NeuroRehabilitation - Volume 39, issue 1

Article Type: Editorial

DOI: 10.3233/NRE-161333

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 1-2, 2016

Authors: Anaki, David | Goldenberg, Rosalind | Devisheim, Haim | Rosenfelder, Diana | Falik, Lou | Harif, Idit

Article Type: Research Article

Abstract: NG is an architect who suffered a left occipital-parietal hemorrhage cerebral vascular accident (CVA) in 2000, resulting in aphasia of Wernicke and conduction types. He was characterized with fluent paraphasic speech, decreased repetition, and impaired object naming. Comprehension was relatively preserved but reading and writing were severely compromised, as well as his auditory working memory. Despite a grim prognosis he underwent intensive aphasia therapy, lasting from 2001 to 2010, at the Center for Cognitive Rehabilitation of the Brain Injured at the Feuerstein Institute. The tailored-made interventions, applied in NG’s therapy, were based upon the implementation of the principles of the …Structural Mediated Learning Experience (MLE) and the Feuerstein Instrumental Enrichment (FIE) Program, to optimize his rehabilitation. As a result NG improved in most of his impaired linguistic capacities, attested by the results of neuropsychological and linguistic assessments performed throughout the years. More importantly, he was able to manage again his daily functions at a high level, and to resume his occupational role as an architect, a role which he holds to this day. Show more

Keywords: Aphasia, rehabilitation, structural cognitive modifiability, mediated learning experience

DOI: 10.3233/NRE-161334

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 3-17, 2016

Authors: Lebeer, Jo

Article Type: Research Article

Abstract: BACKGROUND: The theory of Structural Cognitive Modifiability and Mediated Learning Experience of Reuven Feuerstein states that individuals with brain impairment, because of congenital or acquired origin, may substantially and structurally improve their cognitive functioning, by a systematic intervention based on a specific, criteria-based type of interaction (“mediated learning”). Three application systems are based on it: a dynamic-interactive assessment of learning capacity and processes of learning, the LPAD (Learning Propensity Assessment Device); a cognitive intervention program called “Instrumental Enrichment Program”, which trains cognitive, metacognitive and executive functions; and a program, which is oriented at working in context, Shaping Modifying Environments. …These programs have been applied in widely different target groups: from children and young adults with learning and developmental disabilities, at risk of school failure, or having failed at school, because of socio-economic disadvantage or congenital neurological impairment; disadvantaged youngsters and adults in vocational training, to elderly people at the beginning of a dementia process. Experience with cognitive rehabilitation of children and adults with acquired brain damage, has been relatively recent, first in the Feuerstein Institute’s Brain Injury Unit in Jerusalem, later in other centers in different parts of the world; therefore scientific data are scarce. OBJECTIVES: The purpose of this paper is to examine how the Feuerstein-approach fits into the goals and proposed approaches of cognitive rehabilitation, and to explore its relevance for assessment and intervention in individuals with congenital or acquired brain damage. METHODS: The methodology of the Feuerstein approach consists of four pillars: dynamic assessment, cognitive activation, mediated learning and shaping a modifying environment. The criteria of mediated learning experience are explained with specific reference to people with acquired brain injury. The procedure of learning propensity assessment device uses visuo-spatial and verbal tasks known from neuropsychological assessment (such as Rey’s complex figure drawing), as well as a in a pre-test – brief intervention – post-test format. Cognitive activation is done in various ways: a paper-and-pencil relatively content-free program called “instrumental enrichment”, with transfer of learned principles into daily life situations, followed by metacognitive feedback. Four case histories of acquired brain damage are analyzed: a 19 year old man with extensive post-astrocytoma frontotemporal brain lesions; a 19 year old man with bilateral frontal and right temporal and parieto-occipital parenchymatous destruction after a traumatic brain injury; a 24 year old man with hemispherectomy for intractable epilepsy because of Sturge-Weber syndrome; and a 30-year old man with left porencephalic cyst after cerebral hemorrhage. RESULTS: Structural cognitive improvement could be demonstrated in positive change scores in visuo-spatial memory, associative and verbal memory, abstract thinking, and organizing tasks, even more than 10 years post-TBI. In some cases a rise in IQ has been documented. Improvement in daily life functioning and academic skills (re)learning has also been seen. CONCLUSIONS: Though impossible to claim scientific evidence, the case histories nevertheless suggest the importance of interactive assessment in designing intervention programs which have sufficient intensity, frequency, duration and consistency of mediation; furthermore, an essential ingredient is the ecological approach which requires working with the patient and the whole network around; a firm “belief system” or that modifiability is possible even with severe brain damage and many years after the injury; a cognitive, metacognitive and executive approach, and a quality of interaction according to criteria of mediated learning. They suggest that Feuerstein approach may offer interesting perspectives to cognitive rehabilitation. More extensive research is needed to provide a broader scientific evidence base. Show more

