Behavioral Problems and Self-Feeding Independence Among Patients With Acute Stroke: A Single-Center Study.

IMPORTANCE: Self-feeding independence is often the first goal in acute stroke rehabilitation. Attention deficits appear frequently after stroke, but neuropsychological tests may be difficult to perform in the acute phase, and the effect on self-feeding activities may be difficult to detect. Therefore, we aimed to clarify behavioral problems with self-feeding using the Moss Attention Rating Scale (MARS), a behavioral observational rating scale of attentional function, for a better understanding of the effects of self-feeding. OBJECTIVE: To identify behavioral problems caused by attention deficits among patients with acute stroke who need assistance in self-feeding, using the MARS. DESIGN: Cross-sectional single-center study. SETTING: St. Marianna University Yokohama Seibu Hospital, Kanagawa, Japan. PARTICIPANTS: A total of 96 patients (42 women and 54 men) were admitted to the hospital for stroke treatment. Patients' median age was 75.0 yr. The date of evaluation was a median of 3.0 days from admission. OUTCOME AND MEASURES: The primary outcome was the FIM® eating subscore. The secondary outcome was the MARS score. RESULTS: Significant differences were noted in the total raw MARS, logit, and three-factor scores for self-feeding independence (p < .01). The effect size of the consistent or sustained factor on independence was large (r = .83). CONCLUSIONS AND RELEVANCE: Behavioral problems related to self-feeding dependence include the inability for sustained attention. Our results suggest that sustained concentration during self-feeding is necessary for eating independence. Rehabilitation focused on sustained attention is important for independent self-feeding. Plain-Language Summary: A patient's self-feeding independence is often the first goal in acute stroke rehabilitation. Patients frequently experience attention deficits after a stroke, but neuropsychological tests may be difficult to perform in the acute phase of rehabilitation, and the effect of attention deficits on self-feeding may be difficult to identify. To have a better understanding of the effects on self-feeding, this study aimed to identify behavioral problems using the Moss Attention Rating Scale (MARS). The study found that the MARS can be used to identify behavioral problems related to self-feeding independence, which can help occupational therapists to develop rehabilitation programs for their clients who have experienced a stroke.

Utility of a novel tablet computer software for memory impairment in participants with brain injuries: A randomized control trial.

This study examined the effectiveness of a novel information and communication technology (ICT) tool developed for external memory compensation to improve memory function in participants with brain injuries. In this 3-month randomized control study, participants with memory impairment secondary to brain injury were randomly assigned on a 1:1 basis to either intervention (the ICT tool [ARATA]) or 3-month waitlist control groups. This study's primary outcome measure was memory-related difficulties in everyday life, assessed using the Everyday Memory Checklist (EMC). Secondary outcomes included tests for memory function and psychosocial status, all of which were administered by blinded assessors. Seventy-eight participants (53 males, 25 females; mean age, 43.5 ± 12.7 [SD] years) were enrolled and 39 participants were allocated to each group (intervention and control). There was no significant difference in EMC scores between the two groups throughout the study (mean 0.26; 95% CI: -2.55-3.07; p=0.853); however, the intervention group scored significantly higher on the Rivermead Behavioural Memory and General Self-Efficacy tests compared to the control group. While the ICT tool did not improve the primary study outcome, evidence suggests that the ICT tool can improve memory functions related to activities of daily living.

Community-based practical behavioral intervention in public transportation for people with acquired brain injury: study of two cases using a single-case experimental design study.

The purpose of this paper was to report on the progress of a behavioral approach to enable patients with acquired brain injury (age 57, male, stroke and age 36, old, female, TBI) using a community activity support center to commute alone using public transportation. In this study, two ABI patients were intervened to enable them to use public transportation. The frequency of intervention was once a month or once a week. The two community-dwelling adults each had post-ABI attention and memory deficits and anxiety. A-B-A single-case experimental design was employed for this study. The transportation route was stepped into multiple steps. Each step was scored in a unique way to determine the degree of assistance the participant received from others. This score was considered the main outcome. Tau-U analysis was used for statistical analysis. Statistically significant improvements in public transportation use were shown between baseline and intervention. There were no significant differences between the intervention and follow-up periods. The results suggest that behavioral interventions are beneficial in reacquiring the ability to use public transportation and that the intervention effects are sustained.

Numeric input operation on electronic devices among individuals with visuospatial working memory impairment.

