Structured Model of Neurorehab: A Pilot Study of Modern Multitouch Technology and Virtual Reality Platforms for Training Sociocognitive Deficit in Children with Acquired Brain Injury.

Social competence is often impaired in children with acquired brain injury (ABI), but evidence-based rehabilitation has remained undeveloped. This pilot-study aimed to create a structured model for sociocognitive rehabilitation for children with ABI. A total of 32 children aged 8-13 years participated: 22 with ABI -epilepsy, traumatic brain injury, or tic disorder and 10 healthy controls. Interactive computer-based applications were implemented into rehabilitation design using multitouch-multiuser tabletop (MMT) devices: Snowflake MultiTeach (MT) and Diamond Touch Table (DTT), plus MediqVR virtual reality (VR) platform. At baseline, patients demonstrated social incompetence compared to healthy controls. Post-training evaluations showed that rehabilitation on Snowflake MT improved children's executive and cooperation skills. DTT developed new communication and language skills, metacognitive skills, and coping with difficult social situations. This structured model for social competence rehabilitation helps therapists to understand the objectives and tools for improving social and cooperation skills in children with ABI. We provide practical recommendations using next-generation devices, which are effective and motivating for children.

Comparing fixed-amount and progressive-amount DRO Schedules for tic suppression in youth with chronic tic disorders.

Chronic tic disorders (CTDs) involve motor and/or vocal tics that often cause substantial distress and impairment. Differential reinforcement of other behavior (DRO) schedules of reinforcement produce robust, but incomplete, reductions in tic frequency in youth with CTDs; however, a more robust reduction may be needed to affect durable clinical change. Standard, fixed-amount DRO schedules have not commonly yielded such reductions, so we evaluated a novel, progressive-amount DRO schedule, based on its ability to facilitate sustained abstinence from functionally similar behaviors. Five youth with CTDs were exposed to periods of baseline, fixed-amount DRO (DRO-F), and progressive-amount DRO (DRO-P). Both DRO schedules produced decreases in tic rate and increases in intertic interval duration, but no systematic differences were seen between the two schedules on any dimension of tic occurrence. The DRO-F schedule was generally preferred to the DRO-P schedule. Possible procedural improvements and other future directions are discussed.

Neurocognitive predictors of treatment response to randomized treatment in adults with tic disorders.

Tourette's disorder (TS) and chronic tic disorder (CTD) are neurodevelopmental disorders characterized by involuntary vocal and motor tics. Consequently, TS/CTD have been conceptualized as disorders of cognitive and motor inhibitory control. However, most neurocognitive studies have found comparable or superior inhibitory capacity among individuals with TS/CTD relative to healthy controls. These findings have led to the hypothesis that individuals with TS/CTD develop increased inhibitory control due to the constant need to inhibit tics. However, the role of cognitive control in TS/CTD is not yet understood, particularly in adults. To examine the role of inhibitory control in TS/CTD, the present study investigated this association by assessing the relationship between inhibitory control and treatment response in a large sample of adults with TS/CTD. As part of a large randomized trial comparing behavior therapy versus supportive psychotherapy for TS/CTD, a battery of tests, including tests of inhibitory control was administered to 122 adults with TS/CTD at baseline. We assessed the association between neuropsychological test performance and change in symptom severity, as well as compared the performance of treatment responders and non-responders as defined by the Clinical Global Impression Scale. Results indicated that change in symptoms, and treatment response were not associated with neuropsychological performance on tests of inhibitory control, intellectual ability, or motor function, regardless of type of treatment. The finding that significant change in symptom severity of TS/CTD patients is not associated with impairment or change in inhibitory control regardless of treatment type suggests that inhibitory control may not be a clinically relevant facet of these disorders in adults.

Cognitive-behavioral therapy induces sensorimotor and specific electrocortical changes in chronic tic and Tourette's disorder.

