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Gao Y, Zhou W, Wang Y, Liu B, Liu J, Wang Q, Zhou L. Nursing management of cognitive dysfunction in adults with brain injury: Summary of best evidence-practiced strategies. J Clin Nurs 2024; 33:2496-2508. [PMID: 38366758 DOI: 10.1111/jocn.17058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/14/2023] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE To summarize the best evidence-based strategies for the management of cognitive dysfunction in patients with brain injury and to provide a reference for clinical nursing practice. DESIGN Review. METHODS The review was presented using PRISMA guidelines. A systematic search of evidence on the management of cognitive dysfunction in patients with brain injury was conducted in computerized decision systems, guideline websites, professional association websites and comprehensive databases from the date of creation to 21 June 2023. The types of evidence included were clinical decision making, guidelines, evidence summaries, best practices, recommended practices, expert consensus, systematic reviews and meta-analyses. Two researchers trained in evidence-based methodological systems independently evaluated the quality of the literature and extracted, integrated and graded the evidence for inclusion. RESULTS A total of 20 articles were selected, including nine guidelines, three expert consensus articles, one clinical practice article and seven systematic reviews, and the overall quality of the literature was high. Thirty pieces of evidence were summarized in seven areas: assessment, multidisciplinary team, rehabilitation program, cognitive intervention, exercise intervention, music intervention and medication management. CONCLUSIONS This study summarizes the latest evidence on the management of cognitive dysfunction in the care of adults with brain injury and provides a reference for clinical nursing practice. The best evidence should be selected for localized and individualized application in clinical work, and the best evidence should be continuously updated to standardize nursing practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Patients with cognitive impairment after brain injury often suffer from memory loss, attention deficit and disorientation and are unable to have a normal life and experience much enjoyment, which seriously affects their physical and mental health and creates a great burden of care for their families and society. Best evidence-based strategies for the nursing management of cognitive impairment in brain injury are essential for standardizing clinical nursing practice and providing timely, professional, systematic and comprehensive nursing interventions for patients. REPORTING METHOD This review is reported following the PRISMA 2020 statement guidelines, as applicable, to enhance transparency in reporting the evidence synthesis. TRIAL AND PROTOCOL REGISTRATION This study has been registered with the Fudan University Centre for Evidence-based Nursing, a JBI Centre of Excellence under registration number ES20232566, http://ebn.nursing.fudan.edu.cn/myRegisterList. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Yitian Gao
- Second Military Medical University, Shanghai, China
| | | | - Ying Wang
- Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Beixue Liu
- Second Military Medical University, Shanghai, China
| | - Jing Liu
- Second Military Medical University, Shanghai, China
| | - Qiuyi Wang
- Second Military Medical University, Shanghai, China
| | - Lanshu Zhou
- Second Military Medical University, Shanghai, China
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Zampolini M, Oral A, Barotsis N, Aguiar Branco C, Burger H, Capodaglio P, Dincer F, Giustini A, Hu X, Irgens I, Negrini S, Tederko P, Treger I, Kiekens C. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2024; 60:165-181. [PMID: 38477069 PMCID: PMC11135123 DOI: 10.23736/s1973-9087.24.08396-5] [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: 01/01/2024] [Accepted: 01/29/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future. AIM The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions. METHODS To produce recommendations for PRM physicians on telerehabilitation, a systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. RESULTS The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure. CONCLUSIONS It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.
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Affiliation(s)
| | - Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye -
| | | | - Catarina Aguiar Branco
- Department of Physical and Rehabilitation Medicine, Hospital of Entre o Douro e Vouga E.P.E., Porto, Portugal
- Faculty of Dentistry, University of Porto, Porto, Portugal
| | - Helena Burger
- University Rehabilitation Institute of the Republic of Slovenia, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Paolo Capodaglio
- Orthopedic Rehabilitation Unit and Research Lab in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, Turin, Italy
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | | | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Ingebjorg Irgens
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Piotr Tederko
- Department of Rehabilitation, Center of Postgraduate Medical Education, Otwock, Poland
| | - Iuly Treger
- Department of Rehabilitation, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Provan SA, Litleskare S, Flaten OE, Pettersen H, Røset L, Calogiuri G. Participatory Development of a Virtual Reality Exercise Program for People with Chronic Pain. Games Health J 2024. [PMID: 38563892 DOI: 10.1089/g4h.2023.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background: By describing how a participatory process led to changes in the design of a study of a virtual reality (VR)-guided exercise and mindfulness intervention tailored to people with chronic musculoskeletal pain, this article makes the case for including end user at an early stage when planning research within this field. Methods: A multidisciplinary panel including end-user representatives, researcher, clinicians, and VR developers participated in a 1-day workshop to design a randomized study and a VR-guided intervention. Results: Through the participatory process, changes were made to the original study design with respect to experimental design, duration, content of VR interventions and mode of delivery. Conclusion: This case exemplifies the importance of including end-user participants in the early phases of planning VR interventions for people with chronic pain.
