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Background:
Approximately 1 million individuals experience a mild traumatic brain injury (TBI) and cost the United States nearly $17 billion each year. Many trauma survivors with mild TBI have debilitating and long-term physical, emotional, and cognitive impairments that are unrecognized at trauma centers. Early intervention studies are needed to...
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Context 1
... six sessions are 30 min and are conducted once a week over the phone. Sessions focus on increasing awareness of one's thoughts and experiences and increasing self-efficacy. Participants learn how to use mindful attention and goal setting to recognize and stop 'absentmindedness' and 'automatic pilot' in order to reduce daily errors and 'slips' (Fig. 2). Each session builds upon the content of the previous ses- sion. Weekly homework is personally tailored based on patient ...
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Non-hospitalized mild traumatic brain injury patients (mTBI) comprise a substantial part of the trauma population. For these patients, guidelines recommend specialized follow-up only in the case of persistent complaints or problems returning to previous activities. This study describes injury and outcome characteristics of non-hospitalized mTBI pat...
Citations
... Over a million Americans sustain a mild traumatic brain injury (mTBI) every year [1]. Mild TBI is defined as an injury to the head with loss of consciousness for 30 minutes or less with posttraumatic amnesia as well as alteration of consciousness for no more than 24 hours with no identifiable lesions on the individual's scans [2]. ...
... It is likely that there are a high number of individuals who have experienced a brain injury but have not been diagnosed [3]. Unfortunately, mTBI symptoms are commonly unrecognized and can cause chronic impairments such as attention deficits, headaches, fatigue, posttraumatic stress symptoms, and deficits in executive functioning, all of which negatively impact daily functioning [1]. Approximately 70% of TBIs are considered mTBI and are usually diagnosed after complaints by the individual without postinjury objective findings [4,5]. ...
... While some may not experience long-term mTBI-related symptoms, a large number of individuals are increasingly reporting cognitive, physical, and psychological symptoms months and years postinjury [1,7]. One of the chronic symptoms of mTBI is impaired executive functioning causing difficulties in holding attention, remembering information, and organization and planning [8]. ...
There is increased awareness of the long-term cognitive sequelae of mild traumatic brain injury (mTBI). Therefore, researchers and clinicians have developed and tested cognitive training protocols to address these challenges. The current review summarized literature that examined existing cognitive rehabilitation/training programs. Specifically, the review listed the impact of these programs on functional domains informed by the Occupational Therapy Practice Framework (OTPF). Literature between the years 2008 and 2022 was gathered from nine databases. Results indicate that several cognitive rehabilitation programs have proven to positively influence domains of occupation, client factors, performance, and context. Occupational therapy practitioners have an opportunity to engage in mTBI management. Furthermore, adopting domains of OTPF may guide assessments, treatment planning, and long-term follow-up.
... Programa de estimulación de funciones ejecutivas dirigido a niños en edad escolar -PEFE -Módulo de planificación -Son varios los estudios que han hecho evidente la existencia de la plasticidad cerebral, y algunos de ellos han encontrado resultados importantes tanto en modelos animales(Fares et al., 2013;Papathanasiou et al., 2006) como en casos clínicos(Fridriksson, 2011;Hamiltona et al., 2011), en enfermedades neurodegenerativas(Landi & Rossini, 2010) y durante el desarrollo cerebral(Eyre, 2007;Zeanah et al., 2011).En general, dichos estudios han permitido identificar algunas características de la plasticidad, como que esta se presenta a lo largo del ciclo vital, pero que está programada genéticamente para variar en ciertas edades, siendo más prominente en los primeros años de vida que en la etapa adulta(Etholm et al., 2013;Giedd et al., 1999;Popli et al., 2013). Incluso, con respecto a esto se hace referencia a "periodos sensibles", donde los efectos de la experiencia son particularmente significativos para adquirir o incorporar nuevas habilidades(Zeanah et al., 2011).Programas de entrenamiento cognitivo para niñosLos programas de entrenamiento cognitivo dirigidos a niños han sido empleados para compensar las alteraciones causadas tanto por lesiones cerebrales(Álvarez et al., 2008;Orjales & Matxalen, 2007) como por enfermedades fisiológicas como la esclerosis múltiple(Portaccio et al., 2010); incluso, con el objetivo de mejorar las habilidades cognitivas, se han aplicado a niños con dificultades en el aprendizaje(Jiménez & Muñetón, 2010;Jiménez & Rojas, 2008) y como una forma de educación compensatoria para niños con deprivación sociocultural(Ben-Hur & Feuerstein, 2011;Ghiglione et al., 2011).En general, estos programas funcionan como complemento de intervenciones que incluyen estrategias compensatorias, como el empleo de instrucciones cortas y la ubicación de señales visuales y auditivas, entre otras actividades similares; y, cuando se realiza el entrenamiento cognitivo, su principal propósito es la enseñanza directa de habilidades de planificación, organización, inhibición de respuestas, memoria operativa y atención sostenida, siendo estas implementadas con actividades de lápiz y papel o por medio de tareas computarizadas(Archer et al., 2015;Gutiérrez, 2003). ...
