Posts Tagged ABI

[I/Ep] Strategies to Cope With Behavior Changes After Acquired Brain Injury – Archives of Physical Medicine and Rehabilitation

First page of article

Behavior changes are common after acquired brain injury (ABI) because the brain processes information differently after the injury. About 62% of people with ABI experience behavior changes.1 For some people with ABI, the changes in behavior have a major effect on their daily lives, while for others they may be relatively small. These changes can make daily tasks and social interactions difficult. People with ABI may be more sensitive to stress and fatigue, which can make the behaviors described in this article worse.

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via Strategies to Cope With Behavior Changes After Acquired Brain Injury – Archives of Physical Medicine and Rehabilitation

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[WEB SITE] Parenting After Brain Injury

Parenting After Brain Injury

Parenting is a challenging life role for all people, yet one of the most valued roles within society. Brain Injury frequently occurs at a life stage where people are yet to complete their parenting responsibilities. For people with acquired brain injury (ABI), facing cognitive, physical, communication, behavioural and psychological challenges, parenting can present complex challenges. In addition, persons with ABI often face societal and environmental barriers. These fact sheets have been developed to assist parents with an ABI and their partners to improve their knowledge and skills to meet the ongoing challenges of parenting. family walking together
little girl finger painting boy doing his homework two little girls arguing

Encouraging your
Developing Child

Setting Routines

Managing Behaviour

Other Useful Parenting Website Links and Resources

Parenting Fact Sheet References and Acknowledgements
Return to Support for Families

Contact ABIOS
abios@health.qld.gov.au

Last updated: 20 March 2017

via Parenting After Brain Injury | Queensland Health

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[BLOG] Lash & Associates’ Award-Winning Blog site

TBI, ABI, PTSD, Stroke, Concussion Blog Posts!

Lash & Associates’
Award-Winning Blog Site
Is Well Worth A Look

Our large variety of blog articles are keyword searchable, and offer help & encouragement.

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No matter what your situation – as a survivor, a clinician, a caregiver, or a family member, our blog site provides a great reference point. Check it out – we’ve got something for most any situation regarding the greater TBI Community!

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[Abstract] Evidence for Training-Dependent Structural Neuroplasticity in Brain-Injured Patients: A Critical Review

Acquired brain injury (ABI) is associated with a range of cognitive and motor deficits, and poses a significant personal, societal, and economic burden. Rehabilitation programs are available that target motor skills or cognitive functioning. In this review, we summarize the existing evidence that training may enhance structural neuroplasticity in patients with ABI, as assessed using structural magnetic resonance imaging (MRI)–based techniques that probe microstructure or morphology. Twenty-five research articles met key inclusion criteria. Most trials measured relevant outcomes and had treatment benefits that would justify the risk of potential harm. The rehabilitation program included a variety of task-oriented movement exercises (such as facilitation therapy, postural control training), neurorehabilitation techniques (such as constraint-induced movement therapy) or computer-assisted training programs (eg, Cogmed program). The reviewed studies describe regional alterations in white matter architecture and/or gray matter volume with training. Only weak-to-moderate correlations were observed between improved behavioral function and structural changes. While structural MRI is a powerful tool for detection of longitudinal structural changes, specific measures about the underlying biological mechanisms are lacking. Continued work in this field may potentially see structural MRI metrics used as biomarkers to help guide treatment at the individual patient level.

via Evidence for Training-Dependent Structural Neuroplasticity in Brain-Injured Patients: A Critical Review – Karen Caeyenberghs, Adam Clemente, Phoebe Imms, Gary Egan, Darren R. Hocking, Alexander Leemans, Claudia Metzler-Baddeley, Derek K. Jones, Peter H. Wilson, 2018

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[Abstract] Functional independence after acquired brain injury: Prospective effects of health self-efficacy and cognitive impairment.

Abstract

Objective: To examine how health self-efficacy and cognitive impairment severity relate to functional independence after acquired brain injury (ABI).

