Posts Tagged Executive function

[Abstract] Music Therapy Enhances Executive Functions and Prefrontal Structural Neuroplasticity after Traumatic Brain Injury: Evidence from a Randomized Controlled Trial

Traumatic brain injury (TBI) causes lifelong cognitive deficits, particularly impairments of executive functioning (EF). Musical training and music-based rehabilitation have been shown to enhance cognitive functioning and neuroplasticity, but the potential rehabilitative effects of music in TBI are still largely unknown. The aim of the present crossover randomized controlled trial (RCT) was to determine the clinical efficacy of music therapy on cognitive functioning in TBI and to explore its neural basis.

Using an AB/BA design, 40 patients with moderate or severe TBI were randomized to receive a 3-month neurological music therapy intervention either during the first (AB, n = 20) or second (BA, n = 20) half of a 6-month follow-up period. Neuropsychological and motor testing and magnetic resonance imaging (MRI) were performed at baseline and at the 3-month and 6-month stage. Thirty-nine subjects who participated in baseline measurement were included in an intention-to-treat analysis using multiple imputation. Results showed that general EF (as indicated by the Frontal Assessment Battery [FAB]) and set shifting improved more in the AB group than in the BA group over the first 3-month period and the effect on general EF was maintained in the 6-month follow-up. Voxel-based morphometry (VBM) analysis of the structural MRI data indicated that gray matter volume (GMV) in the right inferior frontal gyrus (IFG) increased significantly in both groups during the intervention versus control period, which also correlated with cognitive improvement in set shifting. These findings suggest that neurological music therapy enhances EF and induces fine-grained neuroanatomical changes in prefrontal areas.


via Music Therapy Enhances Executive Functions and Prefrontal Structural Neuroplasticity after Traumatic Brain Injury: Evidence from a Randomized Controlled Trial | Journal of Neurotrauma

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[WEB SITE] The Benefits of Playing Music Help Your Brain More Than Any Other Activity

Learning an instrument has showed an increase resilience to any age-related decline in hearing.

The brain-training is big business. For companies like BrainHQ, Luminosity, and Cogmed, it’s actually a multimillion dollar business that is expected to surpass $3 billion by 2020. But, do the actually benefit your brain?


Research doesn’t believe so. In fact, the the University of Illinois determined that there’s little or no evidence that these games improve anything more than the specific tasks being trained. Luminosity was even fined $2 million for false claims.

So, if these brain games don’t work, then what will keep your brain sharp? The answer? Learning to play a musical instrument.

Why Being a Musician Is Good For Your Brain

Science has shown that musical training can change brain structure and function for the better. It can also improve long-term memory and lead to better brain development for those who start at a young age.

Furthermore, musicians tend to be more mentally alert, according to new research from a University of Montreal study.


“The more we know about the impact of music on really basic sensory processes, the more we can apply musical training to individuals who might have slower reaction times,” said lead researcher Simon Landry.


“As people get older, for example, we know their reaction times get slower. So if we know that playing a musical instrument increases reaction times, then maybe playing an instrument will be helpful for them.”


Previously, Landry found that musicians have faster auditory, tactile, and audio-tactile reaction times. Musicians also have an altered statistical use of multi-sensory information. This means that they’re better at integrating the inputs from various senses.


“Music probably does something unique,” explains neuropsychologist Catherine Loveday of the University of Westminster. “It stimulates the brain in a very powerful way, because of our emotional connection with it.”


Unlike brain-games, playing an instrument is a rich and complex experience. This is because it’s integrating information from senses like vision, hearing, and touch, along with fine movements. This can result long-lasting changes in the brain. This can also be applicable in the business world.

Changes in the Brain

Brains scans have been able to identify the difference in brain structure between musicians and non-musicians. Most notably, the corpus callosum, a massive bundle of nerve fibres connecting the two sides of the brain, is larger in musicians. Also, the areas involving movement, hearing, and visuospatial abilities appear to be larger in professional keyboard players.


Initially, these studies couldn’t determine if these differences were caused by musical training of if anatomical differences predispose some to become musicians. Ultimately, longitudinal studies showed that children who do 14 months of musical training displayed more powerful structural and functional brain changes.


These studies prove that learning a musical instrument increases grey matter volume in various brain regions, It also strengthens the long-range connections between them. Additional research shows that musical training can enhance verbal memory, spatial reasoning, and literacy skills.

