Posts Tagged cognitive rehabilitation

[Abstract+References] A Serious Games Platform for Cognitive Rehabilitation with Preliminary Evaluation

Abstract

In recent years Serious Games have evolved substantially, solving problems in diverse areas. In particular, in Cognitive Rehabilitation, Serious Games assume a relevant role. Traditional cognitive therapies are often considered repetitive and discouraging for patients and Serious Games can be used to create more dynamic rehabilitation processes, holding patients’ attention throughout the process and motivating them during their road to recovery. This paper reviews Serious Games and user interfaces in rehabilitation area and details a Serious Games platform for Cognitive Rehabilitation that includes a set of features such as: natural and multimodal user interfaces and social features (competition, collaboration, and handicapping) which can contribute to augment the motivation of patients during the rehabilitation process. The web platform was tested with healthy subjects. Results of this preliminary evaluation show the motivation and the interest of the participants by playing the games.

Source: A Serious Games Platform for Cognitive Rehabilitation with Preliminary Evaluation | SpringerLink

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[ARTICLE] Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients – Full Text

Abstract

Background

Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients’ capability to live independently. There is substancial evidence on post-stroke cognitive rehabilitation benefits, but its implementation is generally limited by the use of paper-and-pencil methods, insufficient personalization, and suboptimal intensity. Virtual reality tools have shown potential for improving cognitive rehabilitation by supporting carefully personalized, ecologically valid tasks through accessible technologies. Notwithstanding important progress in VR-based cognitive rehabilitation systems, specially with Activities of Daily Living (ADL’s) simulations, there is still a need of more clinical trials for its validation. In this work we present a one-month randomized controlled trial with 18 stroke in and outpatients from two rehabilitation units: 9 performing a VR-based intervention and 9 performing conventional rehabilitation.

Methods

The VR-based intervention involved a virtual simulation of a city – Reh@City – where memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. The intervention had levels of difficulty progression through a method of fading cues. There was a pre and post-intervention assessment in both groups with the Addenbrooke Cognitive Examination (primary outcome) and the Trail Making Test A and B, Picture Arrangement from WAIS III and Stroke Impact Scale 3.0 (secondary outcomes).

Results

A within groups analysis revealed significant improvements in global cognitive functioning, attention, memory, visuo-spatial abilities, executive functions, emotion and overall recovery in the VR group. The control group only improved in self-reported memory and social participation. A between groups analysis, showed significantly greater improvements in global cognitive functioning, attention and executive functions when comparing VR to conventional therapy.

Conclusions

Our results suggest that cognitive rehabilitation through the Reh@City, an ecologically valid VR system for the training of ADL’s, has more impact than conventional methods.

Trial registration

This trial was not registered because it is a small sample study that evaluates the clinical validity of a prototype virtual reality system.

Continue —> Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients | Journal of NeuroEngineering and Rehabilitation | Full Text

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[Abstract] Cognitive rehabilitation for memory deficits after stroke – The Cochrane Library

Abstract

Background

Memory problems are a common cognitive complaint following stroke and can potentially affect ability to complete functional activities. Cognitive rehabilitation programmes either attempt to retrain lost or poor memory functions, or teach patients strategies to cope with them.

Some studies have reported positive results of cognitive rehabilitation for memory problems, but the results obtained from previous systematic reviews have been less positive and they have reported inconclusive evidence. This is an update of a Cochrane review first published in 2000 and most recently updated in 2007.

Objectives

To determine whether participants who have received cognitive rehabilitation for memory problems following a stroke have better outcomes than those given no treatment or a placebo control.

The outcomes of interest were subjective and objective assessments of memory function, functional ability, mood, and quality of life. We considered the immediate and long-term outcomes of memory rehabilitation.

Search methods

We used a comprehensive electronic search strategy to identify controlled studies indexed in the Cochrane Stroke Group Trials Register (last searched 19 May 2016) and in the Cochrane Central Register of Controlled Trials (CENTRAL2016, Issue 5), MEDLINE (2005 to 7 March 2016), EMBASE 2005 to 7 March 2016), CINAHL (2005 to 5 February 2016), AMED (2005 to 7 March 2016), PsycINFO (2005 to 7 March 2016), and nine other databases and registries. Start dates for the electronic databases coincided with the last search for the previous review. We handsearched reference lists of primary studies meeting the inclusion criteria and review articles to identify further eligible studies.