ABSTRACTIn human-computer interactions, higher-level visuospatial function is likely needed to effectively use the interface. The aim of this study is to clarify whether individuals with visuospatial defects can use electronic devices effectively. We quantitatively and qualitatively analyzed the ability of seven individuals with Bálint syndrome and seven individuals with left-unilateral spatial neglect (USN) to input a digit sequence into a flat touch interface. Control groups consisted of seven individuals with memory deficits and 11 healthy individuals. Participants with Bálint syndrome took longer and had more hesitations than the USN group and the two control groups to input numerical sequences (Steel-Dwass test, p < .01). In addition, participants with Bálint syndrome had a high percentage of hesitations for exploration of the button array on the interface relative to USN and the memory deficit group (Fisher's exact test, p < .05). Regarding neuropsychological data, participants with Bálint syndrome had a lower score for visuospatial working memory than participants with USN and the memory deficits control group (Steel-Dwass test, p < .01). The results shed some light on the relation between visuospatial working memory deficits and the spatial perception of interface layouts and spatial control during electronic device operation.

Crossover learning of gestures in two ideomotor apraxia patients: A single case experimental design study.

Crossover learning may aid rehabilitation in patients with neurological disorders. Ideomotor apraxia (IMA) is a common sequela of left-brain damage that comprises a deficit in the ability to perform gestures to verbal commands or by imitation. This study elucidated whether crossover learning occurred in two post-stroke IMA patients without motor paralysis after gesture training approximately 2 months after stroke onset. We quantitatively analysed the therapeutic intervention history and investigated whether revised action occurred during gesture production. Treatment intervention was to examine how to influence improvement and generalisation of the ability to produce the gesture. This study used an alternating treatments single-subject design, and the intervention method was errorless learning. Results indicated crossover learning in both patients. Qualitative analysis indicated that revised action occurred during the gesture-production process in one patient and that there were two types of post-revised action gestures: correct and incorrect gestures. We also discovered that even when a comparably short time had elapsed since stroke onset, generalisation was difficult. Information transfer between the left and right hemispheres of the brain via commissural fibres is important in crossover learning. In conclusion, improvements in gesture-production skill should be made with reference to the left cerebral hemisphere disconnection hypothesis.

Work-support techniques used by occupational therapists to facilitate support after acquired brain injuries: A qualitative study.

Background: Ensuring effective return to work following acquired brain injuries is crucial from the perspectives of both quality of life and the economy. However, techniques of occupational therapy support for return to work remain relatively unelucidated. Aims/Objectives: To clarify the specific contents of occupational therapy required for work and work support for clients with acquired brain injuries. Material and Methods: An interview-based survey was conducted with participants who had >10 years of occupational therapy experience and had provided work support. We selected participants via snowball sampling. Data were analyzed using thematic analysis. Results: A total of 20 participants (15 women and 5 men; 6, 12, 1, and 1 in their 30s, 40s, 50s, and 60s, respectively) were included. Six concepts were generated on reviewing the support for work items considered important by the occupational therapist as follows: "Support for vocational life," "Support for interpersonal skills," "Support for work," "Support for illness, disability, and awareness," "Support for utilization of compensation measures," and "Support for goal setting." Conclusions: We clarified the specific contents of work support, including support for vocational life and support for work, that is administered by occupational therapists who provide work support for clients with acquired brain injury. The insights from the study improve understanding of OTs' roles and contributions in supporting clients with acquired brain injuries in returning to work.

Cognitive and self-regulation skills for employment among people with brain injury: A comparison of employed and non-employed people using mixed analysis.

BACKGROUND: Employment for people with brain injuries is challenging, and identifying the factors that can be improved by rehabilitation and establishing appropriate intervention methods are imperative. OBJECTIVE: To examine whether differences in cognitive functions and self-regulation skills exist between employed and non-employed people with brain injuries. In addition, we explored the self-regulation skills characteristic of employed people by qualitatively comparing them to those of non-employed people. METHODS: Using a mixed research method, demographic data, neuropsychological tests, self-efficacy, and self-regulation skills were compared between 38 people with brain injuries (16 employed and 22 unemployed) in the community. Subsequently, self-regulation skills were assessed by the Self-Regulation Skills Interview (SRSI), and participants' responses were qualitatively compared. RESULTS: No significant differences were observed in demographic data and neuropsychological tests, but employed people showed significantly better SRSI scores than unemployed people (p <  0.01). The qualitative analysis of the SRSI showed that employed people recognised themselves as having more specific symptoms than unemployed people. For example, they recognised the behaviour 'when having more than one errand, forgetting it', whereas non-employed people only recognised the category 'failure of prospective memory'. Furthermore, employed people reviewed their behaviour and developed ingenious coping strategies, such as 'looking back on appointments that have been made', 'writing down as soon as having a schedule', whereas unemployed people only exhibited categories such as 'writing schedules on the cell phone'. CONCLUSIONS: Self-regulation skills, such as recognising specific symptoms and developing relevant coping strategies, are effective for gaining employment.

