative changes. Five interrelated themes were identified from the data: (1) "This is rehab" illustrated that participants viewed exciteBCI as having a good fit with rehabilitation practice; (2) "Getting the most out of rehab" highlighted that exciteBCI was perceived as a means to enhance rehabilitation through increased engagement and challenge; (3) "It is a tool not a therapist," revealed views that the technology could either enhance or disrupt the therapeutic relationship; and (4) "Weighing up the benefits versus the burden" and (5) "Don't make me look different" emphasized important design considerations related to device set-up, use, and social acceptability. CONCLUSIONS This study offers several important findings that can inform the design and implementation of rehabilitation technologies. These include (1) the design of rehabilitation technology should support the therapeutic relationship between the patient and therapist, (2) social acceptability is a design priority in rehabilitation technology but its importance varies depending on the use context, and (3) there is value in using design research methods that support understanding usability in the context of sustained use.
Collapse
Affiliation(s)
- Gemma Alder
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Usman Rashid
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Sharon Olsen
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Thonia Brooks
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Gareth Terry
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Imran Khan Niazi
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Sensory Motor Integration, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Nada Signal
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
|
4
|
McCabe C, Sica A, Fortune DG. Awareness through relationships in individuals undergoing rehabilitation following acquired brain injury. Neuropsychol Rehabil 2023:1-29. [PMID: 37903181 DOI: 10.1080/09602011.2023.2273578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/04/2023] [Indexed: 11/01/2023]
Abstract
AIM This cross-sectional study investigated the association between self-awareness and quality of therapeutic relationships following acquired brain injury (ABI) while controlling for the potential impact of cognitive problems. It also aimed to investigate attachment as a potential moderator. METHOD 83 adults with ABI were recruited alongside a key member of their community neurorehabilitation team. The Scale to Assess Therapeutic Relationships (STAR) was used to measure therapeutic relationship quality and attachment was measured using the Experiences in Close Relationships - Relationship Structure (ECR-RS) questionnaire. Awareness was measured using the Patient Competency Rating Scale (PCRS) and the Mayo-Portland Adaptability Inventory (MPAI-4) provided a measure of cognitive problems. The MPAI-4 also provided an additional measure of awareness. RESULTS A significant association between self-awareness and therapeutic relationships was found in some regression models such that higher-quality relationships were associated with better awareness, after controlling for the impact of cognitive problems. Neither childhood parental attachment nor participants' attachment towards their rehabilitation staff were moderators. CONCLUSION The observed associations between awareness in clients and therapeutic relationships with rehabilitation staff may have importance for rehabilitation in this context. Results highlight the value of continuing to prioritize the therapeutic relational environment in ABI rehabilitation and research.
Collapse
Affiliation(s)
- Corinne McCabe
- Department of Psychology, University of Limerick, Co Limerick, Ireland
| | - Andrea Sica
- Acquired Brain Injury Ireland, Co Dublin, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Co Limerick, Ireland
- HSE CHO 3 Mid West, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
|
5
|
Pompon RH, Fassbinder W, McNeil MR, Yoo H, Kim HS, Zimmerman RM, Martin N, Patterson JP, Pratt SR, Dickey MW. Associations among depression, demographic variables, and language impairments in chronic post-stroke aphasia. JOURNAL OF COMMUNICATION DISORDERS 2022; 100:106266. [PMID: 36150239 DOI: 10.1016/j.jcomdis.2022.106266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 08/19/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Depression may influence treatment participation and outcomes of people with post-stroke aphasia, yet its prevalence and associated characteristics in aphasia are poorly understood. Using retrospective data from an overarching experimental study, we examined depressive symptoms and their relationship to demographic and language characteristics in people with chronic aphasia. As a secondary objective, we compared prevalence of depressive symptoms among the overarching study's included and excluded participants. METHODS We examined retrospective data from 121 individuals with chronic aphasia including depression scale scores, demographic information (sex, age, time post onset of stroke, education, race/ethnicity, and Veteran status), and scores on assessments of general and modality-specific language impairments. RESULTS Approximately 50% of participants reported symptoms indicative of depressive disorders: 23% indicative of major depression and 27% indicative of mild depression. Sex (males) and comparatively younger age emerged as statistically significant variables associated with depressive symptoms; naming ability was minimally associated with depressive symptoms. Time post onset of stroke, education level, race/ethnicity, Veteran status, and aphasia severity were not significantly associated with depressive symptoms. Depression-scale scores were significantly higher for individuals excluded from the overarching study compared to those who were included. CONCLUSIONS The rate of depressive disorders in this sample was higher than rates of depression reported in the general stroke literature. Participant sex, age, and naming ability emerged as factors associated with depressive symptoms, though these links appear complex, especially given variable reports from prior research. Importantly, depressive symptoms do not appear to diminish over time for individuals with chronic aphasia. Given these results and the relatively limited documentation of depression in aphasia literature, depression remains a pressing concern for aphasia research and routine clinical care.
