Posts Tagged cognition

[BLOG POST] One day at a time. Cognition and Caregiving after a TBI

By Bill Herrin

Thinking comes so naturally that most people take it for granted, but after a traumatic brain injury – many times, thinking can be more of a deliberate action. It takes focus and effort to put a series of thoughts together after TBI, to speak clearly, or to even move. Simply put, the brain (like the body) takes time to heal. Since no two brain injuries are identical, there is no clear path to better cognition. There are, however, certain broad directives that can get you moving in the right direction in most situations. The hardest part of this is to accept your “new normal”. Acceptance, once you come to terms with it, gives you the desire to work toward the goal of better cognition, coordination, memory, anger management, judgement, attention, and other challenges. Once you accept your situation isn’t going to change overnight, you can start the process of healing, along with testing your limitations. Although finding your limitations is difficult, knowing what they are is a huge step towards improvement in areas that need changing. When a person lacks enough cognition to be self-aware or to strive towards improvement, that’s a test for the caregiver’s guidance and patience. Sometimes just being there for your friend, spouse, or loved one is all you can do.

As a caregiver, high expectations from a TBI survivor shouldn’t be overly discouraged, as they can bring progress through their desire to improve. They may not reach the goal they wanted to, but they’ll make strides towards it! That is positivity in its purest form. Nobody wants to be working through such a huge change in their life without encouragement – cheer them onward and upward! Even if they fail, they are trying, and that shows initiative. Their desire to improve should never be underappreciated.

When cognition is in the early stages of improvement, the changes may be noticed more by the family or caregiver than they are by the survivor. Sometimes incremental change is just too subtle for survivors to realize, but pointing out the changes to them is incredibly positive reinforcement. The following tips on cognition are excerpted from Lash & Associates’ tip card titled “Cognition – Compensatory strategies after brain injury”

Cognitive fatigue is one of the most common consequences of brain injury. The survivor’s brain is simply working harder to think and learn. Cognitive rest is just as important – maybe even more important – as physical rest after the brain has been injured. Cognitive fatigue can have a ripple effect. You may have a shorter temper, find it harder to concentrate, make more errors, misplace things or forget appointments. You may feel like you can’t think straight no matter how hard you try. Many survivors describe cognitive fatigue as “hitting the wall”.

Do you…

• Feel tired after mental exertion?

• Have a harder time thinking after working on longer or more complex tasks?

• Need more sleep than usual?

• Find it hard to get through the day without napping?

Tips on compensatory strategies…

• Take breaks.

• Schedule rest periods.

• Stay organized.

• Use a daily planner.

• Use time management strategies.

• Eat nutritious meals on a regular schedule.

• Go to bed at a consistent time.

– Create a weekly exercise routine.

• Request a medical evaluation.

• Discuss medications that may help with a physician specializing in brain injury rehabilitation.

There are a plenty of great suggestions for compensatory strategies for survivors and their caregivers in the tip card referenced above. Here’s a link to it here!

When it comes to cognitive functional rehabilitation – seek professional advice first (of course), but when the TBI survivor is at home with a caregiver, clinician, friend or family member, there are some great approaches to working on communication, social interaction, organization, reading, attention, problem solving, and rebuilding other deficits through consistent application by any or all of the people involved in the care of the TBI survivor.

Referencing the book titled “Cognition Functional Rehabilitation Activities Manual” (Developed by Barbara Messenger, MEd, ABDA and Niki Ziarnek, MS, CCC-SLP/L), I’m sharing an excerpt that provides a glimpse into the workbook’s approach to helping a person with cognitive challenges. Many of the exercises use interaction and documentation to assess where the TBI survivor is at (cognitively speaking) on an ongoing basis. Remember, this is a workbook, and there are plenty of exercises that build activities and responses ongoing. Here is the example of how the manual challenges a TBI survivor with structured and specific activities:

Task: Provide awareness training.

