The impact of multimodal cognitive rehabilitation on executive functions in older adults with traumatic brain injury

2021 ◽  
Vol 64 (5) ◽  
pp. 101559
Author(s):  
Eduardo Cisneros ◽  
Véronique Beauséjour ◽  
Elaine de Guise ◽  
Sylvie Belleville ◽  
Michelle McKerral
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Executive Functions ◽  
Cognitive Rehabilitation ◽  
The Impact

scholarly journals The impact of multimodal cognitive rehabilitation on executive functions in older adults with traumatic brain injury (TBI)

2020 ◽  
Author(s):  
Eduardo Cisneros ◽  
Véronique Beauséjour ◽  
Elaine de Guise ◽  
Sylvie Belleville ◽  
Michelle McKerral
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Active Control ◽  
Cognitive Rehabilitation ◽  
Daily Life ◽  
Control Group ◽  
Active Control Group ◽  
Daily Life Activities ◽  
The Impact

AbstractObjectivesThis study evaluated the impact of a multimodal cognitive rehabilitation intervention, the Cognitive Enrichment Program (CEP), on executive functioning (EF) and resumption of daily activities following traumatic brain injury (TBI) in older individuals, in comparison to an active control group having received holistic rehabilitation as usual care.MethodsThe CEP’sexecutive function module included planning, problem solving, and goal management training, as well as strategies focusing on self-awareness. Effectiveness was evaluated by psychometric tests (Modified Six Elements Task-adapted – MSET-A, D-KEFS Sorting test and Stroop four-color version), while generalization was measured through self-reported questionnaires about daily functioning (Dysexecutive Functioning Questionnaire – DEX, Forsaken daily life activities). Measures were obtained before and after intervention, and six months later.ResultsANCOVA results showed significant group-by-time interactions on Tackling the 6 subtasks and Avoiding rule-breaking measures of the MSET-A, with moderate effect sizes. Despite improvements in Sorting and Stroop scores, there were no group-by-time interaction on these measures. DEX generalization measure showed a significant reduction in patient/significant other difference on the Executive Cognition subscale. There was a reduction in the number of Forsaken daily life activities in the experimental group compared to controls which was not significant immediately after CEP, but that was significant six months later.ConclusionsOur study shows that older adults with TBI can improve their executive functioning with a positive impact on everyday activities after receiving multimodal cognitive training compared to an active control group.

scholarly journals Executive Function Training in Chronic Traumatic Brain Injury Patients: Study Protocol

2019 ◽  
Author(s):  
Daniel Krawczyk ◽  
Kihwan Han ◽  
David Martinez ◽  
Jelena Rakic ◽  
Matthew Kmiecik ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Working Memory ◽  
Executive Function ◽  
Brain Injury ◽  
Executive Functions ◽  
Inhibitory Control ◽  
Cognitive Rehabilitation ◽  
Daily Life ◽  
Chronic Phase ◽  
Post Injury

Abstract Background: Some individuals who sustain traumatic brain injuries (TBIs) continue to experience significant cognitive impairments chronically (months-to-years post-injury). Many tests of executive function are insensitive to these executive function impairments, as such impairments may only appear during complex daily life conditions. Daily life often requires us to divide our attention and focus on abstract goals. In the current study, we compare the effects of two one-month electronic cognitive rehabilitation programs for individuals with chronic TBI. The active program (Expedition: Strategic Advantage) focuses on improving goal-directed executive functions including working memory, planning, long-term memory, and inhibitory control by challenging participants to accomplish life-like cognitive simulations. The challenge level of the simulations increase in accordance with participant achievement. The control intervention (Expedition: Informational Advantage) is identical to the active; however, the cognitive demand level is capped preventing participants from advancing beyond a set level. We will evaluate these interventions with a military veteran TBI population. Methods: One hundred individuals will be enrolled in this double-blinded clinical trial (all participants and testers are blinded to condition). Each individual will be randomly assigned to one of two interventions. The primary anticipated outcomes are improvement of daily life cognitive function skills and daily life functions. These are measured by a daily life performance task, which tests cognitive skills, and a survey that evaluates daily life functions. Secondary outcomes are also predicted to include improvements in working memory, attention, planning, and inhibitory control as measured by a neuropsychological test battery. Lastly, neuroimaging measures will be used to evaluate changes in brain networks supporting cognition pre-intervention and post-intervention. Discussion: We will test whether electronically delivered cognitive rehabilitation aimed at improving daily life functional skills will provide cognitive and daily life functional improvements for individuals in the chronic phase of TBI recovery (greater than three months post-injury). We aim to better understand the cognitive processes involved in recovery and the characteristics of individuals most likely to benefit. This study will also address the potential to observe generalizability, or transfer, from a software-based cognitive training tool toward daily life improvement. Trial Registration: ClinicalTrials.gov Identifier: NCT03704116 (retrospectively registered) https://clinicaltrials.gov/ct2/show/NCT03704116?term=tbi+krawczyk&rank=1 Keywords: Cognitive rehabilitation, traumatic brain injury, executive functions, daily life functions, memory, attention, planning. Support: Joint Warfighter Program; U. S. Dept. of Defense W81XWH-16-1-0053

scholarly journals In-Hospital Mortality Following Traumatic Brain Injury Among Older Medicare Beneficiaries, Comparing Statin Users With Nonusers

2017 ◽  
Vol 33 (6) ◽  
pp. 225-236 ◽  
Author(s):  
Bilal Khokhar ◽  
Linda Simoni-Wastila ◽  
Julia F. Slejko ◽  
Eleanor Perfetto ◽  
Min Zhan ◽  
...  
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Health Concern ◽  
Future Research ◽  
Small Scale ◽  
Medicare Beneficiaries ◽  
The Impact ◽  
Statin Use

