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Dillon A, Casey J, Gaskell H, Drummond A, Demeyere N, Dawes H. Is there evidence for a relationship between cognitive impairment and fatigue after acquired brain injury: a systematic review and meta-analysis. Disabil Rehabil 2023; 45:4359-4372. [PMID: 36495110 DOI: 10.1080/09638288.2022.2152503] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Fatigue is a major symptom of ABI. Greater fatigue is associated with cognitive impairment. Our aim was to systematically review, describe and analyse the literature on the extent of this relationship. METHODS Five databases were searched from inception. Studies were included where: participants had a defined clinical diagnosis of ABI which included TBI, stroke or subarachnoid haemorrhage; a fatigue measure was included; at least one objective cognitive measure was used. Three reviewers individually identified studies and determined quality using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. RESULTS Sixteen of the 412 identified studies, investigating the relationship between cognitive dysfunction and fatigue, comprising a total of 1,745 participants, were included. Quality ranged from fair to good. Meta-analysis found fatigue was significantly associated with an overall pattern of cognitive slowing on tasks of sustained attention. A narrative synthesis found weak associations with fatigue and information processing, attention, memory and executive function. CONCLUSION Analysis found sustained attentional performance had stronger associations with fatigue after ABI. Whereas, weak associations were found between fatigue and information processing, attention and to some extent memory and executive function. More focused research on specific cognitive domains is needed to understand the mechanisms of fatigue.
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Affiliation(s)
- Avril Dillon
- Department of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Jackie Casey
- Department of Clinical Sciences, Orthopedics, Lund University, Lund, Sweden
| | - Helen Gaskell
- Oxford Centre for Enablement, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Nele Demeyere
- Department of Experimental Psychology, Cognitive Neuropsychology Centre, University of Oxford, Oxford, UK
| | - Helen Dawes
- Exeter BRC, Exeter, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Halfpenny R, Stewart A, Kelly P, Conway E, Smith C. Dysphagia rehabilitation following acquired brain injury, including cerebral palsy, across the lifespan: a scoping review protocol. Syst Rev 2021; 10:312. [PMID: 34903269 PMCID: PMC8667523 DOI: 10.1186/s13643-021-01861-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Swallowing impairment (dysphagia) following brain injury can lead to life-threatening complications such as dehydration, aspiration pneumonia and acute choking episodes. In adult therapeutic practice, there is research and clinical evidence to support the use of swallowing exercises to improve swallowing physiology in dysphagia; however, the use of these exercises in treating children with dysphagia is largely unexplored. Fundamental questions remain regarding the feasibility and effectiveness of using swallowing exercises with children. This review aims to outline the published literature on exercise-based treatment methods used in the rehabilitation of dysphagia secondary to an acquired brain injury across the lifespan. This will allow the range and effects of interventions utilised to be mapped alongside differential practices between adult and child populations to be formally documented, providing the potential for discussions with clinicians about which rehabilitative interventions might be appropriate for further trial in paediatrics. METHODS This study will use a scoping review framework to identify and systematically review the existing literature using Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews (PRISMA) scoping review guidelines. Electronic databases (MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine Database (AMED)), grey literature and the reference lists of key texts including systematic reviews will be searched. Information about the rehabilitation design, dosage and intensity of exercise programmes used as well as demographic information such as the age of participants and aetiology of dysphagia will be extracted. The number of articles in each area and the type of data source will be presented in a written and visual format. Comparison between the literature in adult and child populations will be discussed. DISCUSSION This review is unique as it directly compares dysphagia rehabilitation in adults with that of a paediatric population in order to formally identify and discuss the therapeutic gaps in child dysphagia rehabilitation. The results will inform the next stage of research, looking into the current UK-based speech and language therapy practices when working with children with acquired dysphagia. SYSTEMATIC REVIEW REGISTRATION Open science framework osf.io/ja4dr.
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Affiliation(s)
- Rhiannon Halfpenny
- Great Ormond Street Hospital, Great Ormond Street, London, UK.
