Posts Tagged ABI

[ARTICLE] Cognitive and functional outcomes following inpatient rehabilitation in patients with acquired brain injury: A prospective follow-up study – Full Text

Abstract

Objectives: To study the effects of cognitive retraining and inpatient rehabilitation to study the effects of cognitive retraining and inpatient rehabilitation in patients with acquired brain injury (ABI).

Design and Setting: This was a prospective follow-up study in a neurological rehabilitation department of quaternary research hospital.

Patients and Methods: Thirty patients with ABI, mean age 36.43 years (standard deviation [SD] 12.6, range 18–60), mean duration of illness 77.87 days (SD 91.78, range 21–300 days) with cognitive, physical, and motor-sensory deficits underwent inpatient rehabilitation for minimum of 14 sessions over a period of 3 weeks. Nineteen patients (63%) reported in the follow-up of minimum 3 months after discharge. Type of ABI, cognitive status (using Montreal Cognitive assessment scale [MoCA] and cognitive Functional Independence Measure [Cog FIM]®), and functional status (motor FIM®) were noted at admission, discharge, and follow-up and scores were compared.

Results: Patients received inpatient rehabilitation addressing cognitive and functional impairments. Baseline MoCA, motor FIM, and Cog FIM scores were 15.27 (SD = 7.2, range 3–30), 31.57 (SD = 15.6, range 12–63), and 23.47 (SD = 9.7, range 5–35), respectively. All the parameters improved significantly at the time of discharge (MoCA = 19.6 ± 7.4 range 3–30, motor FIM® = 61.33 ± 18.7 range 12–89, Cog FIM® =27.23 ± 8.10 range 9–35). Patients were discharged with home-based programs. Nineteen patients reported in follow-up and observed to have maintained cognition on MoCA (18.8 ± 6.8 range 6–27), significantly improved (P < 0.01) on Cog FIM® (28.0 ± 7.7 range 14–35) and motor FIM® =72.89 ± 16.2 range 40–96) as compare to discharge scores.

Conclusions: Cognitive and functional outcomes improve significantly with dedicated and specialized inpatient rehabilitation in ABI patients, which is sustainable over a period.

 Introduction

Acquired brain injury (ABI) is defined as “damage to the brain, which occurs after birth and is not related to a congenital or a degenerative disease.” “These impairments may be temporary or permanent and cause physical, functional disability, or psychosocial maladjustment.”[1],[2] By this definition, ABI encompasses a wide variety of disorders of varying etiologies such as vascular, hypoxic, malignant, and traumatic. There are often long-lasting effects on domains of cognition, motor, behavior, and personality in affected individuals.[3] Cognitive impairment is common sequelae and important marker for prediction of rehabilitation outcomes, and cognitive outcome can be modified through targeted interventions.[4]

Studies suggest that traumatic brain injury (TBI) and stroke are the two main causes of ABI and regarded as important public health problem.[5] The incidence of TBI from 23 reports was found to vary greatly among European countries. Most rates were in the range 150–300/100,000 people per year.[6] The prevalence of stroke In western developed world ranges from 500 to 600/100,000. Rates per 100,000 from developing countries are also variable and range from 58 in India and 76 in the United Republic of Tanzania to 620 in China and 690 in Thailand.[7] Between 1.5 and 2 million persons are injured and 1 million die every year in India following TBI.[8] Cardiovascular diseases including stroke caused 19% of deaths in India between 2001 and 2003 and this is estimated to rise to 36% by 2030.[9] According to disease burden in India report September 2005, central nervous system malignancies (included in ABI) comprise 2% of the total cancer burden.[10] Other causes of ABI such as meningoencephalitis and stroke mimics also contribute to this pool of patients.

The majority of ABI survivors continue to live with disabilities without access to comprehensive rehabilitation services and remain a burden on caregivers and society.[11],[12] Physical and cognitive deficits are most commonly observed in these patients but are not adequately addressed due to lack of approachable rehabilitation services and awareness.[13],[14] Many of these patients opt for complementary and alternative medicine, which are popular in India but demonstrate questionable benefits.[15]