Background: Traumatic brain injury (TBI) is a significant public health concern for older adults. Small-scale human studies have suggested pre-TBI statin use is associated with decreased in-hospital mortality following TBI, highlighting the need for large-scale translational research. Objective: To investigate the relationship between pre-TBI statin use and in-hospital mortality following TBI. Methods: A retrospective study of Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 was conducted to assess the impact of pre-TBI statin use on in-hospital mortality following TBI. Exposure of interest included atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. Beneficiaries were classified as current, recent, past, and nonusers of statins prior to TBI. The outcome of interest was in-hospital mortality. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) comparing current, recent, and prior statin use to nonuse. Results: Most statin users were classified as current users (90%). Current atorvastatin (OR = 0.88; 95% = CI 0.82, 0.96), simvastatin (OR = 0.84; 95% CI = 0.79, 0.91), and rosuvastatin (OR = 0.79; 95% CI = 0.67, 0.94) use were associated with a significant decrease in the risk of in-hospital mortality following TBI. Conclusions: In addition to being the most used statins, current use of atorvastatin, rosuvastatin, and simvastatin was associated with a significant decrease in in-hospital mortality following TBI among older adults. Future research must include clinical trials to help exclude the possibility of a healthy user effect in order to better understand the impact of statin use on in-hospital mortality following TBI.

Further Directions in Cognitive Rehabilitation in Community- and Home-based Daily Trainings in Clients with Severe Traumatic Brain Injury

2010 ◽  
pp. 266-281
Author(s):  
Masako Fujii
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Executive Functions ◽  
Severe Traumatic Brain Injury ◽  
Cognitive Rehabilitation ◽  
Reading Abilities ◽  
Home Based ◽  
Severe Tbi ◽  
One Year ◽  
Paper Method

Community- and home-based daily intense cognitive rehabilitation (CR) of traumatic brain injury (TBI) clients was initiated on the basis on knowledge mentioned in Chapter 17. In the CR, statistically significant changes were demonstrated in attention and reading abilities in sixteen severe TBI clients by one-year daily CR. Improvement of memory and executive functions required more training periods as shown later. The temporary minimum scores of four neuropsychological tests required for social reentry, namely, 50 in TEA, 15 in RBMT, 80 in BADS and 40 in JART, were determined as a goal of our CR. In addition to the drill (pen and paper) method mainly using workbooks, a more advanced program for CR, particularly in clients who reached the required level, was developed together with the clients.

scholarly journals Patterns of Statin Use in Older Medicare Beneficiaries With Traumatic Brain Injury

2017 ◽  
Vol 33 (4) ◽  
pp. 156-166
Author(s):  
Bilal Khokhar ◽  
Linda Simoni-Wastila ◽  
Julia F. Slejko ◽  
Eleanor Perfetto ◽  
Min Zhan ◽  
...  
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
National Sample ◽  
Pharmacological Therapy ◽  
Medicare Beneficiaries ◽  
Future Studies ◽  
Factors Associated ◽  
The Impact ◽  
Statin Use

Background: In addition to lowering lipids, statins also may be beneficial for older adults sustaining a traumatic brain injury (TBI), as statin use prior to and following trauma may decrease mortality following injury. However, despite statins’ potential to reduce mortality, there is limited research regarding statin use among older adults. Objective: To characterize and investigate factors associated with statin use among older adults with TBI. Methods: A retrospective drug utilization study was used to characterize statin use among Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 and with continuous Medicare Parts A, B, and D coverage 6 months prior and 12 months following TBI. Logistic regression was used to investigate the factors associated with statin use. The exposure of interest was statin use prior to and following TBI. Results: Of the 75 698 beneficiaries included in the study, 37 874 (~50%) of beneficiaries used a statin at least once during the study period. The most common statin used was simvastatin, while fluvastatin was the least used statin. Statin users were more likely to have cardiovascular diseases when compared to nonusers. Hyperlipidemia was a major factor associated with statin use and had the greatest impact on statin use compared to nonuse (odds ratio = 9.54; 95% confidence interval = 9.07, 10.03). Conclusions: This national sample of older adults with TBI suggests that statins are commonly used. Future studies must next examine the impact of statin use on mortality and secondary injury in order to shape pharmacological therapy guidelines following TBI.

scholarly journals Effects of Systematic Categorization Training on Cognitive Performance in Healthy Older Adults and in Adults with Traumatic Brain Injury

2019 ◽  
Vol 2019 ◽  
pp. 1-17
Author(s):  
Fofi Constantinidou
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Young Adults ◽  
Brain Injury ◽  
Cognitive Rehabilitation ◽  
Neuropsychological Testing ◽  
Cognitive Learning ◽  
Cognitive Stimulation ◽  
Future Research ◽  
Control Group

This study investigated the effects of hierarchical cognitive training using the categorization program (CP), designed initially for adults with cognitive deficits associated with traumatic brain injury (TBI). Fifty-eight participants were included: a group of fifteen young adults with TBI (ages 18-48), another group of fifteen noninjured young adults (ages 18-50), and two groups of adults over 60 randomly assigned into the experimental group (n=14) or the control group (n=14). Following neuropsychological testing, the two young adult groups and the experimental older adult group received the CP training for 10-12 weeks. The CP training consisted of 8 levels targeting concept formation, object categorization, and decision-making abilities. Two CP tests (administered before and after the training) and three probe tasks (administered at specified intervals during the training) assessed skills relating to categorization. All treated groups showed significant improvement in their categorization performance, although younger participants (with or without TBI) demonstrated greater gains. Gains on the categorization measures were maintained by a subgroup of older adults up to four months posttraining. Implications of these findings in terms of adult cognitive learning and directions for future research on adult cognitive rehabilitation and cognitive stimulation programs are discussed.

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