Fatigue after acquired brain injury impacts health-related quality of life: an exploratory cohort study.

This study aimed to identify the consequences of fatigue, fatigability, cognitive and executive functioning, and emotional state on health-related quality of life (HRQoL) in a clinical group of outpatients after acquired brain injury (ABI). This cross-sectional retrospective study included assessing outpatients at a rehabilitation clinic with WAIS-III working memory and coding subtests, and self-rating scales (Fatigue Impact Scale, Dysexecutive Questionnaire, Hospital Anxiety and Depression Scale, and the dimension of health-related quality of life from EQ-5D-3L). The predictive variables were investigated using a binary logistic regression with HRQoL as the dependent variable. Descriptive statistics and correlations were analyzed. Participants reported a lower than average HRQoL (95%), fatigue (90%), and executive dysfunction (75%). Fatigue had a significant impact and explained 20-33% of the variance in HRQoL with a moderate significance on depression (p = 0.579) and executive dysfunction (p = 0.555). Cognitive and executive function and emotional state showed no association with HRQoL. A lower HRQoL, as well as fatigue and cognitive and executive dysfunctions, are common after ABI, with fatigue is a partial explanation of a lower HRQoL.

A randomized study of computerized working memory training and effects on functioning in everyday life for patients with brain injury.

BACKGROUND: Working memory (WM) problems influence most activities of daily living. The aim was to evaluate if computerized working memory training after brain injury has a significant effect on functioning in daily life. METHOD: Outpatients with WM deficits, aged 22-63 years, were randomized to either intervention group (IG, n = 20) or control group (CG, n = 18) and received 5 weeks standard rehabilitation. The IG also received WM training with the Cogmed QM training program. Assessments were made before (A1), immediately (A2) and 3 months (A3) after intervention. After follow-up, the CG was offered the computerized training and assessed after this (A4; n = 8). Assessments included the WAIS-III Digit span reversed, Fatigue Impact Scale (FIS), Assessment of Motor and Process Skills (AMPS), Rivermead Behavioural Memory Test-II (RBMT-II) and a WM questionnaire. RESULTS: The IG improved on digit span and FIS, A1-A2, and significantly more than the CG on the WM questionnaire, A1-A3. Both groups improved in AMPS motor skill and the AMPS process skill score tended towards significant improvement in the IG, from A1-A3. After training (A3-A4), the CG improved in digit span and RBMT-II. CONCLUSION: The WM training seems to have a generalized effect on functional activity and lessens fatigue.

Can computerized working memory training improve impaired working memory, cognition and psychological health?

OBJECTIVE: To study if computerized working memory (WM) training, in the sub-acute phase after acquired brain injury, in patients with impaired WM, improves WM, cognition and psychological health. RESEARCH DESIGN: A randomized study (n = 47) with an intervention group (IG) and a control group (CG), mean age 47.7 years. The WAIS-III NI, Digit span, Arithmetic, Letter-Number Sequences (Working Memory sub-scale), Spatial span, the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and the self-rating scales DEX and HADS were administered at baseline and at follow-ups at 6 and 18 weeks. Both groups underwent integrated rehabilitation. The IG also trained with the computerized WM training program, Cogmed QM, which was offered to the CG and followed up after the study completion. RESULTS: Both groups improved after their WM training in Working Memory, BNIS and in Digit span, particularly the reversed section. Both the BNIS and the Digit span differed significantly between the IG and CG due to the greater improvement in the IG after their WM training. Psychological health improved as both groups reported less depressive symptoms and the CG also less anxiety, after the training. CONCLUSION: Results indicated that computerized WM training can improve working memory, cognition and psychological health.