BACKGROUND: Tic disorders, such as the Gilles de la Tourette syndrome and persistent tic disorder, are neurodevelopmental movement disorders involving impaired motor control. Hence, patients show repetitive unwanted muscular contractions in one or more parts of the body. A cognitive-behavioral therapy, with a particular emphasis on the psychophysiology of tic expression and sensorimotor activation, can reduce the frequency and intensity of tics. However, its impact on motor activation and inhibition is not fully understood. METHODS: To study the effects of a cognitive-behavioral therapy on electrocortical activation, we recorded the event-related potentials (ERP) and lateralized readiness potentials (LRP), before and after treatment, of 20 patients with tic disorders and 20 healthy control participants (matched on age, sex and intelligence), during a stimulus-response compatibility inhibition task. The cognitive-behavioral therapy included informational, awareness training, relaxation, muscle discrimination, cognitive restructuration and relapse prevention strategies. RESULTS: Our results revealed that prior to treatment; tic patients had delayed stimulus-locked LRP onset latency, larger response-locked LRP peak amplitude, and a frontal overactivation during stimulus inhibition processing. Both stimulus-locked LRP onset latency and response-locked LRP peak amplitude normalized after the cognitive behavioral therapy completion. However, the frontal overactivation related to inhibition remained unchanged following therapy. CONCLUSIONS: Our results showed that P300 and reaction times are sensitive to stimulus-response compatibility, but are not related to tic symptoms. Secondly, overactivity of the frontal LPC and impulsivity in TD patients were not affected by treatment. Finally, CBT had normalizing effects on the activation of the pre-motor and motor cortex in TD patients. These results imply specific modifications of motor processes following therapy, while inhibition processes remained unchanged. Given that LRPs are partially generated within the sensorimotor and supplementary motor area, the reported reduction in tic frequency and improvements of LRPs components suggest that CBT induced a physiological change in patients' motor area.

Evaluation of cognitive behaviour therapy for paediatric obsessive-compulsive disorder in the context of tic disorders.

BACKGROUND AND OBJECTIVES: Paediatric obsessive-compulsive disorder (OCD) and tic disorders (TD) often present together. However, there has been relatively little research on whether comorbid tic disorders influence response to cognitive behaviour therapy (CBT) for OCD. This study aimed to examine the outcomes of CBT for paediatric patients with OCD and a tic disorder compared to a matched group of children with OCD and no tics. Outcomes were compared post-treatment and at 3 or 6 month follow-up. METHODS: Participants were 29 young people with tic disorders and OCD (OCD + TD) and 29 young people with OCD without tic disorders (OCD-TD) who were matched according to age, gender and baseline OCD symptom severity. All participants received a course of CBT and outcomes were assessed using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). RESULTS: OCD symptoms reduced over the course of CBT to an equivalent extent in the OCD + TD and OCD-TD groups. Response or remission rates did not differ significantly at either post-intervention or follow-up between those with OCD + TD and those with OCD-TD. For both groups, response rates were high - 72% of both groups were classified as responders post-intervention and, at follow-up, 81% of the OCD + TD group and 82% of the OCD no tics group responded. Those with OCD + TD responded in significantly fewer sessions than those with OCD without tics. LIMITATIONS: A number of potential confounding factors were not assessed and therefore could not be controlled for, such as other comorbidities and stability of medication. CONCLUSIONS: Paediatric patients with OCD and tic disorders respond equally well to standard CBT for OCD as compared to those with OCD and no tics.

[Effects of habit reversal training in children with chronic tic disorder - a pilot study]. / Die Wirksamkeit der Reaktionsumkehr-Behandlung bei Kindern und Jugendlichen mit chronischen Tic-Störungen.

OBJECTIVE: The present pilot study investigates the effects of habit reversal training in a German speaking population of children and young adults with chronic tic disorders using a new treatment program where the interventions are based on a manualized cognitive-behavioral program. METHODS: 16 children were treated using the program. Tic-symptoms were assessed using direct observation as well as parent, self and clinical ratings. The efficacy of an intense cognitive-behavioral therapy phase was compared with a minimal intervention phase. The statistical analysis focused on different parameters in the therapy. RESULTS: We obtained positive results for the acceptance and efficacy of the program. CONCLUSIONS: These first findings indicate the new developed program is useful. Further studies are necessary to prove the efficacy of the interventions.