Selection criteria

We selected randomised controlled trials in which cognitive rehabilitation for memory problems was compared to a control condition. We included studies where more than 75% of the participants had experienced a stroke, or if separate data were available from those with stroke in mixed aetiology studies. Two review authors independently selected trials for inclusion, which was then confirmed through group discussion.

Data collection and analysis

We assessed study risk of bias and extracted data. We contacted the investigators of primary studies for further information where required. We conducted data analysis and synthesis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. We performed a ‘best evidence’ synthesis based on the risk of bias of the primary studies included. Where there were sufficient numbers of similar outcomes, we calculated and reported standardised mean differences (SMD) using meta-analysis.

Main results

We included 13 trials involving 514 participants. There was a significant effect of treatment on subjective reports of memory in the short term (standard mean difference (SMD) 0.36, 95% confidence interval (CI) 0.08 to 0.64, P = 0.01, moderate quality of evidence), but not the long term (SMD 0.31, 95% CI -0.02 to 0.64, P = 0.06, low quality of evidence). The SMD for the subjective reports of memory had small to moderate effect sizes.

The results do not show any significant effect of memory rehabilitation on performance in objective memory tests, mood, functional abilities, or quality of life.

No information was available on adverse events.

Authors’ conclusions

Participants who received cognitive rehabilitation for memory problems following a stroke reported benefits from the intervention on subjective measures of memory in the short term (i.e. the first assessment point after the intervention, which was a minimum of four weeks). This effect was not, however, observed in the longer term (i.e. the second assessment point after the intervention, which was a minimum of three months). There was, therefore, limited evidence to support or refute the effectiveness of memory rehabilitation. The evidence was limited due to the poor quality of reporting in many studies, lack of consistency in the choice of outcome measures, and small sample sizes. There is a need for more robust, well-designed, adequately powered, and better-reported trials of memory rehabilitation using common standardised outcome measures.

Plain language summary

Cognitive rehabilitation for memory deficits after stroke

Review question

We reviewed the evidence for the effectiveness of cognitive rehabilitation for memory problems in people with stroke.

Background

People often struggle with memory problems following stroke and this can lead to difficulties in everyday life. The degree and kind of memory problems, mood changes, and performance of everyday activities can vary widely depending on many factors, including the location of the stroke in the brain, severity, age, and the previous health of the person experiencing a stroke.

Memory rehabilitation, a part of cognitive rehabilitation, is a therapeutic activity that may play a role in the recovery of memory functions, or in enabling the individual to adapt to the problems. Memory rehabilitation is a standard part of rehabilitation in many settings. However, it is uncertain whether memory rehabilitation can improve people’s memory problems, or whether it has an effect on mood, performance in everyday activities, or quality of life.

Study characteristics

The evidence is current to May 2016. In this review, we included 13 studies with 514 participants. Seven trials were conducted with community participants, four with in-patients, and two with mixed community and in-patient samples. Participants received various types of memory retraining techniques, including training using computer programs and training in the use of memory aids, such as diaries or calendars. In three studies treatment was provided in groups and in 10 studies treatment was provided individually. Treatment lasted between two weeks and 10 weeks. In these studies, those who received the treatment were compared with a control group. The control group included those who did not receive cognitive rehabilitation or received another form of treatment. The control groups varied. Some studies had a control group wherein people received their usual care, whereas in others individuals in the control groups were placed on a waiting list to receive cognitive rehabilitation.

Key results

We found that people who received cognitive rehabilitation reported fewer memory problems in daily life immediately after treatment compared with the control groups. This represents a small to moderate effect of the intervention in comparison to the control group. However, there was no evidence that the benefits persisted in the long term. We found no evidence that cognitive rehabilitation improved people’s independence in activities of daily living, mood, or quality of life. There was no information about any harm caused to participants from taking part in cognitive rehabilitation.