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Affiliation(s)
- Sella A Provan
- Department of Public Health and Sport Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Department of Rheumatology, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Sigbjørn Litleskare
- Department of Public Health and Sport Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Ole Einar Flaten
- Game School-Department of Game Development, Inland Norway University of Applied Sciences, Hamar, Norway
| | - Henning Pettersen
- Department of Rheumatology, Department of Social Work and Guidance, Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Linda Røset
- Department of Public Health and Sport Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Giovanna Calogiuri
- Department of Public Health and Sport Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Department of Nursing and Health Sciences, Centre for Health and Technology, University of South-Eastern Norway, Drammen, Norway
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De Luca R, Gangemi A, Bonanno M, Fabio RA, Cardile D, Maggio MG, Rifici C, Vermiglio G, Di Ciuccio D, Messina A, Quartarone A, Calabrò RS. Improving Neuroplasticity through Robotic Verticalization Training in Patients with Minimally Conscious State: A Retrospective Study. Brain Sci 2024; 14:319. [PMID: 38671971 PMCID: PMC11048571 DOI: 10.3390/brainsci14040319] [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: 02/06/2024] [Revised: 03/17/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
In disorders of consciousness, verticalization is considered an effective type of treatment to improve motor and cognitive recovery. Our purpose is to investigate neurophysiological effects of robotic verticalization training (RVT) in patients with minimally conscious state (MCS). Thirty subjects affected by MCS due to traumatic or vascular brain injury, attending the intensive Neurorehabilitation Unit of the IRCCS Neurolesi (Messina, Italy), were included in this retrospective study. They were equally divided into two groups: the control group (CG) received traditional verticalization with a static bed and the experimental group (EG) received advanced robotic verticalization using the Erigo device. Each patient was evaluated using both clinical scales, including Levels of Cognitive Functioning (LCF) and Functional Independence Measure (FIM), and quantitative EEG pre (T0) and post each treatment (T1). The treatment lasted for eight consecutive weeks, and sessions were held three times a week, in addition to standard neurorehabilitation. In addition to a notable improvement in clinical parameters, such as functional (FIM) (p < 0.01) and cognitive (LCF) (p < 0.01) outcomes, our findings showed a significant modification in alpha and beta bands post-intervention, underscoring the promising effect of the Erigo device to influence neural plasticity and indicating a noteworthy difference between pre-post intervention. This was not observed in the CG. The observed changes in alpha and beta bands underscore the potential of the Erigo device to induce neural plasticity. The device's custom features and programming, tailored to individual patient needs, may contribute to its unique impact on brain responses.
