Self-awareness rehabilitation after Traumatic Brain Injury: A pilot study to compare two group therapies

Cognitive Interventions to Improve a Specific Cognitive Impairment for Adults With TBI (June 2013-October 2020)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on cognitive interventions to improve a specific cognitive impairment for adults with TBI.

Barriers and facilitators linked to discharge destination following inpatient rehabilitation after traumatic brain injury in older adults: a qualitative study

PURPOSE

To identify facilitators and barriers associated with returning home for older adults having received inpatient rehabilitation after traumatic brain injury (TBI).

METHODS

A qualitative design was used. Five older patients with TBI and four family caregivers were interviewed and six healthcare professionals participated in a focus group.

RESULTS

Main facilitators to returning home highlighted by all participants were: (1) Patient's adequate health condition and functional status, (2) Access to health and other services at home, (3) Availability of help from a family caregiver. Conversely, if one of these factors was not met, it represented a barrier. Other facilitators identified were (4) Attachment to one's home, (5) Feeling of commitment toward a loved one, (6) Having the possibility of going through a transitional phase, (7) United front between the patient and the family caregiver towards a return home. Additional barriers to returning home included: (8) Incongruent perspectives, and (9) Unclear knowledge about available health and other services at home.

CONCLUSION

The results of this study could be translated into a practical tool to guide patients, families and professionals in the decision about returning home or exploring an alternative option after inpatient rehabilitation for TBI in older adults.IMPLICATIONS FOR REHABILITATIONWhen orienting an older patient home or to an alternative living environment after a traumatic brain injury (TBI), the perspective of rehabilitation professionals can differ from that of patients and caregivers.Professionals tend to emphasize security, whereas patients and caregivers' focus on the well-being associated with home and on the importance of being with their loved one.Integrating the views, values and wishes of older patients with TBI and their caregivers will support a shared decision-making approach for orientation after rehabilitation.

Life is about "constant evolution": the experience of living with an acquired brain injury in individuals who report higher or lower posttraumatic growth

OBJECTIVE

To explore the experience of living with an Acquired Brain Injury (ABI) in individuals who report higher or lower posttraumatic growth (PTG).

METHOD

A multi-method design was employed. Participant scores on the Posttraumatic Growth Inventory (PTGI) were used to identify groups for qualitative comparative analysis. Individual semi-structured interviews were conducted with fourteen individuals with ABI. Data were analysed thematically.

RESULTS

Four themes emerged. The first two themes: "In my mind I was fine" surviving in aftermath of acquiring a brain injury and The everyday as "derailing" capture the transition process from an initial rehabilitation state characterised by neuropsychological and avoidance coping, towards active rebuilding for PTG. Internal building blocks for PTG and Growing in the social world: "you need to have that social connection" elaborate on the internal (e.g., acceptance, integration of the pre and post-injury self) and external (e.g., social relationships) factors seen to facilitate or obstruct PTG.

CONCLUSIONS

Under certain conditions, individuals living with ABI may construe positive growth from their experiences. Practitioners can support PTG development by providing individual and family-based supports aimed at increasing acceptance, the integration of self, and social connection throughout all stages of ABI rehabilitation.IMPLICATIONS FOR REHABILITATIONInternal factors such as having a flexible and positive mindset and external factors such as one's social environment can affect how individuals living with an ABI construe positive growth.Individuals with ABI and their families require access to individualised longitudinal support for neuropsychological and social challenges that can result in increased distress and obstruct the development of PTG.Efforts to facilitate acceptance and support the integration of the pre and post-injury self through recognition of continuity of self and processing of new schematic beliefs can benefit PTG development.Rehabilitation providers should support individuals with ABI to develop or maintain a positive social identity within new or existing social groups.

Choice-based assessments outperform traditional measures for chronic depressive-like behaviors in rats after brain injury

Depression is the most common psychiatric comorbidity to be diagnosed following traumatic brain injury (TBI). In clinical populations, TBI-induced depression may be particularly difficult to treat due to both unique underlying causes and the propensity for treatment resistance. Preclinical assays are needed to characterize depressive-like behavior in models of TBI and evaluate treatments. In the current study, two traditionally-acute assays of depressive-like behaviors, the Forced Swim Task and Saccharin Preference, were extended longitudinally to evaluate chronic TBI-induced depressive-like behaviors in male rats. Two chronic measures of motivation, the Progressive Ratio (PR) task and Effort Discounting Task (EDT), were also tested. The PR measures motivation to exert effort, while the EDT parametrically evaluates choice between low- and high-effort requirements. The EDT was the only assay which captured chronic depressive-like behavior after TBI, albeit with a degree of recovery over time. We found that traditionally-acute measures (Forced Swim Task, Saccharin Preference), and even our other chronic measure (PR), failed to capture long-term deficits. We also challenged serotonin and dopamine systems (via fluoxetine and bupropion) to evaluate how TBI-induced changes to these systems might drive depressive-like behaviors. Although we found no effect of fluoxetine, high-dose bupropion differentially impaired TBI rats. These findings suggest that (1) TBI-induced depressive symptoms remain difficult to measure at the preclinical level, (2) treatment for TBI-induced depression requires further exploration, and (3) obstacles at the preclinical level may translate to treatment failure at the clinical level.