Long Lasting Benefits For Musicians

Brain scanning studies have found that the anatomical change in musicians’ brains is related to the age when training began. It shouldn’t be surprising, but learning at a younger age causes the most drastic changes.


Interestingly, even brief periods of musical training can have long-lasting benefits. A 2013 study found that even those with moderate musical training preserved sharp processing of speech sounds. It was also able to increase resilience to any age-related decline in hearing.


Researchers also believe that playing music helps speech processing and learning in children with dyslexia. Furthermore, learning to play an instrument as a child can protect the brain against dementia.

“Music reaches parts of the brain that other things can’t,” says Loveday. “It’s a strong cognitive stimulus that grows the brain in a way that nothing else does, and the evidence that musical training enhances things like working memory and language is very robust.”

Other Ways Learning an Instrument Strengthens Your Brain

Guess what? We’re still not done. Here are eight additional ways that learning an instrument strengthens your brain.


1. Strengthens bonds with others. This shouldn’t be surprising. Think about your favorite band. They can only make a record when they have contact, coordination, and cooperation with each other.


2. Strengthens memory and reading skills. The Auditory Neuroscience Laboratory at Northwestern University states that this is because music and reading are related via common neural and cognitive mechanisms.


3. Playing music makes you happy. McMaster University discovered that babies who took interactive music classes displayed better early communication skills. They also smiled more.


4. Musicians can process multiple things at once. As mentioned above, this is because playing music forces you to process multiple senses at once. This can lead superior multisensory skills.


5. Musical increases blood flow in your brain. Studies have found that short bursts of musical training increase the blood flow to the left hemisphere of the brain. That can be helpful when you need a burst of energy. Skip the energy drink and jam for 30 minutes.

6. Music helps the brain recover. Motor control improved in everyday activities with stroke patients.

7. Music reduces stress and depression. A study of cancer patients found that listening and playing music reduced anxiety. Another study revealed that music therapy lowered levels of depression and anxiety.


8. Musical training strengthens the brain’s’ executive function. Executive function covers critical tasks like processing and retaining information, controlling behavior, making, and problem-solving. If strengthened, you can boost your ability to live. Musical training can improve and strengthen executive functioning in both children and adults.


And, wrap-up, check out this awesome short animation from TED-Ed on how playing an instrument benefits your brain.


via The Benefits of Playing Music Help Your Brain More Than Any Other Activity |

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[ARTICLE] Functional Magnetic Resonance Imaging of Cognitive Control following Traumatic Brain Injury

Novel and non-routine tasks often require information processing and behavior to adapt from moment to moment depending on task requirements and current performance. This ability to adapt is an executive function that is referred to as cognitive control. Patients with moderate-to-severe traumatic brain injury (TBI) have been reported to exhibit impairments in cognitive control and functional magnetic resonance imaging (fMRI) has provided evidence for TBI-related alterations in brain activation using various fMRI cognitive control paradigms. There is some support for greater and more extensive cognitive control-related brain activation in patients with moderate-to-severe TBI, relative to comparison subjects without TBI. In addition, some studies have reported a correlation between these activation increases and measures of injury severity. Explanations that have been proposed for increased activation within structures that are thought to be directly involved in cognitive control, as well as the extension of this over-activation into other brain structures, have included compensatory mechanisms, increased demand upon normal processes required to maintain adequate performance, less efficient utilization of neural resources, and greater vulnerability to cognitive fatigue. Recent findings are also consistent with the possibility that activation increases within some structures, such as the posterior cingulate gyrus, may reflect a failure to deactivate components of the default mode network (DMN) and that some cognitive control impairment may result from ineffective coordination between the DMN and components of the salience network. Functional neuroimaging studies examining cognitive control-related activation following mild TBI (mTBI) have yielded more variable results, with reports of increases, decreases, and no significant change. These discrepancies may reflect differences among the various mTBI samples under study, recovery of function in some patients, different task characteristics, and the presence of comorbid conditions such as depression and posttraumatic stress disorder that also alter brain activation. There may be mTBI populations with activation changes that overlap with those found following more severe injuries, including symptomatic mTBI patients and those with acute injuries, but future research to address such dysfunction will require well-defined samples with adequate controls for injury characteristics, comorbid disorders, and severity of post-concussive symptoms.

