Posts Tagged ABI

[ARTICLE] The Use of Therapeutic Music Training to Remediate Cognitive Impairment Following an Acquired Brain Injury: The Theoretical Basis and a Case Study – Full Text


Cognitive impairment is the most common sequelae following an acquired brain injury (ABI) and can have profound impact on the life and rehabilitation potential for the individual. The literature demonstrates that music training results in a musician’s increased cognitive control, attention, and executive functioning when compared to non-musicians. Therapeutic Music Training (TMT) is a music therapy model which uses the learning to play an instrument, specifically the piano, to engage and place demands on cognitive networks in order to remediate and improve these processes following an acquired brain injury. The underlying theory for the efficacy of TMT as a cognitive rehabilitation intervention is grounded in the literature of cognition, neuroplasticity, and of the increased attention and cognitive control of musicians. This single-subject case study is an investigation into the potential cognitive benefit of TMT and can be used to inform a future more rigorous study. The participant was an adult male diagnosed with cognitive impairment as a result of a severe brain injury following an automobile accident. Pre- and post-tests used standardized neuropsychological measures of attention: Trail Making A and B, Digit Symbol, and the Brown– Peterson Task. The treatment period was twelve months. The results of Trail Making Test reveal improved attention with a large decrease in test time on both Trail Making A (−26.88 s) and Trail Making B (−20.33 s) when compared to normative data on Trail Making A (−0.96 s) and Trail Making B (−3.86 s). Digit Symbol results did not reveal any gains and indicated a reduction (−2) in free recall of symbols. The results of the Brown–Peterson Task reveal improved attention with large increases in the correct number of responses in the 18-s delay (+6) and the 36-s delay (+7) when compared with normative data for the 18-s delay (+0.44) and the 36-s delay (−0.1). There is sparse literature regarding music based cognitive rehabilitation and a gap in the literature between experimental research and clinical work. The purpose of this paper is to present the theory for Therapeutic Music Training (TMT) and to provide a pilot case study investigating the potential efficacy of TMT to remediate cognitive impairment following an ABI.

