Application of neuropsychology and imaging to brain injury and use of the integrative cognitive rehabilitation psychotherapy model

2021 ◽  
Vol 49 (2) ◽  
pp. 307-327
Author(s):  
Mark Pedrotty ◽  
Tiffanie S. Wong ◽  
Elisabeth A. Wilde ◽  
Erin D. Bigler ◽  
Linda K. Laatsch
Keyword(s):  
Brain Injury ◽  
Functional Imaging ◽  
Cognitive Rehabilitation ◽  
Treatment Plan ◽  
Neuropsychological Testing ◽  
Comprehensive Treatment ◽  
Imaging Studies ◽  
Treatment Techniques ◽  
History Of ◽  
Tools And Techniques

BACKGROUND: An early approach to cognitive rehabilitation therapy (CRT) was developed based on A. R. Luria’s theory of brain function. Expanding upon this approach, the Integrative Cognitive Rehabilitation Psychotherapy model (ICRP) was advanced. OBJECTIVE: To describe the ICRP approach to treatment of clients post brain injury and provide a comprehensive list of evaluation tools to determine the client’s abilities and needs. Finally, to provide a link between CRT and functional imaging studies designed to improve rehabilitation efforts. METHODS: History of cognitive rehabilitation and neuropsychological testing is reviewed and description of cognitive, academic, psychiatric, and substance abuse tools are provided. Cognitive and emotional treatment techniques are fully described. Additionally, a method of determining the client’s stage of recovery and pertinent functional imaging studies is detailed. RESULTS: Authors have been able to provide a set of tools and techniques to use in comprehensive treatment of clients with brain injury. CONCLUSIONS: Inclusive treatment which is outlined in the ICRP model is optimal for the client’s recovery and return to a full and satisfying life post brain injury. The model provides a framework for neuropsychologists to integrate issues that tend to co-occur in clients living with brain injury into a unified treatment plan.

The Psychiatric Interview and Mental Status Examination

2017 ◽  
Author(s):  
Donald W. Black
Keyword(s):  
Differential Diagnosis ◽  
Social History ◽  
Mental Status ◽  
Treatment Plan ◽  
Essential Elements ◽  
Comprehensive Treatment ◽  
Psychiatric Interview ◽  
Psychomotor Activity ◽  
History Of ◽  
Mental Status Examination

The interview and mental status examination are integral to the comprehensive patient assessment and typically follow a standard approach that most medical students and residents learn. The psychiatrist should adjust his or her interview style and information-gathering approach to suit the patient and the situation. For example, inpatients are typically more symptomatic than outpatients, may be in the hospital on an involuntary basis, and may be too ill to participate in even the briefest interview. Note taking is an essential task but should not interfere with patient rapport. The interview should be organized in a systematic fashion that, although covering all essential elements, is relatively stereotyped so that it allows the psychiatrist to commit the format to memory that, once learned, can be varied. The psychiatrist should start by documenting the patient’s identifying characteristics (age, gender, marital status) and then proceed to the chief complaint, history of the present illness, past medical history, family and social history, use of drugs and alcohol, medications, and previous treatments. A formal mental status includes assessment of the patient’s appearance, attitude, and behavior; orientation and sensorium; mood and affect; psychomotor activity; thought process, speech, and thought content; memory and cognition (including attention and abstraction); and judgment and insight. With the data collected, the psychiatrist will construct an accurate history of the symptoms that will serve as the basis for developing a differential diagnosis, followed by the development of a comprehensive treatment plan. This review contains 1 figure, 3 tables, and 12 references. Key words: assessment, differential diagnosis, interviewing, mental status examination, treatment plan

scholarly journals PET Imaging of Neurodegeneration With [18F]AV-1451 PET After Repetitive Traumatic Brain Injury

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Matthew Mesley ◽  
Ross Puffer ◽  
Charles Laymon ◽  
Brian Lopresti ◽  
Kathryn Edelman ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pet Imaging ◽  
Neuropsychological Test ◽  
Neuropsychological Testing ◽  
Uptake Pattern ◽  
Increased Risk ◽  
History Of

