Posts Tagged Executive function
[Abstract] Executive function is associated with off-line motor learning in people with chronic stroke
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
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] 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 . 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 . To combat debilitating effects of stroke, resistance exercise (RE), favoring high-intensity muscle actions has shown efficacy . Interestingly, individuals with stroke show markedly less reduction in eccentric (ECC; lengthening) than concentric (CON; shortening) muscle force . 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 . 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 . 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 . 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 . 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 . 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  and stroke survivors [16, 17]. In older adults, this effect appears amplified if aerobic exercise is combined with RE . 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 . 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 . 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 . 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 , and the higher activity in specific cortical areas induced by ECC-based RE  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
[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.
…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…
[ARTICLE] Behavioral Changes and Depression, Disability, and Life Satisfaction in Two Cohorts of Adults With TBI
For all individuals who sustain a TBI, regardless of initial severity, behavioral changes may negatively influence depression, disability, and life satisfaction, beginning in the first year post-injury and continuing well beyond five years post-injury.Therefore, behavior may represent a viable target – both early after injury and for individuals living in the community – for rehabilitation interventions to improve various long-term outcomes after TBI…
Cognitive rehabilitation following traumatic brain injury: Assessment to Treatment