Addressing a continuum of recovery after acquired brain 
injury

In their dialogue published in JINS, Wilson (1997) and Prigatano (1997) have eloquently and concisely presented the challenges facing neuropsychology with respect to cognitive rehabilitation. However, both authors neglect two important issues that must be addressed if people with cognitive disorders are to be effectively treated. First, cognitive impairment must be treated during the acute stages of recovery; as to ignore cognitive deficits until patients are more fully recovered may bypass an opportune time for intervention. Evidence is mounting that the injured brain adapts to the losses sustained and that the adaptation will be enhanced by increasing interaction with the environment, as compared to more passive states (Johansson & Ohlsson, 1996; Stein et al., 1995). Given such information, it is difficult to justify withholding cognitive stimulation and remediation from people during acute stages of recovery and instead awaiting a point when spontaneous recovery (presumably) will be complete.

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Computer-based cognitive stimulation for posttraumatic cognitive impairment: a clinical case

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2020-6-131-136 ◽

2020 ◽

Vol 12 (6) ◽

pp. 131-136

Author(s):

E. M. Zubritskaya ◽

S. V. Prokopenko ◽

E. Yu. Mozheyko ◽

V. A. Gurevich

Keyword(s):

Traumatic Brain Injury ◽

Cognitive Impairment ◽

Brain Injury ◽

Cognitive Deficits ◽

Clinical Case ◽

Positive Impact ◽

Cognitive Stimulation ◽

Moderate Cognitive Impairment ◽

Computer Based ◽

Post Traumatic

The paper describes a clinical case of applying a set of computer-based stimulation programs for cognitive impairment arising from severe open traumatic brain injury (TBI). It demonstrates the rehabilitation capabilities of a set of «Neurotechnology+» stimulation programs for correction of cognitive deficits in patients with dysregulated moderate cognitive impairment resulting from experienced severe open TBI. It is noted that the use of a set of the programs contributed to the improvement of impaired regulatory and neurodynamic functions, the expansion of phonemic and semantic speech activity, and the improvement of memory processes. The described case suggests that computer-based cognitive training has a positive impact on cognitive recovery after post-traumatic brain injury.

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The Use of Therapeutic Music Training to Remediate Cognitive Impairment Following an Acquired Brain Injury: The Theoretical Basis and a Case Study

Healthcare ◽

10.3390/healthcare8030327 ◽

2020 ◽

Vol 8 (3) ◽

pp. 327

Author(s):

Cheryl Jones

Keyword(s):

Cognitive Impairment ◽

Brain Injury ◽

Cognitive Control ◽

Cognitive Rehabilitation ◽

Normative Data ◽

Acquired Brain Injury ◽

Digit Symbol ◽

Music Training ◽

Trail Making

Cognitive impairment is the most common sequelae following an acquired brain injury (ABI) and can have profound impact on the life and rehabilitation potential for the individual. The literature demonstrates that music training results in a musician’s increased cognitive control, attention, and executive functioning when compared to non-musicians. Therapeutic Music Training (TMT) is a music therapy model which uses the learning to play an instrument, specifically the piano, to engage and place demands on cognitive networks in order to remediate and improve these processes following an acquired brain injury. The underlying theory for the efficacy of TMT as a cognitive rehabilitation intervention is grounded in the literature of cognition, neuroplasticity, and of the increased attention and cognitive control of musicians. This single-subject case study is an investigation into the potential cognitive benefit of TMT and can be used to inform a future more rigorous study. The participant was an adult male diagnosed with cognitive impairment as a result of a severe brain injury following an automobile accident. Pre- and post-tests used standardized neuropsychological measures of attention: Trail Making A and B, Digit Symbol, and the Brown– Peterson Task. The treatment period was twelve months. The results of Trail Making Test reveal improved attention with a large decrease in test time on both Trail Making A (−26.88 s) and Trail Making B (−20.33 s) when compared to normative data on Trail Making A (−0.96 s) and Trail Making B (−3.86 s). Digit Symbol results did not reveal any gains and indicated a reduction (−2) in free recall of symbols. The results of the Brown–Peterson Task reveal improved attention with large increases in the correct number of responses in the 18-s delay (+6) and the 36-s delay (+7) when compared with normative data for the 18-s delay (+0.44) and the 36-s delay (−0.1). There is sparse literature regarding music based cognitive rehabilitation and a gap in the literature between experimental research and clinical work. The purpose of this paper is to present the theory for Therapeutic Music Training (TMT) and to provide a pilot case study investigating the potential efficacy of TMT to remediate cognitive impairment following an ABI.

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Neuropsychological Assessments of Patients With Acquired Brain Injury: A Cluster Analysis Approach to Address Heterogeneity in Web-Based Cognitive Rehabilitation

Frontiers in Neurology ◽

10.3389/fneur.2021.701946 ◽

2021 ◽

Vol 12 ◽

Author(s):

Alejandro García-Rudolph ◽

Alberto García-Molina ◽

Eloy Opisso ◽

Josep María Tormos ◽

Vince I. Madai ◽

...