Abstract INTRODUCTION TBI (traumatic brain injury) is associated with an increased risk of late neurodegeneration in chronic TBI survivors. The underlying pathophysiology of trauma-related neurodegeneration is hypothesized to involve a tauopathy, with p-tau deposited in beta-pleated sheets. Current research focuses on identifying strategies to detect trauma-related neurodegeneration in-Vivo. [F-18]AV-1451, a tau-specific PET radiotracer, may detect hyper-phosphorylated tau deposits in living patients. METHODS Participants with a history of TBI >6 mo prior with concern for cognitive decline with age-matched controls were recruited. Subjects were classified into three groups: few (=3 TBI exposures), intermediate (4–10 exposures), and numerous (>10 exposures). Participants underwent PET imaging with [F-18]AV-1451, and qualitative and semi-quantitative (SUVR) analyses of radiotracer retention were performed. Visual classification of tau positivity (+/−) was performed with absence of established positivity thresholds for [F-18]AV-1451 SUVR values. All subjects underwent neuropsychological evaluation, including measures of processing speed, executive function, and memory. RESULTS Twenty-seven TBI subjects and 7 controls were enrolled. A total of 9 participants were categorized as few, 2 as intermediate, 7 as numerous. All TBI subjects demonstrated impairment on at least one neurocognitive measure, while control subjects had normal neuropsychological test results. Analysis of [F-18]AV-1451 uptake patterns demonstrated evidence of tauopathy in 3 subjects, based on visual reads. Significantly increased [F-18]AV-1451 retention was noted in occipital gray matter, posterior cingulate gyrus, and parietal cortex in these 3 tau (+) TBI subjects compared to 24 TBI subjects visually classified as tau (−) and also normal controls. CONCLUSION Evidence of tauopathy, indicative of trauma-related neurodegeneration, was noted in 3 chronic TBI subjects, all of whom were categorized as numerous (>10) TBI exposures and cognitive deficits on neuropsychological testing. No tau PET [F-18]AV-1451 uptake was noted in control participants or in participants categorized as few or intermediate. The data represent a possible [F-18]AV-1451 PET uptake pattern associated with a clinical neurodegeneration syndrome in repetitive 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.

A-140 Computer Based Cognitive Rehabilitation Interventions for Visual Attention Following Mild Traumatic Brain Injury

2021 ◽  
Vol 36 (6) ◽  
pp. 1193-1193
Author(s):  
Alia Westphal ◽  
Jason Bailie ◽  
Melissa Caswell ◽  
Juan Lopez ◽  
Angela Basham ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Visual Attention ◽  
Mild Traumatic Brain Injury ◽  
Cognitive Rehabilitation ◽  
Service Members ◽  
Rehabilitation Programs ◽  
Cohen’S D ◽  
History Of ◽  
Cohen's D

Abstract Background Service members with a history of mild traumatic brain injury (mTBI) frequently report problems paying attention. In combat and training settings, visual attention is critical given the demand to warfighter performance. Many computerized cognitive rehabilitation programs exist, however the impact of their effectiveness on improving visual attention is unknown. Methods A randomized controlled trial consisted of 22 active-duty service members with a history of mTBI. Participants were randomized to Lumosity (N = 8) which focused on multiple cognitive domains or UCR which has a specific focus on visual attention (N = 14). Cognitive assessment was completed at baseline and following treatment. The Neuropsychological Assessment Battery (NAB) Driving Scenes subtest was used as the primary assessment of visual attention. All participants passed a validity measure pre and post assessment. Results A one-way ANOVA revealed that performance on NAB Driving Scenes improved for all participants after treatment (F = 4.18, p = 0.046); however, when computer program type was analyzed there was no interaction (F = 0.32, p = 0.860). Participants who completed the UCR intervention improved from M = 41.64, SD = 11.58 to M = 46.79, SD = 14.52, Cohen’s d = 0.43. For the Lumosity condition, there was a medium effect size (Cohen’s d = 0.46) from baseline (M = 38.63, SD = 14.33) to post treatment (M = 44.75, SD = 9.47) Conclusions The results indicated that both programs proved effective at improving visual attention symptoms. These findings provide support for the use of computerized cognitive rehabilitation programs as a form of intervention for mTBI.

Epilepsy at a large psychiatric hospital: survey and audit of its management

2011 ◽  
Vol 28 (3) ◽  
pp. 156-160 ◽  
Author(s):  
Camilla Haw
Keyword(s):  
Brain Injury ◽  
Psychiatric Hospital ◽  
Treatment Plan ◽  
Time History ◽  
Psychiatric Inpatients ◽  
Care Plan ◽  
Seizure Type ◽  
National Guidelines ◽  
Cross Sectional Survey ◽  
History Of

