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1.
BMC Psychol ; 8(1): 125, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-33243286

RESUMO

BACKGROUND: Acquired Brain Injury (ABI) admissions have an incidence of 385 per 100,000 of the population in the UK, and as brain injury often involves the frontal networks, cognitive domains affected are likely to be executive control, working memory, and problem-solving deficits, resulting in difficulty with everyday activities. The above observations make working memory, and related constructs such as attention and executive functioning attractive targets for neurorehabilitation. We propose a combined home-based rehabilitation protocol involving the concurrent administration of a working memory training program (adaptive N-back task) with non-invasive transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex to promote long-lasting modification of brain areas underlying working memory function. METHOD: Patients with a working memory deficit will be recruited and assigned to two age-matched groups receiving working memory training for 2 weeks: an active group, receiving tDCS (2 mA for 20 min), and a control group, receiving sham stimulation. After the end of the first 2 weeks, both groups will continue the working memory training for three more weeks. Outcome measures will be recorded at timepoints throughout the intervention, including baseline, after the 2 weeks of stimulation, at the end of the working memory training regimen and 1 month after the completion of the training. DISCUSSION: The aim of the study is to assess if non-invasive tDCS stimulation has an impact on performance and benefits of a working memory training regimen. Specifically, we will examine the impact of brain stimulation on training gains, if changes in gains would last, and whether changes in training performance transfer to other cognitive domains. Furthermore, we will explore whether training improvements impact on everyday life activities and how the home-based training regimen is received by participants, with the view to develop an effective home healthcare tool that could enhance working memory and daily functioning. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov: NCT04010149 on July 8, 2019.


Assuntos
Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/terapia , Cognição/fisiologia , Memória de Curto Prazo/fisiologia , Estimulação Transcraniana por Corrente Contínua , Adulto , Idoso , Encéfalo/fisiologia , Encéfalo/fisiopatologia , Lesões Encefálicas/reabilitação , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
PLoS One ; 15(10): e0238506, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002026

RESUMO

The aim of the study is to investigate how time and uncertainties of clinical action and decision-making plays out in the practical work of early neurorehabilitation in order to present new analytical ways to understand the underlying logics and dynamic social processes that take place during professional treatment of patients with severe acquired brain injury. Drawing on ethnographic fieldwork in a Danish neuro-intensive step-down unit (NISU) specialising in early neurorehabilitation, we found that negotiation of futures takes place in the modern ICU in the present by strategically building upon past experiences. We have argued that the clinical programme therefore cannot be understood only from a "here and now perspective", since the early neurorehabilitation practice is embedded in overlapping temporalities of the past, the present, and desired futures. The study discusses the underlying logics-often hidden or unnoticed-that impact clinical practice of early neurorehabilitation, in what we have termed a logic of clinical reenactment, a logic of future negotiation and a logic of paradox.


Assuntos
Lesões Encefálicas/reabilitação , Reabilitação Neurológica/métodos , Antropologia Cultural , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/psicologia , Tomada de Decisões , Dinamarca , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Reabilitação Neurológica/ética , Fatores de Tempo , Incerteza
3.
Ann Neurol ; 88(4): 747-758, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32740976

RESUMO

OBJECTIVE: We conducted a multisite, randomized, double-blinded, controlled trial to examine the effectiveness of a digital health intervention targeting the intrinsic regulation of goal-directed alertness in patients with chronic hemispatial neglect. METHODS: Forty-nine participants with hemispatial neglect, who demonstrated significant spatially biased attention after acquired brain injury, were randomly assigned to the experimental attention remediation treatment or the active control group. The participants engaged with the remotely administered interventions for 12 weeks. The primary outcome was spatial bias on the Posner cueing task (response time difference: left minus right target trials). Secondary outcomes included functional abilities (measured via the Catherine Bergego scale and Barthel index), spatial cognition, executive function, quality of life, and sleep. Assessments were conducted before and immediately after participation in the experimental intervention or control condition, and again after a 3-month no-contact period. RESULTS: Compared with the active control group, the intervention group exhibited a significant improvement in the primary outcome, a reduction in spatially biased attention on the Posner cueing task (p = 0.010, Cohen's d = 0.96), in addition to significant improvements in functional abilities as measured on the Catherine Bergego and Barthel indices (p = 0.027, Cohen's d = 0.24). INTERPRETATION: Our results demonstrate that our attention training program was effective in improving the debilitating attention deficits common to hemispatial neglect. This benefit generalized to improvements in real-world functional abilities. This safe, highly scalable, and self-administered treatment for hemispatial neglect might serve as a useful addition to the existing standard of care. ANN NEUROL 2020;88:747-758.