Procedure:

  1. Prompt participant to work on awareness training.
  2. Ask why participant is here receiving rehabilitation.
  3. Ask what skills/activities are harder since the brain injury.
  4. Ask what participant does to compensate for these difficulties and which therapies address them.Ask what participant’s strengths are (what is participant good at?).
  1. Ask the participant how the brain injury and difficulties affect daily activities.
  2. Provide answers and examples when needed.
  3. Provide positive reinforcement for strengths, being receptive to information regarding brain injury, for participating in the task, and for being motivated to participate in rehabilitation.

Staff Reminder: (clinician, caregivers, family, etc.)

Provide a complete description of this activity in the Functional Rehabilitation Documentation Form.

Last words…

By asking specific questions, and recording the corresponding answers, this workbook is a great tool for tracking progress – and the exercises can be done more than once, to check and see how/if the answers have changed. So, what’s the takeaway from this excerpt? It illustrates that structure and consistency of care and treatment by family/caregivers and professionals can overlap and create a solid overview of cognitive deficits, and improvements.

In closing, the main goal of this post is to address the expectations of TBI survivors and their caregivers, to encourage them to strive for progress and to offer resources for compensatory strategies, and cognitive rehabilitation. If all parties work in tandem with the common goal of helping a TBI survivor make it to the next level, they’re all closer to the goal…and the whole team wins. That’s the goal!

 

via cognition-caregiving-tbi

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[Abstract] Cognition, Health-Related Quality of Life, and Depression Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study

The aim of this study was to evaluate cognitive function 10 years after moderate-severe traumatic brain injury (TBI) and to investigate the associations among cognitive function, depression, and health-related quality of life (HRQoL). In this prospective cohort study, with measurements at 3, 6, 12, 18, 24, 36, and 120 months post-TBI, patients 18–67 years of age (n = 113) with moderate-severe TBI were recruited. Main outcome measures were depression (Center for Epidemiologic Studies-Depression Scale [CES-D]), subjective cognitive functioning (Cognitive Failure Questionnaire [CFQ]), objective cognitive functioning, and HRQoL (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]). Fifty of the initial 113 patients completed the 10 year follow-up. Twenty percent showed symptoms of depression (CES-D ≥ 16). These patients had more psychiatric symptoms at hospital discharge (p = 0.048) and were more often referred to rehabilitation or nursing homes (p = 0.015) than non-depressed patients. Further, they also had significantly lower scores in six of the eight subdomains of the SF-36. The non-depressed patients had equivalent scores to those of the Dutch norm-population on all subdomains of the SF-36. Cognitive problems at hospital discharge were related with worse cognitive outcome 10 years post-TBI, but not with depression or HRQoL. Ten years after moderate-severe TBI, only weak associations (p < 0.05) between depression scores and two objective cognitive functioning scores were found. However, there were moderate associations (p < 0.01) among depression scores, HRQoL, and subjective cognitive functioning. Therefore, signaling and treatment of depressive symptoms after moderate-severe TBI may be of major importance for optimizing HRQoL in the long term. We did not find strong evidence for associations between depression and objective cognitive functioning in the long term post-TBI. Disease awareness and selective dropping out may play a role in long-term follow-up studies in moderate-severe TBI. More long-term research is needed in this field.

 

via Cognition, Health-Related Quality of Life, and Depression Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study | Journal of Neurotrauma

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[Review] Evolution of Cognitive Rehabilitation After Stroke From Traditional Techniques to Smart and Personalized Home-Based Information and Communication Technology Systems: Literature Review – Full Text

ABSTRACT

Background: Neurological patients after stroke usually present cognitive deficits that cause dependencies in their daily living. These deficits mainly affect the performance of some of their daily activities. For that reason, stroke patients need long-term processes for their cognitive rehabilitation. Considering that classical techniques are focused on acting as guides and are dependent on help from therapists, significant efforts are being made to improve current methodologies and to use eHealth and Web-based architectures to implement information and communication technology (ICT) systems that achieve reliable, personalized, and home-based platforms to increase efficiency and level of attractiveness for patients and carers.

Objective: The goal of this work was to provide an overview of the practices implemented for the assessment of stroke patients and cognitive rehabilitation. This study puts together traditional methods and the most recent personalized platforms based on ICT technologies and Internet of Things.