AbstractObjectives: Although epilepsy and psychiatric disorder are known to be associated, little is known about the nature of epilepsy in psychiatric inpatients and how well psychiatrists manage psychiatric patients with epilepsy. The aim of this study was to describe the nature of epilepsy in patients at a large specialist independent psychiatric hospital and to audit the management of epilepsy using patients' records.Method: Cross-sectional survey of inpatients and audit of clinical documents. Audit standards were derived from good clinical practice and UK guidelines.Results: In total, 83/488 (17%) patients had a life-time history of epileptic seizures and 67 (14%) were receiving anti-epileptic drugs. The prevalence of epilepsy was 37% among brain injury patients, compared with 10-11% in adult male and female forensic patients and in the elderly and 2% in adolescents. Generalised tonic-clonic seizures predominated. Common aetiological factors were: traumatic brain injury, antipsychotics, cerebral hypoxia, cerebrovascular disease and learning disability. In 53/67 (79%) cases the care plan stated the patient had epilepsy but in only 20 (30%) was the seizure type recorded. For 30 (45%) there was no history of how epilepsy had been diagnosed. Of those patients with a history of status epilepticus, 5/15 (33%) had a readily accessible emergency treatment plan. The patient's last seizure was incompletely documented in 29/44 (66%) cases, while for only 7/67 (10%) patients was there documented evidence of a review of epilepsy management within the past year.Conclusions: Epilepsy was common in this group of psychiatric inpatients. Documentation and management needed improvement and to be in line with national guidelines.

The Neuropsychology of Traumatic Brain Injury: Looking Back, Peering Ahead

2017 ◽  
Vol 23 (9-10) ◽  
pp. 806-817 ◽  
Author(s):  
Keith Owen Yeates ◽  
Harvey S. Levin ◽  
Jennie Ponsford
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Rehabilitation ◽  
Neuropsychological Testing ◽  
Critical Role ◽  
Future Research ◽  
Common Data Elements ◽  
The Past ◽  
Data Elements

AbstractThe past 50 years have been a period of exciting progress in neuropsychological research on traumatic brain injury (TBI). Neuropsychologists and neuropsychological testing have played a critical role in these advances. This study looks back at three major scientific advances in research on TBI that have been critical in pushing the field forward over the past several decades: The advent of modern neuroimaging; the recognition of the importance of non-injury factors in determining recovery from TBI; and the growth of cognitive rehabilitation. Thanks to these advances, we now have a better understanding of the pathophysiology of TBI and how recovery from the injury is also shaped by pre-injury, comorbid, and contextual factors, and we also have increasing evidence that active interventions, including cognitive rehabilitation, can help to promote better outcomes. The study also peers ahead to discern two important directions that seem destined to influence research on TBI over the next 50 years: the development of large, multi-site observational studies and randomized controlled trials, bolstered by international research consortia and the adoption of common data elements; and attempts to translate research into health care and health policy by the application of rigorous methods drawn from implementation science. Future research shaped by these trends should provide critical evidence regarding the outcomes of TBI and its treatment, and should help to disseminate and implement the knowledge gained from research to the betterment of the quality of life of persons with TBI. (JINS, 2017,23, 806–817)

scholarly journals A Bezoar Composed of Bilirubin Calcium, Calcium Carbonate, and Fatty Acid Calcium

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Masaya Iwamuro ◽  
Haruo Urata ◽  
Shoichiro Hirata ◽  
Toru Ueki ◽  
Tetsuro Hanabata ◽  
...  
Keyword(s):  
Fatty Acid ◽  
Calcium Carbonate ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Treatment Plan ◽  
Common Bile Duct Stones ◽  
Bile Duct Stones ◽  
Imaging Studies ◽  
Old Japanese ◽  
History Of

A 68-year-old Japanese man was diagnosed with bezoar in the stomach, which was endoscopically retrieved. The bezoar was composed of bilirubin calcium, calcium carbonate, and fatty acid calcium. Due to the presence of bilirubin calcium in the bezoar, we performed imaging studies of the bile duct; gallstones and common bile duct stones were identified. Although bezoar with components similar to bile is infrequently encountered, our findings suggest that a bezoar originating from bile should be considered among the differential diagnoses in patients without a recent consumption history of persimmons who demonstrate a mass in the digestive tract. This case highlights the importance of component analysis of gastric bezoars because its findings may alter the treatment plan.

