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

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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Addressing a continuum of recovery after acquired brain injury

Journal of the International Neuropsychological Society ◽

10.1017/s1355617798004093 ◽

1998 ◽

Vol 4 (4) ◽

pp. 409-409 ◽

Cited By ~ 1

Author(s):

THOMAS A. NOVACK ◽

BRICK JOHNSTONE

Keyword(s):

Cognitive Impairment ◽

Brain Injury ◽

Cognitive Deficits ◽

Cognitive Rehabilitation ◽

Spontaneous Recovery ◽

Cognitive Disorders ◽

Acquired Brain Injury ◽

Cognitive Stimulation ◽

Injured Brain ◽

Opportune Time

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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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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