- University College London, London, UK.
| | - Alexandra Stewart
- Great Ormond Street Hospital, Great Ormond Street, London, UK
- University College London, London, UK
| | - Paula Kelly
- Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Eleanor Conway
- Great Ormond Street Hospital, Great Ormond Street, London, UK
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Meijering L, Lettinga A. Hopeful adaptation after acquired brain injury: The case of late referrals in the Netherlands. Soc Sci Med 2021; 293:114651. [PMID: 34915241 DOI: 10.1016/j.socscimed.2021.114651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 11/03/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
A substantial number of people with 'mild' acquired brain injury (ABI) suffer from cognitive impairments that are not immediately acknowledged as such. Some are eventually referred to multidisciplinary rehabilitation care after months or years of suffering, which is why we have labelled them 'late referrals'. The aim of this paper is to add to the discussion on hopeful adaptation by focussing on the diverse adaptive strategies of late referrals. Hope is typically discussed as a positive emotion that can contribute to transformative processes, but that is also mirrored by despair. We conducted in-depth interviews with ten late referrals in the Netherlands. Our findings demonstrate that the trajectories of late referrals are characterised by wandering and navigating. Wandering is predominantly associated with feeling lost, and not knowing where one is going. While navigating is more purposeful, we found that our participants sometimes navigated in directions that turned out to be dead-end streets. We conclude that hopeful adaptation encompasses a circuitous way of trying and adapting and trying again. As a key recommendation for practice, we suggest that people with cognitive problems due to mild ABI should be supported in reducing the complexities of their everyday lives by taking up challenges one place at a time.
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Affiliation(s)
- Louise Meijering
- Population Research Centre (PRC), Faculty of Spatial Sciences, University of Groningen, the Netherlands.
| | - Ant Lettinga
- University Medical Center Groningen, Department of Epidemiology, the Netherlands.
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Keller J, Štětkářová I, Macri V, Kühn S, Pětioký J, Gualeni S, Simmons СD, Arthanat S, Zilber P. Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury. J Neuroeng Rehabil 2020; 17:127. [PMID: 32919473 PMCID: PMC7488738 DOI: 10.1186/s12984-020-00754-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/02/2020] [Indexed: 01/02/2023] Open
Abstract
Background Individuals with acquired brain injuries (ABI) are in need of neurorehabilitation and neurorepair. Virtual anatomical interactivity (VAI) presents a digital game-like format in which ABI survivors with upper limb paresis use an unaffected limb to control a standard input device and a commonplace computer mouse to control virtual limb movements and tasks in a virtual world. Methods In a prospective cohort study, 35 ambulatory survivors of ABI (25/71% stroke, 10/29% traumatic brain injury) were enrolled. The subjects were divided into three groups: group A received VAI therapy only, group B received VAI and physical/occupational therapy (P/OT), and group C received P/OT only. Motor skills were evaluated by muscle strength (hand key pinch strength, grasp, and three-jaw chuck pinch) and active range of motion (AROM) of the shoulder, elbow, and wrist. Changes were analyzed by ANOVA, ANCOVA, and one-tailed Pearson correlation analysis. MRI data was acquired for group A, and volumetric changes in grey matter were analyzed using voxel-based morphometry (VBM) and correlated with quantified motor skills. Results AROM of the shoulder, elbow, and wrist improved in all three groups. VBM revealed grey matter increases in five brain areas: the tail of the hippocampus, the left caudate, the rostral cingulate zone, the depth of the central sulcus, and the visual cortex. A positive correlation between the grey matter volumes in three cortical regions (motor and premotor and supplementary motor areas) and motor test results (power and AROM) was detected. Conclusions Our findings suggest that the VAI rehabilitation program significantly improved motor function and skills in the affected upper extremities of subjects with acquired brain injuries. Significant increases in grey matter volume in the motor and premotor regions of affected hemisphere and correlations of motor skills and volume in nonaffected brain regions were present, suggesting marked changes in structural brain plasticity. Trial registration The trial “Limitations of motor brain activity – use of virtual reality for simulation of therapeutic interventions” has been registered under reference number ISRCTN11757651.
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Affiliation(s)
- Jiří Keller
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic. .,Department of Neurology, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vince Macri
- 3D PreMotorSkill Technologies LLC, Tallahassee, FL, USA
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Jakub Pětioký
- REGIBASE, Prague, Czech Republic.,Rehabilitation Center, Kladruby, Czech Republic
| | - Stefano Gualeni
- Institute of Digital Games, University of Malta, Msida, Malta
| | - С Douglas Simmons
- School of Occupational Therapy, MCPHS University, Manchester, NH, USA
| | - Sajay Arthanat
- Department of Occupational Therapy, University of New Hampshire, Durham, NH, USA
| | - Paul Zilber
- 3D PreMotorSkill Technologies LLC, Tallahassee, FL, USA
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Abstract
Objective: Following acquired brain injury (ABI), young people may experience increased anxiety as well as difficulties with their psychosocial functioning. This study examined trait mindfulness as a mediator of the relationship between anxiety and psychosocial domains of School and Leisure Activities (SLA), Interpersonal Relationships (IR) and Daily Living Skills (DLS).Method: Participants were adolescents with ABI (aged 12-19 years, N = 38). Standardised measures were used to assess anxiety, trait mindfulness, and psychosocial functioning.Results: Higher levels of anxiety were found to be associated with reduced IR (p < .05) and DLS (p < .05). Increased trait mindfulness was found to be associated with lowered anxiety (p < .01), as well as with better IR (p < .05) and DLS (p <.01). Mediation analyses found a significant indirect effect for the relationship between anxiety and DLS through trait mindfulness.Conclusion: Findings highlight the contribution of trait mindfulness as a mediator between anxiety and psychosocial functioning, such that increased mindfulness and lower levels of anxiety are related to better DLS.