Methods: A literature review has been distributed to a multidisciplinary team of researchers from engineering, psychology, and sport science fields. The systematic review has been focused on published scientific research, other European projects, and the most current innovative large-scale initiatives in the area. A total of 3469 results were retrieved from Web of Science, 284 studies from Journal of Medical Internet Research, and 15 European research projects from Community Research and Development Information Service from the last 15 years were reviewed for classification and selection regarding their relevance.

Results: A total of 7 relevant studies on the screening of stroke patients have been presented with 6 additional methods for the analysis of kinematics and 9 studies on the execution of goal-oriented activities. Meanwhile, the classical methods to provide cognitive rehabilitation have been classified in the 5 main techniques implemented. Finally, the review has been finalized with the selection of 8 different ICT–based approaches found in scientific-technical studies, 9 European projects funded by the European Commission that offer eHealth architectures, and other large-scale activities such as smart houses and the initiative City4Age.

Conclusions: Stroke is one of the main causes that most negatively affect countries in the socioeconomic aspect. The design of new ICT-based systems should provide 4 main features for an efficient and personalized cognitive rehabilitation: support in the execution of complex daily tasks, automatic error detection, home-based performance, and accessibility. Only 33% of the European projects presented fulfilled those requirements at the same time. For this reason, current and future large-scale initiatives focused on eHealth and smart environments should try to solve this situation by providing more complete and sophisticated platforms.[…]

Continue —> JRAT-Evolution of Cognitive Rehabilitation After Stroke From Traditional Techniques to Smart and Personalized Home-Based Information and Communication Technology Systems: Literature Review | Cogollor | JMIR Rehabilitation and Assistive Technologies

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[ARTICLE] What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes – Full Text

Abstract

Background

Virtual-reality based rehabilitation (VR) shows potential as an engaging and effective way to improve upper-limb function and cognitive abilities following a stroke. However, an updated synthesis of the literature is needed to capture growth in recent research and address gaps in our understanding of factors that may optimize training parameters and treatment effects.

Methods

Published randomized controlled trials comparing VR to conventional therapy were retrieved from seven electronic databases. Treatment effects (Hedge’s g) were estimated using a random effects model, with motor and functional outcomes between different protocols compared at the Body Structure/FunctionActivity, and Participation levels of the International Classification of Functioning.

Results

Thirty-three studies were identified, including 971 participants (492 VR participants). VR produced small to medium overall effects (g = 0.46; 95% CI: 0.33–0.59, p < 0.01), above and beyond conventional therapies. Small to medium effects were observed on Body Structure/Function (g = 0.41; 95% CI: 0.28–0.55; p < 0.01) and Activityoutcomes (g = 0.47; 95% CI: 0.34–0.60, p < 0.01), while Participationoutcomes failed to reach significance (g = 0.38; 95% CI: -0.29-1.04, p = 0.27). Superior benefits for Body Structure/Function (g = 0.56) and Activity outcomes (g = 0.62) were observed when examining outcomes only from purpose-designed VR systems. Preliminary results (k = 4) suggested small to medium effects for cognitive outcomes (g = 0.41; 95% CI: 0.28–0.55; p < 0.01). Moderator analysis found no advantage for higher doses of VR, massed practice training schedules, or greater time since injury.

Conclusion

VR can effect significant gains on Body Structure/Function and Activity level outcomes, including improvements in cognitive function, for individuals who have sustained a stroke. The evidence supports the use of VR as an adjunct for stroke rehabilitation, with effectiveness evident for a variety of platforms, training parameters, and stages of recovery.