Keywords: Cognitive rehabilitation, Feuerstein’s theory of structural cognitive modifiability, acquired brain damage, mediated learning experience, ecological plasticity, dynamic assessment

DOI: 10.3233/NRE-161335

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 19-35, 2016

Authors: Chaney, Grace-Anna S. | Parente, Rick

Article Type: Research Article

Abstract: BACKGROUND: Acquired Brain Injury (ABI) limits a survivor’s ability to appraise their task performance. There are, however, few measures of self-appraisal. OBJECTIVE: This study developed a technique for measuring self-appraisal originally proposed by Wilbur, Wilk, Silver, and Parente (2008). METHODS: A multivariate model of self-appraisal that includes measures of predicted performance as well as measures of over- and under-estimation of performance was evaluated with ABI survivors, participants with diagnosed learning disabilities, and others with emotional impairments to determine which measures were the most sensitive to the differences among the groups. RESULTS: This model …provided a more accurate assessment of self-appraisal than the one previously proposed by Wilbur et al. (2008) . The two measures of self-appraisal measure different psychological processes, and the overall model measures aspects of performance that are unrelated to an individual’s IQ. A measure of over- or under-estimation of performance was the most sensitive component of the model. CONCLUSIONS: Self-appraisal is a multi-dimensional concept, with at least two main components. The findings corroborate previous literature suggesting that persons with ABI have difficulty accurately assessing their task performance resulting in inflated performance judgments. This self-appraisal technique can be applied to most assessments of performance. Show more

Keywords: Self-appraisal, self-appraisal assessments, brain injury, learning disabilities, emotional impairments, performance judgments, Wechsler Adult Intelligence Scale, WAIS, neurorehabilitation

DOI: 10.3233/NRE-161336

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 37-43, 2016

Authors: English, Megan | St. Pierre, Maria E. | Delahay, Anita | Parente, Rick

Article Type: Research Article

Abstract: BACKGROUND: Anosognosia is a lack of awareness of personal deficits that is commonly observed in people with a traumatic brain injury (TBI). OBJECTIVE: The purpose of this paper is to examine whether self-appraisal of executive functioning differs for students with and without TBI. METHODS: Students who had survived a TBI and those who had never had a TBI filled out the Behavior Rating Inventory of Executive Functioning from three different perspectives. Each participant was paired with an observer who was familiar with the person’s behavior. Self-appraisal ratings, observer ratings of the participant, and reflective appraisal …of how the participant thought the observer would rate them were compared. RESULTS: For the students without TBI, reflective appraisal was significantly correlated with self-appraisal but observer appraisal was not. For students with TBI, neither reflected appraisal nor observer appraisal correlated with self-appraisal. Both TBI and non-TBI participants overestimated their problems on measures of Inhibition, Shifting, Emotional Control, Initiation, and Planning/Organizing. TBI participants underestimated their problems on measures of Working Memory, Organization, and Task Monitoring relative to the non-TBI group. CONCLUSIONS: Students with TBI do not accurately perceive how others perceive their behavior. Show more

Keywords: Anosognosia, awareness, self-appraisal, reflected appraisal, executive functioning, acquired brain injury