Assuntos
Lesões Encefálicas/reabilitação , Transtornos da Percepção/reabilitação , Recuperação de Função Fisiológica , Software , Adulto , Idoso , Atenção , Lesões Encefálicas/complicações , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Percepção/etiologia
4.
PLoS One ; 15(8): e0237136, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790771

RESUMO

BACKGROUND: There is increasing focus on earlier rehabilitation in patients with traumatic or hypoxic brain injury or stroke. This systematic review evaluates the benefits and harms of early head-up mobilisation versus standard care in patients with severe acquired brain injury. METHODS: We searched Medline, CENTRAL, EMBASE, four other databases and 13 selected clinical trial registries until April 2020. Eligible randomised clinical trials compared early head-up mobilisation versus standard care in patients with severe acquired brain injury and were analysed conducting random- and fixed-effects meta-analyses and Trial Sequential Analysis (TSA). Certainty of evidence was assessed by GRADE. MAIN RESULTS: We identified four randomised clinical trials (total n = 385 patients) with severe acquired brain injury (stroke 86% and traumatic brain injury 13%). Two trials were at low risk and two at high risk of bias. We found no evidence of a difference between early mobilisation vs. standard care on mortality or poor functional outcome at end of the intervention (relative risk (RR) 1.19, 95% CI 0.93 to 1.53; I2 0%; very low certainty) or at maximal follow-up (RR 1.03, 95% CI 0.89 to 1.21; I2 0%; very low certainty). We found evidence against an effect on quality of life at maximal follow-up. The proportion of patients with at least one serious adverse event did not differ at end of intervention or at maximal follow-up. For most comparisons, TSA suggested that further trials are needed. CONCLUSIONS: We found no evidence of a difference between early mobilisation versus standard care for patients with severe acquired brain injury. Early mobilisation appeared not to exert a major impact on quality of life. This systematic review highlights the insufficient evidence in patients with severe brain injury, and no firm conclusions can be drawn from these data. TRIAL REGISTRATION: Protocol uploaded to PROSPERO: April 2018 (revised October 2018, CRD42018088790).


Assuntos
Lesões Encefálicas/reabilitação , Posicionamento do Paciente/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/terapia , Humanos , Pessoa de Meia-Idade , Posicionamento do Paciente/efeitos adversos , Posicionamento do Paciente/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Reabilitação do Acidente Vascular Cerebral/normas
5.
NeuroRehabilitation ; 47(1): 11-24, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32675423

RESUMO

BACKGROUND: Stress is common to the experience of TBI. Stressors challenge physical and psychological coping abilities and undermine wellbeing. Brain injury constitutes a specific chronic stressor. An issue that hinders the usefulness of a stress-based approach to brain injury is a lack of semantic clarity attaching to the term stress. A more precise conceptualisation of stress that embraces experienced uncertainty is allostasis. OBJECTIVE: An emerging body of research, collectively identifiable as 'the social cure' literature, shows that the groups that people belong to can promote adjustment, coping, and well-being amongst individuals confronted with injuries, illnesses, traumas, and stressors. The idea is deceptively simple, yet extraordinarily useful: the sense of self that individuals derive from belonging to social groups plays a key role in determining health and well-being. The objective of this research was to apply a social cure perspective to a consideration of an individual's lived experience of TBI. METHODS: In a novel application of interpretative phenomenological analysis (IPA) this research has investigated one person's lived experience in a single case study of traumatic brain injury. RESULTS: Paradox, shifting perspectives and self under stress, linked by uncertainty, were the themes identified. CONCLUSIONS: A relational approach must be key to TBI rehabilitation.


Assuntos
Adaptação Psicológica , Lesões Encefálicas Traumáticas/reabilitação , Lesões Encefálicas/reabilitação , Lesões Encefálicas/psicologia , Lesões Encefálicas Traumáticas/psicologia , Objetivos , Humanos
6.
Arch Phys Med Rehabil ; 101(11): 1937-1945, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32585170