Investigating Brain Network Changes and Their Association With Cognitive Recovery After Traumatic Brain Injury: A Longitudinal Analysis

Traumatic brain injury (TBI) can result in acute cognitive deficits and diffuse axonal injury reflected in white matter brain network alterations, which may, or may not, later recover. Our objective is to first characterize the ways in which brain networks change after TBI and, second, investigate if those changes are associated with recovery of cognitive deficits. We aim to make initial progress in discerning the relationships between brain network changes, and their (dys)functional correlates. We analyze longitudinally acquired MRI from 23 TBI patients (two time points: 6 days, 12 months post-injury) and cross-sectional data from 28 controls to construct white matter brain networks. Cognitive assessment was also performed. Graph theory and regression analysis were applied to identify changed brain network metrics after injury that are associated with subsequent improvements in cognitive function. Sixteen brain network metrics were found to be discriminative of different post-injury phases. Eleven of those explain 90% (adjusted R 2) of the variability observed in cognitive recovery following TBI. Brain network metrics that had a high contribution to the explained variance were found in frontal and temporal cortex, additional to the anterior cingulate cortex. Our preliminary study suggests that network reorganization may be related to recovery of impaired cognitive function in the first year after a TBI.

The influence of self-compassion on perceived responsibility and shame following acquired brain injury

PRIMARY OBJECTIVE

The purpose of this study was to investigate the influence of perceived personal responsibility for an acquired ABI (ABI) on shame, and whether self-compassion moderates this relationship. We hypothesized that people who perceived themselves to be responsible for their injury would have high levels of shame and poorer recovery outcomes.

RESEARCH DESIGN

A mixed-methods design was employed using both standardized measures and a series of open questions.

METHODS AND PROCEDURES

66 participants with ABI were included in the analysis. Data were analyzed using descriptive statistics, correlations, multiple regression, and thematic analysis.

MAIN OUTCOMES AND RESULTS

Significant relationships were found between self-compassion, shame, anxiety, and depression, but perceived responsibility for ABI was not correlated with any examined variables. Due to issues with the measurement of responsibility, it was not possible to complete all proposed forms of analysis. The thematic analysis revealed the ways participants' injuries affected their perceived level of functioning, its consequences for sense of self, shame, and self-compassion.

CONCLUSIONS

This study concluded that people with ABI might experience shame with respect to the injury's impact on functioning. Study limitations and implications for providing therapeutic interventions such as Compassion Focused Therapy and Acceptance and Commitment Therapy are discussed.

Early deviation from normal structural connectivity: A novel intrinsic severity score for mild TBI

Objective

Studies of outcome after traumatic brain injury (TBI) are hampered by the lack of robust injury severity measures that can accommodate spatial-anatomical and mechanistic heterogeneity. In this study we introduce a Mahalanobis distance measure (M) as an intrinsic injury severity measure that combines in a single score the many ways a given injured brain's connectivity can vary from that of healthy controls. Our objective is to test the hypotheses that M is superior to univariate measures in (1) discriminating patients and controls and (2) correlating with cognitive assessment.

Methods

Sixty-five participants (34 with mild TBI, 31 controls) underwent diffusion tensor MRI and extensive neuropsychological testing. Structural connectivity was inferred for all participants for 22 major white matter connections. Twenty-two univariate measures (1 per connection) and 1 multivariate measure (M), capturing and summarizing all connectivity change in a single score, were computed.

Results

Our multivariate measure (M) was able to better discriminate between patients and controls (area under the curve 0.81) than any individual univariate measure. M significantly correlated with cognitive outcome (Spearman ρ = 0.31; p < 0.05). No univariate measure showed significant correlation after correction for multiple comparisons.

Conclusions

Heterogeneity in the severity and distribution of injuries after TBI has traditionally complicated the understanding of outcomes after TBI. Our approach provides a single, continuous variable that can fully capture individual heterogeneity. M's ability to distinguish even mildly injured patients from controls and its correlation with cognitive assessment suggest utility as an imaging-based marker of intrinsic injury severity.

Improving Self-awareness After Acquired Brain Injury Leads to Enhancements in Patients’ Daily Living Functionality

Objective:

To explore whether the improvement in self-awareness induced by a structured intervention programme in patients suffering a brain injury is associated with an enhancement in their functional outcomes.

Method:

This study uses a pre- and post-test control group design with a sample of 56 patients with acquired brain injury randomly assigned to an experimental and a control group. Pre- and post-intervention measurements were self-awareness (using a previously developed scale) and functional outcome (using the Lawton Instrumental Activities of Daily Living Scale).

Results:

Patients who received the intervention programme showed a greater improvement in their self-awareness level and functional outcome than patients in the control group. Additionally, the correlation analyses between improvements at both measures showed a relation between improvement in self-awareness and improvement in functional outcome, especially when the pre-treatment self-awareness level was considered.