DOI: 10.3233/NRE-161337

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 45-52, 2016

Authors: Goodwin, Rachel A. | Lincoln, Nadina B. | Bateman, Andrew

Article Type: Research Article

Abstract: BACKGROUND: Following acquired brain injury (ABI), deficits in executive functioning (EF) are common. As a result many brain-injured patients encounter problems in every-day functioning, and their families experience significant strain. Previous research has documented the benefits of cognitive rehabilitation for executive dysfunction, and rehabilitation programmes designed to ameliorate functional problems associated with ABI. OBJECTIVES: This study primarily aims to evaluate whether a neuropsychological rehabilitation programme reduces reported symptoms of everyday dysexecutive behaviour and carer strain. METHODS: In this study 66 ABI outpatients attended comprehensive holistic neuropsychological rehabilitation programme. A repeated-measures design was employed to determine …the effect of rehabilitation on EF and carer strain, as part of a service evaluation. Outcome measures comprised the dysexecutive questionnaire (DEX/DEX-I) and carer strain index (CSI), applied pre- and post-rehabilitation. RESULTS: Results indicate rehabilitation benefited clients and carers in 5 of 6 DEX/DEX-I subscales, and 2 of 3 CSI subscales, (p  < 0.05). An effect of aetiology on rehabilitation was found on the metacognitive scale of the DEX-I. CONCLUSIONS: Therefore, this study supports a comprehensive holistic neuropsychological rehabilitation programme as effective in reducing reported symptoms of dysexecutive behaviour and carer strain following ABI. Show more

Keywords: Neuropsychological rehabilitation, executive function, carer strain, brain injury, aetiology

DOI: 10.3233/NRE-161338

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 53-64, 2016

Authors: Ford, Catherine Elaine Longworth | Malley, Donna | Bateman, Andrew | Clare, Isabel C.H. | Wagner, Adam P. | Gracey, Fergus

Article Type: Research Article

Abstract: BACKGROUND: Outcome measurement challenges rehabilitation services to select tools that promote stakeholder engagement in measuring complex interventions. OBJECTIVES: To examine the suitability of outcome measures for complex post-acute acquired brain injury (ABI) rehabilitation interventions, report outcomes of a holistic, neuropsychological ABI rehabilitation program and propose a simple way of visualizing complex outcomes. METHODS: Patient/carer reported outcome measures (PROMS), experience measures (PREMS) and staff-rated measures were collected for consecutive admissions over 1 year to an 18-week holistic, neuropsychological rehabilitation programme at baseline, 18 weeks and 3- and 6-month follow-up. RESULTS: Engagement with outcome measurement …was poorest for carers and at follow-up for all stakeholders. Dependence, abilities, adjustment, unmet needs, symptomatology including executive dysfunction, and self-reassurance showed improvements at 18 weeks. Adjustment, social participation, perceived health, symptomatology including dysexecutive difficulties, and anxiety were worse at baseline for those who did not complete rehabilitation, than those who did. A radar plot facilitated outcome visualization. CONCLUSIONS: Engagement with outcome measurement was best when time and support were provided. Supplementing patient- with staff-rated and attendance measures may explain missing data and help quantify healthcare needs. The MPAI4, EBIQ and DEX-R appeared suitable measures to evaluate outcomes and distinguish those completing and not completing neuropsychological rehabilitation. Show more

Keywords: Brain injuries, health services research, stroke, outcome and process assessment, neuropsychology, rehabilitation

DOI: 10.3233/NRE-161339

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 65-79, 2016

Authors: Nickels, Lyndsey | McDonald, Belinda | Mason, Catherine

Article Type: Research Article

Abstract: BACKGROUND: Traditional group-based aphasia intervention has been shown to benefit people with aphasia in a variety of ways. However, despite the prevalence of anomia and the impact it has for communication, there has been little investigation as to whether these interventions improve word retrieval. OBJECTIVE: This study aimed to determine the effects on word retrieval of a ‘traditional’ out-patient group intervention. METHODS: A 6-week group therapy programme focused on current-affairs topics with facilitator-led discussion and language tasks. Half the topics received a supplementary, self-directed, anomia home programme. Using a single case experimental design, replicated across …three participants, we examined the effectiveness of the group, and the group+home programme, in facilitating word retrieval in picture naming and connected speech. RESULTS: The participants showed a pattern of improved picture naming over the course of the study for the treated topics which was not evident for the untreated control topics. However, it was difficult to attribute this improvement unequivocally to the treatment. CONCLUSIONS: While participants felt that the group was beneficial, there was little clear evidence for treatment-related gains in word retrieval. ‘Traditional’ group treatment has many positive features, but clinicians need to be cautious regarding the extent of impairment-related gains that can be expected, which seem small at best. Show more