Age-related learning difficulty through trial-and-error method associated with decreased default mode network integration in healthy middle-aged adults.

INTRODUCTION: Efficient learning is critical to adapting to different environments. There are well-known learning principles in cognitive rehabilitation, including errorless (EL) and trial-and-error (T&E) learning; however, little is known about their underlying neural mechanisms. In the current study, to understand the age-related changes in learning benefits and neural mechanisms applying EL and T&E learning methods in healthy middle-aged adults, we conducted a graph theoretical analysis using functional magnetic resonance imaging data and analyzed the relationship between learning benefits and age, as well as functional network connectivity and age, with both learning principles. METHOD: A total of 43 participants performed a color-name association task through EL and T&E learning methods. We focused on the functional connectivity patterns of the default mode network (DMN) since previous studies demonstrated this network to be more distinctive and important for the T&E learning method than EL. Within-network functional connectivity was used as the graph metric. RESULTS: Age showed significant moderate negative correlations with T&E scores and within-DMN functional connectivity in the test state following T&E learning. Conversely, age was not significantly correlated with EL scores or within-DMN functional connectivity in either the EL learning or test states. CONCLUSIONS: Our findings demonstrate the age-related learning decline associated with decreased DMN integration with aging, when applying the T&E method but not the EL method, even in healthy middle-aged adults. Relationships between the underlying neural network and age are different depending on the learning method. This suggests the need to take into consideration the remaining learning ability through the T&E learning method compared to normal aging and to utilize residual DMN functioning, in addition to the comparison between score differences between EL and T&E methods, when tailoring an individual learning approach.

Default mode network-associated intrinsic connectivity relates to individual learnability differences in errorless and trial-and-error learning.

The intrinsic functional network architecture accounts for task-evoked brain activity changes and variabilities in cognitive performance. Relationships between the intrinsic functional network architecture and task performance or learning ability have been previously reported. However, the relationships between learning benefits and the characteristics of intrinsic functional network architecture for different types of learning methods remain unclear. In this study, we used graph theoretical analysis to examine the relationships between intrinsic functional network connectivity and learning benefits in two well-known learning methods in the field of cognitive rehabilitation-errorless learning (EL learning) and trial-and-error learning (T&E learning). We focused on the default mode network (DMN) as a task-relevant network, which can differentiate between EL and T&E learning and was found to be more important for T&E learning in a previous study. Participants performed a color-name association task with both learning methods. The graph metrics used were within-network connectivity and efficiency for the DMN. Within-DMN connectivity and DMN efficiency showed a significantly weak positive correlation with T&E scores but not with EL scores. These findings show that the intrinsic integration strength within the DMN relates to individuals' learnability through the T&E method.

Cognitive functions relating to aberrant interactions between task-positive and task-negative networks: Resting fMRI study of patients with schizophrenia.

Brain functional connectivity in the resting-state represents intrinsic functional states and correlates with cognitive performance. In patients with schizophrenia, reports on the relationships between forms of functional disconnectivity in local areas and cognitive disability have used resting-state functional magnetic resonance imaging data. Meanwhile, cognitive deficits in relation to inter-network forms of functional connectivity on a large scale are not well understood. This study examines cognitive functions in relation to the number of resting-state inter-network forms of functional connectivity focusing on task-positive networks (fronto-parietal network [FPN] and cingulo-opercular network [CON]) and task-negative network (default mode network [DMN]). We compare patients with schizophrenia (SCH group) and healthy controls (HC group). We conducted a functional network analysis by applying graph theory and evaluated cognitive functions using the Brief Assessment of Cognition in Schizophrenia. The number of forms of functional connectivity between FPN and DMN and between CON and DMN were significantly higher in SCH group than in HC group, and those in SCH group were also weakly correlated with their attention scores. It is suggested that fewer than typical functional segregations between task-positive and task-negative networks in SCH group relate to inefficient distribution of cognitive resources and low attentional abilities.

Effectiveness of robotic-assisted therapy for upper extremity function in children and adolescents with cerebral palsy: a systematic review protocol.