Keyword(s):

Cluster Analysis ◽

Cognitive Impairment ◽

Brain Injury ◽

Cognitive Rehabilitation ◽

Acquired Brain Injury ◽

R Package ◽

Life Assessment ◽

Web Based ◽

Post Hoc ◽

Cluster 2

We aimed to (1) apply cluster analysis techniques to mixed-type data (numerical and categorical) from baseline neuropsychological standard and widely used assessments of patients with acquired brain injury (ABI) (2) apply state-of-the-art cluster validity indexes (CVI) to assess their internal validity (3) study their external validity considering relevant aspects of ABI rehabilitation such as functional independence measure (FIM) in activities of daily life assessment (4) characterize the identified profiles by using demographic and clinically relevant variables and (5) extend the external validation of the obtained clusters to all cognitive rehabilitation tasks executed by the participants in a web-based cognitive rehabilitation platform (GNPT). We analyzed 1,107 patients with ABI, 58.1% traumatic brain injury (TBI), 21.8% stroke and 20.1% other ABIs (e.g., brain tumors, anoxia, infections) that have undergone inpatient GNPT cognitive rehabilitation from September 2008 to January 2021. We applied the k-prototypes algorithm from the clustMixType R package. We optimized seven CVIs and applied bootstrap resampling to assess clusters stability (fpc R package). Clusters' post hoc comparisons were performed using the Wilcoxon ranked test, paired t-test or Chi-square test when appropriate. We identified a three-clusters optimal solution, with strong stability (>0.85) and structure (e.g., Silhouette > 0.60, Gamma > 0.83), characterized by distinctive level of performance in all neuropsychological tests, demographics, FIM, response to GNPT tasks and tests normative data (e.g., the 3 min cut-off in Trail Making Test-B). Cluster 1 was characterized by severe cognitive impairment (N = 254, 22.9%) the mean age was 47 years, 68.5% patients with TBI and 22% with stroke. Cluster 2 was characterized by mild cognitive impairment (N = 376, 33.9%) mean age 54 years, 53.5% patients with stroke and 27% other ABI. Cluster 3, moderate cognitive impairment (N = 477, 43.2%) mean age 33 years, 83% patients with TBI and 14% other ABI. Post hoc analysis on cognitive FIM supported a significant higher performance of Cluster 2 vs. Cluster 3 (p < 0.001), Cluster 2 vs. Cluster 1 (p < 0.001) and Cluster 3 vs. Cluster 1 (p < 0.001). All patients executed 286,798 GNPT tasks, with performance significantly higher in Cluster 2 and 3 vs. Cluster 1 (p < 0.001).

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Efficacy of a Computerized Program of Cognitive Rehabilitation of Attention in People With Acquired Brain Injury (ABI)

Case Medical Research ◽

10.31525/ct1-nct04214314 ◽

2019 ◽

Author(s):

Keyword(s):

Brain Injury ◽

Cognitive Rehabilitation ◽

Acquired Brain Injury

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Artificial metaplasticity prediction model for cognitive rehabilitation outcome in acquired brain injury patients

Artificial Intelligence in Medicine ◽

10.1016/j.artmed.2013.03.005 ◽

2013 ◽

Vol 58 (2) ◽

pp. 91-99 ◽

Cited By ~ 6

Author(s):

Alexis Marcano-Cedeño ◽

Paloma Chausa ◽

Alejandro García ◽

César Cáceres ◽

Josep M. Tormos ◽

...

Keyword(s):

Brain Injury ◽

Prediction Model ◽

Cognitive Rehabilitation ◽

Acquired Brain Injury ◽

Rehabilitation Outcome

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Investigating therapists’ intention to use serious games for acquired brain injury cognitive rehabilitation

Journal of King Saud University - Computer and Information Sciences ◽

10.1016/j.jksuci.2014.03.019 ◽

2015 ◽

Vol 27 (2) ◽

pp. 160-169 ◽

Cited By ~ 2

Author(s):

Ahmed Mohammed Elaklouk ◽

Nor Azan Mat Zin ◽

Azrulhizam Shapii

Keyword(s):

Brain Injury ◽

Serious Games ◽

Cognitive Rehabilitation ◽

Acquired Brain Injury ◽

Intention To Use

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A functional magnetic resonance proof of concept pilot trial of cognitive rehabilitation in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458510389219 ◽

2010 ◽

Vol 17 (4) ◽

pp. 457-467 ◽

Cited By ~ 66

Author(s):

J Sastre-Garriga ◽

J Alonso ◽

M Renom ◽

MJ Arévalo ◽

I González ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Impairment ◽

Magnetic Resonance ◽

Healthy Subjects ◽

Cognitive Rehabilitation ◽

Brain Activity ◽

Cognitive Stimulation ◽

Rehabilitation Programme ◽

Functional Magnetic Resonance ◽

Computer Aided

Background: Cognitive impairment is frequent in multiple sclerosis (MS) and lacks effective treatment. Cognitive rehabilitation is widely applied in neurorehabilitation settings. Functional magnetic resonance imaging (fMRI) may help in investigating changes in brain activity and provide a tool to assess the efficacy of rehabilitation. Aim: To investigate the effect on brain activity as measured by fMRI of a cognitive rehabilitation programme in patients with MS and cognitive impairment. Method: Fifteen patients with MS and cognitive impairment and five healthy subjects were recruited. Neuropsychological assessments were performed in patients with MS at study entry and after rehabilitation to assess cognitive changes. fMRI scans were performed at week −5 (baseline), week 0 (immediately before rehabilitation) and week 5 (immediately after rehabilitation). The fMRI paradigm was the Paced Auditory Serial Addition Test (PASAT). The cognitive rehabilitation programme was composed of 15 computer-aided drill and practice sessions and five non-computer-aided cognitive stimulation group sessions (over 5 weeks). Strict guidelines ensured comparability of all rehabilitation interventions. Results: Patients had increased brain fMRI activity after rehabilitation in several cerebellar areas when compared with healthy subjects. After rehabilitation, patients had significantly improved their performance on the backward version of the Digit Span Test ( p = 0.007) and on a composite score of neuropsychological outcomes ( p = 0.009). Conclusion: The results of the present study indicate that this cognitive rehabilitation programme increases brain activity in the cerebellum of cognitively impaired patients with MS. The role of fMRI in the assessment of neurorehabilitation schemes warrants further investigation.

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