Keywords: Aphasia, anomia, group treatment, word retrieval, rehabilitation

DOI: 10.3233/NRE-161340

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 81-95, 2016

Authors: Nickels, Lyndsey | Osborne, Amanda

Article Type: Research Article

Abstract: BACKGROUND: Constraint Induced Aphasia Therapy (CIAT) has been shown to be effective in the treatment of aphasia, but clinicians have expressed concern regarding how far CIAT is practical to implement in clinical practice. OBJECTIVE: To determine whether CIAT delivered in a less-intense, lower dose, reduced constraint and volunteer-led format could produce positive outcomes in people with chronic aphasia. METHODS: Two groups were run, each with two people with chronic aphasia. Treatment involved a standard CIAT card-exchange game, supplemented by a home activity. Spoken language was required for responses but alternative modalities of communication were also …permitted. Each group was led by a trained volunteer, lasted 90 minutes and was delivered twice a week for four weeks. RESULTS: Three of the four participants showed significant improvements in target word retrieval following treatment. No significant improvements were observed for untreated stimuli or language tasks. Two participants showed increases in the elaboration of their responses, and the same two showed an increase in the frequency with which they engaged in communication activities. CONCLUSIONS: Clear gains in performance were observed for the majority of people with aphasia who participated in a less intense format, considerably lower dose and less constrained form of CIAT led by trained volunteers. This suggests that this ‘clinically realistic’ service delivery model for CIAT could be added to the clinical repertoire of speech pathologists. Show more

Keywords: Aphasia, volunteer, group treatment, constraint induced aphasia therapy, rehabilitation

DOI: 10.3233/NRE-161341

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 97-109, 2016

Authors: Rose, Anita | Wilson, Barbara A. | Manolov, Rumen | Florschutz, Gerhard

Article Type: Research Article

Abstract: BACKGROUND AND AIMS: Balint’s Syndrome is a rare condition, often associated with hypoxic brain damage. The major characteristic is an inability to localise objects in space, another is simultanagnosia frequently resulting in reading difficulties. We present RN, a 37 year old woman whose major problem with reading was her inability to recognise individual letters correctly in either lower or upper case. We noted, however, that she was better if the letters were shown in red type. The aims were to determine if RN could relearn letters of the alphabet, investigate whether colour affected her ability to learn, and to …explore more specifically whether the red type also helped her to read words. METHOD: Using a single case experimental ABA design, we first determined that the optimal font for RN was size 16. In the baseline (A) phase, we assessed her ability to read all lower and upper case letters of the alphabet in black ink. In the intervention (B) phase we used font size 16 in red ink and an errorless learning approach to teaching the letters. Sessions ran 5 times per week (20 minutes per session). The intervention was then applied to picture recognition and word reading with four sets of 10 words and corresponding pictures. RESULTS: A consistent difference was noted between initial baseline and intervention. Improvement carried over when we returned to baseline. CONCLUSION: Using red type and an errorless learning approach enabled RN to re-learn letters of the alphabet and read words she was previously unable to read. This did not however generalise to her everyday life. Show more

Keywords: Balint’s Syndrome, hypoxia, acquired dyslexia, reading

DOI: 10.3233/NRE-161342

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 111-117, 2016

Authors: Shaw, Dorothy R.