It is evident, both clinically and scientifically, that the improvement in motor control after ABI is training dependent, responding best to repetitive task training with continuous modification of the program to keep training tasks challenging to the patients (activity-based recovery and neural plasticity).[16],[17] Single or multiple domains of cognition can be affected in these patients depending on the site (s) and severity of injury. Disturbances in memory, attention, and/or executive functions are commonly involved. Deficits in language and speech, learning, abstract thinking, and orientation occur in severe cases. It is well established that cognitive deficits interfere with rehabilitation efforts and also result in a greater negative impact on quality of life.[18] Cognitive rehabilitation (CR) is a specialized treatment procedure designed to improve the cognition affected by internal or external injury to the brain. There are two types of CR: restorative and compensatory rehabilitation.[19],[20],[21] Restorative rehabilitation enables the patient to develop lost functions through specialized computerized and manual cognitive exercises. Compensatory rehabilitation helps the patient to train and use aids and tools to overcome the impairment. The objective of the present study was to rehabilitate ABI patients in all affected domains including cognitive, physical, sensory-motor, and behavior with customized inpatient programs. Another objective was to observe the effect of inpatient rehabilitation in improving cognition and functionality of the patients (by comparing admission and discharge scores). We also tried to observe whether the benefits of inpatient rehabilitation are sustainable by assessing the patients in follow-up examination a minimum of 3 months after discharge.[…]

Continue —>  Cognitive and functional outcomes following inpatient rehabilitation in patients with acquired brain injury: A prospective follow-up study Patil M, Gupta A, Khanna M, Taly AB, Soni A, Kumar J K, Thennarasu K – J Neurosci Rural Pract

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[BLOG POST] Combating Struggles with Acquired Brain Injury

The physical, neurological and emotional challenges that may arise from an acquired brain injury (ABI) are vast. Different causes and injuries create consequences that vary among individuals. Therapists need to be perceptive in order to both address struggles and provide avenues for constructive thinking.

One of the largest hurdles therapists encounter in rehabilitation with individuals who have suffered an ABI is the patient often lacks insight into their own deficits. Their injured brain signals they are fine and can successfully perform activities they used to do before injury, when in fact they may be struggling with anything from orientation and memory to executive function. This is challenging for family members and caregivers and is also is a barrier for treatment if the patient does not come to terms with these new deficits. Although insight typically improves to some degree as the patient progresses, giving the right level and amount of explanation about what has happened and future planning is helpful.

A thorough evaluation should be completed early on to identify cognitive deficits. Once strengths and deficits are identified, treatment can begin. Include tasks to promote gains in deficit areas such as memory and attention, such as deductive and/or abstract reasoning tasks, working memory tasks or word-retrieval activities. Also think about how strengths can be utilized to assist in this processIf a patient’s reading comprehension is better than auditory comprehension, printed information should be used to improve their ability to comprehend spoken information.

Combat common struggles by demonstrating compensatory strategies that aid the individual in participating in life activities. For patients experiencing memory and organization deficits, be prepared with a list of smart phone apps and functions they can use to set alerts for appointments, manage tasks, make lists, etc.

Fatigue is common in individuals recovering from a brain injury. Their brain is working “overtime” to make sense of things, and performing tasks successfully may take a great deal of conscious thought and effort. Assist patients in creating a schedule to work on their cognitive exercises and/or stay active in doing their daily activities, and include rest to help the brain recover. Once the brain begins to fatigue, there is a decrease in function. The patient will notice activities and tasks become harder, and head pain may also occur. This should signal the patient that it’s time to rest.

Lastly, there are things the brain injury survivor can focus on that will help their recovery, including:

  • Accepting their new persona
  • Allowing themselves to make mistakes
  • Striving to keep a positive attitude
  • Remembering they can continue to improve

Continued improvements may be the most important point in keeping your patient motivated. In years past, it was commonly accepted that after a window of about three years, the brain would not have any further recovery. It is now known that neuroplasticity allows for continued recovery over time with focused effort. Different parts of the brain can establish neuropathways and take over functions lost through damage to other parts of the brain.

Area Manager Jean Herauf, SLP has 30+ years’ experience, more than 20 of them with RehabVisions. Jean is active in her clinic’s local brain injury support group and has attended numerous courses over the years, and read a good deal on ABI.

Source: Combating Struggles with Acquired Brain Injury – RehabVisions

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[ARTICLE] Visual dysfunction is underestimated in patients with acquired brain injury – Full Text

Abstract

Objectives: More than 50% of human cerebral activity is related to vision. Visual impairments are therefore common after acquired brain injury, although they are often overlooked. In order to evaluate the prevalence of visual deficits in our Out-patient Brain Injury Program, a structured screening questionnaire, the Visual Interview, was administered.