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Affiliation(s)
- Rosaria De Luca
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Antonio Gangemi
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Rosa Angela Fabio
- Department of Economics, University of Messina, 98100 Messina, Italy;
| | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Maria Grazia Maggio
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Carmela Rifici
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Giuliana Vermiglio
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Daniela Di Ciuccio
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Angela Messina
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
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Ning Y, Wang H, Liu Y, Wang Q, Rong Y, Niu J. Design and analysis of a compatible exoskeleton rehabilitation robot system based on upper limb movement mechanism. Med Biol Eng Comput 2024; 62:883-899. [PMID: 38081953 DOI: 10.1007/s11517-023-02974-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/19/2023] [Indexed: 02/22/2024]
Abstract
Rehabilitation robots are used to promote structural and functional recovery of the nervous system with repetitive, task-oriented training and have been gradually applied to clinical rehabilitation training. This paper proposes an upper limb exoskeleton rehabilitation robot system that could realize shoulder-elbow-wrist joint rehabilitation training. Firstly, a motion equivalent model was established based on the upper limb movement mechanism, the robot mechanism configuration was designed, and the optimization algorithm and spatial mechanism theory were used to optimize and analyze the structural parameters and human-machine compatibility of the robot, which will guide the design of the robot's model. Then, the robot kinematics were solved, and its maximum motion range, dexterity distribution, and daily motion trajectory were simulated. Finally, a system prototype was built to test the maximum range of robot-assisted human upper limb training by laser tracker, while the pressure of human-machine interaction during training was captured and analyzed by flexible sensors. The results show that the proposed rehabilitation robot could nearly completely cover the range of motion of upper limb joints and meet the needs of trajectory training, and the linear velocity dexterity and angular velocity dexterity in the motion space are maximum 0.55 and 0.89, and the human-machine interaction pressures during the training process are all less than 10 kPa. Besides, this paper also conducted a system evaluation based on the fuzzy comprehensive evaluation model, and the evaluation result was 0.39, with an excellent evaluation grade, it indirectly indicates that the robot's overall performance was good.
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Affiliation(s)
- Yuansheng Ning
- Hebei Province Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao, China
| | - Hongbo Wang
- Hebei Province Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao, China
- Academy for Engineering & Technology, Fudan University, Shanghai, China
- Key Laboratory of Advanced Forging & Stamping Technology and Science of Ministry of Education, Yanshan University, Qinhuangdao, China
- Shanghai Clinical Research Center for Aging and Medicine, Shanghai, 200040, China
| | - Ying Liu
- Qinghuangdao Haigang Hospital, Qinghuangdao, China
| | - Qi Wang
- Hebei Province Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao, China
- Key Laboratory of Advanced Forging & Stamping Technology and Science of Ministry of Education, Yanshan University, Qinhuangdao, China
| | - Yu Rong
- College of Vehicles and Energy, Yanshan University, Qinhuangdao, Hebei, China
| | - Jianye Niu
- Hebei Province Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao, China.
- Key Laboratory of Advanced Forging & Stamping Technology and Science of Ministry of Education, Yanshan University, Qinhuangdao, China.
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Maggio MG, Baglio F, Arcuri F, Borgnis F, Contrada M, Diaz MDM, Leochico CF, Neira NJ, Laratta S, Suchan B, Tonin P, Calabrò RS. Cognitive telerehabilitation: an expert consensus paper on current evidence and future perspective. Front Neurol 2024; 15:1338873. [PMID: 38426164 PMCID: PMC10902044 DOI: 10.3389/fneur.2024.1338873] [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: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
The progressive improvement of the living conditions and medical care of the population in industrialized countries has led to improvement in healthcare interventions, including rehabilitation. From this perspective, Telerehabilitation (TR) plays an important role. TR consists of the application of telemedicine to rehabilitation to offer remote rehabilitation services to the population unable to reach healthcare. TR integrates therapy-recovery-assistance, with continuity of treatments, aimed at neurological and psychological recovery, involving the patient in a family environment, with an active role also of the caregivers. This leads to reduced healthcare costs and improves the continuity of specialist care, as well as showing efficacy for the treatment of cognitive disorders, and leading to advantages for patients and their families, such as avoiding travel, reducing associated costs, improving the frequency, continuity, and comfort of performing the rehabilitation in its own spaces, times and arrangements. The aim of this consensus paper is to investigate the current evidence on the use and effectiveness of TR in the cognitive field, trying to also suggest some recommendations and future perspectives. To the best of our knowledge, this is the first consensus paper among multiple expert researchers that comprehensively examines TR in different neurological diseases. Our results supported the efficacy and feasibility of TR with good adherence and no adverse events among patients. Our consensus summarizes the current evidence for the application of cognitive TR in neurological populations, highlighting the potential of this tool, but also the limitations that need to be explored further.