Article Type: Research Article

Abstract: BACKGROUND: Cognitive Rehabilitation Therapy (CRT) is efficacious in remediating cognitive deficits, and has been demonstrated to be effective in a school setting. OBJECTIVE: The purpose of this paper is to review the literature on pediatric CRT as it relates to successful re-integration of TBI survivors into the school system and community. METHODS: This systematic review of the literature suggests that social re-integration strategies which incorporate problem-solving, reasoning, self-awareness, and positive social skills within a developmental framework are the most effective techniques for Pediatric CRT. RESULTS: Children and adolescents with cognitive impairments benefit from …a holistic approach to rehabilitation which incorporates developmental, social, and emotional considerations, as well as, cognitive rehabilitation techniques. CONCLUSIONS: This systematic review identifies several avenues for effective therapeutic interventions for school aged TBI survivors. Many are supported by laboratory based efficacy studies. Future research should investigate optimal ages for particular treatments, as well as, the effectiveness of treatments across different social settings. Show more

Keywords: Pediatric, cognitive rehabilitation, systematic review, elementary school, middle school

DOI: 10.3233/NRE-161343

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 119-123, 2016

Authors: St. Pierre, Maria E. | Parente, Rick

Article Type: Research Article

Abstract: BACKGROUND : Literature has compared the frequency of aggressive behaviors of the TBI population and the non-TBI population, suggesting that the TBI population is predisposed to aggressive tendencies because the injury enables impulsivity, loss of self-control, and the inability to modify behaviors. These behavior changes have consequently, been found to lead to criminal involvement. In fact, the majority of the prison population has sustained at least one TBI in their lifetime compared to the prevalence of brain injuries in the general population. However, there is little research investigating the perceptions of criminality and guilt of these individuals. METHODS: …Two experiments were conducted that investigated the perceptions of morality, level of guilt, and appropriate sentencing of crimes committed by defendants with different severities of TBI (i.e., mild, severe, and no TBI). Participants were asked to read scenarios about crimes being committed by the defendant. Experiment 1 used a 1-between (crime), 1-within (TBI) mixed design ANOVA testing three dependent variables (morality, guilt, and sentencing). Using a more in vivo jury approach, Experiment 2 used a 3 (TBI)×2 (crime) independent groups factorial design testing the three dependent measures. RESULTS: Overall, defendants with TBI were found less guilty of their crime, perceived as behaving morally to the crime, and receiving a milder punishment relative to the no-TBI defendants. CONCLUSIONS: In the courtroom, the defense attorney should educate the judge and/or the jury on the effects brain injuries have on the cognition, behavior, and emotions of an individual. Thus, this education will ensure the best verdict is being reached. Show more

Keywords: Traumatic brain injury, jury, attribution theory, verdict, forensic psychology, perception, decision making

DOI: 10.3233/NRE-161344

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 125-134, 2016

Authors: Stapleton, Mary

Article Type: Research Article

Abstract: BACKGROUND: Animal Assisted Therapy (AAT) has been widely used as a complementary therapy in mental health treatment especially to remediate social skill deficits. The goal of AAT is to improve social, emotional, and cognitive functioning. OBJECTIVE: The purpose of this article is to draw upon the literature on AAT and explore specific applications to cognitive rehabilitation therapy (CRT) and social skills training. METHODS: This study provides a systematic review of most of the available literature on ATT and assesses that potential uses of ATT for brain injury rehabilitation. RESULTS: Although the efficacy of …AAT is not currently well documented by rigorous research, (Kazin, 2010 ) anecdotal evidence suggests that brain injury survivors may benefit from the combination of AAT and cognitive rehabilitation techniques. CONCLUSIONS: Acquired Brain Injury (ABI) survivors with cognitive impairments can benefit from AAT as part of a comprehensive and holistic rehabilitation treatment plan. Show more

Keywords: Animal Assisted Therapy, cognitive rehabilitation acquired brain injury, therapy, service dog, therapy dog

DOI: 10.3233/NRE-161345

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 135-140, 2016

Authors: Sebastian, Rajani | Tsapkini, Kyrana | Tippett, Donna C.