Background

Stroke is one of the leading global causes of disability [12], with over 17 million individuals worldwide sustaining a stroke each year [2]. Although stroke mortality is decreasing with improvements in medical technology [3], the neurological trauma resulting from stroke can be devastating, and the majority of stroke survivors have substantial motor [45], cognitive [6789] and functional rehabilitation needs [31011], and much reduced quality of life [31213]. Targeted rehabilitation can help address some of these post-stroke deficits, however, historically, many individuals, in particular patients with cognitive impairment, have difficulty engaging in standard therapies [141516] at a level that will produce meaningful and lasting improvements [16171819]. Enriched and interactive rehabilitation programs are clearly needed to minimize functional disability [1320], increase participation in age-appropriate roles and activities [21], lead to greater motivation and treatment compliance [1722], and reduce the long-term expense of care in stroke survivors [202324].[…]

 

Continue —> What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes | Journal of NeuroEngineering and Rehabilitation | Full Text

 

Fig. 1 Population, Intervention, Comparison, Outcome (PICO) Question and the main variables included in the systematic literature review and meta-analysis

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[BLOG] Food for Brain: Cognitive Enhancement via Diet

by  | January 15, 2018

It is often said that we are what we eat. The food we eat is used not only to fuel our body, but also to build it. This applies to the brain as well. Food choices can influence our brain functions in both positive and negative ways. The right food may enhance brain functioning and ameliorate the cognitive decline associated with aging. In addition, some foods can improve our emotional status and prevent conditions like depression.

Lipids are good for brain—myth or reality?

It is a fact that some lipids, including unsaturated fatty acids, are necessary for brain developmentand functioning. This is not surprising if we consider that the brain is the second richest organ in lipids. Approximately 50–60% of the brain is made of lipids. But not all the fatty acids are equally good for the brain. Omega-3 fatty acids found in fatty fish (salmon, mackerel, herring) and seafood are essential for the brain. These fatty acids constitute brain cell membranes. Also, they are main compounds of myelin, a fatty coat that insulates neurons (brain and ensures transmission of signals.

Omega-3 fats play vital functions in improving cognitive functions, providing proper neuronal communication and securing adequate attention. Interestingly, consumption of just one fish meal per weak is believed to decrease the risk of Alzheimer’s disease by up to 60%. Human clinical trials showed that supplementation with omega-3 fatty acids might improve mood, cooperation and cognitive score in subjects with dementia. Omega-3 fatty acids are extremely important for neonatal development as well. A deficit in these fats in pregnant and breastfeeding women, as well as in early childhood, may lead to conditions like autism and attention deficit hyperactivity disorder (ADHD).

Polyunsaturated (omega-3) and monounsaturated fatty acids also regulate the brain’s dopamine system. This is how they improve levels of dopamine and serotonin—the chemicals that make us feel happy. This is why diets with high fish consumption are associated with a low prevalence of depression. Cross-national analyses declared Japan as a country with the highest fish intake on the one hand and the lowest depression score on the other.

Apart from fish meals, walnuts (and nuts in general) are rich sources of omega-3 fatty acids. They contain essential alpha-linolenic fatty acids that cannot be synthesized inside our body and need to be obtained from our diet. Flaxseed and flaxseed oils are other valuable sources of this fatty acid.  In addition to omega-3 fats, walnuts contain potential brain antioxidants—vitamin E and polyphenols.

Olive oil is an especially rich source of monounsaturated fatty acids, with oleic acid as the main representative. Like omega-3, monounsaturated fatty acids help to improve cognitive functions and prevent age-related cognitive decline. These fats are also found in avocados. This is why avocado is commonly labeled as a brain superfood. It is assumed that eating just a quarter or half of a avocado daily can help maintain brain health.

Antioxidants: food for thought

Brain membranes are rich in polyunsaturated fatty acids that are highly susceptible to oxidation. The oxidation of fatty acids leads to changes in membrane structure that can jeopardize brain functioning. When fatty acids are oxidized, membranes are damaged or even ruptured. This makes the intake of nutrients into brain cells quite difficult. The lack of nutrients stops normal functions of brain cells and eventually causes their death.