Methods: A total of 170 patients with acquired brain injury, mean age 47 years, who were enrolled in the programme during 2010–12, underwent the Visual Interview. The interview consists of 18 questions concerning visual impairment and was performed on admission. The different types of visual impairment were compared with regard to sex and diagnosis.

Results: Fifty-four percent of the patients reported visual changes, mainly reading difficulties, photosensitivity, blurred vision and disorders of the visual field. Sixteen patients who did not experience visual changes also reported visual symptoms in 4–9 questions. Only slight differences were noted in the occurrence of visual symptoms when correlated with sex or diagnosis.

Conclusion: Visual impairments are common after acquired brain injury, but some patients do not define their problems as vision-related. A structured questionnaire, covering the most common visual symptoms, is helpful for the rehabilitation team to facilitate assessment of visual changes.

Introduction

The visual system is widely distributed in the brain. It is integrated in more than 50% of human cerebral activity and is fundamental for interpretation of, and interaction with, the environment (1, 2).

A pyramidal hierarchical model of visual perceptual function was presented by Warren in 1993 (3). In this model, visual cognition forms the top level, followed by, in descending order: visual memory, pattern recognition, scanning, attention and a base level holding acuity, visual fields, and ocular motor control. The model illustrates how higher visual skills evolve from integration and interaction with lower skills and how visual cognition depends on well-functioning lower levels of visual perception.

Base level disturbances, such as visual field defects (VFDs), visual acuity changes, diplopia, strabismus, photophobia and different types of binocular disorders, are common after acquired brain injury (ABI) (4, 5), and lead to chronic headache, fatigue, dizziness, reading problems, and difficulties navigating the environment (6, 7). Although a complete VFD or manifest diplopia seldom escapes notice, disturbances of ocular motor abilities and photophobia are likely to be overlooked. Examinations of convergence and accommodation are not customary in standard ophthalmological assessments. Ordinary short examinations are unable to reveal declining attention ability and fatigue. Thus, the true problems may remain hidden.

Several reports of prevalence and quality of visual deficits after ABI document visual dysfunctions in approximately 50–75% of patients (8–13). The occurrence of different visual symptoms differs between the studies, including reading disturbances, VFD, diplopia, ocular motor dysfunction and photophobia. Nevertheless, visual symptoms are often overlooked in neurorehabilitation. The observations of Sand et al. (14) are noteworthy, i.e. that 1 of 4 stroke patients with VFD, 6 months after onset of stroke, considered that their visual problems reduced quality of life and increased their disability.

Visual disturbances after ABI are common and lead to reduced quality of life. An important question is why they are so often overlooked in neurorehabilitation? A possible explanation is the difficulty for different professionals to co-operate. Vision disturbances are complex and many different professionals operate in the field. An ability to co-operate is needed for a high-quality assessment. Another explanation could be the patients’ difficulty describing their shortcomings. They experience decreased reading speed, fatigue and dizziness, but do not recognize these problems as expressions of visual deficits. A structured questionnaire at admission would help the clinician to obtain informative answers.

In 1990, Kerkhoff et al (15). compiled an “Interview Questionnaire” in order to capture visual disorders after ABI. This interview was used by Wilhelmsen 2003 (12). Jacobsson & Hamelius translated it from Norwegian to Swedish in 2010 (16). During the last 5 years we have used this questionnaire, slightly modified, termed the Vision Interview (TVI), as an aid to discover visual deficits in our Out-patient Brain Injury Program.

The aim of the present study was to examine and analyse the occurrence of self-reported visual changes in a Swedish out-patient group with medium to severe ABI, based on TVI.

Continue —> Journal of Rehabilitation Medicine – Visual dysfunction is underestimated in patients with acquired brain injury – HTML

 

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[Abstract] The feasibility and impact of a yoga pilot programme on the quality-of-life of adults with acquired brain injury – CNS

Abstract

OBJECTIVE: This pilot study measured the feasibility and impact of an 8-week yoga programme on the quality-of-life of adults with acquired brain injury (ABI).