INTRODUCTION: The application of advanced technologies in paediatric rehabilitation to improve performance and enhance everyday functioning shows considerable promise. The aims of this systematic review are to investigate the effectiveness of robotic-assisted therapy for upper extremity function in children and adolescents with cerebral palsy and to extend the scope of intervention from empirical evidence. METHODS AND ANALYSIS: Multiple databases, including MEDLINE (Ovid), PubMed, CINAHL, Scopus, Web of Science, Cochrane Library and IEEE Xplore, will be comprehensively searched for relevant randomised controlled trials and non-randomised studies. The grey literature will be accessed on the ProQuest Dissertations & Theses Global database, and a hand search from reference lists of previous articles will be performed. The papers written in English language will be considered, with no limitation on publication date. Two independent reviewers will identify eligible studies, evaluate the level of evidence (the Oxford Centre for Evidence-Based Medicine) and appraise methodological quality and risk of bias (the Standard quality assessment criteria for evaluating primary research papers from a variety of fields (QualSyst tool); the Grading of Recommendations Assessment, Development and Evaluation). Data will be appropriately extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. A narrative synthesis will be provided to summarise the results, and a meta-analysis will be conducted if there is sufficient homogeneity across outcomes. PROSPERO REGISTRATION NUMBER: CRD42020205818. ETHICS AND DISSEMINATION: Ethical approval is not required for this study. The findings will be disseminated via a peer-reviewed journal and international conferences.

Effect of a Combined Exercise and Cognitive Activity Intervention on Cognitive Function in Community-dwelling Older Adults: A Pilot Randomized Controlled Trial.

OBJECTIVE: The purpose of this study is to investigate the effect of an intervention combining exercise and cognitive activity on cognitive function in healthy older adults. METHODS: This pilot randomized controlled trial recruited 33 eligible, healthy communitydwelling older adults (mean age, 77.1 years old; women, 51.5%), who were divided into intervention and waitlist control groups. The intervention group was engaged weekly in a group activity comprising exercise and discussions of homework, which included reading aloud, simple arithmetic, and simple activities, like spotting differences, for cognitive stimulation. They were also required to complete cognitive activity homework twice a week. The waitlist control group received no intervention. The main outcomes were cognitive function assessed using the Mini-Mental State Examination, delayed recall score on the Logical Memory IIA of the Wechsler Memory Scale Revised, Trail Making Test, and digit symbol substitution test. RESULTS: According to the results, Mini-Mental State Examination scores were maintained in the intervention group but declined in the control group [Mean change in outcomes in control group (95% confidence interval): -1.68 (-2.89 to -0.48)]. Additional mean change in outcomes in intervention group were found [1.68 (0.02 to 3.35)]. CONCLUSIONS: Interventions combining exercise and cognitive activity can be helpful for preserving cognitive function in healthy older adults.

Functional network activity during errorless and trial-and-error color-name association learning.

INTRODUCTION: In cognitive rehabilitation, errorless (EL) and trial-and-error (T&E) learning are well-known methods, but their neural mechanisms are not well known. In this study, we investigated functional magnetic resonance imaging data for healthy adults during EL and T&E learning. METHODS: Participants memorized color-name associations in both methods using Japanese traditional colors which were unfamiliar to study participants. A functional network analysis was conducted by applying graph theory. We focused on two major cognitive networks: the default mode network (DMN) and the fronto-parietal network (FPN). Also, we used "within-network connectivity" and "between-network connectivity" graph metrics. The former represents the functional connectivity strength of a subnetwork, namely the within-DMN connectivity and within-FPN connectivity, while the latter represents the number of links between the DMN and FPN. RESULTS: The within-DMN connectivity in T&E learning was significantly higher than in EL learning. The difference between the memory scores of EL and T&E learning weakly correlated with the between-network connectivity differences between both learning tasks. CONCLUSIONS: Our results suggest that within-DMN connectivity is important in T&E learning and that the learning benefit differences between EL and T&E approaches potentially relate to the functional integration strength between the DMN and FPN.

Reduced Temporal Activation During a Verbal Fluency Task is Associated with Poor Motor Speed in Patients with Major Depressive Disorder.

OBJECTIVE: Substantial research has revealed cognitive function impairments in patients with major depressive disorder (MDD). However, the relationship between MDD cognitive function impairment and brain activity is yet to be elucidated. This study aimed to reveal this relationship using near-infrared spectroscopy (NIRS) to extensively measure frontotemporal cortex function. METHODS: We recruited 18 inpatients with MDD and 22 healthy controls. Regional oxygenated hemoglobin changes (oxy-Hb) were measured during a verbal fluency task and its relationship to cognitive function was assessed. Cognitive function was assessed using the Japanese version of the Brief Assessment of Cognition in Schizophrenia. RESULTS: Compared to healthy controls, patients with MDD displayed poorer motor speed, attention and speed of information processing, and executive function. In the bilateral prefrontal and temporal surface regions, regional oxy-Hb changes were significantly lower in patients with MDD than in healthy individuals. Moreover, we observed a correlation between reduced activation in the left temporal region and poor motor speed in patients with MDD. CONCLUSION: We suggest that reduced activation in the left temporal region in patients with MDD could be a biomarker of poor motor speed. Additionally, NIRS may be useful as a noninvasive, clinical measurement tool for assessing motor speed in these patients.