1. Introduction

An acquired brain injury (ABI) can result in impairment in a variety of domains including motor, speech, emotional, and cognitive. Cognitive impairment is the most common sequelae following an ABI [1,2,3,4] and is a result of deficit in one or more areas of cognition such as the various forms of attention, working memory, memory, executive function, or processing speed [5,6,7,8,9,10,11]. An individual with cognitive impairment may experience challenge to suppress distraction, remain on task, shift between tasks, follow directions, organize and initiate a response, or have difficulties with memory. Cognitive impairment can impact participation and progress in rehabilitation therapies for any of the above domains due to reduced attention, poor executive functioning, or impaired memory. The inability to attend to instructions of the therapist, to cognitively plan and organize a response, or to remember rehabilitation objectives outside the therapy session can potentially disqualify an individual from participation in rehabilitative programs or may impede progress in them. Furthermore, cognitive impairment is reported by family and caregivers as a significant source of stress [8,12,13,14]. Addressing cognitive impairment should be a priority in patient treatment following an acquired brain injury. Therefore, it is important to have on-going research into potentially effective cognitive rehabilitation tools.Music training has been noted in the literature to impact areas of non-musical functioning including phonological awareness [15], speech processing [16], listening skills [17], perceiving speech in noise [18] and reading [19,20]. Of significance to the theory of Therapeutic Music Training, the literature demonstrates the impact of music training on cognitive abilities including attention and executive functioning [21,22,23,24,25,26,27].Therapeutic Music Training (TMT) is a music therapy model in which the use of music training, specifically learning to play the piano, is used to address and remediate cognitive impairment following an acquired brain injury [28]. TMT is informed by clinical work and is grounded in literature. The hypothesis of the efficacy of TMT to remediate cognitive impairment is supported by literature regarding the influence of music training on cognition [23,24,25,29], musician’s enhanced abilities in attention, working memory, and cognitive control [26], theories of attention [30,31,32,33,34,35] and the neuroplasticity of the brain, including following injury [36,37,38,39,40]. Because of the engagement of the prefrontal cortex and the demands placed on working memory and attention during TMT, it can be an effective tool to address cognitive impairment. Although functionally interconnected, specific aspects of cognition such as working memory, attention, executive function, and memory are targeted in TMT tasks. TMT is a remedial approach to cognitive rehabilitation, that is, the goal is to drive, strengthen, and improve the underlying neural processes involved in the target cognitive areas. This is in contrast to a compensatory approach to cognitive rehabilitation, in which the goal is to provide the individual with strategies and accommodations to deal with the outcomes of cognitive impairment. The tangible outcome of producing a song provides motivation for the client to engage in cognitive rehabilitation and to remain in the rehabilitative process for an extended period of time as is required to stimulate a neuroplastic response and for the remediation of neural processing to take place.TMT is distinct from modified music education in that the goal of TMT is the remediation of cognitive processes rather than music performance. Tasks involved in learning to play the piano are designed with the goal of placing demands on the various components of cognition. The sequencing and pacing of tasks are determined by the cognitive goals with consideration to target cognitive processes and the time required to drive and strengthen the networks involved. Novelty and the gradual increase in complexity of tasks are utilized to place on-going demands on attention networks and to gradually benefit higher cognitive processes. This is in contrast to modified music education, in which the primary goal is the acquisition of musical abilities and performance.TMT is distinct from other models of music therapy in that it uses music training as the intervention for rehabilitative purposes. TMT contrasts from other music therapy models which use music primarily for expressive purposes, lack corrective feedback from the therapist, or use isolated music tasks which are not intended as music training. TMT is distinct from Neurologic Music Therapy (NMT) [41] in addressing cognitive goals as NMT does not use music training in its music-based rehabilitative interventions. Bruscia highlighted the importance of the music therapist’s “non-judgemental acceptance of what the client does musically” [42] (p. 3). While the TMT therapist would express empathy and support to the client, s/he would also provide constructive and corrective feedback as required in the learning to play an instrument. As in other models of music therapy, the therapist’s use-of-self and the role of the client–therapist relationship are important contributors to the success of the therapy.Remarkably, much of cognitive rehabilitation is not grounded in the literature [36,43,44,45]. This may be due in part to the fact that rehabilitation therapy used to address cognitive impairment is most often based on a compensatory approach, accommodating or supporting the impairment, rather than attempting to remediate the cognitive processes that have been impaired. While the use of music and instrument playing for motor rehabilitation has been widely investigated [41,46,47,48], there is sparse literature investigating the potential efficacy of music-based cognitive rehabilitation interventions. This paper provides a brief introduction to the theory for TMT. This case study investigates the hypothesis of the potential effectiveness of therapeutic music training, TMT, to remediate cognitive impairment and serves as a pilot project to inform future, more rigorous studies. This investigation can contribute to the literature regarding music-based cognitive rehabilitation and inform clinical practice. There is a gap between cognitive experimental research and treatment applications [49]. The hypothesis for TMT has been informed by clinical work and this study can help fill in the gap between experimental research and clinical application. […]

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[ARTICLE] Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury – Full Text



Individuals with acquired brain injuries (ABI) are in need of neurorehabilitation and neurorepair. Virtual anatomical interactivity (VAI) presents a digital game-like format in which ABI survivors with upper limb paresis use an unaffected limb to control a standard input device and a commonplace computer mouse to control virtual limb movements and tasks in a virtual world.


In a prospective cohort study, 35 ambulatory survivors of ABI (25/71% stroke, 10/29% traumatic brain injury) were enrolled. The subjects were divided into three groups: group A received VAI therapy only, group B received VAI and physical/occupational therapy (P/OT), and group C received P/OT only. Motor skills were evaluated by muscle strength (hand key pinch strength, grasp, and three-jaw chuck pinch) and active range of motion (AROM) of the shoulder, elbow, and wrist. Changes were analyzed by ANOVA, ANCOVA, and one-tailed Pearson correlation analysis. MRI data was acquired for group A, and volumetric changes in grey matter were analyzed using voxel-based morphometry (VBM) and correlated with quantified motor skills.


AROM of the shoulder, elbow, and wrist improved in all three groups. VBM revealed grey matter increases in five brain areas: the tail of the hippocampus, the left caudate, the rostral cingulate zone, the depth of the central sulcus, and the visual cortex. A positive correlation between the grey matter volumes in three cortical regions (motor and premotor and supplementary motor areas) and motor test results (power and AROM) was detected.


Our findings suggest that the VAI rehabilitation program significantly improved motor function and skills in the affected upper extremities of subjects with acquired brain injuries. Significant increases in grey matter volume in the motor and premotor regions of affected hemisphere and correlations of motor skills and volume in nonaffected brain regions were present, suggesting marked changes in structural brain plasticity.


Neurological disorders, including acquired brain injuries (ABIs) are important causes of disability and death worldwide [12]. Although age-standardized mortality rates for ischemic and hemorrhagic strokes have decreased in the past two decades, the absolute number of stroke survivors is increasing, with most of the burden in low- and middle-income countries [3]. Another major issue is that trends toward increasing stroke incidence at younger ages has been observed [4]. Moreover, this type of ABI is the leading cause of long-term disability in the United States, with an estimated incidence of 795,000 strokes yearly [2].