Traumatic brain injury (TBI) is a neurological insult of major public health significance with over 1.7 million new injuries each year among Americans under the age of 35 (1). Numerous studies, most of which have been conducted with moderate-to-severe TBI due to blunt head trauma, have reported findings consistent with a mixed and highly heterogeneous neuropathology that may include multifocal or diffuse axonal injury, as well contusions and other focal lesions (2). Additional injury may occur as a result of edema, herniation, hemorrhage, ischemia, inflammation, and excitotoxic processes (2, 3). Structures and connections of the frontal and limbic regions have been said to be especially vulnerable to these various pathological processes (3, 4). Executive functions are highly dependent on the integrity of this neural substrate, and it is not surprising that such functions, including cognitive control, are often impaired following TBI (57).

Cognitive control allows for flexibility in human thought and behavior and may be defined as the ability to pursue task-related goals in the presence of conditions that include conflicting information or interference, prepotent response alternatives, or the need to interrupt or switch an ongoing activity (810). A common factor in all of these situations is the top-down direction, or biasing, of cognition and this is necessary for information processing and behavior to adapt from moment to moment depending on task requirements and performance (8, 11, 12). Cognitive control relies upon the active maintenance of neural activity associated with the internal representation of goals and task-related rules or contingencies (1113). However, it is a complex construct that likely includes multiple component processes, some of these processes overlap with those of other executive functions (e.g., working memory), and it contributes to performance on various high level cognitive tasks, including those representing domains such as attention, memory, and language (810, 14).

Although prefrontally guided top-down direction is critical for cognitive control and other executive functions, the prefrontal cortex (PFC) is only one of several structures that contribute to cognitive control (15). Another important structure is the anterior cingulate cortex, which is thought to monitor performance and internal bodily states associated with task-related reward conditions, to determine whether task performance is adequate, and to signal to the dorsolateral PFC when mental effort or top-down direction needs to be increased (11, 1517). Some anterior cingulate functions, including the detection of states associated with reward and expected outcomes, likely depend on distant connections with structures such as the insula (17). These various structures may be vulnerable to disconnection associated with diffuse axonal injury and other TBI-related neuropathology (1820).

Functional magnetic resonance imaging (fMRI) provides an indirect measure of neural activity and has the potential to reveal changes in brain function associated with neuropathology, including alterations following TBI (21, 22). One powerful application of this method is the use of fMRI paradigms to examine brain activation during cognitive tasks (22), including those which place a demand upon executive functions such as cognitive control. This type of research has the potential to reveal relationships between specific cognitive impairments and dysfunction within the underlying neural substrate, to provide a neuroimaging marker that may contribute to differential diagnosis, and to lead to the development of methods to track changes in brain activity associated with recovery and treatment (23). Cognitive control is a high level function that is critical for the completion of many complex and non-routine tasks (8, 11). Despite the importance of this topic and the incredible potential offered by fMRI research, only a few studies have examined changes in cognitive control-related activation following TBI, and these have often suffered from various methodological limitations. The purpose of this article is to provide an overview of that existing research, to discuss findings that contribute to our understanding of how cognitive control may be impaired following TBI, and to provide some suggestions to improve future research and increase its relevance.

Although fMRI research has also investigated working memory and other executive functions following TBI (24, 25), the current review will focus on cognitive control by examining fMRI studies that have specifically addressed the top-down direction of cognition and related cognitive control processes (e.g., performance monitoring). This research has employed fMRI paradigms adapted from common clinical measures of cognitive control, such as the Stoop Test (26), as well as experimental procedures developed specifically for the purpose of acquiring fMRI data [e.g., Ref. (27)]. Studies using paradigms that assess other functions, such as working memory or attention, are also included within this review if they had incorporated procedures to investigate top-down control [e.g., Ref. (28)]. Some had utilized a block design approach [e.g., Ref. (29)], whereas others had employed event-related fMRI [e.g., Ref. (30)]. A major feature of block design fMRI paradigms is that this method combines images acquired across an entire block of trials, which then prevents the separation of images acquired within a block to examine activation relative to different types of stimuli or responses (31). Event-related designs have the advantage of allowing the examination of images at the trial level, including the ability to isolate correct or incorrect responses, but these designs typically have less statistical power (31). It is also possible to capitalize upon some of the advantages of both approaches by employing a mixed design (32). […]

