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Group treatment of problem‐solving deficits in outpatients with traumatic brain injury: A randomised outcome study
Abstract
Sixty higher‐level outpatients with traumatic brain injury (TBI), all at least 1 year post‐injury, were randomly assigned to either conventional group neuropsychological rehabilitation or an innovative group treatment focused on the treatment of problem‐solving deficits. Incorporating strategies for addressing underlying emotional self‐regulation and logical thinking/reasoning deficits, the innovative treatment is unique in its attention to both motivational, attitudinal, and affective processes and problem‐solving skills in persons with TBI. Participants in the innovative group improved in problem solving as assessed using a variety of measures, including (1) executive function, (2) problem‐solving self‐appraisal, (3) self‐appraised emotional self‐regulation and clear thinking, and (4) objective observer ratings of roleplayed scenarios. These improvements were maintained at follow‐up. Baseline performance on timed attention tasks was related to improvement; individuals who processed the most slowly benefited the most. These participants did not show improvements on timed attention tasks, but did improve on problem‐solving measures. Such findings are consistent with successful compensatory strategy use—the person may still have deficits and symptoms, but now has effective strategies for reducing their impact on daily functioning.
... Examples are Pinel (2009), Rath, Simon, Langenbahn, Sherr, & Diller (2003, and Simony, Honey, Chen, Lositsky, Yeshurun, Wiesel, & Hasson (2016). ...
... ry in a human subject for science. Psychologists have recently found that providing emotional rehabilitation to patients with frontal lobe injuries can assist those patients with problem-solving tasks, indicating that the emotional capacity to confront external obstacles and internal and interpersonal conflicts can be mediated by emotional control (Rath et. al, 2003). D'Zurilla and ...
... Rath, J,F. Simon, D., Langenbahn, Donna M., Sherr, R.L., Diller, L. (2003). Group treatment of problemsolving deficits in outpatients with traumatic brain injury: A randomised outcome study. ...
This is a domain-based, systematic literature review in the fields of art education and neuroscience. The goal of this research is to understand the effects of art education on the developing human brain. This I seek to accomplish by looking at qualitative and quantitative studies on the development of visual processing, executive function, hand-eye coordination, and creativity. Surveying literature on the subject, I will examine what effect art education has on the cognitive development of children. As education is about children solving cognitive problems, arts inquiries engaging neural centers, connections, processes, and systems contribute to a child’s development differently from other classes. I consider art education to be essential to healthy cognitive development, and argue the subject be protected within our school systems. This literature review thesis surveys terms and biomedical studies potentially grounding pedagogy informed by empirical neuroscientific research that can not only drive innovation and efficacy in art classrooms of the future, but also advocate for art and other elective programs in every school.
... 15 Problem-solving treatment (PST) is a cognitive behavioral treatment that remediates problem-solving impairment for other conditions (eg, traumatic brain injury). 16, 17 We performed a randomized clinical trial to examine the efficacy of telephone-delivered PST compared with an active control, telephone-delivered health education (HE), for reducing the disability and problem-solving impairment of veterans with GWI. ...
... Telephone-delivered PST included 12 one-hour sessions using a workbook and was modeled after established PSTs and tailored for veterans with GWI. 16,24 Veterans were taught how to develop a positive mindset around problem-solving ("I can solve problems"). Veterans were also taught a 5-step approach to problem-solving. ...
... 45 We hypothesized, but did not find, that PST reduced objective problem-solving impairment, pain, and fatigue. Divergent self-report and objective problem-solving outcomes are consistent with findings from earlier clinical trials of PST 16,46 and suggest the importance of using multidimensional assessments. 47 The virtue of self-report is that it elicits the individual's acknowledgment of relevant difficulties. ...
Importance
Few evidence-based treatments are available for Gulf War illness (GWI). Behavioral treatments that target factors known to maintain the disability from GWI, such as problem-solving impairment, may be beneficial. Problem-solving treatment (PST) targets problem-solving impairment and is an evidence-based treatment for other conditions.
Objective
To examine the efficacy of PST to reduce disability, problem-solving impairment, and physical symptoms in GWI.