RESUMO

OBJECTIVES: To investigate whether the combination of self-efficacy levels of individuals with spinal cord injury (SCI) or acquired brain injury (ABI) and their significant others, measured shortly after the start of inpatient rehabilitation, predict their personal and family adjustment 6 months after inpatient discharge. DESIGN: Prospective longitudinal study. SETTING: Twelve Dutch rehabilitation centers. PARTICIPANTS: Volunteer sample consisting of dyads (N=157) of adults with SCI or ABI who were admitted to inpatient rehabilitation and their adult significant others. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-efficacy (General Competence Scale) and personal and family adjustment (Hospital Anxiety and Depression Scale and McMaster Family Assessment Device General Functioning). RESULTS: In 20 dyads, both individuals with SCI or ABI and their significant others showed low self-efficacy at baseline. In 67 dyads, both showed high self-efficacy. In the low-self-efficacy dyads, 61% of the individuals with SCI or ABI and 50% of the significant others showed symptoms of anxiety 6 months after discharge, vs 23% and 30%, respectively, in the high-self-efficacy dyads. In the low-self-efficacy dyads, 56% of individuals with SCI or ABI and 50% of the significant others reported symptoms of depression, vs 20% and 27%, respectively, in the high-self-efficacy dyads. Problematic family functioning was reported by 53% of the individuals with SCI or ABI and 42% of the significant others in the low-self-efficacy dyads, vs 4% and 12%, respectively, in the high-self-efficacy dyads. Multivariate analysis of variance analyses showed that the combination of levels of self-efficacy of individuals with SCI or ABI and their significant others at the start of inpatient rehabilitation predict personal (V=0.12; F6,302=2.8; P=.010) and family adjustment (V=0.19; F6,252=4.3; P<.001) 6 months after discharge. CONCLUSIONS: Low-self-efficacy dyads appear to be more at risk for personal and family adjustment problems after discharge. Screening for self-efficacy may help healthcare professionals to identify and support families at risk for long-term adjustment problems.


Assuntos
Adaptação Psicológica , Lesões Encefálicas/psicologia , Família/psicologia , Autoeficácia , Traumatismos da Medula Espinal/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/reabilitação , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Países Baixos , Alta do Paciente , Participação do Paciente/psicologia , Estudos Prospectivos , Centros de Reabilitação , Traumatismos da Medula Espinal/reabilitação , Fatores de Tempo , Adulto Jovem
7.
Arch Phys Med Rehabil ; 101(12): 2093-2102, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32599061

RESUMO

OBJECTIVES: To identify intra- and interpersonal sociodemographic, injury-related, and psychological variables measured at admission of inpatient rehabilitation that predict psychological distress among dyads of individuals with spinal cord injury (SCI) or acquired brain injury (ABI) and their significant others (ie, individuals close to the individual with a disability, mostly family members) 6 months after discharge. Differences in predictors were investigated for persons with SCI or ABI and their significant others and were compared between diagnoses. DESIGN: Prospective longitudinal study. SETTING: Twelve Dutch rehabilitation centers. PARTICIPANTS: Dyads (N=157) consisting of adults with SCI or ABI who were admitted to inpatient rehabilitation and their adult significant others. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Psychological distress (Hospital Anxiety and Depression Scale). RESULTS: Sociodemographic and injury-related variables were not or were only weakly associated with psychological distress among individuals with SCI or ABI and their significant others 6 months after discharge. Bivariately, higher baseline psychological distress, lower scores on adaptive psychological characteristics (combination of self-efficacy, proactive coping, purpose in life, resilience), and higher scores on maladaptive psychological characteristics (combination of passive coping, neuroticism, appraisals of threat and loss) were related to higher psychological distress, as well as crosswise between individuals with SCI or ABI and their significant others, although less strongly. Combined prediction models showed that psychological distress among persons with SCI or ABI was predicted by education level of their significant other, their own baseline psychological distress, and their own maladaptive psychological characteristics (explained variance, 41.9%). Among significant others, only their own baseline psychological distress predicted psychological distress (explained variance, 40.4%). Results were comparable across diagnoses. CONCLUSIONS: Although a dyadic connection was shown, primarily one's own baseline psychological distress and psychological characteristics were important in the prediction of later psychological distress among both individuals with SCI or ABI and their significant others. Screening based on these variables could help to identify persons at risk for psychological distress.


