NeuroRehabilitation - Volume 31, issue 1

Authors: Kowlakowsky-Hayner, Stephanie A.

Article Type: Editorial

DOI: 10.3233/NRE-2012-0769

Citation: NeuroRehabilitation, vol. 31, no. 1, pp. 1-1, 2012

Authors: Martelli, Michael F. | Zasler, Nathan D. | Tiernan, Patricia

Article Type: Research Article

Abstract: The primary goal in the developing field of community based rehabilitation (CBR) for individuals with TBI / ABI is community participation and integration. At present, CBR is less than clearly defined and is represented by a set of interventions with varied types, degrees of clinical support and models of intervention that are conducted for a diverse and complex set of individuals, situations, deficits and settings. Nonetheless, holistic neurorehabilitation programs should be considered both evidence based and a practice standard. This paper attempts to address some of the significant issues relevant to optimizing long term adaptation for persons receiving CBR. The …article also addresses the current need for definitions, models, program classifications and comparisons, as well as programmatic methodologies by attempting to integrate some of the best scientifically supported methodologies within an eclectic holistic rehabilitation model that is easily understood and teachable to persons with TBI, families and rehabilitation professionals. This model and associated methodologies are intended to inform best practices while offering a framework for hypothesis generation, clinical decision-making, evaluation of treatment outcomes and direction of future research. Show more

Keywords: Post-acute rehabilitation, community care, brain injury, biopsychosocial, community based rehabilitation, community reintegration

DOI: 10.3233/NRE-2012-0770

Citation: NeuroRehabilitation, vol. 31, no. 1, pp. 3-18, 2012

Authors: Hayes, Allison | Chen, Celia S. | Clarke, Gayle | Thompson, Annette

Article Type: Research Article

Abstract: The incidence of visual deficits following stroke ranges from 20%–68% and has significant impact on activities of daily living. The NVT system is a compensatory visual scanning training program that consists of combined static and mobility training and transfer to activities of daily living. The study aims to evaluate functional changes following the NVT program for people who have homonymous hemianopia (HH) following stroke. Method: Interventional case series of 13 consecutive participants with HH undergoing NVT vision rehabilitation. The primary outcome measure was the number of targets missed on a standardized Mobility Assessment Course (MAC). Other outcome measures included …assessment of visual scanning, vision specific Quality of Life questionnaires and reading performance. Results: The average number of targets (sd) missed on the MAC course was 39.6 ± 20.9% before intervention, 27.5 ± 16.3% immediately post intervention and 20.8 ± 15.5% at 3 months post rehabilitation. The study showed a statistically significant trend in improvement in mobility related subscales of National Eye Institute Visual Function Questionnaire-NEI VFQ-25 (p = 0.003) and the Veteran Affairs Low Vision Visual Function Questionnaire-VA LVFQ-48 (p = 0.036) at 3 months post rehabilitation. Discussion: The NVT intervention resulted in functional improvements in mobility post rehabilitation. The NVT training showed improvement in vision specific quality of life. There is a need for standardised vision therapy intervention, in conjunction with existing rehabilitation services, for patients with stroke and traumatic brain injury. Show more

Keywords: Neurological vision deficits, acquired brain injury, hemianopia, stroke, traumatic brain injury, mobility, activities of daily living, quality of life, compensatory visual scanning.

DOI: 10.3233/NRE-2012-0771

Citation: NeuroRehabilitation, vol. 31, no. 1, pp. 19-30, 2012

Authors: Ashley, Mark J. | Ashley, Jessica | Kreber, Lisa

Article Type: Research Article

Abstract: Traumatic brain injury (TBI) results in disruption of information processing via damage to primary, secondary, and tertiary cortical regions, as well as, subcortical pathways supporting information flow within and between cortical structures. TBI predominantly affects the anterior frontal poles, anterior temporal poles, white matter tracts and medial temporal structures. Fundamental information processing skills such as attention, perceptual processing, categorization and cognitive distance are concentrated within these same regions and are frequently disrupted following injury. Information processing skills improve in accordance with the extent to which residual frontal and temporal neurons can be encouraged to recruit and bias neuronal networks or …the degree to which the functional connectivity of neural networks can be re-established and result in re-emergence or regeneration of specific cognitive skills. Higher-order cognitive processes, i.e., memory, reasoning, problem solving and other executive functions, are dependent upon the integrity of attention, perceptual processing, categorization, and cognitive distance. A therapeutic construct for treatment of attention, perceptual processing, categorization and cognitive distance deficits is presented along with an interventional model for encouragement of re-emergence or regeneration of these fundamental information processing skills. Show more