Conclusions:

Implementing an intervention programme in self-awareness, in the context of a global rehabilitation process of patients with acquired brain injury, is useful for improving their self-awareness level and the functionality in their daily activities.

Children’s Psychological Representation of Earthquakes: Analysis of Written Definitions and Rasch Scaling

Natural disasters have a potential highly traumatic impact on psychological functioning. This is notably true for children, whose vulnerability depends on their level of cognitive and emotional development. Before formal schooling, children possess all the basic abilities to represent the phenomena of the world, including natural disasters. However, scarce attention has been paid to children’s representation of earthquakes, notwithstanding its relevance for risk awareness and for the efficacy of prevention programs. We examined children’s representation of earthquakes using different methodologies. One hundred and twenty-eight second- and fourth-graders completed a written definition task and an online recognition task, analyzed through the Rasch model. Findings from both tasks indicated that, in children’s representation, natural elements such as geological ones were the most salient, followed by man-made elements, and then by person-related elements. Older children revealed a more complex representation of earthquakes, and this was detected through the online recognition task. The results are discussed taking into account their theoretical and applied relevance. Beyond advancing knowledge of the development of the representation of earthquakes, they also inform on strengths and limitations of different methodologies. Both aspects are key resources to develop prevention programs for fostering preparedness to natural disasters and emotional prevention.

Comprehensive cognitive training improves attention and memory in patients with severe or moderate traumatic brain injury

Traumatic brain injury (TBI) leads to cognitive disorders, the most frequently affected functions being attention and memory. The present study aimed to investigate the effects of a cognitive rehabilitation program, consisting of individual and group interventions, on attention and memory in patients with TBI. Fifteen patients-in the postacute phase of recovery from moderate-to-severe TBI and subsequent cognitive disorders-were enrolled on a three-week waiting list and then underwent a three-week cognitive rehabilitation program. The patients were assessed using a set of five neuropsychological attention and memory tests. The patients and their caregivers were questioned to assess subjective changes in the everyday functioning of the former. The introduction of cognitive training was associated with improvement in one memory test and in two measures of attention. Mean effect size across all tests was higher over the period with treatment compared to the period without (d = 0.36 vs. 0.03). Both patients and caregivers reported significant improvements in everyday functioning (p < .05). There were no further improvements at the four-month follow-up assessment. A comprehensive program of cognitive rehabilitation may improve attention and memory, as well as everyday cognitive functioning, in patients with severe or moderate TBI.

Use of Diffusional Kurtosis Imaging and Dynamic Contrast-Enhanced MR Imaging to Predict Posttraumatic Epilepsy in Rabbits

BACKGROUND AND PURPOSE

Finding a reliable biomarker to thoroughly assess the brain structure changes in posttraumatic epilepsy is of great importance. Our aim was to explore the value of diffusional kurtosis imaging combined with dynamic contrast-enhanced MR imaging in the evaluation of posttraumatic epilepsy.

MATERIALS AND METHODS

A modified weight-drop device was used to induce traumatic brain injury. Rabbits were exposed to traumatic brain injury or sham injury. Diffusional kurtosis imaging and dynamic contrast-enhanced MR imaging were performed 1 day after injury. Posttraumatic epilepsy was investigated 3 months after injury. The traumatic brain injury group was further divided into 2 groups: the posttraumatic epilepsy and the non-posttraumatic epilepsy groups. Mean kurtosis and volume transfer coefficient values in the cortex, hippocampus, and thalamus were analyzed. After follow-up, the experimental animals were sacrificed for Nissl staining.

RESULTS

The posttraumatic epilepsy group comprised 8 rabbits. In the ipsilateral cortex, the volume transfer coefficient in the traumatic brain injury group was higher than that in the sham group; the volume transfer coefficient in the posttraumatic epilepsy group was higher than that in the non-posttraumatic epilepsy group. In the ipsilateral hippocampus, the volume transfer coefficient in the posttraumatic epilepsy group was higher than that in the non-posttraumatic epilepsy and sham groups. No difference was observed between the non-posttraumatic epilepsy and sham groups. In the ipsilateral cortex, mean kurtosis in the traumatic brain injury group was lower than that in the sham group, and mean kurtosis in the posttraumatic epilepsy group was lower than that in the non-posttraumatic epilepsy group. In the ipsilateral thalamus and hippocampus, mean kurtosis in the traumatic brain injury group was lower than that in the sham group, and mean kurtosis in the posttraumatic epilepsy group was lower than that in the non-posttraumatic epilepsy group. In the contralateral thalamus, mean kurtosis in the traumatic brain injury group was lower than that in the sham group; however, no difference was observed between the posttraumatic epilepsy and non-posttraumatic epilepsy groups.

CONCLUSIONS

Diffusional kurtosis imaging and dynamic contrast-enhanced MR imaging could be used to predict the occurrence of posttraumatic epilepsy in rabbits exposed to experimental traumatic brain injury.