Design, Setting, and Participants
This multicenter randomized clinical trial conducted in the US Department of Veterans Affairs compared PST with health education in a volunteer sample of 511 Gulf War veterans with GWI and disability (January 1, 2015, to September 1, 2019); outcomes were assessed at 12 weeks and 6 months. Statistical analysis was conducted between January 1, 2019, and December 31, 2020.
Interventions
Problem-solving treatment taught skills to improve problem-solving. Health education provided didactic health information. Both were delivered by telephone weekly for 12 weeks.
Main Outcomes and Measures
The primary outcome was reduction from baseline to 12 weeks in self-report of disability (World Health Organization Disability Assessment Schedule). Secondary outcomes were reductions in self-report of problem-solving impairment and objective problem-solving. Exploratory outcomes were reductions in pain, pain disability, and fatigue.
Results
A total of 268 veterans (mean [SD] age, 52.9 [7.3] years; 88.4% male; 66.8% White) were randomized to PST (n = 135) or health education (n = 133). Most participants completed all 12 sessions of PST (114 of 135 [84.4%]) and health education (120 of 133 [90.2%]). No difference was found between groups in reductions in disability at the end of treatment. Results suggested that PST reduced problem-solving impairment (moderate effect, 0.42; P = .01) and disability at 6 months (moderate effect, 0.39; P = .06) compared with health education.
Conclusions and Relevance
In this randomized clinical trial of the efficacy of PST for GWI, no difference was found between groups in reduction in disability at 12 weeks. Problem-solving treatment had high adherence and reduced problem-solving impairment and potentially reduced disability at 6 months compared with health education. These findings should be confirmed in future studies.
Trial Registration
ClinicalTrials.gov Identifier: NCT02161133
... Problem-solving interventions have documented success in individual sessions provided in primary care settings (Mynors-Wallis, Garth, Lloyd- Th omas, & Tomlinson, 1995), structured group therapy (Rath, Simon, et al., 2003), telephone sessions with community-residing adults (Grant, Elliott, Weaver, Bartolucci, & Giger, 2002), inhome sessions with family caregivers of individuals with TBI ( Rivera, Elliott, Berry, & Grant, 2008), and in internet-based online sessions for parents of children with TBI (Wade, Carey, & Wolfe, 2006a; and with observed benefi ts on child functioning, Wade, Carey, & Wolfe, 2006b). ...
... As applied to cognitive rehabilitation, D'Zurilla and Goldfried's model has been infl uential in assessment (Rath, Simon, Sherr, Langenbahn, & Diller, 2000), conceptualization and formulation (Gordon, Cantor, Ashman, & Brown, 2006;Rath, Hennessy, et al., 2003;Rath et al, 2004) and intervention (Rath, Simon, et al., 2003;von Cramon, 1991) for individuals with acquired brain injury. Due to decreased attentional and emotional selfregulatory resources, individuals with brain injury with direct relevance to rehabilitation psychology, signifi cant empirical support has accumulated for the premise that eff ective problem-solving (with an adaptive problem orientation playing a key role) is an important coping strategy that has signifi cant impact on psychological well-being and adjustment for individuals with and without disabilities. ...
... Indeed, the broader concept of "problem-solving" is considered an essential element in chronic disease education and self-management programs (Hill- Briggs, 2003). Problem-solving training grounded explicitly in the principles espoused by D'Zurilla and Goldfried (i.e., incorporating both problem orientation and problem-solving skills) has been applied with notable success in alleviating distress among persons with cancer (Nezu, Felgoise, McClure, & Houts, 2003;Nezu, Nezu, Friedman, & Faddis, 1998) and in improving coping and emotional selfregulation skills among persons with acquired brain injury (Rath, Simon, Langenbahn, Sherr, & Diller, 2003). ...
... Rath and colleagues' study [12] is an example of applying clinical practice for rehabilitation of behavioural/emotional self-regulation and executive functions. Researchers compared innovative approach of group therapy, involving emotional self-regulation and strategic thinking in problem solving, to traditional cognitive rehabilitation. ...
... Researchers concluded that this method is more efficient in problem-solving, emotional self-regulation, and more realistic self-evaluation among participants, compared to traditional cognitive rehabilitation. All these improvements were preserved during the follow-up six months later [12]. ...