In more than 80% of stroke survivors, impairments are seen in at least one of the upper limbs. Six months after a stroke, 38% of patients recover some dexterity in the paretic arm, though only 12% recover substantial function even in spite of having received physical/occupational therapy (P/OT) [5]. Only a few survivors are able to regain some useful function of the upper limb. Failing to achieve useful function has highly negative impacts on the performance of daily living activities [67]. Regaining control and improving upper limb motor function after ABIs are therefore crucial goals of motor system rehabilitation. In left-sided limb impairment, neglect syndrome can contribute to a worsened clinical state, making the alleviation of symptoms even more difficult to achieve. Mirror therapy has been reported as a promising approach to improve neglect symptoms [89].

MRI has been used to track changes in brain connectivity related to rehabilitation [10], and several studies of healthy individuals playing off-the-shelf video games have demonstrated changes in the human brain resulting from interactions in a virtual world (VW) [1112]. Furthermore, playing video games results in brain changes associated with regaining improved, purposeful physical movements [1314]. The socio-cultural relevance of virtual reality (VR) and VW applications lies, more generally, in the fact that these technologies offer interactive environments to users. These interactive environments are actually present in the users’ experiences while less so in the world they share as biological creatures [15]. The way in which we engage with VWs allows for rehabilitation exercises and activities that feel similar to their actual physical world counterparts [11]. In the past two decades, researchers have demonstrated the potential for the interactive experiences of VWs to provide engaging, motivating, less physically demanding, and effective environments for ABI rehabilitation [916,17,18].

One of the suitable rehabilitation methods seems to be exercises and tasks in VW called virtual anatomical interactivity (VAI) [19]. This method provides sensory stimulation / afferent feedback and allows the independent control of an anatomically realistic virtual upper extremity capable of simulating human movements with a true range of motion. ABI survivors are able to relearn purposeful physical movements and regain movement in their disabled upper extremities [19]. Contrary to conventional therapy, which exercises impaired upper limbs to improve limb movement, the general VAI hypothesis is that brain exercises alone (or combined with traditional therapy) may positively influence neuroplastic functions. In the VW, subjects can move their virtual impaired limbs using their healthy hands, meaning simulated physical movements are survivor-authored. Virtual visuomotor feedback may help regain functional connectivity between the brain and the impaired limb, therefore also regaining voluntary control of the limb.

The aim of the study was to test if the shoulder, elbow, and wrist movement; hand pinch strength; and grip strength of the paretic side improved through the use of VAI exclusively or combined with P/OT for upper extremities and how these approaches improved functional outcomes measured by the Action Reach Arm Test [20]. The relationship between changes in abilities to control upper extremities and volumetric changes in cortex grey matter measured by VBM and using MRI was also explored.[…]

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Examples of VAI games: multi-finger actions to pick up a spoon and drop it into a cup, tapping actions using the index and middle fingers on a remote control, removing a light bulb and reinserting it into another fixture designated by a letter of the alphabet, choosing letters of the alphabet to form words and phrases. All actions are performed by clicking and draging mouse on the appropriate body part

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[Abstract] The predictors of proxy- and self-reported quality of life among individuals with acquired brain injury



Acquired brain injury (ABI) diminishes quality of life (QoL) of affected individuals and their families. Fortunately, new multidimensional instruments such as the calidad de vida en daño cerebral (CAVIDACE) scale are available. However, differences in self- and proxy-reported QoL remain unclear. Therefore, this study examined these differences and identified predictors of QoL among individuals with ABI.

Materials and methods

This cross-sectional study comprised 393 adults with ABI (men: 60%; M age = 54.65, SD = 14.51). Self-, family-, and professional-reported QoL were assessed using the CAVIDACE scale. Other personal and social variables were assessed as predictors of QoL.


Professionals had the lowest QoL scores (M = 1.88, SD = 0.45), followed by family members (M = 2.02, SD = 0.44) and individuals with ABI (M = 2.10, SD = 0.43). Significant differences were found for almost all QoL domains, finding the highest correlations between family and professional proxy measures (r = 0.63). Hierarchical regression analysis revealed that sociodemographic, clinical, rehabilitation, personal, and social variables were significant predictors of QoL.


It is necessary to use both self- and proxy-report measures of QoL. Additionally, the identification of the variables that impact QoL permits us to modify the interventions that are offered to these individuals accordingly.