Quality of the evidence

The quality of the evidence ranged from very low (effect on outcomes that relate to everyday activities) to moderate (effect on self-reported memory problems, memory tests, and mood measures). There were a number of flaws in these studies, such as having very few people in them, and these could have affected our findings.

Source: Cognitive rehabilitation for memory deficits after stroke – das Nair – 2016 – The Cochrane Library – Wiley Online Library

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[ARTICLE] Cognitive impairment and rehabilitation strategies after traumatic brain injury – Full Text

Abstract

Traumatic brain injury (TBI) is among the significant causes of morbidity and mortality in the present world. Around 1.6 million persons sustain TBI, whereas 200,000 die annually in India, thus highlighting the rising need for appropriate cognitive rehabilitation strategies. This literature review assesses the current knowledge of various cognitive rehabilitation training strategies. The entire spectrum of TBI severity; mild to severe, is associated with cognitive deficits of varying degree. Cognitive insufficiency is more prevalent and longer lasting in TBI persons than in the general population. A multidisciplinary approach with neuropsychiatric evaluation is warranted. Attention process training and tasks for attention deficits, compensatory strategies and errorless learning training for memory deficits, pragmatic language skills and social behavior guidance for cognitive-communication disorder, meta-cognitive strategy, and problem-solving training for executive disorder are the mainstay of therapy for cognitive deficits in persons with TBI. Cognitive impairments following TBI are common and vary widely. Different cognitive rehabilitation techniques and combinations in addition to pharmacotherapy are helpful in addressing various cognitive deficits.

   Introduction Top

Traumatic brain injury (TBI) is a steadily rising public health concern and one of the significant causes of morbidity and mortality in India.[1] Around 10 million people sustain TBI worldwide annually.[2] The recent global status report on road safety by the World Health Organization, 2013 has clearly highlighted the existing and growing enormity of this problem across the world and has emphasized on the outmost need for well-designed and evaluated programs in prevention, management, and rehabilitation. As India continues to progress to greater urbanization with rapid development in terms of motorization, incidence of TBIs will increase significantly. Data from an epidemiological study undertaken in Bengaluru have shown incidence, mortality, and case fatality rates of 150/100,000, 20/100,000 and 10%, respectively.[3] An estimated 2 million people sustain brain injuries with nearly a million requiring rehabilitation services at the national level.[3]

Persons, who survive TBI, end up with chronic disability.[1] It significantly impacts on an individual’s life, in terms of cognitive, behavioral, psychosocial and physical factors, and vocational issues.[4] Among them, cognitive disabilities are often the most disabling and distressing for the affected persons, family members, and the society. Cognitive deficits can significantly impair activities of daily living (ADL), employment, social relationships, recreation, and active participation in the community.

TBI is classified as mild, moderate, and severe depending on the level of consciousness, particularly duration of coma and posttraumatic amnesia (PTA).[4],[5] In moderate to severe TBI, cognition appears to be markedly impaired around 1-month postinjury [6] or shortly after resolution of PTA.[7],[8] Cognitive impairments persisting even after 3 months were found to be associated with higher frequency disability.[9] In moderate to severe TBI, cognitive recovery does not return to baseline even after 2 years of injury. In contrast, the cognitive recovery tends to be rapid in patients with mild TBI, returning almost to “normal baseline functioning” within 3 months.[10],[11]

Literature and studies have reported that effective cognitive rehabilitation interventions initiated post-TBI enhance the recovery process and minimize the functional disability. Hence, it is necessary to have a proper guideline for the cognitive rehabilitation of traumatic brain injured persons with multiple cognitive impairments. This article has been adapted from various literatures and outlines briefly the commonly encountered cognitive deficits following TBI. It also provides a summary of effective rehabilitation strategies for the cognitively impaired persons.