Assuntos
Lesões Encefálicas/psicologia , Família/psicologia , Pacientes Internados/psicologia , Angústia Psicológica , Traumatismos da Medula Espinal/psicologia , Adaptação Psicológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/reabilitação , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Países Baixos , Alta do Paciente , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Centros de Reabilitação , Parceiros Sexuais/psicologia , Traumatismos da Medula Espinal/reabilitação , Adulto Jovem
8.
NeuroRehabilitation ; 46(4): 511-518, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32538884

RESUMO

BACKGROUND: Caregiver burden is experienced by a significant number of caregivers of survivors of acquired brain injury (ABI). It is known that self-awareness can impact functioning following ABI. However, the impact of self-awareness on caregiver burden has not been established. OBJECTIVE: To investigate the relationship between self-awareness and caregiver burden following ABI. METHODS: We studied 57 patient-caregiver pairs up to 28 years post-discharge from a post-acute comprehensive holistic milieu-oriented neurorehabilitation program. The Mayo-Portland Adaptability Inventory-4 (MPAI-4) was completed by survivors of ABI and their caregivers. Discrepancies in reports between survivors of ABI and their caregivers were used to determine self-awareness. Additionally, caregivers completed the Zarit Burden Interview (ZBI). RESULTS: Survivors of ABI with impaired self-awareness reported significantly higher levels of functioning than survivors of ABI with unimpaired self-awareness (p < 0.001). Unimpaired self-awareness (p < 0.001) and lower survivor self-reported MPAI-4 Total Score (p < 0.001) significantly predicted caregiver burden. CONCLUSIONS: Survivors of ABI's level of functioning and their level of self-awareness significantly impacted caregiver burden. Survivors of ABI with impaired self-awareness not only lack insight into their functional abilities but also tend to overestimate their capabilities; this likely contributes to the need for greater levels of supervision and worsened caregiver burden.


Assuntos
Adaptação Psicológica , Lesões Encefálicas/psicologia , Cuidadores/psicologia , Reabilitação Neurológica/psicologia , Atividades Cotidianas , Adulto , Idoso , Lesões Encefálicas/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Lancet Neurol ; 19(7): 611-622, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32562686

RESUMO

More patients are surviving cardiac arrest than ever before; however, the burden now lies with estimating neurological prognoses in a large number of patients who were initially comatose, in whom the ultimate outcome is unclear. Neurologists, neurointensivists, and clinical neurophysiologists must accurately balance the concern that overly conservative prognostication could leave patients in a severely disabled state, with the possibility that inaccurately pessimistic prognostication could lead to the withdrawal of life-sustaining treatment in patients who might otherwise have a good functional outcome. Prognostic tools have improved greatly, including electrophysiological tests, neuroimaging, and chemical biomarkers. Conclusions about the prognosis should be delayed at least 72 h after arrest to allow for the clearance of sedative drugs. Cognitive impairments, emotional problems, and fatigue are common among patients who have survived cardiac arrest, and often go unrecognised despite being related to caregiver burden and a decreased participation in society. Through simple screening, these problems can be identified, and patients can be provided with adequate information and rehabilitation.


Assuntos
Coma/etiologia , Coma/reabilitação , Parada Cardíaca/complicações , Hipóxia Encefálica/etiologia , Hipóxia Encefálica/reabilitação , Lesões Encefálicas/etiologia , Lesões Encefálicas/reabilitação , Humanos , Prognóstico
10.
Arch Phys Med Rehabil ; 101(11): 1906-1913, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32428445

RESUMO

OBJECTIVE: To identify the effect of some clinical characteristics of severe acquired brain injury (sABI) patients on decannulation success during their intensive rehabilitation unit (IRU) stay. DESIGN: Nonconcurrent cohort study. SETTING: Don Gnocchi Foundation Institute. PARTICIPANTS: Patients (N=351) with sABI and tracheostomy were retrospectively selected from the database of the IRU of the Don Gnocchi Foundation Institute. MAIN OUTCOME MEASURES: Potential predictors of decannulation were screened from variables collected at admission during clinical examination, conducted by trained and experienced examiners. The association between clinical characteristics and decannulation status was investigated through a Cox regression model. Kaplan-Meier curves were then created for time-event analysis. RESULTS: Among the patients (mean age, 64.1±15.5y), 54.1% were decannulated during their IRU stay. Absence of pulmonary infections (P<.001), sepsis (P=.001), tracheal alteration at the fibrobronchoscopy examination (P=.004) and a higher Coma Recovery Scale-Revised (CRS-R) score (P<.001) or a better state of consciousness at admission (P=.001) were associated with a higher probability of decannulation. CONCLUSIONS: Fibrobronchoscopy assessment of patency of airways and accurate evaluation of the state of consciousness using the CRS-R are relevant in this setting of care to better identify patients who are more likely to have the tracheostomy tube removed. These results may help clinicians choose the appropriate timing and intensity of rehabilitation interventions and plan for discharge.


