Posts Tagged Cognitive impairments
INTRODUCTION: Long-term functional cognitive impairments are common sequelae of stroke, often resulting in decreased participation in daily life activities. Earlier research showed the benefits of training paradigms targeted at memory, attention, and some executive functions.
METHODS: The current study examined the feasibility of a functionally relevant training program called Strategic Memory Advanced Reasoning Training (SMART). The SMART program teaches strategies to improve abstract reasoning skills and has been shown to enhance aspects of functional cognition, strengthen brain networks, and improve participation in daily life activities across clinical populations. The current study describes the benefits of the SMART program in adults (N = 12) between 54 and 77 years (64.46 ± 8.14 years) with chronic stroke. Participants had 10 sessions of the SMART program over a period of 6 weeks.
RESULTS: The findings showed significant gains in abstract reasoning (p < .05) and participation in daily activities after the SMART program. These gains were relatively stable 6 months later.
CONCLUSION: These findings offer the promise of cognitive gains, even years after stroke. Limitations of the study include a small sample size, potential confounding as a result of additional ongoing therapy, and a relatively short period of follow-up. Further research is needed to examine the benefits of the SMART program. [Annals of International Occupational Therapy. 2020;X(X):xx–xx.]
Source: Annals of International Occupational Therapy. https://doi.org/10.3928/24761222-20200116-03
Although we may take it for granted, driving is a very complex activity requiring a number of cognitive and physical skills, as well as the ability to co-ordinate these. Any of these skills may be impaired after a brain injury.
Can I drive after brain injury?
Fortunately, many people who have sustained a brain injury retain most of their previous driving abilities, and are able to return to driving soon afterwards. However, there are legal requirements which must be adhered to.
It is sensible to take precautions such as having a driving assessment, even if you feel that your driving skills remain intact. It should be remembered that a car is a potentially lethal weapon: many people with a brain injury were themselves injured in a road traffic collision.
It can be relatively straightforward to make adaptations to a vehicle in order to compensate for physical disabilities. However, the less obvious effects of brain injury – on thinking, memory, judgement, decision making and emotions – can be more difficult to overcome.
Ultimately, the decision on whether someone is safe to drive lies with the licensing authorities. This booklet explains the processes involved in reporting a medical condition and provides advice on minimising cognitive and physical impairments.
What are the legal requirements for driving after brain injury?
If you drive and have had a brain injury, you must inform the licensing authorities. This applies to any ‘notifiable’ condition which could affect your ability to drive and failure to inform the authorities could result in a fine of up to £1000. It would also mean that your licence is not valid and that you would be uninsured in the event of an accident.
As a general rule, the medical standards state that after a traumatic brain injury drivers with an ordinary car or motorcycle (Group 1) licence should cease driving for 6 to 12 months, depending on factors such as post-traumatic amnesia, seizures, and clinical recovery. Other forms of acquired brain injury have slightly different rules, but if there are lasting impairments which affect driving ability then the licence is likely to be removed for a period.
However, because every brain injury is different, each case is considered on an individual basis.
Further information on the legal requirements, rules for professional drivers and how to inform the authorities is contained in the Headway booklet Driving after brain injury, which is available to download in the Related resources section.
Support with driving after brain injury
As your driving ability can change after a brain injury, you may need support to get back on the road.
If you are receiving the higher rate mobility component of Disability Living Allowance or the enhanced rate moving around component of Personal Independence Payment, you may be able to get a car through Motability. They also have a list of accredited suppliers who can make adaptations to your car if you find it hard to operate because of a physical disability.
You might need to get an assessment before getting back on the road, to see if you are fit to drive and/or to get advice on adaptations you might need. For more information, contact Driving Mobility.
Our booklet Driving after brain injury (PDF) provides detailed information on the subject, from the legal requirements and the effect of brain injury on driving, to the process of returning to driving and financial support for those who wish to do so.
You can download it now using the link above or through our information library.
Immersive VR environment for the training of safe road crossing decisions.
Relevant Lanes and Traffic Speed have a clear influence on task difficulty.
No clear influence could be found for the Gap Size.
The Number of Vehicles had almost no effect on the perceived task difficulty.
Two neuropsychologists stated that the system is ready for a study on patients.
- CogniFit’s team of neuropsychologists, researchers and developers have introduced new features to the CogniFit application for iOS and Android.
- Updating this medical app technology aims to help the diagnostic process and prevention of cognitive impairments through monitoring the cognitive health of any user in real time.
- Now, anyone can perform assessments from their mobile device, study their brain function and accurately measure the risk index of major cognitive disorders such as ADHD, dyslexia, dyscalculia, depression, insomnia, Parkinson’s, chemofog, etc.
CogniFit, a leading developer of medical technologies for cognitive assessment and brain stimulation, has released an update of its App for iOS and Android. It includes new functionalities and incorporates complete neuropsychological batteries that digitally allow studying the cognitive functioning of children from 7 years old, young, adults or seniors. Users will know their cognitive status in less than 30-40 minutes.
This medical application is fully accessible. Any user can download CogniFit’s mobile application for iOS or Android and easily manage any of the cognitive tests.