METHODS: Thirty-one adults with ABI were allocated to yoga (n = 16) or control (n = 15) groups. Participants completed the Quality of Life After Brain Injury (QOLIBRI) measure pre- and post-intervention; individuals in the yoga group also rated programme satisfaction. Mann-Whitney/Wilcoxon and the Wilcoxon Signed Rank tests were used to evaluate between- and within-group differences for the total and sub-scale QOLIBRI scores, respectively.

RESULTS: No significant differences emerged between groups on the QOLIBRI pre- or post-intervention. However, there were significant improvements on overall quality-of-life and on Emotions and Feeling sub-scales for the intervention group only. The overall QOLIBRI score improved from 1.93 (SD = 0.27) to 2.15 (SD = 0.34, p = 0.01). The mean Emotions sub-scale increased from 1.69 (SD = 0.40) to 2.01 (SD = 0.52, p = 0.01), and the mean Feeling sub-scale from 2.1 (SD = 0.34) to 2.42 (SD = 0.39, p = 0.01).

CONCLUSION: Adults with ABI experienced improvements in overall quality-of-life following an 8-week yoga programme. Specific improvements in self-perception and negative emotions also emerged. High attendance and satisfaction ratings support the feasibility of this type of intervention for people with brain injury.

Source: Traumatic Brain Injury Resource Guide – Research Reports – The feasibility and impact of a yoga pilot programme on the quality-of-life of adults with acquired brain injury

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[WEB SITE] Neurofatigue / Invisible consequences /  

Fatigue fatigue fatigue, that is what people with brain injury often experience.

Everything takes effort. The energy for the whole day is often consumed completely within two hours. There are many brain injury victims who have insomnia ón top of this all. Another group of brain injury survivors have an increased need for sleep. But the similarity is FATIGUE.

Mental fatigue is different from physical fatigue.
We can all get an idea when talking about physical fatigue. Being tired after anexercise, after a brisk walk, after strenuous physical labor, after housework and so on.

Mental fatigue comes in thinking processes, learning and information processing,watching television extensively, doing computer actvities, but also solving problems,interpreting the behavior of other people and thinking logically.

A healthy person can also be mentally tired of all such functions if it is intense andlong enough. Healthy people can also come to a point that they become annoyed whenthe “energy” is low, and especially if that mental activity was filled with noise. It seems like you cannot endure radio or TV, or something like that, anymore.

For brain injury victims that is many times worse. The mental energy has already been exhausted after a short time. They use more parts of the brain, because the dead area must be passed by, in the communication between braincells.

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Neuro-fatigue is one of the most debilitating consequences of a brain injury, as it influences everything the injured person does, both physically and mentally. A person’s emotions can also become raw when they are tired.

At the beginning, the ABI survivor is likely to find out that he or she will be tired easily after any activity, even chatting to friends or watching television, but particularly after tasks that require concentration or physical effort. This can be very depressing, particularly if the individual is aware of this change.

They will often try to push themselves to complete a task in the belief that they might overcome their fatigue. This is seldom the right thing to do as it can lead to increased fatigue in long-term. It takes time to build up energy. Taking rest periods both in between activities and when feeling tired is essential.

More brain activity in brain injury patients

Scientists have discovered that the brain of a brain injured works harder and uses more braincells. To process information more nerve activity is shown. They try to make more interconnections to braincells.

More brain areas are involved in activities than before the brain injury. That difference can be seen with PET scans. Parts in the brain that normally show little activity in the conduct of an activity, become actively involved in the thinking process after a brain injury.

This requires many extra bypasses and energy. Therefore, the reaction is often a bit slower on a brain injured person and it requires more energy. For each brain signalbetween brain cells, needs electricity to be generated and that takes energy. It can make someone really tired.


Definition of fatigue in the scientific literature: the sense of a reduction in the capacityfor physical and / or mental labor, caused by an imbalance in the presence, the use and / or recovery of energy that is needed to perform activitiesAaronson et al (1999)

So….Brain injury = Top Sport. It deserves respect.

 

Fatigue management

Fatigue management is the starting point for a recovery. In order to manage fatigue, a person first need to accept that he or she does not have the same physical and mental stamina that he or she had before the accident.

 

Signals that the battery is running low

Tell-tale signs of fatigue can be a drawn, tense look, a pale or greyish pallor, glazed eyes, irritability and, ironically, too much activity in that the person may become restless, more distracted or more talkative and make an increased number of mistakes.