Cognitive-behaviour therapy and skilled motor performance in adults with chronic tic disorder.

The first aim of the present study was to compare performance of people with tic disorders (TD) and controls on executive function and a range of skilled motor tests requiring complex performance, guided movements, hand co-ordination, and fine control of steadiness. The second aim was to investigate the effect of cognitive behaviour therapy (CBT) on motor performance. A total of 55 patients with TD were recruited at baseline from participants in a behavioural management programme. A comparison group of 55 patients suffering from a variety of habit disorders (HD) involving complex manual movements, were matched on age and level of education to 34 non-psychiatric controls. Participants were evaluated pre- and post-treatment and post-waitlist with a neuropsychological evaluation focusing on executive function (Wisconsin Card Sorting Test, WCST) and skilled motor performance (Purdue Pegboard, Hole Steadiness Test, and the Groove Test). Results revealed WCST scores in the normal range, while motor performance differed significantly on the Purdue Pegboard Tests in both TD and HD as compared to the control group. Cognitive-behavioural treatment selectively improved motor performance in both clinical groups compared to waitlist control, and this improvement related to clinical outcome measures.

[Causes of tic disorders in children]. / Przyczyny tików u dzieci hospitalizowanych.

THE AIM OF THE WORK: Tic disorders are differentiated in their symptomatology and time of duration. Assessing the courses of tics can be crucial for more successful treatment. The aim of the study was to identify the egzogenic and endogenic causes of tic disorders. MATERIAL AND METHODS: The group of 20 children and adolescents, 6 girls and 14 boys, aged 4-16 years, with tic disorders were analysed. 8 of them were identified as having transient tics 6 chronic motor or vocal tics and 6 Tourette's syndrome. WISC-R, Terman-Merrill, and Raven, Bender-Koppitz and Benton tests and questionnaire "Who are you", and projection tests, talk to children and their parents were used. RESULTS: The analysed group consisted of 70% boys. Gestational and perinatal risk factors were confirmed in 5 children, in similar percentage of different types of tics. In 20% of patients CT or MRI examination showed mild abnormalities, whereas EEG examination excluded epileptic discharges. Majority of children with tics demonstrated significant emotional sesitivity (70%) and tendency to repress fear and anger (60%). Hyperkinetic disorders co-existing with Tourette's syndrome in 3 patients, while learning disabilities were confirmed in 30% children with tic disorders. The presence of negative environmental factors which may contribute to trigger tics showed a half of children from analysed group. Above all children experienced stress in family (40%) and/or in school (20%). The biological and/or environmental factors were detected in 80% children. They were not established in four patients: in one with transient tics and in three with Tourrete's syndrome. CONCLUSION: The identification of biological and environmental factors is necessary in children with tics, because they are present and significant in majority of children. In 20% of children these factors were not confirmed and in this group other causes should be considered. Considering the risk of disordered emotional and social functioning of children with tics, leading in many cases to tics exacerbation, complex therapeutic care should be provided.

Applying behavior analysis to clinical problems: review and analysis of habit reversal.

This article provides a review and analysis of habit reversal, a multicomponent procedure developed by Azrin and Nunn (1973, 1974) for the treatment of nervous habits, tics, and stuttering. The article starts with a discussion of the behaviors treated with habit reversal, behavioral covariation among habits, and functional analysis and assessment of habits. Research on habit reversal and simplified versions of the procedure is then described. Next the article discusses the limitations of habit reversal and the evidence for its generality. The article concludes with an analysis of the behavioral processes involved in habit reversal and suggestions for future research.

Brief functional analysis and treatment of a vocal tic.

This study sought to extend functional methodology to the assessment and treatment of habits. After a descriptive assessment indicated that coughing occurred while eating, a brief functional analysis suggested that social attention was the maintaining variable. Results demonstrated that treatment, derived from the assessment and analysis data, rapidly eliminated the cough. We discuss the appropriateness of using functional analysis procedures for deriving treatments for habits in a clinical setting.