Oxidation of brain lipids occurs when the production of free radicals is greater than their removal by antioxidants present in the body. Thus, the adequate intake of antioxidants can prevent oxidation of brain lipids and slow down the loss of brain functions. This is why berries and fruits with high antioxidant potential are often recommended as good foods for the brain. Some findings suggest that high intake of blueberries and strawberries can halt the onset of age-related cognitive decline by up to 2.5 years. What makes berries powerful antioxidants is the presence of polyphenols, chemicals that give color to these fruits. Berries can decrease aging-related vulnerability to oxidative stress. These decrease further manifests with improvements in behavior. Human trials in people with mild cognitive impairments suggested the positive impact of berries on verbal memory performance. Apart from combating oxidative stress in the brain, polyphenols can also improve microcirculation. By enhancing blood flow, polyphenols help the proper nourishment of the brain that is important for its functioning.

Another food rich in polyphenols (more precisely epicatechin) that is believed to enhance cognition is dark chocolate. It is assumed that by decreasing oxidative stress and inflammation, dark chocolate improves memory and confers neuroprotection. Still, human trials are required to establish if dark chocolate can be considered as a brain superfood.

Curcuminoids are phenolic compounds from turmeric (popular curry spice) that can enhance memory and protect from neurodegenerative diseases, like Alzheimer’s. Although this opinion is mostly based on animal studies, it is likely that prevalence of Alzheimer’s disease in India is very low due to the common consumption of curry.

A diet rich in vitamins, minerals, and antioxidants, such as polyphenols and their subclass flavonoids, is assumed to suppress the incidence of Alzheimer’s disease. One of the foods containing all of these components is spinach. Spinach, like other leafy green vegetables, contains folic acid and vitamin K that are believed to help keep the brain sharp. Although vitamin K is important for producing myelin, the substance that insulates neurons, the effects of dietary vitamin K supplementation on the function of brain myelin have not been tested so far.

Other cognitive enhancers

Another possible brain stimulator representing one of the most popular drinks worldwide is tea. An interesting study in Chinese adults tracked the association between tea consumption and cognitive decline. The higher tea intake was associated with lower prevalence of cognitive impairments, suggesting that regular tea consumption may slow down cognitive decline. Interestingly, the association was most evident for black tea. The same study showed no association between coffee intake and cognitive status.

Extracts from herb Ginkgo biloba have been traditionally used for memory and concentration problems, but also for dealing with depression and anxiety. A recent meta-analysis found no impact of ginkgo on cognitive functions in healthy subjects, suggesting that the effects of Ginko may be rather minor. Nonetheless, some earlier studies showed that ginkgo together with ginseng may acutely enhance memory in a dose-dependent manner. Unlike ginkgo, human trials with ginseng showed that its consumption can improve working memory performance and mood in terms of calmness.

Although further clinical trials are needed to confirm the cognitive enhancement by many foods, it is evident that diet represents a promising tool for maintaining and improving brain health.

References

Muldoon, M.F., Ryan, C.M., Sheu, L., Yao, J.K., Conklin, S.M., Manuck, S.B. (2010). Serum phospholipid docosahexaenonic acid is associated with cognitive functioning during middle adulthood. Journal of Nutrition. 140(4): 848-853. doi: 10.3945/jn.109.119578

Terano, T., Fujishiro, S., Ban, T., Yamamoto, K., Tanaka, T., et al. (1999). Docosahexaenoic acid supplementation improves the moderately severe dementia from thrombotic cerebrovascular diseases. Lipids. 34 Supplement: S345-S346. PMID: 10419198

Gómez-Pinilla, F. (2008). Brain foods: the effects of nutrients on brain function. Nature Reviews. Neuroscience. 9(7): 568-578. doi: 10.1038/nrn2421

Joseph, J.A., Shukitt-Hale, B., Willis, L.M. (2009). Grape juice, berries, and walnuts affect brain aging and behavior. Journal of Nutrition. 139(9): 1813S-1817S. doi: 10.3945/jn.109.108266

Ahmed, T., Enam, S.A., Gilani, A.H. (2010). Curcuminoids enhance memory in an amyloid-infused rat model of Alzheimer’s disease. Neuroscience. 169(3): 1296-1306. doi: 10.1016/j.neuroscience.2010.05.078

Ng, T.P., Feng, L., Niti, M., Kua, E.H., Yap, K.B. (2008). Tea consumption and cognitive impairment and decline in older Chinese adults. American Journal of Clinical Nutrition. 88(1): 224-231. PMID: 18614745