Assuntos
Extubação , Lesões Encefálicas/reabilitação , Transtornos da Consciência/reabilitação , Traqueostomia , Idoso , Lesões Encefálicas/complicações , Lesões Encefálicas/fisiopatologia , Broncoscopia , Transtornos da Consciência/etiologia , Bases de Dados Factuais , Feminino , Escala de Coma de Glasgow , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento
11.
Tog (A Coruña) ; 17(1): 55-64, mayo 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196305

RESUMO

OBJETIVOS: valorar la eficacia del uso de la Tele-rehabilitación en la terapia ocupacional en pacientes con daño neurológico. MÉTODOS: se realizó una búsqueda a través de OTSeeker, Pubmed, Cochrane Library, Tripdatabase, International Journal of Telerehabilitation, The American Journal of Occupational Therapy, International Journal of Stroke, Journal of Telemedicine and Telecare, Clinical Rehabilitation y SAGE sobre artículos que hayan sido publicados entre los años 2009 y 2020 de la literatura inglesa y con un rango de edad de los y las pacientes variable. Fueron seleccionadas aquellas publicaciones donde se implicará el ámbito neurológico en el uso de la tele-rehabilitación. RESULTADOS: se evaluaron un total de 20 publicaciones, de las cuales 16 se referían a ensayos controlados aleatorizados, ensayos cuasi experimentales e informes de caso. Las 4 publicaciones restantes se referían a revisiones sistemáticas. En dichas publicaciones, se mostraron resultados positivos en componentes motores, cognitivos y emocionales. Además de que, la implementación de este método, no suponía un alto coste económico para los pacientes. CONCLUSIONES: Para mejorar nuestro entendimiento en este tema es necesario realizar un mayor número de estudios. Sin embargo, según los resultados mostrados, se puede evidenciar que el uso de la tele-rehabilitación en terapia ocupacional en pacientes con daño neurológico es una opción eficaz y viable como complemento a la terapia ocupacional convencional


OBJECTIVE: To evaluate the efficacy of Tele-rehabilitation in Occupational Therapy on patients with neurological damage. METHODS: Research was focused on publications made between 2009 and 2020, published in English literature and based on patients within a variable range of age. These include: OTSeeker, Pubmed, Cochrane Library, Tripdatabase, International Journal of Telerehabilitation, The American Journal of Occupational Therapy, International Journal of Stroke, Journal of Telemedicine and Telecare, Clinical Rehabilitation and SAGE. The publications were selected according to the involvement of the neurological field with the use of tele-rehabilitation. RESULTS: A total of 20 publications were evaluated, of which 16 referred to randomized controlled trials, quasi-experimental trials and case reports. The remaining 4 publications concerned systematic reviews. In these publications, positive results were shown in motor, cognitive and emotional components. In addition the implementation of this method did not imply a high economic cost for patients. CONCLUSIONS: In order to improve our understanding in this topic it is necessary to carry out a greater number of studies. However according to the results shown, it can be concluded that the use of tele-rehabilitation in occupational therapy in patients with neurological damage is an effective and viable option as a complement to conventional occupational therapy


Assuntos
Humanos , Telerreabilitação/métodos , Terapia Ocupacional/métodos , Resultado do Tratamento , Lesões Encefálicas/reabilitação , Acidente Vascular Cerebral/terapia , Telemedicina/métodos , Doenças do Sistema Nervoso/reabilitação , Doenças do Sistema Nervoso/terapia
12.
Rev Med Suisse ; 16(692): 894-897, 2020 May 06.
Artigo em Francês | MEDLINE | ID: mdl-32374532

RESUMO

Deficits of episodic memory and subjective memory complaints are common in adults with acquired brain injury. These impairments are likely to have a negative impact on daily activities and vocational integration. Neuropsychological assessments examine their degree of severity, the nature of the impaired processes and the presence of other, associated cognitive or affective symptoms. Cognitive rehabilitation mainly aims at reducing the impact of persisting memory difficulties on everyday life using compensation strategies. Cognitive rehabilitation studies have improved their quality in the last decade, as indicated by the increased number of randomized controlled trials and demonstrated the efficacy of some therapeutic interventions on various variables.