Everyday technology use among older adults in Sweden and Japan: A comparative study.

BACKGROUND: As context may impact everyday technology (ET) use it is relevant to study this within different contexts. AIMS: To examine the usefulness of the Everyday Technology Use Questionnaire (ETUQ) in different contexts by investigating and comparing (1) the level of challenge of ETs in the ETUQ and (2) the relevance of and perceived ability to use ET in samples of Swedish and Japanese older adults. MATERIALS AND METHODS: The Swedish and the Japanese samples (n = 86/86) were interviewed using the ETUQ about relevance of and perceived ability to use ET. Data were analyzed using Rasch analysis, chi square and a general linear model. Moreover, Differential Item Functioning (DIF) was investigated. RESULTS: The hierarchy of ETs' level of challenge was generally stable in the two contexts. On group-level, the relevance was somewhat higher and the perceived ability to use ET significantly higher in the Swedish sample than in the Japanese. CONCLUSIONS AND SIGNIFICANCE: The similarities and differences between the technological landscapes of Sweden and Japan could be detected by ETUQ, demonstrating its usefulness in both countries. The potential causes to the differences in relevance of and perceived ability to use ET between older adults in Sweden and Japan need further exploration.

Development of Computer-Aided Cognitive Training Program for Elderly and Its Effectiveness through a 6 Months Group Intervention Study.

Since the increasing population of aging, cognitive training is focused as one of the non-pharmacological preventive approach of cognitive decline. Although the accumulation of the knowledge, they hardly reflect to the programs for clinical use. We developed a task set named "Atama-no-dojo," designed to activate multiple cognitive functions and enhance motivational incentives. The objective of our study is to confirm the effect of our program through a 6 months group intervention program. The intervention program conducted in a day service center for 6 months in the duration of 45 minutes per day, 4 days per month for a total of 25 sessions. Participants worked to the tasks on the screen all together with filling in the answering sheet. Neuropsychological tests, SF36 and GDS were assessed at pre-/post-intervention periods. Participants filled in a questionnaire about impression to the program at the last training session. Fourteen women (82.2 ± 2.9 years old) were analyzed and significant changes were found in the improvement of memory, attention, inhibition, GDS and some items of SF36. All participants recognized the program as fun and wanted to continue. Some of the participants' positive impressions to the program correlated to cognitive improvement. The improved cognitive functions by 6 months intervention of "Atama-no-dojo" were mainly related to prefrontal cortex and the motivational incentives seemed supported the effect of task contents. We recognized the importance of task difficulty setting and motivational incentives to reduce frustration from working on difficult tasks and enhance the effects of improvement from activating brain function.

Social cognition and its relationship to functional outcomes in patients with sustained acquired brain injury.

Deficits in social cognition are common after traumatic brain injury (TBI). However, little is known about how such deficits affect functional outcomes. The purpose of this study was to investigate the relationship between social cognition and functional outcomes in patients with TBI. We studied this relationship in 20 patients with TBI over the course of 1 year post-injury. Patients completed neurocognitive assessments and social cognition tasks. The social cognition tasks included an emotion-perception task and three theory of mind tasks: the Faux Pas test, Reading the Mind in the Eyes (Eyes) test, and the Moving-Shapes paradigm. The Craig Handicap Assessment and Reporting Technique was used to assess functional outcomes. Compared with our database of normal subjects, patients showed impairments in all social cognition tasks. Multiple regression analysis revealed that theory of mind ability as measured by the Eyes test was the best predictor of the cognitive aspects of functional outcomes. The findings of this pilot study suggest that the degree to which a patient can predict what others are thinking is an important measure that can estimate functional outcomes over 1 year following TBI.

Awareness in Apraxia and Agnosia.

Disconnected awareness in a diagonistic dyspraxic patient and degraded awareness in a visually agnosic patient were investigated. The first case was a male patient with disconnection syndrome including diagonistic dyspraxia. Speech regulation of interruptive actions in his left hand was introduced for the purpose of reorganization of bimanual activity. As a result of the therapy, he became able to restrain his left hand activities, and be independent in activities of daily living. The second case was a male patient with visual agnosia whose dominant complaint was face recognition impairment. Measurable recovery of visual perception was achieved through activities planned to reorganize his visual perception with intact kinesthetic information.