Laws, K.R., Sweetnam, H., Kondel, T.K. (2012). Is Ginkgo biloba a cognitive enhancer in healthy individuals? A meta-analysis. Human Psychopharmacology. 27(6):527-533. doi: 10.1002/hup.2259

via Food for Brain: Cognitive Enhancement via Diet | Brain Blogger

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[Abstract] Effects of an Exercise Protocol for Improving Handgrip Strength and Walking Speed on Cognitive Function in Patients with Chronic Stroke

BACKGROUND: Handgrip strength and walking speed predict and influence cognitive function. We aimed to investigate an exercise protocol for improving handgrip strength and walking speed, applied to patients with chronic stroke who had cognitive function disorder.
MATERIAL AND METHODS: Twenty-nine patients with cognitive function disorder participated in this study, and were randomly divided into one of two groups: exercise group (n=14) and control group (n=15). Both groups underwent conventional physical therapy for 60 minutes per day. Additionally, the exercise group followed an exercise protocol for handgrip using the hand exerciser, power web exerciser, Digi-Flex (15 minutes); and treadmill-based weight loading training on their less-affected leg (15 minutes) using a sandbag for 30 minutes, three times per day, for six weeks. Outcomes, including cognitive function and gait ability, were measured before and after the training.
RESULTS: The Korean version of Montreal Cognitive Assessment (K-MoCA), Stroop test (both simple and interference), Trail Making-B, Timed Up and Go, and 10-Meter Walk tests (p<0.05) yielded improved results for the exercise group compared with the control group. Importantly, the K-MoCA, Timed Up and Go, and 10-Meter Walk test results were significantly different between the two groups (p<0.05).
CONCLUSIONS: The exercise protocol for improving handgrip strength and walking speed had positive effects on cognitive function in patients with chronic stroke.

Link to Full Text Download —> Get your full text copy in PDF | Medical Science Monitor

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[Abstract] Active exergames to improve cognitive functioning in neurological disabilities: a systematic review and meta-analysis

INTRODUCTION: Exergames represent a way to perform physical activity through active video games, serving as potentially useful tool in the field of neurorehabilitation. However, little is known regarding the possible role of exergames in improving cognitive functions in persons suffering from neurological disabilities.
EVIDENCE ACQUISITION: A search for relevant articles was carried out on PubMed/Medline, Scopus, PEDro, and Google Scholar. Only randomized controlled studies and non-randomized but controlled studies were retained. The following additional inclusion criteria were applied: studies focused on physical activity interventions carried out by means of exergames; populations targeted were affected by neurological disabilities; and reported results were related to cognitive outcomes. We calculated standardized mean differences (SMD) and pooled results using a random effects meta-analysis.
EVIDENCE SYNTHESIS: Of 520 abstracts screened, thirteen studies met the criteria to be included yielding a total of 465 participants, 233 randomized to exergames, and 232 allocated to the alternative or no intervention. The included studies varied in terms of studied populations (e.g., multiple sclerosis, post-stroke hemiparesis, Parkinson’s disease, dementia, dyslexia, Down syndrome), type and duration of interventions, and cognitive outcome measures. Exergames significantly improved executive functions (SMD=0.53, p=0.005; 8 studies, n=380) and visuo-spatial perception (SMD=0.65, p<0.0001; 5 studies, n=209) when compared to the alternative or no intervention. There were no significant differences for attention (SMD=0.57, p=0.07; 7 studies, n=250) and global cognition (SMD=0.05, p=0.80; 6 studies, n=161).
CONCLUSIONS: Exergames are a highly-flexible tool for rehabilitation of both cognitive and motor functions in adult populations suffering from various neurological disabilities and developmental neurological disorders. Additional high-quality clinical trials with larger samples and more specific cognitive outcomes are needed to corroborate these preliminary findings.
CLINICAL REHABILITATION IMPACT: Exergames could be considered either as a supplemental treatment to conventional rehabilitation, or as strategy to extend benefits of conventional programs at home.