During the day, for some much earlier, the person get signals that the battery is running low.
For example, they notice that they are tired,  make more mistakes or loses concentration. Some people get headaches, others lose the overview or become irritated. These are signs that let you know that the bottom of the battery is in sight. It’s time to take a rest so that the battery can charge again.

Pay attention to bodily signals:

Do you get headaches, do you feel dizzy or feel a tension in neck and shoulders?

Pay attention to the way you do things:
Is the pace going down or do you make more mistakes than usual?

Please take notice of negative feelings: Are you cranky, you have somewhere lost interest in something, or do you feel irritated?

Please take notice of negative thoughts:

For example do you think: “I can’t take it anymore’, “How long is this gonna last?’

‘I feel inferior because I can not do it’, ‘It no longer interests me’ ?

Do you notice anything yourself these signs, ask people who know you well, whether they have in mind when your energy runs out. Ask them what signals they notice. A person’s emotions can become raw when they are tired.

 

Sleepingdisorders

Many brain injured suffer from sleeping disorders as well.

Read these factsheets..thanks to synapse.org.au

See for example our page on CSAS.

Lack of sleep has a negative effect on our cognition, mood, energy levels and appetite. The average person needs eight hours of sleep a night or will suffer from decreased concentration, energy and many other problems. These effects are multiplied many times by a brain injury.

Unfortunately, brain injury can often lead to a sleep disorder. The American Academy of Neurology reports that as many as 40 to 65 percent of people with mild traumatic brain injury complain of insomnia.

This can be hard to detect because people with brain injuries can also have a fatigue disorder. Although some may have problems with getting too much sleep, the usual sleep disorder is trouble sleeping at night, particularly problems with timing of sleep, then feeling drowsy during the day.

Causes

After a brain injury many find it not only difficult to sleep, but they are very easily awakened, sometimes dozens of times a night. On top of this, they may find themselves unable to sleep at all around 3 am, despite being desperately tired. Sleep will usually be very light, so the smallest noise brings the person instantly awake. Research suggests a major cause is disruption to normal release of certain quantities of certain neurotransmitters in the brain during sleep which causes “sleep fragmentation” due to waking up so often.

There can be a variety of other causes disrupting sleep. Discomfort from headache, neck pain or back pain will always make it hard to get to sleep. Depression is a common feature after a brain injury and survivors may find they fall asleep easily but wake up several hours before dawn, unable to sleep again. Anxiety and inability to handle stress are other problems for many. Negative thoughts whirring through the mind will usually make it very hard to fall asleep.

 

 

 

Resources: Brain injury-explanation, Rehabilitationcentre de Hoogstraat, Cognitive Therapy (Joke Heins, Rose Sevat, Corine Werkhoven) nebasnsg.nl, stroke association of The Netherlands, The rehab group ABI webportal

Source: Neurofatigue / Invisible consequences / Consequences | Braininjury-explanation.com

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[Poster] Relationship Between Positive Personality Traits and Rehabilitation Outcomes Following Acquired Brain Injury Several Years Post-Injury

The study investigated the relationship between positive personality traits of hope and optimism and rehabilitation outcomes of participation and quality of life in individuals with Acquired Brain Injury (ABI), living in the community. Self-awareness to injury related deficits was also examined.

Source: Relationship Between Positive Personality Traits and Rehabilitation Outcomes Following Acquired Brain Injury Several Years Post-Injury – Archives of Physical Medicine and Rehabilitation

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[Abstract] Pilot study of intensive exercise on endurance, advanced mobility and gait speed in adults with chronic severe acquired brain injury – CNS

Brain Inj. 2016 Jul 28:1-7. [Epub ahead of print]

BACKGROUND AND PURPOSE: Effects of high-intensity exercise on endurance, mobility and gait speed of adults with chronic moderate-to-severe acquired brain injury (ABI) were investigated. It was hypothesized that intensive exercise would be associated with improvements in impairment and activity limitation measures.

PARTICIPANTS: Fourteen adults with chronic ABI in supported independent living who could stand with minimal or no assist and walk with or without ambulation device were studied. Eight presented with low ambulatory status.

METHODS: This was a single group pre- and post-intervention study. Participants received a 6-week exercise intervention for 60-90 minutes, 3 days/week assisted by personal trainers under physical therapist supervision. Measures (6MWT, HiMAT and 10MWT) were collected at baseline, post-intervention and 6 weeks later. Repeated measures T-test and Wilcoxon Signed Ranks test were used.