Keywords: Cognitive rehabilitation, traumatic brain injury, information processing

DOI: 10.3233/NRE-2012-0772

Citation: NeuroRehabilitation, vol. 31, no. 1, pp. 31-39, 2012

Authors: Schaub, Chris | Peters, Christina | Peters, Scott

Article Type: Research Article

Abstract: Individuals with acquired brain injuries often display problematic behaviors, such as impulsivity, disinhibition, lack of initiation, isolation, and aggression, that impact their readiness to return to home and/or the community. The occurrence and treatment of these behaviors is often complicated by impairments in cognition and self-awareness, as well as by co-occurring issues including substance abuse. Community reintegration for these individuals is a goal that can be both hazardous and difficult to attain. This article briefly reviews the literature and describes a treatment philosophy and methodology by which an interdisciplinary team can employ evidence-based behavioral principles and procedures to assess and …promote behavioral stability toward the goal of community readiness within a residential rehabilitation setting. Assessment includes a comprehensive evaluation of individual strengths and barriers across all disciplines as well as an analysis of the function of problematic behaviors. Based upon these assessments and analyses, integrated interdisciplinary treatment efforts then support the development and implementation of specific strategies and tools to promote community readiness and ultimately reentry. These strategies and tools are intended to provide direction and support to the client and include prompts and cues to self-manage, as well as ways to assist clients and staff to collect and reflect upon relevant data. Additionally, other methods of data collection, techniques to develop self-management skills, and the use of contingencies as part of a community reentry plan are discussed. Show more

Keywords: Behavior analysis, community reintegration, brain injury, behavioral strategies, data collection, self-management

DOI: 10.3233/NRE-2012-0773

Citation: NeuroRehabilitation, vol. 31, no. 1, pp. 41-49, 2012

Authors: Tyerman, Andy

Article Type: Research Article

Abstract: Background: A recent systematic review suggests that around 40% of people with traumatic brain injury (TBI) return to work (RTW). Yet in the UK currently only a small minority of people with TBI receive vocational rehabilitation (VR) to enable a RTW. Agencies with an interest in developing such services are likely to favour different models of VR. Objective: The primary objective of this paper was to review models of specialist VR after TBI and their outcomes to inform service development across relevant agencies. Method: A literature review on VR after TBI was undertaken in MEDLINE, EMBASE …and PsychINFO (from 1967 to date). Papers reporting models of VR were selected for more detailed consideration. Results: Illustrative examples of VR models are outlined: brain injury rehabilitation programmes with added VR elements, VR models adapted for TBI, case coordination/resource facilitation models, and consumer-directed models. Models differ, both within and across these four broad categories, in provision of core TBI rehabilitation, work preparation, work trials and supported placements. Methodological variation limits direct comparison of outcomes across models with few comparative or controlled studies. Conclusions: There is evidence to support the benefits of a wide range of models of specialist VR after TBI. However, there remains a need for controlled studies to inform service development and more evidence on cost-effectiveness to inform funding decisions. Show more

Keywords: Brain injury, return to work, vocational rehabilitation models

DOI: 10.3233/NRE-2012-0774

Citation: NeuroRehabilitation, vol. 31, no. 1, pp. 51-62, 2012

Authors: Kolakowsky-Hayner, Stephanie A. | Wright, Jerry | Shem, Kazuko | Medel, Robert | Duong, Thao