Describe el proceso de diseño y desarrollo de un programa de entrenamiento cognitivo dirigido a niños en edad preescolar para estimular la planificación cognitiva.
... While numerous studies have reported the use of homework in the TBI population (e.g., Archer et al. 2015;Ashman et al. 2014;Ponsford et al. 2016), only two have actually measured homework compliance Zencius et al. 1991). The study by Zencius et al. (1991) involved memory notebook training with four participants in the cognitive rehabilitation context. ...
Traumatic Brain Injury (TBI) associated cognitive impairments may pose an obstacle to homework engagement in Cognitive Behavior Therapy (CBT) for depression and anxiety. The current study examined the association of demographic, injury-related and CBT process variables with homework engagement in CBT adapted for TBI -related cognitive impairments (CBT-ABI). The audio-recordings of 177 CBT-ABI sessions, representing 31 therapist-client dyads, were assessed from the independent observer perspective. Client homework engagement, therapist competence in assigning and reviewing homework, and working alliance strength, were measured. Multi-level mixed model regressions showed that older client age, more time since injury, stronger working alliance and greater therapist competence in homework review, were significantly associated with higher levels of homework engagement. The findings highlight how CBT-ABI therapists can possibly enhance homework engagement for clients with TBI.
... While telephone-based interventions have been used successfully for treatment of depressive symptoms, executive dysfunction, sleep, and other post-traumatic symptoms after TBI (predominantly mild TBI) [36][37][38][39][40][41][42][43][44][45][46][47][48], the majority of these studies relied on phone contact or video conferencing to replace face-to-face therapy, rather than making use of the remote technology available in smartphones. Prior to the advent of smartphone technology, studies using personal digital assistants (PDAs), voice organizers, and portable paging systems suggested that using mobile technology after TBI was feasible and potentially effective as a memory aid for communitydwelling individuals with cognitive impairment after TBI [49][50][51]. ...
Purpose of Review
Mobile health (mHealth) interventions may be useful for individuals with traumatic brain injury (TBI), but there is minimal knowledge regarding how mHealth technology is currently being used for TBI treatment or rehabilitation. The purpose of this review is to examine the extant literature on the use of mHealth for intervention delivery in order to identify considerations for using mHealth with the TBI population, and to provide recommendations for further study.
Recent Findings
Consistent with recent literature in other disability populations, mHealth shows promise for people with TBI as a compensatory strategy for cognitive impairment, a method for monitoring and reducing symptoms, and a means of addressing goals in social and educational spheres.
Summary
In this review article, we summarize the results of 16 articles on mHealth interventions for individuals with TBI, highlighting relevant findings for clinical application and discussing challenges unique to the use of mHealh post-TBI.