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Affiliation(s)
| | | | - Francesco Arcuri
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | | | - Marianna Contrada
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | | | - Carl Froilan Leochico
- University of the Philippines Manila, Manila, Philippines
- St. Luke’s Medical Center, Quezon City, Philippines
| | | | - Stefania Laratta
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | - Boris Suchan
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Paolo Tonin
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
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Valenzuela-López L, Moreno-Verdú M, Cuenca-Zaldívar JN, Romero JP. Effects of Hand Motor Interventions on Cognitive Outcomes Post-stroke: A Systematic Review and Bayesian Network Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00029-7. [PMID: 38211761 DOI: 10.1016/j.apmr.2023.12.013] [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: 05/30/2023] [Revised: 11/29/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To synthetize the evidence on the effects of hand rehabilitation (RHB) interventions on cognition post-stroke and compare their efficacy. DATA SOURCES PubMed, Embase, Cochrane, Scopus, Web of Science, and CINAHL were searched from inception to November 2022. DATA SELECTION Randomized controlled trials conducted in adults with stroke where the effects of hand motor interventions on any cognitive domains were assessed. DATA EXTRACTION Data were extracted by 2 independent reviewers. A Bayesian Network Meta-analysis (NMA) was applied for measures with enough studies and comparisons. Risk of bias was assessed with the Cochrane Risk of Bias tool. DATA SYNTHESIS Fifteen studies were included in qualitative synthesis, and 11 in NMA. Virtual reality (VR) (n=7), robot-assisted (n=5), or handgrip strength (n=3) training were the experimental interventions and conventional RHB (n=14) control intervention. Two separate NMA were performed with MoCA (n=480 participants) and MMSE (n=350 participants) as outcome measures. Both coincided that the most probable best interventions were robot-assisted and strength training, according to SUCRA and rankogram, followed by conventional RHB and VR training. No significant differences between any of the treatments were found in the MoCA network, but in the MMSE, robot-assisted and strength training were significantly better than conventional RHB and VR. No significant differences between robot-assisted and strength training were found nor between conventional RHB and VR. CONCLUSIONS Motor interventions can improve MoCA/MMSE scores post-stroke. Most probable best interventions were robot-assisted and strength training. Limited literature assessing domain-specific cognitive effects was found.
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Affiliation(s)
- Laura Valenzuela-López
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain
| | - Marcos Moreno-Verdú
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain.
| | - Juan Nicolás Cuenca-Zaldívar
- Research Group in Physiotherapy and Pain, Department of Nursing and Physiotherapy, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute - Segovia de Arana (IDIPHISA), Madrid, Spain; Physical Therapy Unit. Primary Health Care Center "El Abajón", Madrid, Spain; Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Juan Pablo Romero
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Damage Unit, Beata María Ana Hospital, Madrid, Spain
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Hu Y, Hu L, Wang Y, Luo X, Zhao X, He L. The effects of non-invasive brain stimulation on disorder of consciousness in patients with brain injury: A systematic review and meta-analysis of randomized controlled trial. Brain Res 2024; 1822:148633. [PMID: 37839670 DOI: 10.1016/j.brainres.2023.148633] [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: 06/30/2023] [Revised: 09/30/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Disorders of consciousness (DOC) result from neural system injury and manifest as changes in arousal or awareness. This systematic review and meta-analysis aimed to investigate the therapeutic effects of non-invasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), on consciousness dysfunction in patients with brain disorders. METHODS Literature was systematically searched in Medline, Embase, Cochrane database, Web of Science, EBSCO from inception to May 2023. Only randomized controlled trial with NIBS as an intervention and participants with DOC were included. RESULTS A total of 7 studies with 313 participants were included for meta-analysis. Compared with sham- or placebo-stimulation, NIBS can improve the Coma Recovery Scale-Revised scores significantly (mean difference [MD] = 1.96, 95 % confidence interval [CI] = [1.49; 2.43], P <.0001). CONCLUSION NIBS has a significant positive effect in enhancing the symptoms of DOC. Nevertheless, it is imperative for further investigations comprising high-quality research designs and larger sample sizes in order to comprehensively elucidate the effects of NIBS techniques on diverse targets of stimulation within the population of individuals suffering from DOC.
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Affiliation(s)
- Yu Hu
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Linzhe Hu
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Yuchan Wang
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Xiaozhou Luo
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Xin Zhao
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Lin He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu 610041, China.