Assuntos
Lesões Encefálicas/diagnóstico , Lesões Encefálicas/reabilitação , Cognição , Transtornos da Memória/diagnóstico , Transtornos da Memória/reabilitação , Memória Episódica , Lesões Encefálicas/psicologia , Humanos , Transtornos da Memória/psicologia , Testes Neuropsicológicos , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Rev Med Suisse ; 16(692): 901-903, 2020 May 06.
Artigo em Francês | MEDLINE | ID: mdl-32374533

RESUMO

Patients with acquired brain injury often suffer from pathological fatigue that differs from "normal" fatigue in that it appears more quickly and during non-demanding tasks, and recovery is not complete despite rest. It limits physical and cognitive activities, interferes with rehabilitation and return to work. The underlying mechanisms are poorly understood but appear to involve dysfunction of brain interactions. Current management combining physical reconditioning, cognitive compensatory strategies, and treatment of associated factors often leads to significant clinical improvement and promotes socio-professional reintegration. However, the effect remains insufficient in some patients, which underlines the importance of developing new therapeutic approaches based on a better understanding of the underlying neuronal deficits.


Assuntos
Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/reabilitação , Encéfalo/fisiopatologia , Fadiga/complicações , Fadiga/fisiopatologia , Lesões Encefálicas/complicações , Lesões Encefálicas/psicologia , Cognição , Humanos , Descanso
14.
Am J Occup Ther ; 74(3): 7403205130p1-7403205130p10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365319

RESUMO

IMPORTANCE: Before introducing strategy training into a cross-cultural (Chinese) context, it is necessary to evaluate its feasibility. OBJECTIVE: To examine the feasibility of applying strategy training to improve participation outcomes of rehabilitation patients in Taiwan and evaluate the potential intervention effects. DESIGN: A single-group, repeated-measures study. SETTING: Rehabilitation outpatient settings. PARTICIPANTS: A convenience sample of adults (N = 20) with a primary diagnosis of acquired brain injury (ABI) and with cognitive impairment received the intervention and were assessed before and after it. INTERVENTION: The participation-focused strategy training intervention, a modified version of the strategy training intervention, was provided to participants in 1-2 sessions weekly for a total of 10-20 intervention sessions. OUTCOMES AND MEASURES: Feasibility indicators, Participation Measure-3 Domains, 4 Dimensions (PM-3D4D), and Canadian Occupational Performance Measure (COPM). RESULTS: Eighteen participants completed 100% of the scheduled intervention sessions. Participants had very good engagement in the intervention sessions with sufficient comprehension. Participants reported moderate to high satisfaction. Positive score changes were observed for the PM-3D4D (d = 0.46-1.25) and COPM scales (d = 1.82 and 2.12). CONCLUSIONS AND RELEVANCE: This study demonstrated the feasibility of delivering participation-focused strategy training in Taiwan to people with cognitive impairment after ABI. The preliminary evidence also showed that participants who received the strategy training intervention had positive changes in participation outcomes and in performance of their self-identified goals. On the basis of this study's findings, a larger clinical trial is warranted to evaluate the efficacy of the strategy training intervention. WHAT THIS ARTICLE ADDS: Participation-focused strategy training is feasible and acceptable for Taiwanese community-dwelling adults with cognitive impairment after ABI. However, because strategy training is quite different from traditional rehabilitation delivered in Taiwan, additional instructions and discussion among the therapist, client, and caregiver may be needed before the intervention is provided.


Assuntos
Lesões Encefálicas/reabilitação , Disfunção Cognitiva/reabilitação , Terapia Ocupacional , Adulto , Estudos de Viabilidade , Humanos , Taiwan
15.
NeuroRehabilitation ; 46(3): 271-285, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310195

RESUMO

BACKGROUND: Neurorehabilitation services are often delivered through group psycho-education programmes. However, little is known about the therapeutic process at work during such sessions. The present study is the first to gain insight into the therapeutic alliance, during a seven-session group programme. In addition, cognitive, emotional, and demographic predictors of the alliance, and participants' feelings towards their group members, were investigated, together with predictors of patient engagement. METHODS: Forty-five participants with an acquired brain injury completed a series of questionnaires, and neuropsychological assessment, following group psycho-education. The group facilitator completed a parallel therapeutic alliance questionnaire, and rated participants' engagement. RESULTS: Results demonstrated that a strong alliance can be formed in seven group sessions. Notably, no demographic or cognitive factors appear to pose a barrier to developing a therapeutic alliance, nor to group attraction. CONCLUSION: High levels of depression, however, may be a challenge, and clinicians may need to tailor their clinical skills to ensure a good therapeutic relationship with such patients. To promote engagement, clinicians may also need to provide additional support to patients with lower levels of education, working memory, and episodic memory impairment.