Continue —> Frontiers | Functional Magnetic Resonance Imaging of Cognitive Control following Traumatic Brain Injury | Neurology

Figure 3. Integrity of the white matter tract connecting the right anterior insula with the pre-supplementary motor area and the dorsal anterior cingulate cortex (rAI-preSMA/dACC) predicts default mode network deactivation during the stop-signal task. (A) Coronal view of the rAI-preSMA/dACC tract (blue) overlaid on the activation map for the contrast comparing correct stop trials with correct go trials (StC > Go) in traumatic brain injury (TBI) patients (orange). (B) Fractional anistropy (FA) of the rAI-preSMA/dACC tracts in TBI patients plotted against the percent signal change within a precuneus/posterior cingulate gyrus (Precu/PCC) region of interest on correct stop trials relative to go trials. FA measures are normalized and are corrected for age and whole-brain FA. (C) Sagittal view of brain regions with a negative correlation between activation for the StC > Go contrast and FA within the rAI-preSMA/dACC tract. Activation is superimposed on the Montreal Neurological Institute 152 T1 template (R = right side of image) [reused with permission from Ref. (18)].

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[Abstract] Executive function is associated with off-line motor learning in people with chronic stroke

Provisional Abstract:
Background and Purpose: Sleep has been shown to promote off-line motor learning in individuals following stroke. Executive function ability has been shown to be a predictor of participation in rehabilitation and motor recovery following stroke. The purpose of this study was to explore the association between executive function and off-line motor learning in individuals with chronic stroke compared to healthy control participants.

Methods: Seventeen individuals with chronic stroke (> 6 months post stroke) and nine healthy adults were included in the study. Participants underwent three consecutive nights of polysomnography (PSG), practiced a continuous tracking task (CTT) the morning of the third day, and underwent a retention test the morning after the third night. Participants underwent testing on four executive function tests after the CTT retention test.

Results: Stroke participants showed a significant positive correlation between the off-line motor learning score and performance on the Trail Making Test (TMT D-KEFS) (r= .652 p= .005), while the healthy controls did not. Regression analysis showed that the TMT D-KEFS is a significant predictor of off-line motor learning (p= .008).

Discussion and Conclusions: This is the first study to demonstrate that better performance on an executive function test of attention and set-shifting predicts a higher magnitude of off-line motor learning in individuals with chronic stroke. This emphasizes the need to consider attention and set-shifting abilities of individuals following stroke as these abilities predict off-line motor learning. This in turn could affect learning of ADL’s and impact functional recovery following stroke.

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[ARTICLE] Improving executive function deficits by playing interactive video-games: secondary analysis of a randomized controlled trial for individuals with chronic stroke

BACKGROUND: Executive function deficits negatively impact independence and participation in everyday life of individuals with chronic stroke. Therefore, it is important to explore therapeutic interventions to improve executive functions.
AIM: The aim of this study was to determine the effectiveness of a 3-month interactive video-game group intervention compared to a traditional motor group intervention for improving executive functions in individuals with chronic stroke.
DESIGN: This study is a secondary analysis of a single-blind randomized controlled trial for improving factors related to physical activity of individuals with chronic stroke. Assessments were administered pre and post the intervention and at 3-month follow-up by assessors blind to treatment allocation.
METHODS: Thirty-nine individuals with chronic stroke with executive function deficits participated in an interactive video-game group intervention (N.=20) or a traditional group intervention (N.=19). The intervention included two 1-hour group sessions per week for three months, either playing video-games or performing traditional exercises/activities. Executive function deficits were assessed using The Trail Making Test (Parts A and B) and by two performance-based assessments; the Bill Paying Task from the Executive Function Performance Test (EFPT) and the Executive Function Route-Finding Task (EFRT).
RESULTS: Following intervention, scores for the Bill Paying Task (EFPT) decreased by 27.5% and 36.6% for the participants in the video-game and traditional intervention, respectively (F=17.3, P<0.000) and continued to decrease in the video-game group with small effect sizes. Effect size was small to medium for the TMT-B (F=0.003, P=0.954) and EFRT (F=1.2, P=0.28), without any statistical significance difference.
CONCLUSIONS: Interactive video-games provide combined cognitive-motor stimulation and therefore have potential to improve executive functioning of individuals with chronic stroke. Further research is needed.
CLINICAL REHABILITATION IMPACT: These findings highlight the potential of utilizing interactive video-games in a small group for keeping these individuals active, while maintaining and improving executive functioning especially for individuals with chronic stroke, who have completed their formal rehabilitation.