Design: Observational. Setting: Outpatient rehabilitation hospital.

Participants: Seventy-five adults with predominately stroke or traumatic brain injury who were beginning a course of occupational therapy.

Main Measures: Health self-efficacy was assessed with the Self-Rated Abilities for Health Practices. Cognitive functioning was assessed via a composite z score of neuropsychological tests. Trait affectivity was assessed with the Positive and Negative Affect Schedule. Functional independence was assessed with the Barthel Index and Lawton Instrumental Activities of Daily Living Scale.

Results: Health self-efficacy correlated moderately with functional independence. A moderation threshold effect was detected that revealed for whom health self-efficacy predicted functional independence. Among participants with normal to mildly impaired cognition (>−2 z cognitive composite), health self-efficacy correlated positively with functional independence, which held after accounting for trait affectivity. In contrast, health self-efficacy was not correlated with functional independence among participants with greater impairment (<−2 z cognitive composite).

Conclusions: Health self-efficacy predicts functional independence and may serve as a protective factor after ABI among individuals with relatively intact cognition. However, health self-efficacy does not predict functional independence among individuals with moderate or severe cognitive impairment, possibly due to limited self-awareness.

This study extends the literature linking health self-efficacy with rehabilitation outcomes and reinforces the need for promoting self-management in ABI. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

via PsycNET Record Display – PsycNET

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[ARTICLE] A Review of Stem Cell Therapy for Acquired Brain Injuries and Neurodegenerative Central Nervous System Diseases – Full Text

Abstract

Cell-based therapies have been the subject of much discussion regarding their potential role in enhancing central nervous system function for a number of pathologic conditions. Much of the current research has been in preclinical trials, with clinical trials in the phase I or I/II stage. Nevertheless, there is considerable interest in the public about the potential regenerative role that stem cells may have in improving function for these neurologic conditions. This review will describe the different types of stem cells that are available, review their possible effects, and discuss some of the variables that investigators need to consider when designing their studies. Current clinical research in the areas of stroke, traumatic brain injury, and neurodegenerative diseases (amyotrophic lateral sclerosis and Parkinson disease) will be reviewed. As this article is aimed at a rehabilitation audience, outcome measures, and the role of concurrent rehabilitation therapies will also be mentioned.

Introduction

Potential Roles That Stem Cells May Play in Regeneration

Stem cells may exert positive effects on the recovery process in a number of ways. Some cells have the ability to replicate and play a direct role in the repair of damaged neural tissue. These neural progenitor or neural stem cells (NSCs) may differentiate into different cell types and may be subsumed to roles of previously damaged or lost neurons. Such cells have been studied in a number of clinical conditions, but ethical issues have arisen, primarily because embryonic or fetal tissues have often been used. As these are allogeneic transplants, efforts must be taken to suppress the immune response, which may lead to complications. Additionally, concerns regarding tumorigenicity are greater for these cells because of their replicative ability [1]. Adult neural stem cells can be found in some areas of the human brain including the subventricular zone and the hippocampal dentate gyrus [2]. These are pluripotent cells that can replicate and differentiate based on intrinsic and environmental factors. They also have the ability to migrate, and differentiation may be driven by their ultimate location [3]. There is the possibility that these cells can be cultured and engineered to carry out specific functions based on modulation of these factors, but much needs to be learned in order to achieve this goal [4].

Induced pluripotent stem cells (IPSCs) can also be generated from adult cells. They are reprogrammed by transcription factors into a more embryonic state. It is possible to perform this in an autologous fashion (the patient is the source for his or her IPSCs), although this can be difficult as this is an inefficient process that may take time to produce adequate cell numbers. Some concerns regarding tumorigenicity also exist for this strategy. Mesenchymal stem cells (MSCs) are another option for cell-based therapies. Autologous and allogeneic sources for these cells are available. These cells usually do not differentiate into neural cells. Rather, it is believed that their primary role in neural recovery is by producing trophic factors into their environment to stimulate endogenous neurogenesis and repair as well as modulating inflammation [5]. MSCs do not appear to have the potential to become tumorigenic. However, they may have an immunosuppressive effect that, among other complications, might increase the risk of tumor formation [6].