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Kotyrba M, Habiballa H, Volna E, Jarusek R, Smolka P, Prasek M, Malina M, Jaremova V. Proposal of neural network model for neurocognitive rehabilitation and its comparison with fuzzy expert system model. BMC Med Inform Decis Mak 2023; 23:221. [PMID: 37845677 PMCID: PMC10580608 DOI: 10.1186/s12911-023-02321-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
This article focuses on the development of algorithms for a smart neurorehabilitation system, whose core is made up of artificial neural networks. The authors of the article have proposed a completely unique transfer of ACE-R results to the CHC model. This unique approach allows for the saturation of the CHC model domains according to modified ACE-R factor analysis. The outputs of the proposed algorithm thus enable the automatic creation of a personalized and optimized neurorehabilitation plan for individual patients to train their cognitive functions. A set of tasks in 6 levels of difficulty (level 1 to level 6) was designed for each of the nine CHC model domains. For each patient, the results of the ACE-R screening helped deter-mine the specific CHC domains to be rehabilitated, as well as the initial gaming level for rehabilitation in each domain. The proposed artificial neural network algorithm was adapted to real data from 703 patients. Experimental outputs were compared to the outputs of the initially designed fuzzy expert system, which was trained on the same real data, and all outputs from both systems were statistically evaluated against expert conclusions that were available. It is evident from the conducted experimental study that the smart neurorehabilitation system using artificial neural networks achieved significantly better results than the neurorehabilitation system whose core is a fuzzy expert system. Both algorithms are implemented into a comprehensive neurorehabilitation portal (Eddie), which was supported by a research project from the Technology Agency of the Czech Republic.
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Affiliation(s)
- Martin Kotyrba
- Department of Informatics and Computers , University of Ostrava, Faculty of Science, 30.dubna 22, Ostrava, 70103, Czech Republic
| | - Hashim Habiballa
- Department of Informatics and Computers , University of Ostrava, Faculty of Science, 30.dubna 22, Ostrava, 70103, Czech Republic
| | - Eva Volna
- Department of Informatics and Computers , University of Ostrava, Faculty of Science, 30.dubna 22, Ostrava, 70103, Czech Republic.
| | - Robert Jarusek
- Department of Informatics and Computers , University of Ostrava, Faculty of Science, 30.dubna 22, Ostrava, 70103, Czech Republic
| | - Pavel Smolka
- Department of Informatics and Computers , University of Ostrava, Faculty of Science, 30.dubna 22, Ostrava, 70103, Czech Republic
| | - Martin Prasek
- Department of Informatics and Computers , University of Ostrava, Faculty of Science, 30.dubna 22, Ostrava, 70103, Czech Republic
| | - Marek Malina
- Department of Informatics and Computers , University of Ostrava, Faculty of Science, 30.dubna 22, Ostrava, 70103, Czech Republic
| | - Vladena Jaremova
- University Hospital of Ostrava, 17. listopadu 1790/5, Ostrava, 70852, Czech Republic
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10
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Pullia M, Ciatto L, Andronaco G, Donato C, Aliotta RE, Quartarone A, De Cola MC, Bonanno M, Calabrò RS, Cellini R. Treadmill Training Plus Semi-Immersive Virtual Reality in Parkinson's Disease: Results from a Pilot Study. Brain Sci 2023; 13:1312. [PMID: 37759913 PMCID: PMC10526302 DOI: 10.3390/brainsci13091312] [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: 08/25/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Parkinson's disease (PD) is one of the most common neurodegenerative disorders that causes postural instability and gait alterations, such as reduced walking speed, shorter step length, and gait asymmetry, exposing patients to a higher risk of falling. Recently, virtual reality (VR) was added to a treadmill, in order to promote motor functional recovery and neuroplastic processes. Twenty PD patients were enrolled and randomly assigned to two groups: the experimental group (EG) and the control group (CG). In particular, patients in the EG were trained with the C-Mill, an innovative type of treadmill, which is equipped with semi-immersive VR, whereas the CG performed conventional physiotherapy. Patients in both groups were evaluated through a specific motor assessment battery at baseline (T0) and after the training (T1). Comparing pre-(T0) and post-(T1) treatment scores, in the EG, we found statistical significances in the following outcome measures: 6 Minutes Walking Test (6MWT) (p < 0.0005), Timed up and go (TUG right) (p < 0.03), Berg Balance Scale (BBS) (p < 0.006), Tinetti Scale (TS) (p < 0.002), Falls Efficacy Scale- International (FES-I), (p < 0.03) Unified PD Rating Scale-III (UPDRS) (p < 0.002), and Functional Independence Measure (FIM) (p < 0.004). Also, the CG showed statistical significances after the training. Between-group (EG and CG) analysis showed significative statistical differences in 6MWT (p < 0.006), BBS (p < 0.006), TS (p < 0.008), FES-I (p < 0.01), and FIM (p < 0.009). From our results it emerges that both groups (EG and CG) achieved better outcome scores after the treatment, suggesting that both physiotherapy interventions were effective. However, the EG training using VR seemed to have induced more improvements, especially in gait and balance skills. Then, C-Mill could be a valid adjunctive treatment in the context of gait and balance disturbances, which are very common in the PD population.