Assuntos
Reabilitação Neurológica/psicologia , Relações Profissional-Paciente , Psicoterapia de Grupo , Lesões Encefálicas/reabilitação , Depressão , Humanos , Testes Neuropsicológicos , Inquéritos e Questionários
16.
Artigo em Inglês | MEDLINE | ID: mdl-32244476

RESUMO

Workplace participation of individuals with disabilities continues to be a challenge. The International Classification of Functioning, Disability and Health (ICF) places importance on the environment in explaining participation in different life domains, including work. A scoping review was conducted to investigate environmental facilitators and barriers relevant to workplace participation for transition-aged young adults aged 18-35 with brain-based disabilities. Studies published between 1995 and 2018 were screened by two reviewers. Findings were categorized into the ICF's environmental domains: Products and technology/Natural environment and human-made changes to environment, Support and relationships, Attitudes, and Services, systems and policies. Out of 11,515 articles screened, 31 were retained. All environmental domains of the ICF influenced workplace participation. The majority of the studies (77%) highlighted factors in the Services, systems and policies domain such as inclusive and flexible systems, and well-defined policies exercised at the organizational level. Social support mainly from family, friends, employers and colleagues was reported as a facilitator (68%), followed by physical accessibility and finally, the availability of assistive technology (55%). Attitudes of colleagues and employers were mostly seen as a barrier to workplace participation (48%). Findings can inform the development of guidelines and processes for implementing and reinforcing policies, regulations and support at the organization level.


Assuntos
Pessoas com Deficiência , Local de Trabalho , Adolescente , Adulto , Encéfalo , Lesões Encefálicas/reabilitação , Estudos de Coortes , Estudos Transversais , Humanos , Estudos Longitudinais , Qualidade de Vida , Estudos Retrospectivos , Participação Social , Apoio Social , Adulto Jovem
17.
Phys Ther ; 100(5): 747-756, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32339243

RESUMO

Beth E. Fisher, PT, PhD, FAPTA, is a physical therapist, educator, and scholar whose clinical career has been shaped by numerous observations and experiences of patients' remarkable potential to recover ideal movement capability. Currently, Dr Fisher is a Professor of Clinical Physical Therapy in the Division of Biokinesiology and Physical Therapy at the University of Southern California. She is Director of the Neuroplasticity and Imaging Laboratory, primarily using transcranial magnetic stimulation to investigate brain-behavior relationships during motor skill learning and motor control in both individuals without disabilities and individuals with neurologic disorders. Dr Fisher previously worked at Rancho Los Amigos Medical Center on the Adult Neurology and Brain Injury Services. During her years as a clinician and rehabilitation specialist, it was her greatest ambition to be a part of developing physical therapist interventions that would maximize neural and behavioral recovery in individuals with pathological conditions affecting the nervous system. Toward this goal, she has continued to consult and teach nationally and internationally on current concepts for the treatment of adults with neurological disorders. It has been her consistent clinical observation not only that patients are limited by impairments that result from their injury, but that movement abnormalities are in part the result of a patient's automatic, implicit tendency to "respond" to those impairments via compensation.


Assuntos
Lesões Encefálicas/reabilitação , Movimento/fisiologia , Doenças do Sistema Nervoso/reabilitação , Plasticidade Neuronal/fisiologia , Fisioterapeutas/tendências , Encéfalo/fisiopatologia , Humanos
18.
J Allied Health ; 49(1): 60-66, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32128540

RESUMO

BACKGROUND: Preliminary evidence shows the successes of student-run free clinics (SRFC) in improving patient health; however, continued research is required on the effectiveness of student-delivered occupational therapy (OT) for individuals with acquired brain injury (ABI). The purpose of this study was to evaluate the effectiveness of OT treatment on patient outcomes in a SRFC for ABI. METHODS: A single-group pre/post study examined the effect of a 12-week OT intervention for 26 individuals with ABI on seven outcome measures using Cohen's d and effect size r for non-normal samples. RESULTS: The intervention had a large effect (≥0.8) on upper extremity function, goal improvement, and functional balance, a medium effect (0.5 < x < 0.8) on self-perceived physical health and activity participation, and a small effect (0.2 < x < 0.5) on cognition and mood outcomes. CONCLUSIONS: This is the first study to show the effectiveness of an OT SRFC. Participation in this clinic had a positive effect on activity-based goals, physical, cognitive, health, and psychosocial outcomes of clients with ABI.