Full Text  PDF  

via Active exergames to improve cognitive functioning in neurological disabilities: a systematic review and meta-analysis – European Journal of Physical and Rehabilitation Medicine 2017 Oct 25 – Minerva Medica – Journals

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[Poster] Implementing Best Practices in Cognitive Rehabilitation: What are Rehabilitation Teams’ Priorities and Why?

via Implementing Best Practices in Cognitive Rehabilitation: What are Rehabilitation Teams’ Priorities and Why? – Archives of Physical Medicine and Rehabilitation

First page of article

This study represents the first step of a knowledge translation initiative to support the implementation of best practices in cognitive rehabilitation post-acquired brain injury (ABI). The objective was to identify rehabilitation teams’ priorities regarding the implementation of best practices in cognitive rehabilitation, as well as the factors influencing decision-making processes about implementation.

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[SLIDE SHOW] The Invisible Effects of Stroke – PDF File

The Invisible Effects of Stroke

By Nicole Walmsley

Overview

The objective is to:
1. identify four common invisible effects of a stroke
2. demonstrate how nursing staff can identify these on an
acute stroke unit

Download the PDF File

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[ARTICLE] Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable – Full Text

In practical terms, biomarkers should improve our ability to predict long-term outcomes after stroke across multiple domains. This is beneficial for: (a) patients, caregivers and clinicians; (b) planning subsequent clinical pathways and goal setting; and (c) identifying whom and when to target, and in some instances at which dose, with interventions for promoting stroke recovery.2 This last point is particularly important as methods for accurate prediction of long-term outcome would allow clinical trials of restorative and rehabilitation interventions to be stratified based on the potential for neurobiological recovery in a way that is currently not possible when trials are performed in the absence of valid biomarkers. Unpredictable outcomes after stroke, particularly in those who present with the most severe impairment3 mean that clinical trials of rehabilitation interventions need hundreds of patients to be appropriately powered. Use of biomarkers would allow incorporation of accurate information about the underlying impairment, and thus the size of these intervention trials could be considerably reduced,4 with obvious benefits. These principles are no different in the context of stroke recovery as compared to general medical research.5

Interventions fall into two broad mechanistic categories: (1) behavioural interventions that take advantage of experience and learning-dependent plasticity (e.g. motor, sensory, cognitive, and speech and language therapy), and (2) treatments that enhance the potential for experience and learning-dependent plasticity to maximise the effects of behavioural interventions (e.g. pharmacotherapy or non-invasive brain stimulation).6 To identify in whom and when to intervene, we need biomarkers that reflect the underlying biological mechanisms being targeted therapeutically.

Our goal is to provide a consensus statement regarding the evidence for SRBs that are helpful in outcome prediction and therefore identifying subgroups for stratification to be used in trials.7 We focused on SRBs that can investigate the structure or function of the brain (Table 1). Four functional domains (motor, somatosensation, cognition, and language (Table 2)) were considered according to recovery phase post stroke (hyperacute: <24 h; acute: 1 to 7 days; early subacute: 1 week to 3 months; late subacute: 3 months to 6 months; chronic: > 6 months8). For each functional domain, we provide recommendations for biomarkers that either are: (1) ready to guide stratification of subgroups of patients for clinical trials and/or to predict outcome, or (2) are a developmental priority (Table 3). Finally, we provide an example of how inclusion of a clinical trial-ready biomarker might have benefitted a recent phase III trial. As there is generally limited evidence at this time for blood or genetic biomarkers, we do not discuss these, but recommend they are a developmental priority.912 We also recognize that many other functional domains exist, but focus here on the four that have the most developed science. […]

Continue —> Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation RoundtableInternational Journal of Stroke – Lara A Boyd, Kathryn S Hayward, Nick S Ward, Cathy M Stinear, Charlotte Rosso, Rebecca J Fisher, Alexandre R Carter, Alex P Leff, David A Copland, Leeanne M Carey, Leonardo G Cohen, D Michele Basso, Jane M Maguire, Steven C Cramer, 2017

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