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Affiliation(s)
| | | | | | | | | | | | | | - Mirjam Bonanno
- IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113, Cda Casazza, 98124 Messina, Italy; (M.P.); (L.C.); (G.A.); (C.D.); (R.E.A.); (A.Q.); (M.C.D.C.); (R.C.)
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11
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Bonanno M, Calabrò RS. Bridging the Gap between Basic Research and Clinical Practice: The Growing Role of Translational Neurorehabilitation. MEDICINES (BASEL, SWITZERLAND) 2023; 10:45. [PMID: 37623809 PMCID: PMC10456256 DOI: 10.3390/medicines10080045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
Translational neuroscience is intended as a holistic approach in the field of brain disorders, starting from the basic research of cerebral morphology and with the function of implementing it into clinical practice. This concept can be applied to the rehabilitation field to promote promising results that positively influence the patient's quality of life. The last decades have seen great scientific and technological improvements in the field of neurorehabilitation. In this paper, we discuss the main issues related to translational neurorehabilitation, from basic research to current clinical practice, and we also suggest possible future scenarios.
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Affiliation(s)
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi “Bonino-Pulejox”, Via Palermo, SS 113, C. da Casazza, 98124 Messina, Italy;
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12
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Torregrossa W, Torrisi M, De Luca R, Casella C, Rifici C, Bonanno M, Calabrò RS. Neuropsychological Assessment in Patients with Traumatic Brain Injury: A Comprehensive Review with Clinical Recommendations. Biomedicines 2023; 11:1991. [PMID: 37509630 PMCID: PMC10376996 DOI: 10.3390/biomedicines11071991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Traumatic brain injury is damage to the brain occurring after birth, often resulting in the deterioration of cognitive, behavioural, and emotional functions. Neuropsychological evaluation can assist clinicians to better assess the patient's clinical condition, reach differential diagnoses, and develop interventional strategies. However, considering the multiple rating scales available, it is not easy to establish which tool is most suitable for the different brain injury conditions. The aim of this review is to investigate and describe the most used neurocognitive assessment tools in patients with traumatic brain injury to provide clinicians with clear indications on their use in clinical practice. Indeed, during the acute phase, after the head trauma, alertness and wakefulness of the patients affected by a disorder of consciousness can be assessed using different scales, such as the Coma Recovery Scale-Revised. In both postacute and chronic phases after traumatic brain injury, general cognitive assessment tools (such as the Mini Mental State Examination) or more specific cognitive tests (e.g., Wisconsin Card Sorting Test and Trail Making Test) could be administered according to the patient's functional status. In this way, clinicians may be aware of the patient's neuropsychological and cognitive level, so they can guarantee a personalized and tailored rehabilitation approach in this frail patient population.