Introducción: pese a la alta incidencia de dificultades ejecutivas después de sufrir un trauma craneoencefálico (TCE), existen pocos estudios que evalúen la efectividad de su rehabilitación. Objetivo: evaluar el efecto de un programa de rehabilitación en inhibición y memoria de trabajo, en un paciente con antecedente de TCE severo. Método: se empleó el diseño de caso único tipo AB con seguimiento, a través de un programa de intervención computarizado de 15 sesiones, aplicado tres veces a la semana. La evaluación del programa se realizó con medidas objetivo (línea base, durante, posintervención y a largo plazo) y con pruebas estandarizadas de inhibición y memoria de trabajo (pre y posintervención). Resultados: los Análisis Visuales revelaron una trayectoria ascendente en la inhibición y memoria de trabajo, con mayor estabilidad en la evaluación inmediatamente posterior y a largo plazo después de aplicado el programa, no obstante, estos cambios no se pueden atribuir completamente al programa. Conclusión: el programa de rehabilitación es prometedor para mejorar la inhibición, sin embargo, su efecto fue mínimo para mejorar la memoria de trabajo. Estos resultados sugieren considerar la necesidad de diseñar intervenciones cognitivas específicas y evitar las estimulaciones globales para mejorar las funciones ejecutivas. Lo anterior, evidencia las bondades de los diseños de caso único, ya que, al asegurar un seguimiento riguroso a la aplicación y evaluación de las intervenciones, permiten tomar decisiones sobre su efectividad.
Traumatic brain injury (TBI) is common among Veterans and may interact with aging, increasing risk for negative cognitive, emotional, and functional outcomes. However, no accessible (i.e., in-home) group interventions for TBI targeted to older adults exist. Goal Oriented Attentional Self-Regulation (GOALS) is a manualized, group cognitive rehabilitation training that improves executive function and emotional regulation among Veterans with TBI and healthy older adults. Our objectives were to adapt GOALS for delivery to older Veterans via in-home video telehealth (IVT) and evaluate feasibility and participant-rated acceptability of the telehealth GOALS intervention (TeleGOALS). Six Veterans 69+, with multiple TBIs completed the 10-session intervention in groups of 2. One participant withdrew, and another completed the remaining sessions alone (total n enrolled = 8). Required adaptations were noted; questionnaire responses were quantified; and feedback was analyzed and coded to identify themes. Quantitative and qualitative methods were used to examine feasibility (i.e., recruitment and retention) and participant-rated acceptability. Minimal adaptations were required for IVT delivery. Key themes emerged: (a) the importance of telehealth logistics, (b) facilitators’ roles in prioritizing interpersonal connection, and (c) telehealth’s capability to create opportunities for community reintegration. Thematic saturation (the point at which feedback from respondents is consistent and no further adaptations are required) was achieved. Participants stated they would likely recommend TeleGOALS to other Veterans. Although further study with a larger, more diverse sample is required, the adapted TeleGOALS intervention appears highly feasible and acceptable for older Veterans with TBI able and willing to participate in a group-format IVT intervention.
In this review, we discuss the basics of functional MRI (fMRI) techniques including task-based and resting state fMRI, and overview the major findings in patients with traumatic brain injury. We summarize the studies that have longitudinally evaluated the changes in brain connectivity and task-related activation in trauma patients during different phases of trauma. We discuss how these data may potentially be used for prognostication, treatment planning, or monitoring and management of trauma patients.
Importance
Traumatic events are the leading cause of life-altering disability in adults of working age. The management of patients with traumatic injury has substantially improved due to development of sophisticated trauma centers increasing survival after injury. Unlike the adoption of the trauma system framework, the same has not occurred with specialized trauma recovery services to include mental and social health needs. This literature review will discuss unique issues facing trauma survivors, some current recovery programs available, outcomes and benefits of these programs, and barriers that impair widespread incorporation.
Observations
Studies have shown that patients with traumatic injury experience reduction in quality of life and concurrent threats to mental health, including post-traumatic stress disorder (PTSD), alcohol use disorder, and recreational substance abuse. Patients with traumatic injury also have high recidivism rates, low pain management satisfaction, and poor engagement in care following injury. Screening efforts for PTSD, mental illness, and alcohol and substance abuse are more widely available interventions. Early coordinated efforts included dedicated multidisciplinary recovery teams. Recently, more methodical and organized programs, such as the Trauma Survivors Network, trauma collaborative care, Trauma Recovery Services, and Center of Trauma Survivorship, have been implemented.
Conclusions and Relevance
The enrollment of patients with traumatic injury in novel programs to enhance recovery has led to heightened self-efficacy, better coping mechanisms, and increased use of mental health services. Additionally, trauma recovery services have been shown to reduce recidivism and have generated cost savings for hospital systems. While positive outcomes have been demonstrated, they are not consistently predictable. Barriers for widespread implementation include limitations of time, funding, and institutional support. This article describes models of successful programs initiated within some trauma centers, which may be duplicated to serve future trauma survivors.