RESULTS: Post-intervention improvements were achieved on average on all three measures, greater than minimal detectable change (MDC) for this population. Three participants transitioned from low-to-high ambulatory status and maintained the change 6 weeks later.

DISCUSSION AND CONCLUSION: People with chronic ABI can improve endurance, demonstrate the ability to do advanced gait and improve ambulatory status with 6 weeks of intensive exercise. Challenges to sustainability of exercise programmes for this population remain.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Pilot study of intensive exercise on endurance, advanced mobility and gait speed in adults with chronic severe acquired brain injury

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[WEB SITE] Brain Injury Rehabilitation – Cognitive

Brain injury rehabilitation involves two essential processes: restoration of functions that can be restored and learning how to do things differently when functions cannot be restored to pre-injury level.

Brain injury rehabilitation is is based on the nature and scope of neuropsychological symptoms identified on special batteries of test designed to measure brain functioning following brain injury. 

While practice in various cognitive tasks–doing arithmetic problems, solving logic puzzles, concentration skills, or reading–may help brain rehabilitation, this is usually not enough. 

Brain injury rehabilitation must be designed taking into account a broad range of neuro-functional strengths and weaknesses. Basic skills must be strengthened before more complex skills are added. Only through comprehensive neuropsychological analysis can the many possible effects of brain injury be sorted out. This pattern of functional strengths and weaknesses becomes the foundation for designing a program of brain rehabilitation. 

Brain recovery follows patterns of brain development. Gross or large-scale systems must develop (or be retrained) before fine systems. Attention, focus, and perceptual skills develop (or are retrained) before complex intellectual activity can be successful.

What Are the Cognitive and Communication Problems That Result From Traumatic Brain Injury?

  • Cognitive and communication problems that result from traumatic brain injury vary from person to person. These problems depend on many factors which include an individual’s personality, preinjury abilities, and the severity of the brain damage.
  • Cognitive functions refer to what or how much (e.g., How much does s/he know? What can s/he do?. So long as the executive functions are intact, a person can sustain considerable cognitive loss and still continue to be independent, constructively self-serving, and productive. 
  • When executive functions are impaired. the individual may no longer be capable of satisfactory self-care, of performing remunerative or useful work on his or her own, or of maintaining normal social relationships regardless of how well preserved are his or her cognitive capacities — or how high his or her  scores on tests of skills, knowledge, and abilities. 
  • Moreover, cognitive deficits usually involve specific functions or functional areas; impairment in executive functions tend to show up globally, affecting all aspects of behavior.
  • Executive functions consist of those capacities that enable a person to engage in independent, purposive, self-serving behavior successfully. They differ from cognitive functions in a number of ways.  Questions about executive functions ask how or whether a person goes about doing something (e.g., Will s/he do it and, if so how?) 

(Source: Dr. Muriel Lezak,  Neuropsychological Assessment)