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Affiliation(s)
- William Torregrossa
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Michele Torrisi
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Rosaria De Luca
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Carmela Casella
- Department of Clinical and Experimental Medicine "AOU Policlinico G. Martino", University Hospital "G. Martino", 98124 Messina, Italy
| | - Carmela Rifici
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
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13
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Maggio MG, Bonanno M, Manuli A, Onesta MP, De Luca R, Quartarone A, Calabrò RS. Do Individuals with Spinal Cord Injury Benefit from Semi-Immersive Virtual Reality Cognitive Training? Preliminary Results from an Exploratory Study on an Underestimated Problem. Brain Sci 2023; 13:945. [PMID: 37371423 DOI: 10.3390/brainsci13060945] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
A spinal cord injury (SCI) is damage to any part of the spinal cord, caused by traumatic or non-traumatic events. Clinically, SCI is associated with partial or complete loss of motor, sensory, and autonomic functions below the site of injury. However, cognitive alterations in specific domains can also occur. The aim of this study was to evaluate the effects of semi-immersive virtual reality (VR) cognitive training (using the BTS Nirvana, Italy) in promoting global functional recovery in patients with SCI. Forty-two SCI patients were included in this retrospective case-control study, and the analysis was carried out using an electronic data retrieval system. The enrolled patients were divided into two groups with the same demographic and medical characteristics: the control group (CG: 21 patients) participated in traditional therapy, whereas the experimental group (EG: 21 patients) received training using semi-immersive VR. In both groups, there were patients with A- or B-grade impairments according to the American Spinal Injury Association (ASIA) scale. Both study groups underwent the same amount of cognitive training (but using a different type of training: conventional vs. innovative), consisting of three weekly sessions for eight weeks (24 sessions in total), each session lasting approximately sixty minutes, as well as the same amount of physiotherapy. The effect of the two treatments (EG/CG) was significantly different in global cognitive functioning (MOCA: p = 0.001), mood (BDI: p = 0.006), and overall quality of life (SF12 Total: p < 0.001), especially in physical perception (SF12-Physics: p = 0.004). Our results suggest that SCI patients could benefit from cognitive training using semi-immersive VR. Indeed, the integration of cognitive exercises that require movement and provide increased feedback could allow for better motor and cognitive recovery in people with SCI.
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Affiliation(s)
- Maria Grazia Maggio
- Department of Biomedical and Biotechnological Science, University of Catania, Via S. Sofia 64, 95125 Catania, Italy
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi "Bonino Pulejo", S. S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Alfredo Manuli
- Rehabilitation Unit, AOU Policlinico "G. Martino", 98124 Messina, Italy
| | | | - Rosaria De Luca
- IRCCS Centro Neurolesi "Bonino Pulejo", S. S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Angelo Quartarone
- IRCCS Centro Neurolesi "Bonino Pulejo", S. S. 113, Contrada Casazza, 98124 Messina, Italy
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14
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Nieto-Escamez F, Cortés-Pérez I, Obrero-Gaitán E, Fusco A. Virtual Reality Applications in Neurorehabilitation: Current Panorama and Challenges. Brain Sci 2023; 13:brainsci13050819. [PMID: 37239291 DOI: 10.3390/brainsci13050819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Central Nervous System Diseases are a leading cause of disability worldwide, posing significant social and economic burdens for patients, their families, caregivers, and society as a whole [...].
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Affiliation(s)
- Francisco Nieto-Escamez
- Department of Psychology, University of Almeria, 04120 Almeria, Spain
- Center for Neuropsychological Assessment and Rehabilitation (CERNEP), 04120 Almeria, Spain
| | - Irene Cortés-Pérez
- Department of Health Sciences, University of Jaen, Paraje Las Lagunillas s/n, 23071 Jaen, Spain
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaen, Paraje Las Lagunillas s/n, 23071 Jaen, Spain
| | - Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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15
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De Luca R, Bonanno M, Marra A, Rifici C, Pollicino P, Caminiti A, Castorina MV, Santamato A, Quartarone A, Calabrò RS. Can Virtual Reality Cognitive Rehabilitation Improve Executive Functioning and Coping Strategies in Traumatic Brain Injury? A Pilot Study. Brain Sci 2023; 13:brainsci13040578. [PMID: 37190543 DOI: 10.3390/brainsci13040578] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Abstract
Executive dysfunction is among the most common and disabling facets of cognitive impairment following traumatic brain injury (TBI), and may include deficits in reasoning, planning, mental flexibility, some aspects of attention and orientation, awareness and behavior. Rehabilitation programs based on cognitive-behavioral approaches to retrain planning and problem-solving and other executive deficits may improve such cognitive dysfunction. The purpose of this study is to investigate the effects of non-immersive virtual reality-based training to improve executive abilities and to reduce anxiety and depression symptoms in patients with TBI. Twenty patients with moderate to severe TBI were enrolled at our Neurorehabilitation Unit and divided to receive either the standard cognitive training or the virtual reality (VR) based cognitive training using the virtual reality rehabilitation system (VRRS-Evo). Each group received the same amount of rehabilitative training, including ROT (Reality Orientation Therapy) and Executive Training (ET), but using a different approach, i.e., a paper and pencil and an advanced approach. All patients were evaluated with a specific psychometric battery before (T0) and after the end (T1) of each program. Comparing pre- and post- treatment scores, in the VR-CT group, we found statistically significant differences in all administered outcome measures for cognitive and executive functioning, i.e., MoCA (p < 0.005), FAB (p < 0.005), TMT-A (p < 0.005), TMT-B (p < 0.005), TMT-BA (p < 0.001), and mood, i.e., HRS-D (p < 0.008). In the Conventional cognitive training (C-CT) group, we found a significant improvement only in MoCA (p < 0.03), FAB (p < 0.02) and in TMT-BA (p < 0.01). Coping strategies also improved, with better results in the VR-CT group. Our results suggest that VR rehabilitation, using the VRRS system, may be a valuable and motivational approach to improve visuo-executive abilities and coping strategies as well as mood in chronic TBI patients.