Zusammenfassung
Hintergrund
Der Nationale Aktionsplan zur Gesundheitskompetenz (NAP GK) fordert eine nutzerfreundliche und gesundheitskompetente Entwicklung des Gesundheitswesens. Differenziert nach einzelnen Handlungsfeldern und Akteursgruppen existieren bereits zahlreiche Tools zur Stärkung der Gesundheitskompetenz bspw. für die Versorgung in Krankenhäusern. Einrichtungen der Behindertenhilfe wurden bislang selten als Lebenswelt zur Entwicklung und Stärkung der organisationalen Gesundheitskompetenz adressiert.
Fragestellung
Der Beitrag geht folgenden Fragen nach: 1) Welche Tools zur Stärkung der Gesundheitskompetenz liegen für Einrichtungen für Menschen mit Behinderung vor? 2) Welche Tools eignen sich zur Stärkung der Gesundheitskompetenz in den einzelnen Handlungsfeldern?
Methodik
Zur Ermittlung von Tools wurde eine systematische Recherche in den Datenbanken PubMed, Embase, CINAHL und PsycINFO durchgeführt. Insgesamt wurden N = 1130 Treffer identifiziert und n = 116 Volltexte gesichtet. Die ausgewählten Tools ( n = 35) wurden nach den acht Standards bzw. Handlungsfeldern einer gesundheitskompetenten Einrichtung sowie nach der Ebene (d. h. Einrichtung, Mitarbeitende, Nutzende) differenziert.
Ergebnisse
Für Einrichtungen der Behindertenhilfe wurden n = 35 Tools, gefunden und aufbereitet. Die meisten Tools lassen sich dem Handlungsfeld 6 „Gesundheitskompetenz der Nutzenden“ ( n = 24) zuordnen. Für das Handlungsfeld 4 „Navigation“ konnten dagegen keine Tools gefunden werden.
Diskussion
Tools zur Stärkung der organisationalen Gesundheitskompetenz von Einrichtungen der Behindertenhilfe sind v. a. für das englischsprachige Ausland vorzufinden. Diese sollten für den deutschsprachigen Raum adaptiert und erprobt werden. Für einige Handlungsfelder konnten keine Tools gefunden werden, sodass hier künftig geeignete Tools entwickelt werden sollten, um die Gesundheitskompetenz von Mitarbeitenden (d. h. Leitungs-, Fach- und Betreuungspersonal), Bewohner*innen und Klient*innen von Einrichtungen der Behindertenhilfe nachhaltig zu fördern.
Objective:
To provide a brief and comprehensive summary of recent research regarding psychological interventions for patients surviving a traumatic brain injury.
Methods:
A bibliographical search was performed in PubMed, Cochrane Library, PsycNET, Scopus, ResearchGate, and Google Scholar online databases. Analysis included distribution by year of publication, age stage of participants (paediatric, adult), location of the research team, study design, type of intervention, and main outcome variables.
Results:
The initial search eliciting 1541 citations was reduced to 62 relevant papers. Most publications had adult samples (88.7%). The United States outstands as the country with more research (58.1%); Latin America countries provided no results. Cognitive behavioural therapy (CBT) was the most widely used approach for treatment of (sub)clinical mental disturbances (41.9%). Neuropsychological interventions were scarce (4.8%). Outcome measures included psychiatric disorders (e.g., posttraumatic stress disorder (PTSD), depression, and anxiety) (37.1%), postconcussive symptoms (16.1%), cognitive and functional deficits (48.1%), and social and psychological dimensions (62.9%).
Conclusions:
CBT outstands as the preferred therapeutic approach for treating behavioural and emotional disturbances. Also, other related therapies such as dialectical behaviour, mindfulness, and acceptance and commitment therapies have been proposed, and probably in the years to come, more literature regarding their effectiveness will be available. On the other hand, evidence showed that interventions from the field of neuropsychology are minimal if compared with its contribution to assessment. Future research should be aimed at performing studies on more diverse populations (e.g., nonmilitary communities and paediatric and Latin American populations) and at controlling designs to examine the therapeutic efficacy of psychotherapeutic and neurocognitive rehabilitation interventions and compare amelioration by injury severity, age of patients, and clinical profile, in the hopes of creating better guidelines for practitioners.