Article Type: Research Article

Abstract: BACKGROUND: The application of transcranial direct current stimulation (tDCS) in chronic post stroke aphasia is documented in a substantial literature, and there is some new evidence that tDCS can augment favorable language outcomes in primary progressive aphasia. Anodal tDCS is most often applied to the left hemisphere language areas to increase cortical excitability (increase the threshold of activation) and cathodal tDCS is most often applied to the right hemisphere homotopic areas to inhibit over activation in contralesional right homologues of language areas. Outcomes usually are based on neuropsychological and language test performance, following a medical model which emphasizes impairment …of function, rather than a model which emphasizes functional communication. OBJECTIVE: In this paper, we review current literature of tDCS as it is being used as a research tool, and discuss future implementation of tDCS as an adjuvant treatment to behavioral speech-language pathology intervention. METHODS: We review literature describing non-invasive brain stimulation, the mechanism of tDCS, and studies of tDCS in aphasia and neurodegenerative disorders. We discuss future clinical applications. RESULTS/CONCLUSIONS: tDCS is a promising adjunct to traditional speech-language pathology intervention to address speech-language deficits after stroke and in the neurodegenerative disease, primary progressive aphasia. Limited data are available regarding how performance on these types of specific tasks translates to functional communication outcomes. Show more

Keywords: Stroke, aphasia, primary progressive aphasia, transcranial direct current stimulation

DOI: 10.3233/NRE-161346

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 141-152, 2016

Authors: Winegardner, Jill | Keohane, Clare | Prince, Leyla | Neumann, Dawn

Article Type: Research Article

Abstract: BACKGROUND: People with acquired brain injury (ABI) often show increased anger and aggression. Anger has been linked to attributions of hostile intent. The more intentional and hostile the judgments of other’s behaviours are, the angrier the responses tend to be. Some people with ABI tend to make harsher attributions than healthy controls (negative attribution bias). Poor perspective-taking may distort assessment of others’ intentions, thereby contributing to this bias and subsequent anger responses. OBJECTIVE: Examine changes in anger and perspective-taking after a Perspectives Group in two participants with ABI. METHODS: This study is a case report …exploring observational changes in anger, hostility, verbal and physical aggression and perspective-taking in two males with ABI and severe emotion dysregulation. Participants and their spouses also provided qualitative feedback through a semi-structured interview following perspectives training. The six-week “Perspectives Group” used hypothetical and real-life situations to teach participants to consider the perspectives of others when determining their intentions. RESULTS: Both participants showed post-treatment declines in aggression. Although only minimal changes occurred on the perspective-taking measure, spouses described important behavioural changes in their partners that indicated both decreased aggression and better perspective taking. CONCLUSIONS: These preliminary findings support further investigation of perspectives training for reducing anger after ABI. Show more

Keywords: Brain injury, anger management, perspectives training, perspective taking, hostility bias, attributions

DOI: 10.3233/NRE-161347

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 153-162, 2016

Authors: Worthington, Andrew

Article Type: Research Article

Abstract: BACKGROUND: Apraxia and Action Disorganisation Syndrome are characterised by an inability to use tools and carry out ordered sequences of movements in the absence of motor or sensory impairment. To date treatment for these complex but debilitating conditions has received little attention. OBJECTIVES: To provide an overview of apraxia and action disorganisation syndrome and its treatment, providing a state of the art summary for practitioners including likely future therapeutic directions. METHOD: Review of apraxia literature and treatment studies collated from internet searches involving MEDLINE, PubMed, PyscINFO and Google Scholar as well as the author’s own …catalogue. RESULTS: Evidence for current restitution and compensatory approaches is critically reviewed, with limited evidence to date in support of either method. Strategy training is the most promising intervention type with no support for sensory and exploratory interventions, practice effects only for direct task-specific training, and modest support for gestural training. CONCLUSIONS: Larger controlled studies are needed but evidence is sufficient to indicate certain approaches over others. Advances in assistive technology have not translated into mainstream therapy but future interventions are likely to require a model-based approach which embraces current technologies in order to provide a more accessible, effective and cost-efficient approach to rehabilitation. Show more

Keywords: Apraxia, action disorganisation syndrome, cognitive rehabilitation

DOI: 10.3233/NRE-161348

Citation: NeuroRehabilitation, vol. 39, no. 1, pp. 163-174, 2016