Article Type: Research Article

Abstract: Information is presented on a community-based mentoring program, developed to work with existing community agencies and provide structure to the frequently confusing network of services for young adults, ages 16 to 26 years, with a recently acquired disability including TBI, SCI, and other neurological disorders. The over-arching goal of the Mentoring Program was to improve the ability of individuals with disabilities to access and maximally utilize the services and programs that are available in the community. The two objectives of this study were: 1) to demonstrate continuing increases in standardized measures of community integration from the time of enrollment in …the program to the time of exit from the program, and 2) to improve the percentage of youth and young adults with disabilities who successfully access post-secondary education or employment opportunities. 53 participants had post-secondary education as a goal. 12 participants had an employment goal. 12 participants had both education and employment as a combined goal. It was not uncommon for participants to change goals. Of those with education goals, 23/53 achieved educational goals and 7/53 achieved employment goals. Of those with vocational goals, 5/12 achieved vocational goals and 1/12 achieved educational goals. Of those with both goals, 5/12 achieved educational goals and 1/12 achieved vocational goals. Significant community integration and independence improvements were noted for program participants (CHART Mobility and Cognitive Independence, M2PI, DRS, and SRS). Overall, findings suggest that mentoring can be beneficial toward achieving the goals of post-secondary education, employment and community independence for individuals with disabilities; specifically those with traumatic brain injury, spinal cord injury and other neurological disorders. Show more

Keywords: Mentoring, peer support, community-based, traumatic brain injury, spinal cord injury

DOI: 10.3233/NRE-2012-0775

Citation: NeuroRehabilitation, vol. 31, no. 1, pp. 63-73, 2012

Authors: Stejskal, Taryn M.

Article Type: Research Article

Abstract: Rehabilitation professionals have become increasingly aware that family members play a critical role in the recovery process of individuals after brain injury. In addition, researchers have begun to identify a relationship between family member caregivers' well-being and survivors' outcomes. The idea of a continuum of care or following survivors from inpatient care to community reintegration has become an important model of treatment across many hospital and community-based settings. In concert with the continuum of care, present research literature indicates that family intervention may be a key component to successful rehabilitation after brain injury. Yet, clinicians interacting with family members and …survivors often feel confounded about how exactly to intervene with the broader family system beyond the individual survivor. Drawing on the systemic nature of the field of Marriage and Family Therapy (MFT), this article provides information to assist clinicians in effectively intervening with families using theory-based interventions in community settings. First, a rationale for the utilization of systems-based, as opposed to individual-based, therapies will be uncovered. Second, historically relevant publications focusing on family psychotherapy and intervention after brain injury are reviewed and their implications discussed. Recommendations for the utilization of systemic theory-based principles and strategies, specifically Cognitive Behavioral Therapy (CBT), Narrative Therapy (NT), and Solution-Focused Therapy (SFT) will be examined. Descriptions of common challenges families and couples face will be presented along with case examples to illustrate how these theoretical frameworks might be applied to these special concerns postinjury. Finally, the article concludes with an overview of the ideas presented in this manuscript to assist practitioners and systems of care in community-based settings to more effectively intervene with the family system as a whole after brain injury. Show more

Keywords: Brain injury, caregivers, family therapy, intervention

DOI: 10.3233/NRE-2012-0776

Citation: NeuroRehabilitation, vol. 31, no. 1, pp. 75-83, 2012

Authors: Murphy, Mary Pat | Carmine, Helen

Article Type: Research Article

Abstract: Individuals with acquired brain injuries often present with lifelong health challenges. Trauma to the body directly related to the injury, physical and medical sequelae resulting from the brain injury itself, and an increase in the observed onset of physical aging are among the problems which require consideration throughout their lives. For many rehabilitation professionals, issues related to medical stability and health maintenance are unfamiliar and intimidating. As both hospital stays shorten and an existing population of individuals with brain injuries' survival and life expectancy rates increase, rehabilitation professionals have been increasingly challenged by medical issues. Rehabilitation nurses are positioned to …best navigate these issues and facilitate needed care coordination, early intervention, and ongoing education for individuals, their families, and other caregivers. This article describes common medical complications related to the initial and related disability and aging in individuals with brain injury including chronic and late emerging complications involving all body systems including spasticity and changing mobility, aspiration and dysphagia, incontinence, diabetes, and acute and chronic pain. Strategies for successful management of these issues in a home or community setting are also discussed. Special attention is paid to falls and fall prevention, issues specific to aging women, and nutrition and weight control. Ways to promote positive health behaviors to preserve function are also explored. Additionally, patient and family education as part of a lifetime management plan is discussed. Show more

Keywords: Traumatic brain injury, health complications, nursing, healthy aging, chronic disease management

DOI: 10.3233/NRE-2012-0777

Citation: NeuroRehabilitation, vol. 31, no. 1, pp. 85-94, 2012