Source: Improving executive function deficits by playing interactive video-games: secondary analysis of a randomized controlled trial for individuals with chronic stroke – European Journal of Physical and Rehabilitation Medicine 2016 August;52(4):508-15 – Minerva Medica – Journals


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[WEB SITE] Brain Injury Rehabilitation – Cognitive

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 
      • attention 
      • memory 
      • 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.

Source: Brain Injury Rehabilitation – Cognitive

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[ARTICLE] Muscle, functional and cognitive adaptations after flywheel resistance training in stroke patients: a pilot randomized controlled trial – Full Text HTML/PDF



Resistance exercise (RE) improves neuromuscular function and physical performance after stroke. Yet, the effects of RE emphasizing eccentric (ECC; lengthening) actions on muscle hypertrophy and cognitive function in stroke patients are currently unknown. Thus, this study explored the effects of ECC-overload RE training on skeletal muscle size and function, and cognitive performance in individuals with stroke.


Thirty-two individuals with chronic stroke (≥6 months post-stroke) were randomly assigned into a training group (TG; n = 16) performing ECC-overload flywheel RE of the more-affected lower limb (12 weeks, 2 times/week; 4 sets of 7 maximal closed-chain knee extensions; <2 min of contractile activity per session) or a control group (CG; n = 16), maintaining daily routines. Before and after the intervention, quadriceps femoris volume, maximal force and power for each leg were assessed, and functional and dual task performance, and cognitive functions were measured.


Quadriceps femoris volume of the more-affected leg increased by 9.4 % in TG. Muscle power of the more-affected, trained (48.2 %), and the less-affected, untrained limb (28.1 %) increased after training. TG showed enhanced balance (8.9 %), gait performance (10.6 %), dual-task performance, executive functions (working memory, verbal fluency tasks), attention, and speed of information processing. CG showed no changes.


ECC-overload flywheel resistance exercise comprising 4 min of contractile activity per week offers a powerful aid to regain muscle mass and function, and functional performance in individuals with stroke. While the current intervention improved cognitive functions, the cause-effect relationship, if any, with the concomitant neuromuscular adaptations remains to be explored.


Skeletal muscle is a leading target of secondary injury after stroke [1]. While causes explaining muscle deterioration are not completely understood, the sedentary lifestyle typically taken on by stroke survivors may add to the ameliorated lower limb muscle health caused by the injury per se [2]. To combat debilitating effects of stroke, resistance exercise (RE), favoring high-intensity muscle actions has shown efficacy [3]. Interestingly, individuals with stroke show markedly less reduction in eccentric (ECC; lengthening) than concentric (CON; shortening) muscle force [4]. Thus, while traditional RE presents an insufficient stimulus during the ECC action to optimize muscle adaptations in patients with stroke [4, 5], RE calling for maximal ECC actions boosts efficacy of training [6, 7]. Therefore, offering ECC overload during RE appears critical to promote the desired adaptations following stroke.

Flywheel RE was originally designed to maintain muscle health of astronauts during spaceflight [8]. It employs iso-inertial technology rather than gravity dependent weights, which allows for maximal CON and ECC muscle actions, with brief episodes of ECC overload [9]. Due to the energy storage characteristics of the inertial system, and by means of specific instructions to the trainee, the peak force generated during the ECC phase of the movement may be 15-30 % greater than what is produced in the preceding CON action [10]. Flywheel RE produces greater muscle hypertrophy and peripheral neural adaptations than weight-loaded RE in healthy subjects [9, 11]. Recently, we also showed that flywheel RE improves neuromuscular functions and physical abilities, without exacerbating spasticity in stroke victims [12]. This would suggest ECC-overload RE could serve as a highly effective rehabilitation tool following stroke.