The United States Food and Drug Administration (FDA) has on several occasions produced policies that have provided guidance regarding the use of these products to both protect consumers and support the ongoing research and development of regenerative medicine products in general. The stem cells discussed here are regenerative medicine therapies, and there are procedures that must be followed in clinical trials. The FDA has recently made efforts to try to “fast-track” some regenerative medicine therapies, especially those that address “serious diseases and conditions” [7].[…]

 

Continue —> A Review of Stem Cell Therapy for Acquired Brain Injuries and Neurodegenerative Central Nervous System Diseases – PM&R

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[Abstract] Evidence based position paper on physical and rehabilitation medicine professional practice for adults with acquired brain injury. The European PRM position (UEMS PRM Section)

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INTRODUCTION: Acquired brain injury (ABI) is damage to the brain that occurs after birth caused either by a traumatic or by a nontraumatic injury. The rehabilitation process following ABI should be performed by a multi-professional team, working in an interdisciplinary way, with the aim of organizing a comprehensive and holistic approach to persons with every severity of ABI. This Evidence Based Position Paper represents the official position of the European Union through the UEMS Physical and Rehabilitation Medicine (PRM) Section and designates the professional role of PRM physicians for people with ABI.
AIM: The aim was to formulate recommendations on the PRM physician’s professional practice for persons with ABI in order to promote their functioning and enhance quality of life.
METHODS: This paper has been developed according to the methodology defined by the Professional Practice Committee of the UEMS-PRM SECTION: a systematic literature search has been performed in PubMed and Core Clinical Journals. On the basis of the selected papers, recommendations have been made as a result of five Delphi rounds.
RESULTS: The literature review as well as thirty-one reccomendations are presented.
CONCLUSIONS: The expert consensus is that structured, comprehensive and holistic rehabilitation programme delivered by the multi-professional team, working in an interdisciplinary way, with the leadership and coordination of the PRM physician, is likely to be effective, especially for those with severe disability after brain injury.

via Evidence based position paper on physical and rehabilitation medicine professional practice for adults with acquired brain injury. The European PRM position (UEMS PRM Section) – European Journal of Physical and Rehabilitation Medicine 2018 Aug 29 – Minerva Medica – Journals

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[Abstract] A study of the influence of cognitive complaints, cognitive performance and symptoms of anxiety and depression on self-efficacy in patients with acquired brain injury

Abstract

Objective:
To examine the relationship between self-efficacy for managing brain injury–specific symptoms and cognitive performance, subjective cognitive complaints and anxiety and depression symptoms in patients with acquired brain injury (ABI).

Design:
Clinical cohort study.

Setting:
General hospitals, rehabilitation centres.

Subjects:
A total of 122 patients with newly ABI (mean age = 54.4 years (SD, 12.2)) were assessed at discharge home from inpatient neurorehabilitation or at start of outpatient neurorehabilitation after discharge home from acute hospital. Mean time since injury was 14.1 weeks (SD, 8.6).

Main measures:
Self-efficacy was measured using the Traumatic Brain Injury (TBI) Self-Efficacy Questionnaire (SEsx), mean score = 82.9 (SD, 21.8). Objective cognitive performance was measured with the Symbol Digit Modalities Test (SDMT), mean z-score = −1.36 (SD, 1.31). Anxiety and depression symptoms were measured with the Hospital Anxiety and Depression Scale (HADS), cognitive complaints with the self-rating form of the Dysexecutive Questionnaire (DEX-P).

Results:
Higher levels of subjective cognitive complaints and higher levels of anxiety and depression symptoms were significantly associated with lower self-efficacy (β = −0.35; P = .001 and β =−0.43; P < .001, respectively). Objective cognitive performance was not significantly associated with self-efficacy (β = 0.04, P = .53). DEX-P scores accounted for 42% and HADS scores for 7% of the total 57% variance explained. Objective cognitive performance did not correlate significantly with subjective cognitive complaints (r = −.13, P = .16).

