Home based neuropsychological rehabilitation in severe traumatic brain injury: a case report

Attention Training After Moderate-to-Severe Traumatic Brain Injury in Adults: A Systematic Review

OBJECTIVE

To determine the extent and efficacy of attentional training as a form of neuropsychological rehabilitation to ameliorate attention deficits in adults with moderate-to-severe traumatic brain injury.

DATA SOURCES

Articles published in Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, PubMed, PsycINFO, Scopus, and Web of Science were searched between January 17, and February 27, 2021.

STUDY SELECTION

Two reviewers blindly assessed studies for eligibility according to the following criteria: any article evaluating the efficacy of any type of behavioral intervention that targeted attention (by means of cognitive rehabilitative, psychoeducational, or neuropsychological strategies, at either an individual or group level) in adults who had sustained a formally documented moderate-to-severe traumatic brain injury.

DATA EXTRACTION

Methodological quality of each article was blindly assessed by 2 reviewers. Data were extracted from each study, including study type, sample size, sample characteristics, summary of intervention, measures used to assess attention, statistical outcomes and results, effect size, conclusion, and limitations.

DATA SYNTHESIS

7314 articles were retrieved from databases, 4325 articles remained after duplicate removal, and finally 21 articles met eligibility criteria and were included in this review. Articles represented varied methodological quality in group or single subject design. Irrespective of the heterogeneity regarding intervention types and attentional outcome measures used across the studies, overall findings suggest that attentional gains can be made in this sample, irrespective of time since injury, age, and injury severity. Further, a growing interest in technology-based interventions is frequently used and holds promise to bettering rehabilitation efforts. However, there is still limited evidence supporting the ecological validity of attentional training interventions (eg, the transfer of treatment effects to daily activities).

CONCLUSIONS

This article plays a crucial role in informing ongoing rehabilitation practices, guiding clinicians with evidence-based strategies and shaping future research directions for more effective attentional training guidelines.

Efficacy of home based computerized adaptive cognitive training in patients with post stroke cognitive impairment: a randomized controlled trial

Post-stroke cognitive impairment is a common consequence of stroke, characterized by deficits in language, cognitive functioning, functional abilities. Innovative technological approaches, such as computerized cognitive retraining, offer promising strategies for mitigating the cognitive challenges. Despite their potential, the impact of these interventions on neuropsychological function and daily living capabilities has poor outcomes. In this randomized controlled trial (RCT), we assessed the effectiveness of a 4-week, remotely-delivered, multi-domain, computer-adaptive cognitive retraining (CACT) program in patients with post-cognitive cognitive impairment. Fifty male participants were randomly assigned to either the experimental group, which underwent the CACT program tailored to individual performance levels, or an active control group that received standard care. The evaluation focused on neuropsychological functions such as attention, memory, and executive processes, alongside daily living skills. Results indicated that participants in the CACT group exhibited notable improvements in several cognitive areas, including processing speed, category fluency, and visual confrontation naming, when compared to the control group. Nonetheless, enhancements in functional abilities, encompassing basic and instrumental activities of daily living (ADL), were minimal, with no significant changes reported post-intervention. This study demonstrates that CACT effectively improves cognitive functions in patients with post-stroke cognitive impairment during the spontaneous recovery period, suggesting that training patients at their optimal performance levels can lead to meaningful cognitive benefits. These findings are specific to patients recovering from stroke-induced cognitive deficits and highlight the need for further research to generalize these results to other populations with vascular cognitive impairment.

Cognitive Retraining in Traumatic Brain Injury: Experience from Tertiary Care Center in Southern India

Objective  Traumatic brain injury (TBI) is a leading cause of mortality and chronic disability across the globe. This study aimed to understand the effects of cognitive retraining (CR) intervention on neuropsychological functions, symptom reporting, and quality of life in patients with moderate to severe TBI.

Materials and Methods  The present single-group intervention study with a pre–post design included 12 patients diagnosed with moderate to severe TBI within 3–24 months post injury. Outcome measures included National Institute of Mental Health and Neuro Sciences (NIMHANS) Neuropsychology Battery, Perceived Stress Scale, Rivermead Post-Concussion Symptom Questionnaire, World Health Organization Quality of Life Scale—Brief, and Visual Analogue Scale. All patients underwent a total of 20 sessions of hospital-based CR, spanning over a period of 2 months. The CR included tasks targeting to enhance processing speed, attention, executive function, learning, and memory. Outcome assessments were conducted at baseline and immediately at post intervention.

Statistical Analysis  Mean, standard deviation, frequency, and percentage were used as measures of descriptive statistics. Pre- and post-intervention scores were compared using Wilcoxon signed-rank test.

Results  The results showed that at post intervention, significant improvements were found in processing speed, working memory, planning, visuo-spatial construction, visual memory, and verbal encoding. Subjective symptom reporting, perceived stress, and quality of life in psychological domain also improved.

Conclusion  CR can be helpful in improving not only cognition but also symptom reporting and quality of life in moderate to severe TBI.

Feasibility of remotely supervised transcranial direct current stimulation and cognitive remediation: A systematic review

With technological advancements and an aging population, there is growing interest in delivering interventions at home. Transcranial Direct Current Stimulation (tDCS) and Cognitive Remediation (CR) as well as Cognitive Training (CT) have been widely studied, but mainly in laboratories or hospitals. Thus, the objectives of this review are to examine feasibility and the interventions components to support the domiciliary administration of tDCS and CR. We performed a systematic search of electronic databases, websites and reference lists of included articles from the first date available until October 31, 2018. Articles included had to meet the following criteria: original work published in English using human subjects, majority of tDCS or CR intervention administered remotely. A total of 39 studies were identified (16 tDCS, 23 CR/CT, 5 using both tDCS & CT). Four studies were single case studies and two were multiple case studies. The remaining 33 studies had a range of 9-135 participants. Five tDCS and nine CR/CT studies were double blind randomized controlled trials. Most studies focused on schizophrenia (8/39) and multiple sclerosis (8/39). Literature examined suggests the feasibility of delivering tDCS or CR/CT remotely with the support of information and communication technologies.