“The innovative technology used in CogniFit’s App makes it a tool aimed at imrpoving preventive medicine. A health program focused on helping to improve different diagnosis and reduce medical expenses. The aim has been to unite knowledge and use the most reliable, advanced technology to assist in the diagnosis process and prevention and therefore to take a step towards the future.”- Carlos Rodríguez CTO at CogniFit.
Cognitive results are automatically generated after any of the clinical tests and providing comprehensible and valuable information about a wide range of cognitive skills in areas of memory, attention-concentration, planning, coordination, executive functions or reasoning.
The results report, which is fully detailed, provides an in-depth understanding of a person’s cognitive status, strengths and weaknesses and can help determine whether the cognitive symptoms they experience are normal or may reflect a neurological disorder. The results can help assist detection, and provide valuable information and action guidelines, which are the basis for identifying support strategies.
“Sometimes these symptoms go unnoticed, as they can be very subtle, so these neuropsychological evaluations are a step forward in their ability to detect the risk index of multiple cognitive pathologies at an early stage”- explains Patricia Fernández, CogniFit neuropsychologist and assessment specialist.
The CogniFit App allows you to analyze huge databases. The platform learns from each interaction and has developed an advanced interface that provides valuable information.
CogniFit technology is available to anyone with a smartphone or computer with an internet connection. This technological advance will allow more and more people to assess themselves, thus improving the quality of life of many people.
SaS (Software as a Service) is transforming medical and psychological assistance. Remote monitoring of a patient’s cognitive health through CogniFit ensures better patient care, helps optimize treatment outcomes and reduces the time and health care expense.
In education, it enables non-specialized teachers and professors to identify potential risks and anticipate learning difficulties, helping to reduce school failure. This technology helps the education system to face the digital challenge and brain-based learning, providing tools that can help improve the competitiveness and agility of the system.
CogniFit cognitive assessment batteries have also become a critical support for the transportation or vehicle industry, helping to offer more competitive services, minimize costs and help reduce accidents. These advantages can be transferred to other environments such as insurance companies, human resources, etc.
“We have sought to simplify and create an accessible application to create a bridge in the gaps between the user, school, business, or health professionals by offering graphs and comphrensible information for everyone. We are seeing a great deal of support, more and more patients, users, hospitals, schools and companies from different sectors are using these tools to evaluate cognitive health and brain functioning. We have seen how these advances are transformed into economic advantages for the institutions that apply them.”
Explains Carlos Rodriguez, CTO of CogniFit.
Like a neuropsychologist, CogniFit asks the user a series of simple questions aimed at detecting the main diagnostic criteria, signs, and symptoms. It continues with a battery of digital tasks, clinical scales, and tests validated for the user’s age, aimed at accurately assessing the main cognitive aspects (memory, attention-concentration, planning, coordination, executive functions or reasoning). In this way, we will be able to know the complete cognitive profile and the risk index of suffering from the main cognitive disorders.
These tools oriented towards pre-diagnosis are helping to transform the way people access the health or education system, bringing important benefits to medical teams, researchers, companies, schools, insurance companies, etc.
Carlos Rodríguez adds that “technology is more and more present in society, and it takes on a special role in health and education. For us in this sector we need to meet the challenges that both areas entail.”
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
- 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.
[ARTICLE] Strategy Training Shows Promise for Addressing Disability in the First 6 Months After Stroke
Background. Cognitive impairments occur frequently after stroke and contribute to significant disability. Strategy training shows promise but has not been examined in the acute phase of recovery.
Objective. We conducted a single-blind randomized pilot study estimating the effect of strategy training, relative to reflective listening (attention control), for reducing disability and executive cognitive impairments.
Methods. Thirty participants with acute stroke who were enrolled in inpatient rehabilitation and had cognitive impairments were randomized to receive strategy training (n = 15, 10 sessions as adjunct to usual inpatient rehabilitation) or reflective listening (n = 15, same dose). The Functional Independence Measure assessed disability at baseline, rehabilitation discharge, 3, and 6 months. The Color Word Interference Test of the Delis–Kaplan Executive Function System assessed selected executive cognitive impairments (inhibition, flexibility) at baseline, 3, and 6 months.
Results. Changes in Functional Independence Measure scores for the 2 groups over 6 months showed significant effects of group (F1,27 = 9.25, P = .005), time (F3,74 = 96.00, P < .001), and group * time interactions (F3,74 = 4.37, P < .007) after controlling for baseline differences in stroke severity (F1,27 = 6.74, P = .015). Color Word Interference Inhibition scores showed significant effects of group (F1,26 = 6.50, P = .017) and time (F2,34 = 4.74, P = .015), but the group * time interaction was not significant (F2,34 = 2.55, P = .093). Color Word Interference Cognitive Flexibility scores showed significant effects of group (F1,26 = 23.41, P < .001), time (F2,34 = 12.77, P < .001), and group * time interactions (F2,34 = 7.83, P < .002). Interaction effects suggested greater improvements were associated with strategy training.
Conclusions. Strategy training shows promise for addressing disability in the first 6 months after stroke. Lessons from this pilot study may inform future clinical trials.