  • Implications for rehabilitation
  • Acquired brain injury (ABI) causes significant levels of disability and affects several domains of functioning, which in turn can adversely affect quality of life (QoL).
  • QoL is a multidimensional construct that is affected by numerous factors: sociodemographic, clinical, personal, social, etc; and also, with aspects related to the rehabilitation they receive after ABI.
  • Rehabilitation programs should address the different domains of functioning that have been affected by ABI.
  • Based on research findings about the QoL’s predictors, modifications could be made in the rehabilitation process; paying special attention to the depressive- and anosognosia process, as well as the importance of promoting social support, community integration, and resilience.


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[Infographic] What is the difference between an acquired brain injury and a traumatic brain injury?

An acquired brain injury (ABI) is an injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma. Essentially, this type of brain injury is one that has occurred after birth. The injury results in a change to the brain’s neuronal activity, which affects the physical integrity, metabolic activity, or functional ability of nerve cells in the brain. An acquired brain injury is the umbrella term for all brain injuries.

There are two types of acquired brain injury: traumatic and non-traumatic.

Traumatic Brain Injury

A traumatic brain injury (TBI) is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force. Traumatic impact injuries can be defined as closed (or non-penetrating) or open (penetrating). Examples of a TBI include:

  • falls
  • assaults
  • motor vehicle accidents
  • sports injuries

Non-Traumatic Brain Injury

Often referred to as an acquired brain injury, a non-traumatic brain injury causes damage to the brain by internal factors, such as a lack of oxygen, exposure to toxins, pressure from a tumor, etc. Examples of NTBI include:

  • stroke
  • near-drowning
  • aneurysm
  • tumor
  • infectious disease that affects the brain (i.e., meningitis)
  • lack of oxygen supply to the brain (i.e., heart attack)


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[Abstract] Quantification of abnormal upper limb movement during walking in people with acquired brain injury


  • Abnormal upper limb movements during walking are common after brain injury
  • Composite scores quantify abnormal upper limb movements with strong clinimetrics
  • Arithmetic mean and scaled composite scores provide different information
  • At self-selected walking speed, anormal upper limb movements are almost at maximum
  • Less fast walk abnormality exists when scaled to healthy adult movement variability


Background: Abnormal upper limb movements frequently affect people with acquired brain injury (ABI) during walking. Three-dimensional motion analysis (3DMA) can quantify upper limb abnormality kinematically, with composite scores condensing multiple joint axes data into a single score.

Research Question: Are 3DMA-derived composite scores valid (known-groups and convergent validity), reliable and able to quantify speed-related changes in abnormal upper limb movement during walking?

Methods: This observational study compared 42 adults with ABI and abnormal upper limb movements during walking with 36 healthy controls (HC) at a matched walking speed intention. Participants underwent 3DMA assessment of self-selected and fast walking speeds. Composite scores quantified the affected upper limb’s kinematic abnormality. The Arm Posture Score arithmetic mean version (APSam) and 1.96 standard deviation reference-range scaled versions; the Kinematic Deviation Score mean (KDSm) and worst score (KDSw) were evaluated for association with each other and subjective abnormality rating (Pearson’s r correlation), test-retest reliability (intra-class correlation coefficient (ICC)), and ability to quantify speed-related changes in abnormal upper limb movement (Cohen’s d effect size (ES), % change scores).

Results: Very strong correlations existed between composite scores. The KDSm under-classified upper limb abnormality, whereas the KDSw captured the majority of ABI participants. All scores had moderate-strong correlations with subjective rating of abnormal upper limb movements (r = 0.54-0.79) and very strong test-retest reliability (ICCs>0.81). The APSam demonstrated a 16% (ES 0.76) walking speed-related increase in upper limb abnormality, whilst decreases were demonstrated in the KDSm 26% (ES 0.90) and KDSw 35% (ES 0.96).

Significance: The APSam, KDSw, and number of abnormal joint axes comprehensively assess the whole upper limb abnormal movements, accurately classifies abnormality, and quantifies severity. This study illustrated notable presence of abnormal upper limb movements at self-selected walking speed and small increase at fast speeds. However, when scaled to HC variability, the fast walk kinematics became less abnormal due to increased HC movement variability.

via Quantification of abnormal upper limb movement during walking in people with acquired brain injury – ScienceDirect

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[Infographic] Brain Injury Defilitions

Η εικόνα ίσως περιέχει: κείμενο

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[Infographic] More in Common Than You Think


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[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

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.

Click here to go the our blog site!

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!

via Lash & Associates’ Award-Winning Blog site

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