  • The effects of the brain damage are generally greatest immediately following the injury. However, some effects from traumatic brain injury may be misleading. The newly injured brain often suffers temporary damage from swelling and a form of “bruising” called contusions. These types of damage are usually not permanent and the functions of those areas of the brain return once the swelling or bruising goes away. Therefore, it is difficult to predict accurately the extent of long-term problems in the first weeks following traumatic brain injury.
  • Focal damage, however, may result in long-term, permanent difficulties.Improvements can occur as other areas of the brain learn to take over the function of the damaged areas. Children’s brains are much more capable of this flexibility than are the brains of adults. For this reason, children who suffer brain trauma might progress better than adults with similar damage. 
  • In moderate to severe injuries, the swelling may cause pressure on a lower part of the brain called the brainstem, which controls consciousness or wakefulness. Many individuals who suffer these types of injuries are in an unconscious state called acoma. A person in a coma may be completely unresponsive to any type of stimulation such as loud noises, pain, or smells. Others may move, make noise, or respond to pain but be unaware of their surroundings. These people are unable to communicate. Some people recover from a coma, becoming alert and able to communicate. 
  • In conscious individuals, cognitive impairments often include having problems concentrating for varying periods of time, having trouble organizing thoughts, and becoming easily confused or forgetful. Some individuals will experience difficulty learning new information. Still others will be unable to interpret the actions of others and therefore have great problems in social situations. For these individuals, what they say or what they do is often inappropriate for the situation. Many will experience difficulty solving problems, making decisions, and planning. Judgment is often affected.
  • Language problems also vary. Problems often include: 
    • word-finding difficulty 
    • poor sentence formation 
    • and lengthy and often faulty descriptions or explanations. 
  • These are to cover for a lack of 
    • understanding or inability to think of a word. 
    • For example, when asking for help finding a belt while dressing, an individual may ask for “the circular cow thing that I used yesterday and before.”
    • Many have difficulty understanding multiple meanings in jokes, sarcasm, and adages or figurative expressions such as, “A rolling stone gathers no moss” or “Take a flying leap.” 
  • Individuals with traumatic brain injuries are often unaware of their errors and can become frustrated or angry and place the blame for communication difficulties on the person to whom they are speaking. Reading and writing abilities are often worse than those for speaking and understanding spoken words. Simple and complex mathematical abilities are often affected. 
  • The speech produced by a person who has traumatic brain injury may be slow, slurred, and difficult or impossible to understand if the areas of the brain that control the muscles of the speech mechanism are damaged. 
    • This type of speech problem is called dysarthria
    • These individuals may also experience problems swallowing. 
    • This is called dysphagia. Others may have what is called apraxia of speech, a condition in which strength and coordination of the speech muscles are unimpaired but the individual experiences difficulty saying words correctly in a consistent way. 
    • For example, someone may repeatedly stumble on the word “tomorrow” when asked to repeat it, but then be able to say it in a statement such as, “I’ll try to say it again tomorrow.”
  • How Are the Cognitive and Communication Problems Assessed? 
    • The assessment of cognitive and communication problems is a continual, ongoing process that involves a number of professionals. 
    • Immediately following the injury, a neurologist (a physician who specializes in nervous system disorders) or another physician may conduct an informal, bedside evaluation of 
      • attention 
      • memory 
      • and the ability to understand and speak. 
    • Once the person’s physical condition has stabilized, a 
    • speech-language pathologist may evaluate cognitive and communication skills, and a 
    • neuropsychologist may evaluate other cognitive and behavioral abilities. 
    • Occupational therapists also assess cognitive skills related to the individual’s ability to perform “activities of daily living” (ADL) such as dressing or preparing meals. An audiologist should assess hearing. All assessments continue at frequent intervals during the rehabilitative process so that progress can be documented and treatment plans updated. The rehabilitative process may last for several months to a year.
  • How Are the Cognitive and Communication Problems Treated?
    • The cognitive and communication problems of traumatic brain injury are best treated early, often beginning while the individual is still in the hospital. 
    • This early therapy will frequently center on increasing skills of alertness and attention. They will focus on improving orientation to person, place, time, and situation, and stimulating speech understanding. 
    • The therapist will provide oral-motor exercises in cases where the individual has speech and swallowing problems.
  • Longer term rehabilitation may be performed individually, in groups, or both, depending upon the needs of the individual. This therapy often occurs in a rehabilitation facility designed specifically for the treatment of individuals with traumatic brain injury. 
  • This type of setting allows for intensive therapy by speech-language pathologists, physical therapists, occupational therapists, and neuropsychologists at a time when the individual can best benefit from such intensive therapy. 
  • Other individuals may receive therapy at home by visiting therapists or on an outpatient basis at a hospital, medical center, or rehabilitation facility.
  • The goal of rehabilitation is to help the individual progress to the most independent level of functioning possible. For some, ability to express needs verbally in simple terms may be a goal. For others, the goal may be to express needs by pointing to pictures. For still others, the goal of therapy may be to improve the ability to define words or describe consequences of actions or events. 
  • Therapy will focus on regaining lost skills as well as learning ways to compensate for abilities that have been permanently changed because of the brain injury. Most individuals respond best to programs tailored to their backgrounds and interests. The most effective therapy programs involve family members who can best provide this information. Computer-assisted programs have been successful with some individuals.

What Research Is Being Done for the Cognitive and Communication Problems Caused by Traumatic Brain Injury?

  • Researchers are studying many issues related to the special cognitive and communication problems experienced by individuals who have traumatic brain injuries.
  • Scientists are designing new evaluation tools to assess the special problems that children who have suffered traumatic brain injuries encounter. 
  • Because the brain of a child is vastly different from the brain of an adult, scientists are also examining the effects of various treatment methods that have been developed specifically for children. 
  • These new strategies include the use of computer programs. In addition, research is examining the effects of some medications on the recovery of speech, language, and cognitive abilities following traumatic brain injury.