Continue —> Cognitive impairment and rehabilitation strategies after traumatic brain injury Barman A, Chatterjee A, Bhide R – Indian J Psychol Med

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[Abstract] Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation: European Psychologist: Vol 21, No 1

Source: Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation: Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation: European Psychologist: Vol 21, No 1

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[WEB SITE] Computerized rehab aids those suffering from brain injuries | EurekAlert! Science News

(Boston) — For the first time, researchers have shown that computerized cognitive rehabilitation (a program to help brain-injured or otherwise cognitively impaired individuals to restore normal functioning) can improve attention and executive functioning in brain injury survivors including traumatic brain injury (TBI) and stroke.

The findings, which appear online in the Journal of Head Trauma Rehabilitation, may lead to improved treatment outcomes in patients with brain injury, especially for patients with limited mobility and means and those residing in rural areas.

Persistent cognitive problems are very common following brain injury, especially in executive functioning, attention and learning.

The research team conducted a systematic literature review of computerized treatment for attention and executive function in adults who suffered a brain injury. Studies published before or during April 2015 were evaluated for quality and methodology as no previous reviews had been completed. They found eight of 11 studies reported significant gains in cognitive function following treatment in TBI patients, with the three remaining studies reporting trends toward significance. Similarly, 10 of 12 mixed population studies observed significant improvements on measures of attention and executive function, with the remaining two studies reporting positive trends. Five studies reported significant improvements subsequent to treatment for stroke patients.

“The results of this systematic review provide encouraging evidence that computerized cognitive rehabilitation can improve attention and executive functioning in brain injury survivors,” explained corresponding author Yelena Bogdanova, PhD, assistant professor of psychiatry at Boston University School of Medicine and principal investigator at the VA Boston Healthcare System.

According to the researchers computerized treatment delivery can significantly reduce the wait time and cost of treatment, provide immediate access to treatment in any location, improve the quality of life of patients and reduce the burden of caregivers.

Bogdanova believes further studies are needed. “It is important to evaluate the efficacy of computerized cognitive training programs and to provide specific guidelines for computerized methods of rehabilitation in patients with brain injury, as it can reduce cost and increase accessibility of treatment to traditionally underserved populations,” she added.

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Funding for this study was provided by the Rehabilitation Research & Development Service of the Department of Veterans Affairs (VA) grants D6996W and I21RX001773-01 to YB, the National Institutes of Health and Boston University Clinical & Translational Science Institute grant UL1-RR025771 to YB, the VA Translation Research Center for TBI & Stress Disorders [YB], and the VA BHS Psychology Research Service [YB].

Contact:

Gina DiGravio,
617-638-8480
ginad@bu.edu

Source: Computerized rehab aids those suffering from brain injuries | EurekAlert! Science News

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[ARTICLE] The Effect of Occupation-based Cognitive Rehabilitation for Traumatic Brain Injury: A Meta-analysis of Randomized Controlled Trials

Abstract

Traumatic brain injury (TBI) is the leading cause of death and disability among people younger than 35 years in the United States. Cognitive difficulty is a common consequence of TBI. To address cognitive deficits of patients with TBI, various cognitive rehabilitation approaches have been used for the clinical setting. The purpose of this study was to investigate the overall effect of occupation-based cognitive rehabilitation on patients’ improvement in cognitive performance components, activity of daily living (ADL) performance, and values, beliefs and spirituality functions of patients with TBI.

The papers used in this study were retrieved from the Cochrane Database, EBSCO (CINAHL), PsycINFO, PubMed and Web of Science published between 1997 and 2014. The keywords for searching were cognitive, rehabilitation, occupation, memory, attention, problem-solving, executive function, ADL, values, beliefs, spirituality, randomized controlled trials and TBI. For the meta-analysis, we examined 60 effect sizes from nine studies that are related to the occupation-based cognitive rehabilitation on persons with TBI. In persons with TBI, overall mental functions, ADL, and values, beliefs and spirituality were significantly improved in the groups that received occupation-based cognitive rehabilitation compared with comparison groups (mean d = 0.19, p < .05).