Conclusion:
Control over interfering emotions and mastery over brain injury–associated symptoms seems important in the development of self-efficacy for managing brain injury–specific symptoms.

via A study of the influence of cognitive complaints, cognitive performance and symptoms of anxiety and depression on self-efficacy in patients with acquired brain injury – Ingrid MH Brands, Inge Verlinden, Gerard M Ribbers, 2018

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[WEB SITE] Taking music therapy into the mainstream – ACNR

Taking music therapy into the mainstream

Posted in on 3rd Jun 2018

Conference details: March 15th, 2018, London, UK.
Report by: Daniel Thomas, Joint Managing Director at Chroma.
Conflict of interest statement: None declared.
Published online: 3/6/18


Every 90 seconds, someone in the UK is admitted to hospital with an Acquired Brain Injury.

With over one million people in the UK currently living with the effects of a brain injury the estimated bill to the UK is £15 billion. The devastating impact radiates across families causing distress, relationship strain, financial hardship and an uncertain future. The injury has a huge physical and psychological payload.

Neurologic Music Therapy (NMT) offers an effective rehabilitation treatment that is backed by a wealth of clinical evidence and has been shown to have a profound influence on the brain. However, raising awareness of the benefits of arts therapies, including NMT, can be extremely difficult.

Chroma’s recent ABI conference entitled ‘Arts Therapies and Brain Injury: Optimising Outcomes Across Assessment, Treatment and Care’ brought together some of the leading international authorities and influencers in the arts therapies field. They delivered the latest research and scientific evidence on how arts therapies are improving outcomes for patients recovering from acquired brain injuries.

Chris Bryant, MP, and chair of the All Party Parliamentary Group on Acquired Brain Injury opened the conference by highlighting the growing problem of brain injuries and the wider impact it has on society.

Caroline Klage, Head of the Child Brain Injury Team at leading niche London law firm, Bolt Burdon Kemp, who sponsored the conference, welcomed the delegates.

She said: “As a firm, Bolt Burdon Kemp is keen to support NMT and raise awareness of its benefits. We are driven by the desire to ensure our clients receive the best quality input at the earliest point possible, with a view of enabling them to flourish and thrive post brain injury. NMT definitely has a role to play in that.”

Dr Jeanette Tamplin, of the University of Melbourne, provided an introduction to the evolving field of the creative arts therapies, specifically Neurologic Music Therapy. Dr Tamplin is pioneering the use of Virtual Reality to improve the participation and engagement of rehab patients on music therapy protocols.

“Music can bypass damaged areas, providing a scaffold to do the part of the work the brain is not doing in coordinating movement. But there is also the basic ‘use it or lose it principle’. When you exercise something, it gets stronger and the more you exercise, the better it becomes.”

The inspiring responses seen in some cases still needs to be backed up by more clinical research and Dr Tamplin added: “I want people to understand that we are an evidence-based profession and there are functional outcomes from music therapy.

“There are amazing benefits for quality of life and participating in life as well as being able to walk a bit better. Music makes us feel better and we use it in ways to help us through life but I’d like people to understand the research and evidence behind what we are doing.”

Sarah Johnson, a Neurologic Music Therapist and NMT pioneer from Colorado State University, presented a session on demonstrating the efficacy of NMT. She outlined the ‘Transformational Design Model’ a system that uses a clinical reasoning process to link assessments, goals, and learning through music.

Using case studies, video examples and clinical data, Sarah O’Doherty and Rebecca O’Connor, from the National Rehabilitation Hospital in Ireland, illustrated an innovative approach to assessing and treating children with acquired brain injuries. The approach involves a systematic observation and recording of the development of the child by a neuropsychologist during a music therapy treatment.

Practical hands-on workshops on applications in neuro-rehabilitation and articulating art therapy allowed delegates to experience, engage with and understand an arts therapy process from a client’s/patient’s point of view.