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Affiliation(s)
- Cheryl Soo
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | | | - Vicki Anderson
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
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Yeo YX, Pestell CF, Bucks RS, Allanson F, Weinborn M. Metacognitive knowledge and functional outcomes in adults with acquired brain injury: A meta-analysis. Neuropsychol Rehabil 2019; 31:453-478. [PMID: 31876262 DOI: 10.1080/09602011.2019.1704421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pronounced difficulties in functional outcomes often follow acquired brain injury (ABI), and may be due, in part, to deficits in metacognitive knowledge (being unaware of one's cognitive strengths and limitations). A meta-analytic review of the literature investigating the relationship between metacognitive knowledge and functional outcomes in ABI is timely, particularly given the presence of apparently inconsistent findings. Twenty-two articles revealed two distinct methods of measuring metacognitive knowledge: (1) absolute (the degree of inaccurate self-appraisal regardless of whether the error tends towards under- or over-confident estimations) and (2) relative (the degree and the direction of the inaccuracy) discrepancy. Separate meta-analyses were conducted for absolute and relative discrepancy studies to assess the relationship between metacognitive knowledge and functional outcomes (affect-related quality of life, family and community integration, and work outcomes). The pattern of results found suggested that better metacognitive knowledge is related to better overall functional outcomes, but the relationship may differ depending on the outcome domain. These findings generally support the importance of focusing on metacognitive knowledge to improve outcomes following ABI. Nonetheless, the relatively small effect sizes observed suggest that other predictors of functional outcome should be investigated, including other subdomains of metacognition.
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Affiliation(s)
- Yong Xiang Yeo
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Carmela F Pestell
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Fiona Allanson
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, University of Western Australia, Perth, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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Kothari M, Madsen VLF, Castrillon EE, Nielsen JF, Svensson P. Spontaneous jaw muscle activity in patients with acquired brain injuries-Preliminary findings. J Prosthodont Res 2017; 62:268-272. [PMID: 28606421 DOI: 10.1016/j.jpor.2017.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 04/26/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
Abstract
PATIENTS High or excessive parafunctional jaw muscle activity is a frequent complication of acquired brain injury (ABI) and may have some similarities to bruxism. Bruxism has been associated with increased tooth wear, masseter hypertrophy and headaches. The aim of this observational study was to identify the levels of jaw muscle activity from fourteen ABI patients having different functional and cognitive levels in their early phase of neurological rehabilitation (according to their Ranchos Los Amigos Scale (RLAS) score). Nine patients were severely cognitive impairement (RLAS score 1-3): with no or little response to any external stimuli due to low arousal and five patients were with RLAS score 4-8: depending on responses to stimuli and confusion level i.e. defining that patients had enough arousal to respond and react and therefore were able to follow the instructions. A single-channel electromyographic (EMG) device was used to assess the jaw muscle EMG activity in ABI patients for two hours continuously at two different days. DISCUSSION The mean (±SD) jaw muscle activity observed in patients with ABI was 46.9±6.5 EMG events/h with a wide range between 1-163 EMG events/h but with no significant difference between days (P=0.230). CONCLUSION Irrespective of functional and cognitive ability scores patients with ABI had a wide range of EMG activity. The use of ambulatory single-channel EMG devices might open a path for further studies to determine levels of jaw muscle activity associated with potential side effects in ABI patients.
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Affiliation(s)
- Mohit Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark.
| | | | - Eduardo E Castrillon
- Section of Orofacial Pain and Jaw function, Institute of Odontology and Oral Health, Aarhus University, Denmark; Scandinavian Center for Orofacial Neuroscience (SCON), Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Peter Svensson
- Section of Orofacial Pain and Jaw function, Institute of Odontology and Oral Health, Aarhus University, Denmark; Scandinavian Center for Orofacial Neuroscience (SCON), Denmark; Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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