Evidence from the present meta-analytic study suggests that occupation-based cognitive rehabilitation would be beneficial for individuals with TBI for improving daily functioning and positively be able to affect their psychosocial functions. Collecting many outcome measures in studies with relatively few participants and the final data are less reliable than the whole instrument itself. Future research should evaluate the effectiveness of specific occupation-based cognitive rehabilitations programmes in order to improve consistency among rehabilitation providers. Copyright © 2015 John Wiley & Sons, Ltd

via The Effect of Occupation-based Cognitive Rehabilitation for Traumatic Brain Injury: A Meta-analysis of Randomized Controlled Trials – Park – 2015 – Occupational Therapy International – Wiley Online Library.

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[BOOK] Epilepsy and the Interictal State: Co-morbidities and Quality of Life. Chapter 7: Cognitive Rehabilitation strategies iin Epilepsy – Google Books

Epilepsy and the Interictal State: Co-morbidities and Quality of Life – 2015 – books.google.com

Pharmacologic treatments for the management of epilepsy have increased in number over  time but progress in neuropsychological/cognitive rehabilitation has received somewhat less  attention as an ameliorative intervention in complications of epilepsy, including cognitive…

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[ARTICLE] A Brief Overview and Assessment of the Role and Benefits of Cognitive Rehabilitation

Abstract

Cognition is one of our most important attributes. Arresting its decline whether in association with normal aging, a diagnosis of mild cognitive impairment, acquired brain injury or dementia concerns everyone-regardless of whether their role is that of spouse, child, or clinician. This paper provides a brief, and by necessity, somewhat superficial appraisal of the status of our knowledge of the benefits of cognitive rehabilitation in these conditions and the authors’ assessment of it strengths and weaknesses. In summary, there is support for the belief that participation in exercise as well as socially and cognitively stimulating activities (whether or not rehabilitative in nature) is beneficial for all but perhaps the most demented. Focused efforts at cognitive training/rehabilitation also appear potentially helpful but are best established for those with acquired brain injury. There are, however, caveats to this assessment. For example, cognitive retraining is resource and time intensive while, even for those most likely to benefit, its impact on their daily activities and quality of life remain unclear. In addition, responses to training may vary from person to person and are likely to be influenced by factors such as an individual’s acceptance of the need for assistance. Future research may benefit from continued efforts to treat the patient holistically, fit the treatment to those most likely to benefit, and encouraging the translation of training effects to functioning in the real world.

via A Brief Overview and Assessment of the Role and Benefits of Cognitive Rehabilitation – Archives of Physical Medicine and Rehabilitation.

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[Proceedings] The ReHAB@HOMe Project: engaging Game-based Home Rehabilitation for Improved quality of Life – Full Text PDF

Abstract
The REHAB@HOME project is intended as an advanced
activity – with the involvement of highly qualified medical
and technical partners, as well as real patients – aimed at an
extensive investigation of the issues related to long-term
physical/cognitive rehabilitation processes and the
identification of suitable technical solutions to efficiently
support them. REHAB@HOME will enable elderly
people to enjoy high quality rehabilitation for a much
longer period than the Health System can currently afford.
By investigating and using standard hardware components
and devices, suitable medical data processing algorithms,
personalized and serious-games based rehabilitation
pathways, Web2.0 social and communication tools, the
project will develop an efficient, effective and engaging
virtual rehabilitation environment for home-based
rehabilitation. The basic project idea is inspired by
existing commercial platforms, like Wii and Kinect, that
allow the user acting within a virtual environment and
interacting with other users, thanks to special input devices
and suitable technologies able to monitor the real
environment and track the user’s behavior. Having this in
mind, REHAB@HOME aim at the user-centred design
and development of an open solution capable to: provide
exercises and training – based on serious-games – within a
personalized, user friendly and engaging rehabilitation
program, offer a cost effective and not bulky infrastructure
with sensors integrated, collect relevant physical and
medical parameters for patients’ status inspection and
relapse prevention, support off-line/on-line management
and monitoring of the rehabilitation protocol, promote
patient’s social participation and community building. In
other words, REHAB@HOME will transform the
patient’s home in a place where physical and cognitive
rehabilitation process can be performed in an intensive and
engaging though properly controlled way, while
promoting social inclusion and quality of life.

Get The Full Text PDF

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