In addition to functional and muscle alterations, up to 80 % of individuals with stroke show cognitive dysfunction [13]. This impedes vital daily-life activities, interferes with functional recovery, and hence increases dependency [13, 14]. Aerobic exercise training improves cognitive abilities in both older adults [15] and stroke survivors [16, 17]. In older adults, this effect appears amplified if aerobic exercise is combined with RE [15]. These results suggest RE per se facilitates activity of different cognitive domains. Indeed, aging individuals showed improved memory, executive functions, attention and conflict resolution after RE training [18, 19].

Due to different neural strategies, RE performed at variable velocity induces more profound adaptations (e.g. greater force gains) than constant velocity (i.e. isokinetic) muscle actions [20]. Compared with CON or isometric actions, executing ECC muscle actions requires a unique activation strategy by the nervous system including altered recruitment order of motor units and decreased motor-evoked potentials [21]. Furthermore, amplitude and area of brain activity is greater during ECC than CON actions, indicating more functional regions of the brain are involved in ECC actions [22]. Given that flywheel RE requires the trainee to accommodate to ECC overload, and acceleration and deceleration, this exercise paradigm would likely prompt substantial adaptations at the cortical level. Although the mechanisms dictating exercise-induced cognitive adaptations are largely unknown, the cortical neuroplasticity reported after RE training in individuals with stroke [23], and the higher activity in specific cortical areas induced by ECC-based RE [22] may play a role in such adaptations.

To this background, this study explored the effects of a 12-week ECC-overload flywheel RE training program of the more-affected lower limb of individuals with chronic stroke on (i) skeletal muscle size, strength and power, (ii) functional performance, and (iii) cognitive function. Given the efficacy of this particular exercise paradigm in more abled populations, we hypothesized there would be substantial muscle hypertrophy and increases in muscle force and power of the more-affected limb. It was also hypothesized these adaptations would be accompanied by improved performance of numerous cognitive functions.

Continue —> Muscle, functional and cognitive adaptations after flywheel resistance training in stroke patients: a pilot randomized controlled trial | Journal of NeuroEngineering and Rehabilitation | Full Text

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Fig. 3 Magnetic resonance images showing thigh muscles (mid-thigh level) of more-affected (R) and less-affected (L) limbs of individual with stroke before (PRE) and after (POST) 12 weeks of ECC-overload flywheel RE training. Quadriceps femoris muscles denoted by numbers are: 1 m. rectus femoris, 2 m. vastus lateralis, 3 m. vastus intermedius, 4 m. vastus medialis. In this particular individual, m. quadriceps femoris volume of more-affected, trained limb increased by 11.8 %

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[WEB SITE] Computerized cognitive rehabilitation of attention and executive function in acquired brain injury – Systematic review – CNS

OBJECTIVE: Comprehensive review of the use of computerized treatment as a rehabilitation tool for attention and executive function in adults (aged 18 years or older) who suffered an acquired brain injury.

DESIGN: Systematic review of empirical research.

MAIN MEASURES: Two reviewers independently assessed articles using the methodological quality criteria of Cicerone et al. Data extracted included sample size, diagnosis, intervention information, treatment schedule, assessment methods, and outcome measures.

RESULTS: A literature review (PubMed, EMBASE, Ovid, Cochrane, PsychINFO, CINAHL) generated a total of 4931 publications. Twenty-eight studies using computerized cognitive interventions targeting attention and executive functions were included in this review. In 23 studies, significant improvements in attention and executive function subsequent to training were reported; in the remaining 5, promising trends were observed.

CONCLUSIONS: Preliminary evidence suggests improvements in cognitive function following computerized rehabilitation for acquired brain injury populations including traumatic brain injury and stroke. Further studies are needed to address methodological issues (eg, small sample size, inadequate control groups) and to inform development of guidelines and standardized protocols.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Computerized cognitive rehabilitation of attention and executive function in acquired brain injury

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


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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[A Systematic Review] Computerized Cognitive Rehabilitation in Acquired Brain Injury

…Cognitive deficits (attention and executive function) are common in acquired brain injury (ABI). Recently, there have been a number of computerized programs aimed to train attention, executive function, and to prevent cognitive aging. No comprehensive review has been published on the use of computerized treatment programs as a rehabilitation tool in ABI. We conducted a systematic review of empirical research on computerized cognitive rehabilitation for attention and executive function after ABI…

via Computerized Cognitive Rehabilitation in Acquired Brain Injury: A Systematic Review – Archives of Physical Medicine and Rehabilitation.

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