Source: Brain Injury Rehabilitation – Cognitive

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[Abstract] Strategies for increasing the intensity of upper limb task-specific practice after acquired brain impairment: A secondary analysis from a randomised controlled trial. – 

Abstract

Introduction Patients with acquired brain impairments require intensive, task-specific training to maximise upper limb recovery. Current evidence suggests, however, that they rarely achieve this. The purpose of this study was to describe the amount of practice that can be achieved by patients with acquired brain impairment during intensive upper limb treatment within a public hospital, and to examine the strategies used by therapists to maximise practice.

Method A secondary analysis was conducted using data from a previously published randomised trial. The training received by 20 people with acquired brain impairment over the 6-week trial period was recorded. The strategies used by therapists to maximise practice were also noted.

Results Over the 6-week period, 45 hours of upper limb training was provided. The median (interquartile range) amount of actual practice achieved by patients was 59 (54–63) minutes per day, with a median (interquartile range) of 186 (50–330) repetitions of active movement. Patients’ practice was maximised through the use of task-specific feedback, practice books, counters, environmental cues and stopwatches. In addition, therapists provided coaching as well as ensuring tasks were goal-oriented, measurable and patient-driven.

Conclusion Described strategies enabled patients with acquired brain impairment to practise upper limb tasks at intensities greater than currently reported in the literature.

 

Source: Strategies for increasing the intensity of upper limb task-specific practice after acquired brain impairment: A secondary analysis from a randomised controlled trial

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[WEB SITE] Combating Struggles with Acquired Brain Injury – RehabVisions

Posted: 6/10/15
RehabVisions

The physical, neurological and emotional challenges that may arise from an acquired brain injury (ABI) are vast. Different causes and injuries create consequences that vary among individuals. Therapists need to be perceptive in order to both address struggles and provide avenues for constructive thinking.

One of the largest hurdles therapists encounter in rehabilitation with individuals who have suffered an ABI is the patient often lacks insight into their own deficits. Their injured brain signals they are fine and can successfully perform activities they used to do before injury, when in fact they may be struggling with anything from orientation and memory to executive function. This is challenging for family members and caregivers and is also is a barrier for treatment if the patient does not come to terms with these new deficits. Although insight typically improves to some degree as the patient progresses, giving the right level and amount of explanation about what has happened and future planning is helpful.

A thorough evaluation should be completed early on to identify cognitive deficits. Once strengths and deficits are identified, treatment can begin. Include tasks to promote gains in deficit areas such as memory and attention, such as deductive and/or abstract reasoning tasks, working memory tasks or word-retrieval activities. Also think about how strengths can be utilized to assist in this process. If a patient’s reading comprehension is better than auditory comprehension, printed information should be used to improve their ability to comprehend spoken information.

Combat common struggles by demonstrating compensatory strategies that aid the individual in participating in life activities. For patients experiencing memory and organization deficits, be prepared with a list of smart phone apps and functions they can use to set alerts for appointments, manage tasks, make lists, etc.

Fatigue is common in individuals recovering from a brain injury. Their brain is working “overtime” to make sense of things, and performing tasks successfully may take a great deal of conscious thought and effort. Assist patients in creating a schedule to work on their cognitive exercises and/or stay active in doing their daily activities, and include rest to help the brain recover. Once the brain begins to fatigue, there is a decrease in function. The patient will notice activities and tasks become harder, and head pain may also occur. This should signal the patient that it’s time to rest.

Lastly, there are things the brain injury survivor can focus on that will help their recovery, including:

  • Accepting their new persona
  • Allowing themselves to make mistakes
  • Striving to keep a positive attitude
  • Remembering they can continue to improve

Continued improvements may be the most important point in keeping your patient motivated. In years past, it was commonly accepted that after a window of about three years, the brain would not have any further recovery. It is now known that neuroplasticity allows for continued recovery over time with focused effort. Different parts of the brain can establish neuropathways and take over functions lost through damage to other parts of the brain.

Area Manager Jean Herauf, SLP has 30+ years’ experience, more than 20 of them with RehabVisions. Jean is active in her clinic’s local brain injury support group and has attended numerous courses over the years, and read a good deal on ABI.

Source: Combating Struggles with Acquired Brain Injury – RehabVisions

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