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Affiliation(s)
- Rosaria De Luca
- IRCCS Centro Neurolesi "Bonino Pulejo", 98123 Messina, Italy
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi "Bonino Pulejo", 98123 Messina, Italy
| | - Angela Marra
- IRCCS Centro Neurolesi "Bonino Pulejo", 98123 Messina, Italy
| | - Carmela Rifici
- IRCCS Centro Neurolesi "Bonino Pulejo", 98123 Messina, Italy
| | | | - Angelo Caminiti
- IRCCS Centro Neurolesi "Bonino Pulejo", 98123 Messina, Italy
| | | | - Andrea Santamato
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
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16
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Hendryckx C, Nalder E, Drake E, Leclaire É, Pituch E, Gouin-Vallerand C, Wang RH, Poulin V, Paquet V, Bottari C. Managing challenging behaviours in adults with traumatic brain injury: A scoping review of technology-based interventions. J Rehabil Assist Technol Eng 2023; 10:20556683231191975. [PMID: 37614442 PMCID: PMC10443634 DOI: 10.1177/20556683231191975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Challenging behaviours are one of the most serious sequelae after a traumatic brain injury (TBI). These chronic behaviours must be managed to reduce the associated burden for caregivers, and people with TBI. Though technology-based interventions have shown potential for managing challenging behaviours, no review has synthesised evidence of technology aided behaviour management in the TBI population. The objective of this scoping review was to explore what technology-based interventions are being used to manage challenging behaviours in people with TBI. Two independent reviewers analysed 3505 studies conducted between 2000 and 2023. Studies were selected from five databases using search strategies developed in collaboration with a university librarian. Sixteen studies were selected. Most studies used biofeedback and mobile applications, primarily targeting emotional dysregulation. These technologies were tested in a variety of settings. Two interventions involved both people with TBI and their family caregivers. This review found that technology-based interventions have the potential to support behavioural management, though research and technology development is at an early stage. Future research is needed to further develop technology-based interventions that target diverse challenging behaviours, and to document their effectiveness and acceptability for use by people with TBI and their families.
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Affiliation(s)
- Charlotte Hendryckx
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la Réadaptation en déficience Physique de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Research Center from CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, QC, Canada
- Department Of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Emily Nalder
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Emma Drake
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Éliane Leclaire
- Department Of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Evelina Pituch
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Charles Gouin-Vallerand
- Centre de Recherche Createch sur les Organisations Intelligentes, Université de Sherbrooke, Sherbrooke, QC, Canada
- DOMUS Laboratory, Université de Sherbrooke, Sherbrooke, QC, Canada
- University of Sherbrooke, Sherbrooke, QC, Canada
| | - Rosalie H Wang
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Valérie Poulin
- Department Of Occupational therapy, Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS de la Capitale-Nationale, QC, Canada
| | - Virginie Paquet
- Bibliothèque Marguerite-D’Youville, Université de Montréal, Montréal, QC, Canada
| | - Carolina Bottari
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la Réadaptation en déficience Physique de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
- Occupational Therapy Program, School of Rehabilitation, Université de Montréal, Montréal, QC, Canada
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