Dr Wendy Magee, a professor in the Music Therapy Department, at Temple University, Philadelphia, US showcased the MATADOC assessment for patients with prolonged disorders of consciousness (PDOC) that she and her colleagues pioneered.

According to Dr Magee, music is the auxiliary engine that has the power to reboot the brain following a catastrophic head injury, tumour or stroke. Dr Magee said: “A human being is born with the capacity to express emotions such as distress, anger and pleasure through musical parameters such as volume, dynamic range, pitch and melodic contour. So, in working with people who have lost the ability to communicate we can see that music is an innate way to communicate feelings.

“There is strong neurological evidence that music activates many different areas across the brain. The motor system is very sensitive to picking up cues from the auditory system so when we hear music, particularly pulse or rhythm, it kicks straight into the motor system going around the brain.”

Summing up the conference, Daniel Thomas, managing director of Chroma, who organised the event, said: “As a neurologic music therapist and parent, I am deeply aware of the need for arts therapies to be provided in line with the rehabilitation code at the earliest possible point in someone’s recovery.

“As a profession, we regularly punch above our weight and this conference has demonstrated our ability to make a significant difference to the lives of people with brain injuries, their families and the professional teams around them.

“It has also given a glimpse into the future developments of arts therapies and shown how it can be an absolutely essential rehabilitation treatment in mainstream health services.”

via Taking music therapy into the mainstream | ACNR | Online Neurology Journal

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[WEB SITE] Neurosexuality Needs to Be Better Addressed in Patients with Neurodisabilities

Summary: Experts raise awareness of neurosexuality challenges faced by patients with neurodisabilities, including members of the LGBTQIA+ community, and provide guidance for healthcare providers and caregivers.


For people with brain disorders, whether from injury or disease, rehabilitation is a complex process. Neurosexuality is an emerging area of study and practice that focuses on the relationships between brain and sexual function in individuals with and without neurological disorders. Experts on the subject, reporting in NeuroRehabilitation, discuss how sexuality can affect neurorehabilitation in patients suffering from a range of conditions, from stroke and spinal cord injuries to sexual behavior in patients with dementia.

Research addressing the relationship between sexuality and the brain has a long history in neurological and behavioral sciences. This increased awareness has led to a better understanding within the scientific community regarding the importance of sexuality as a health outcome to promote the quality of life of individuals with neurodisabilities.

“This thematic issue of NeuroRehabilitation emphasizes that neurosexuality care should be driven by a transdisciplinary approach to appraise the evidence base of the potential negative consequences of different neurodisabilities on sexuality and to build upon sound treatment strategies to address these complexities,” explained guest editors Alexander Moreno, PhD, Caron Gan, RN, MScN, RP, AAMFT, and Nathan D. Zasler, MD.

An important contribution to this issue advocates for changing the culture of neurodisability through language and sensitivity of providers in order to create a safe place for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and people with other sexual orientations and forms of gender expression (LGBTQIA+). “The particular needs of LGBTQIA+ individuals living with a neurological disorder are neglected in clinical practice and research. The invisibility of LGBTQIA+ individuals with neurological disorders reflects the historical exclusion of marginalized identities and creates disparities of access to healthcare,” explained Alexander Moreno, PhD, Faculty of Human Sciences, Department of Sexology, Université du Québec à Montréal (UQÀM) and the Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Ari Laoch, MS, Virginia Commonwealth University, and Nathan D. Zasler, MD, Concussion Care Centre of Virginia, Ltd. and Tree of Life Services, Inc. (VA).

The invisibility of LGBTQIA+ individuals with neurological disorders translates into diminished quality of care or inappropriate care, lack of recognition of all family configurations, exclusion of family caregivers, and violations of human rights (e.g., the right to be treated with dignity). Shedding light on the diversity of individuals with neurological disorders has the potential to improve healthcare by helping rehabilitation professionals to be sensitive to the particular needs of LGBTQIA+ individuals. In addition, the results of this study help promote the inclusion of sexual and gender diversity in the curricula of future practitioners and delineate future directions for research. Most importantly, the current study provides concrete clinical recommendations aiming to orient healthcare professionals wanting to improve their practice.