Collapse
Affiliation(s)
| | - W Fassbinder
- VA Pittsburgh Health Care System, Pittsburgh, PA
| | - M R McNeil
- VA Pittsburgh Health Care System, Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA
| | - H Yoo
- Baylor University, Waco, TX
| | - H S Kim
- Saint Mary's College, Notre Dame, IN
| | | | - N Martin
- Temple University, Philadelphia, PA
| | - J P Patterson
- VA Northern California Health Care System, Martinez, CA
| | - S R Pratt
- VA Pittsburgh Health Care System, Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA
| | - M W Dickey
- VA Pittsburgh Health Care System, Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
|
6
|
It takes two to tango: The therapeutic alliance in community brain injury rehabilitation. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective:
A positive therapeutic (or working) alliance has been associated with better outcomes for clients in the psychotherapeutic and traumatic brain injury (TBI) rehabilitation literature. The aim of this pilot study was to gain an understanding of the therapeutic alliance in community rehabilitation from the perspectives of adults with TBI and their close others who have completed a community rehabilitation programme.
Method:
This study used a constructivist, qualitative methodology which applied grounded theory analysis techniques. Using purposeful sampling, three pairs of participants (adults with TBI and close others) who had finished a community rehabilitation programme completed separate in-depth interviews which were transcribed verbatim and progressively analysed using a process of constant comparison.
Results:
A preliminary framework illustrating participants’ experience of a therapeutic alliance was generated, comprising three interconnected themes: being recognised as an individual, working together and feeling personally connected. All participants viewed being able to work together as important in their experience of community rehabilitation and described features that helped and hindered the alliance.
Conclusion:
These pilot study results demonstrate the importance of the therapeutic alliance to the rehabilitation experience of individuals with TBI and those close to them.
Collapse
|
|
7
|
Cherney LR, DeDe G, Hoover EL, Murray L, Obermeyer J, Pompon RH. Applying the Rehabilitation Treatment Specification System (RTSS) to Functional Communication Treatment Approaches for Aphasia. Arch Phys Med Rehabil 2021; 103:599-609. [PMID: 34742706 DOI: 10.1016/j.apmr.2021.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/30/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022]
Abstract
There are many different approaches to the rehabilitation of aphasia, a communication disorder that affects a person's understanding and expression of spoken and written language. One approach called "functional communication interventions" aims to enhance communication success as opposed to solely improve linguistic abilities. This approach encompasses many skills (e.g., gesturing) and factors (e.g., access to communication supports) that support sending and receiving messages in "real world" daily activities and environments. Functional communication treatments are highly diverse and not always well described. A framework that may provide structure to the description of functional communication interventions for aphasia is the Rehabilitation Treatment Specification System (RTSS). The RTSS was developed by an interdisciplinary research team to describe interventions across any rehabilitation discipline and in any setting or format. The RTSS uses a common language and a systematic approach to describing treatment and includes three connected elements - a single target, one or more ingredients, and a mechanism of action - that, taken together, attempt to explain how and why a treatment works. While the RTTS has been described previously within the field of speech-language pathology, it has not yet been applied to the field of aphasiology. We applied the RTSS framework to a sample of peer-reviewed studies that represent functional communication treatments, including Promoting Aphasics' Communicative Effectiveness (PACE), Modified Response Elaboration Training (M-RET), Script Training, Conversation Treatment, and Communication Partner Training. We discuss both the advantages and disadvantages of using the RTSS framework to better understand the important elements of functional communication treatment approaches for aphasia.
Collapse
Affiliation(s)
- Leora R Cherney
- Shirley Ryan AbilityLab, Chicago, IL; Physical Medicine and Rehabilitation, Communication Sciences and Disorders, Northwestern University, Chicago, IL.
| | - Gayle DeDe
- Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | | | - Laura Murray
- Communication Disorders and Sciences, Western University, London, Ontario, CA
| | - Jessica Obermeyer
- Communication Sciences and Disorders, University of North Carolina at Greensboro, Greensboro, NC
| | | |
Collapse
|