The Psychiatric Interview and Mental Status Examination

2017 ◽  
Author(s):  
Donald W. Black
Keyword(s):  
Differential Diagnosis ◽  
Social History ◽  
Mental Status ◽  
Treatment Plan ◽  
Essential Elements ◽  
Comprehensive Treatment ◽  
Psychiatric Interview ◽  
Psychomotor Activity ◽  
History Of ◽  
Mental Status Examination

The interview and mental status examination are integral to the comprehensive patient assessment and typically follow a standard approach that most medical students and residents learn. The psychiatrist should adjust his or her interview style and information-gathering approach to suit the patient and the situation. For example, inpatients are typically more symptomatic than outpatients, may be in the hospital on an involuntary basis, and may be too ill to participate in even the briefest interview. Note taking is an essential task but should not interfere with patient rapport. The interview should be organized in a systematic fashion that, although covering all essential elements, is relatively stereotyped so that it allows the psychiatrist to commit the format to memory that, once learned, can be varied. The psychiatrist should start by documenting the patient’s identifying characteristics (age, gender, marital status) and then proceed to the chief complaint, history of the present illness, past medical history, family and social history, use of drugs and alcohol, medications, and previous treatments. A formal mental status includes assessment of the patient’s appearance, attitude, and behavior; orientation and sensorium; mood and affect; psychomotor activity; thought process, speech, and thought content; memory and cognition (including attention and abstraction); and judgment and insight. With the data collected, the psychiatrist will construct an accurate history of the symptoms that will serve as the basis for developing a differential diagnosis, followed by the development of a comprehensive treatment plan. This review contains 1 figure, 3 tables, and 12 references. Key words: assessment, differential diagnosis, interviewing, mental status examination, treatment plan

scholarly journals Combining Functional and Psychoanalytic Techniques, Using Rhythmic Auditory Stimulation (RAS) and Songwriting to Treat a Man with a Traumatic Brain Injury

2012 ◽  
Vol 12 (3) ◽  
Author(s):  
Alex Street
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Treatment Plan ◽  
Term Treatment ◽  
Short Term Treatment ◽  
Music Therapists ◽  
Psychotherapeutic Treatment ◽  
Holistic Treatment ◽  
Treatment Techniques ◽  
Song Writing

A common dilemma for music therapists, particularly when treating the symptoms of neurological damage, is deciding whether to employ functional or psychotherapeutic treatment techniques (Jochims 2004). This paper discusses the process and outcomes of combining two different techniques as a short-term treatment with a man with a traumatic brain injury (TBI) who is transitioning from post acute into the community stage of rehabilitation. Beginning with a brief review of examples where other music therapists have used a combination of techniques in the treatment of TBI patients, I will continue with a case study describing the referral, assessment and treatment plan for the client, including the outcomes of the two main techniques and concluding with a discussion of the process, outcomes and some interpretation of the client’s responses within the six week period.   Working with Will, a 35-year-old man with a TBI, sessions began using several techniques in order to assess his condition, establish goals and begin treatment. Following an initial four months of weekly music therapy we planned to employ two different techniques over a six week period with two different aims:  1. RAS to improve gait parameters, 2. song writing to help sustain motivation for RAS and to address adjustment, self-expression, identity and communication difficulties. This resulted in a highly motivating, holistic treatment plan that was structured, with clear goals and timescales. Sessions lasted for 70 minutes, with 50 minutes of RAS and pregait exercises, followed by 20 minutes spent working on a song: ‘Life After a Bike Crash (that I can’t remember having)’. The RAS programme was set up conjointly with a privately employed physiotherapist and also supported with a daily home programme of RAS and pregait exercises.

Case Exercise: Toxic Exposure-Related Illness: Causation, Diagnosis, and Permanent Impairment

2007 ◽  
Vol 12 (2) ◽  
pp. 4-8
Author(s):  
Frederick Fung
Keyword(s):  
Concentration Level ◽  
Treatment Plan ◽  
Toxic Exposure ◽  
Dose Response Relationship ◽  
Specialty Board ◽  
History Of ◽  
Subjective Complaints ◽  
Based Medicine ◽  
Illness Causation ◽  
Rule Out

Abstract A diagnosis of toxic-related injury/illness requires a consideration of the illness related to the toxic exposure, including diagnosis, causation, and permanent impairment; these are best performed by a physician who is certified by a specialty board certified by the American Board of Preventive Medicine. The patient must have a history of symptoms consistent with the exposure and disease at issue. In order to diagnose the presence of a specific disease, the examiner must find subjective complaints that are consistent with the objective findings, and both the subjective complaints and objective findings must be consistent with the disease that is postulated. Exposure to a specific potentially causative agent at a defined concentration level must be documented and must be sufficient to induce a particular pathology in order to establish a diagnosis. Differential diagnoses must be entertained in order to rule out other potential causes, including psychological etiology. Furthermore, the identified exposure at the defined concentration level must be capable of causing the diagnosis being postulated before the examiner can conclude that there has been a cause-and-effect relationship between the exposure and the disease (dose-response relationship). The evaluator's opinion should make biological and epidemiological sense. The treatment plan and prognosis should be consistent with evidence-based medicine, and the rating of impairment must be based on objective findings in involved systems.

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