The authors surveyed the literature concerning neurological disorders affecting LGBTQIA+ individuals. They found that the relative neglect of LGBTQIA+ individuals with neurological disorders in clinical practice and research is striking. Healthcare professionals working with individuals with neurological disorders have the responsibility to create safer spaces in their clinical practice, including the use of inclusive language, the modification of admission forms to reflect diverse realities, the inclusion of sexual orientation and gender identity in their institutional policies, and participate in continuing education to challenge misconceptions, stereotypes, and negative attitudes. The authors provide 20 recommendations to guide clinicians, researchers, and policy professionals about the care of the LGBTQIA+ community.

Moreno, Laoch, and Zasler emphasized that “being part of a positive change in the rehabilitation of LGBTQIA+ people with neurodisabilities is part of our obligation as healthcare providers who are self-reflective, critical, and willing to improve the quality of the services provided in an ethical framework.”

Additional contributions to the issue cover a variety of important topics.

Sexual Health After Pediatric Acquired Brain Injury (ABI)

The authors reviewed over 2000 studies and found that literature about sexuality in children and adolescents with ABI has mainly addressed physical issues (e.g., precocious puberty), with positive sexual health needing further development in topics such as body image, sexual orientation, and social competence including flirting, dating, and romance.

Sexual health after traumatic brain injury (TBI) in younger and older adults Sexual problems were more likely for older (average mid-40s) patients with TBI than for younger (average 30s) patients. Older patients showed lower sexual desire and suffered more from anxiety and depression. Younger patients did not exhibit these symptoms to the same degree, suggesting that clinicians should be aware of age differences when treating their patients.

Stroke and Sexual Functioning

A literature review of post-stroke sexual functioning describes how various dysfunctions are related to stroke location, laterality, and physical and psychological changes. Three programs are presented to address post-stroke rehabilitation.

Multiple Sclerosis (MS) and Sexual Dysfunction

For patients with MS, assessment and treatment of sexual dysfunctions are described, including sexual assessment tools especially for MS. The authors also explore related topics including relationships, fertility, pregnancy, and parenting issues. They emphasize that, like other neurological disorders, there is a need for more collaboration among providers in addressing sexual concerns in MS.

How perceptions of sexuality in individuals with amyotrophic lateral sclerosis (ALS) can affect care

Surveys of both patients with ALS, also known as Lou Gehrig’s disease, and ALS care providers revealed uncomfortable feelings when the subject of sexuality was raised. The authors call for more education among ALS specialists in sexuality and a policy change that guarantees the inclusion of sexuality in their guidelines.

Sexual Concerns After Spinal Cord Injury (SCI)

SCI can impact sexual response, male infertility and its treatments, as well as pregnancy issues. The authors emphasize the importance of providing education and specific sexual recommendations based on the individual’s remaining sexual potential, and to include their partners, when available. They also present basic and advanced treatments for sexual dysfunctions and discuss other challenges in the management of sexual dysfunction of individuals with SCI.

Studying Intimacy And Sexuality In Clients With Dementia

Obtaining consent to study individuals with cognitive impairment is a controversial topic. In the environment of a residential care facility, the authors propose a multi-step approach involving authorized representatives (e.g., family caregivers), professional caregivers working in the facility, a pre-consent phase, a consent presentation phase, and a final consent before data collection. Their reflections and suggestions illuminate the ethical challenges involved in the study of sexuality and intimacy in individuals with severe cognitive impairment.

In summary, the guest editors write, “We hope that this thematic issue provides an impetus for rehabilitation and other health professionals, students in the health sciences, and researchers to develop their competence and awareness of the importance of sexual neurorehabilitation in persons with neurodisabilities.”


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via Neurosexuality Needs to Be Better Addressed in Patients with Neurodisabilities – SexualDiversity.Org

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