Socratic guided feedback therapy after acquired brain injury: A multicenter randomized controlled trial to evaluate effects on self-awareness.

Impaired self-awareness after acquired brain injury (ABI) challenges neuropsychological rehabilitation. The current study aimed to compare the effects of Socratic Guided Feedback therapy to usual care in a multicenter randomized controlled trial with 64 participants with reduced self-awareness after ABI. The objectives were to study the effects on (1) self-awareness and (2) motivation for and participation in therapy, mood, quality of life, and social participation. Patients were recruited from rehabilitation centres in The Netherlands and Belgium. They were 50.8 (±16) years old and 2.7 months (±1.8) post-injury at baseline. Session duration ranged from 20-60 minutes and the number of sessions ranged from 1 to 162 sessions. Self-awareness increased over time in both groups. Between 9 and 12 months after baseline measurement, self-awareness (Patient Competency Rating Scale discrepancy score between patient and significant other) improved in the experimental group and deteriorated in care as usual. No significant differences were found on secondary outcome measures. In conclusion, Socratic Guided Feedback therapy is as effective as care as usual but provides a structure for therapists. We recommend further investigation of the added value of Socratic Guided Feedback therapy in later follow-up measurements, group therapy settings, and on other outcome domains such as caregiver burden.

Problem-Solving Therapy During Outpatient Stroke Rehabilitation Improves Coping and Health-Related Quality of Life: Randomized Controlled Trial.

BACKGROUND AND PURPOSE: This study investigated whether problem-solving therapy (PST) is an effective group intervention for improving coping strategy and health-related quality of life (HRQoL) in patients with stroke. METHODS: In this multicenter randomized controlled trial, the intervention group received PST as add-on to standard outpatient rehabilitation, the control group received outpatient rehabilitation only. Measurements were performed at baseline, directly after the intervention, and 6 and 12 months later. Data were analyzed using linear-mixed models. Primary outcomes were task-oriented coping as measured by the Coping Inventory for Stressful Situations and psychosocial HRQoL as measured by the Stroke-Specific Quality of Life Scale. Secondary outcomes were the EuroQol EQ-5D-5L utility score, emotion-oriented and avoidant coping as measured by the Coping Inventory for Stressful Situations, problem-solving skills as measured by the Social Problem Solving Inventory-Revised, and depression as measured by the Center for Epidemiological Studies Depression Scale. RESULTS: Included were 166 patients with stroke, mean age 53.06 years (SD, 10.19), 53% men, median time poststroke 7.29 months (interquartile range, 4.90-10.61 months). Six months post intervention, the PST group showed significant improvement when compared with the control group in task-oriented coping (P=0.008), but not stroke-specific psychosocial HRQoL. Furthermore, avoidant coping (P=0.039) and the utility value for general HRQoL (P=0.034) improved more in the PST group than in the control after 6 months. CONCLUSIONS: PST seems to improve task-oriented coping but not disease-specific psychosocial HRQoL after stroke >6-month follow-up. Furthermore, we found indications that PST may improve generic HRQoL recovery and avoidant coping. CLINICAL TRIAL REGISTRATION: URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2509. Unique identifier: CNTR2509.

Cognitive neuroactivation using SPECT and the Stroop Colored Word Test in patients with diffuse brain injury.

Psychomotor slowing in patients with diffuse brain injury frequently underlies impaired cognitive performance on neuropsychological tests, for example, the Stroop Colored Word test. The aim of the present study was to determine the neural basis associated with performance on the Stroop interference subtask in patients with diffuse brain injury. We hypothesized that patients would be slower than healthy controls, and that this would be associated with brain activations other than those seen in healthy subjects. Brain perfusion, using a split-dose activation paradigm with single photon emission tomography (SPECT) and the Stroop test, was assessed in 9 patients with diffuse brain injury. The Stroop interference score was calculated as a behavioral parameter, and functional imaging data were analyzed with statistical parametrical mapping (SPM99) to determine significant voxel-wise differences of activation between the control and the activation condition. Patients were impaired on the interference subtask of the Stroop test. Comparison of the SPECT data obtained during the activation condition with those obtained during the control condition by means of SPM showed significant activations in the left inferior parietal lobe, the right anterior cingulate extending into the right middle frontal gyrus and the right caudate, and the left posterior cingulate cortex. Patients with diffuse brain injury were slower than healthy controls on the interference subtask of the Stroop test, suggesting difficulty with resistance to distractions. This finding was associated with activation effects in posterior (mainly parietal) brain areas in addition with activation of previously observed anterior (mainly anterior cingulate) brain regions.

Epidemiology of acquired brain injury (ABI) in adults: prevalence of long-term disabilities and the resulting needs for ongoing care in the region of Flanders, Belgium.

In order to plan services for long-term care of those with acquired brain injury (ABI), the prevalence of ABI was investigated by using a postal inquiry sent to a representative sample of general practitioners, of whom 121 cooperated and registered 186 cases. The corresponding estimated prevalence of adults with ABI-related disabilities is 183 per 100 000 population. The large majority remained at home without professional assistance. One in five had resumed education or regained full employment, but over half spent their day at home with no specific activity. The need for specific care at home was present in almost half of the patients. One-quarter had employment-related needs, and one in five had living needs for specialized accommodation or supported living. In conclusion, this study primarily revealed unfulfilled needs in the area of day services aiming at a maximal social and professional reintegration.