Assuntos
Lesões Encefálicas/reabilitação , Terapia Ocupacional , Clínica Dirigida por Estudantes , Resultado do Tratamento , Adulto , Idoso , Lista de Checagem , Bases de Dados Factuais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pesquisa Qualitativa
19.
Artigo em Russo | MEDLINE | ID: mdl-32207708

RESUMO

INTRODUCTION: Children who have suffered brain damage form a large group of patients in need of rehabilitation. For rehabilitation, patients require not only surgical, neurosurgical, traumatological, pharmacological and other medical support, but also the creation of special conditions for psychiatric care, psychological and pedagogical correction of their psychophysical potential. Neurological, motor and mental consequences of severe injuries of the nervous system in children lead to a high degree of disability with a subsequent restriction of their life, where social maladaptation and a violation of the quality of life are the primary problems. An integrated approach with differentiated qualified help will increase the effectiveness of rehabilitation programs and help the children adapt when they return to their normal environment. AIM: To identify the characteristics of mental activity during the recovery of the level of consciousness in children after acute severe brain damage at an early stage of rehabilitation. MATERIAL AND METHODS: We examined 210 children under the age of 18 years with severe brain damage (traumatic brain injury, hypoxia, hydrocephalus) who were admitted for treatment and rehabilitation. Clinical-psychopathological, pedagogical methods were used for examination as well as diagnostic scales, questionnaires. RESULTS: The main differentiating signs were divided into three groups, depending on the mental activity of the child, the level of consciousness: Group 1 - 37 (18%) patients with mental activity with physical, cognitive and social abilities with the minimal '+' consciousness (a-/hyperkinetic mutism with emotional reactions, understanding of speech); 2-nd group - 67 (32%) patients with dominant manifestations of physical and cognitive abilities with the minimal '-' consciousness (a-/hyperkinetic mutism without emotional manifestations and understanding of speech); 3rd group - 106 (50%) children with a weak manifestation of mental activity (physical abilities) in a vegetative status/exit from a vegetative status. CONCLUSION: Three variants of mental activity in children after acute severe brain injuries were distinguished - from minimal involuntary reactions or their absence during the vegetative status/exit from the vegetative status to arbitrary actions according to the instructions of an adult with a minimum '+' consciousness. Understanding the dynamics of the recovery of children's mental activity after neurotrauma may make it possible to have a differentiated approach to psychiatric, psychological and pedagogical rehabilitation in order to correct the recovery of mental functions in pediatric patients, and to prevent the developmental disorders as the child grows.


Assuntos
Lesões Encefálicas/psicologia , Lesões Encefálicas/reabilitação , Criança , Humanos , Índices de Gravidade do Trauma , Resultado do Tratamento
20.
Eur J Radiol ; 126: 108963, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32208296

RESUMO

PURPOSE: To test markers from conventional and diffusion Magnetic Resonance Imaging (MRI) as possible predictors of cognitive outcome following rehabilitation therapy in children with acquired brain injury (ABI). METHODS: Twenty-one children (10 boys, mean age 11.6 years, range 7.1-19.4) with stroke or traumatic brain injury underwent MRI including Diffusion Tensor Imaging (DTI) before admission to the rehabilitation centre. The conventional images were scored according to a standardised injury scoring system, and mean Fractional Anisotropy (FA) was determined within the Corpus Callosum (CC), as this structure is hypothesised to play an important role in cognition. Both conventional MRI injury scores and mean FA of the CC and its sub-regions were compared with standard functional cognitive outcome scores. Relationships between MRI indices and cognitive outcome scores were assessed using multiple regression and receiver operating characteristic (ROC) analyses. RESULTS: A backwards regression analysis revealed that the mean FA of the CC body and genu and the supratentorial injury score appear to represent the best predictors of outcome, together with the age at rehabilitation and time in rehabilitation. In the ROC analysis, the mean FA values of the CC body and genu and the infratentorial injury score provided the highest sensitivity, while the mean FA of the CC splenium showed the highest specificity for outcome. CONCLUSIONS: The conventional MRI injury scores and DTI metrics from the CC reflect cognitive outcomes following rehabilitation. Neuroimaging methods such as MRI with DTI may therefore provide important markers for cognitive recovery after brain injury.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/reabilitação , Mapeamento Encefálico/métodos , Disfunção Cognitiva/diagnóstico , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Fatores Etários , Encéfalo/diagnóstico por imagem , Lesões Encefálicas/complicações , Criança , Disfunção Cognitiva/etiologia , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fatores Sexuais , Suíça , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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