Executive function disorder rehabilitation in neurological patients is associated with many difficulties. We investigated the effectiveness of group training, proposed by B. Wilson et al., which has the model of frontal lobes functioning by D. T. Stuss as the theoretical background. The study participants were 16 patients with executive function disorder caused by TBI, strokes, and infections. The training was shortened from 9 weeks to 3 and adopted to the conditions of the rehabilitation centre where the study was held. The evaluation of training effectiveness was carried out by the methods of neuropsychological diagnostics proposed by A. R. Luria as well as standardized quantitative tests (CWIT test, Raven test, FAB) and questionnaires (EBIQ) aimed at assessing the state of executive functions and general well-being. In result positive trends, but not reaching the level of significance, were revealed in the performance of all evaluating methods, with the exception of “arithmetic problems” and “inhibitory control” as part of the FAB test. Statistically significant result was obtained concerning such tests as “counting”, “analysis of story pictures”, and index of total uncorrected errors in the CWIT test. Thus, the results of eventual assessment showed positive dynamic of executive functions state.
... In ABI, there may be impairments in self-monitoring and control, in addition to the ability to differentiate emotions, that are revealed through various symptoms of emotional dysregulation, including disinhibited emotion/behavior, and reduced emotional awareness and expression (8,11). Further, emotional regulation is an important aspect of executive functioning (EF) (12,13), broadly described as inter-related top-down processes promoting the control and regulation of cognition, behavior, and emotion (14). In contrast to the view that brain injury is directly responsible for emotional dysregulation, it can also represent secondary reactions to the consequences of ABI (15). ...
... The division between the BRI and MCI is mainly theoretical, and some of the abilities reflected in the MCI (i.e., Initiate, Working Memory, Plan/Organize, Task Monitor, Organization of Materials) may also overlap with aspects of emotional regulation. Clearly, the constructs of emotional regulation and EF are closely connected (13), as the measures are intended to assess everyday manifestations of emotional dysregulation and executive dysfunction, respectively. The BRIEF-A includes behavioral and emotional aspects, such as appropriate inhibition of thoughts and actions, flexibility in shifting problem-solving set, modulation of emotional response, and monitoring of one's activities, that are very important for emotional regulation (8,9). ...
Objective: To examine whether a questionnaire measuring emotional regulation after acquired brain injury adds clinical information beyond what can be obtained with a comprehensive executive function questionnaire and an anxiety and depression measure.
Method: Seventy adult persons (age 19–66 years, Mage = 43, SDage = 13) with acquired brain injury in the chronic phase and executive function complaints. All were recruited to participate in a randomized controlled trial (NCT02692352) evaluating the effects of cognitive rehabilitation. Traumatic brain injury was the dominant cause of injury (64%), and mean time since injury was 8 years. Emotional regulation was assessed with the Brain Injury Trust Regulation of Emotions Questionnaire (BREQ). Executive function was assessed with the Behavior Rating Inventory of Executive Function Adult Version (BRIEF-A). The Hopkins Symptom Checklist 25 (HCSL-25) was employed to measure anxiety and depression symptoms.
Results: Overall, significant correlations were found between reports of emotional regulation (BREQ) and executive function in daily life (BRIEF-A). Furthermore, our analyses revealed a significant relationship between self-reported scores of emotional regulation (BREQ) and symptoms of anxiety and depression (HSCL-25).
Conclusion: The significant associations between the BREQ and most of the other clinical measures indicate that, for patients with acquired brain injury, the BREQ does not add substantial information beyond what can be assessed with the BRIEF-A and the HSCL-25.
... A small pilot randomised controlled trial testing an adaption of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach has been carried out among older adults with subjective cognitive complaints, and findings have been promising [22]. In addition, two neuropsychological studies have concluded that specific problem-solving skills can be improved [23,24] and transferred to (novel) everyday life situations [24]. ...
... A small pilot randomised controlled trial testing an adaption of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach has been carried out among older adults with subjective cognitive complaints, and findings have been promising [22]. In addition, two neuropsychological studies have concluded that specific problem-solving skills can be improved [23,24] and transferred to (novel) everyday life situations [24]. ...
Background: Older adults’ occupational performance is challenged due to chronic health conditions and aging processes and their functioning often deteriorates over time. Thus, their occupational performance cannot be expected to remain stable in the long term after an occupational therapy intervention. Older adults may therefore need to strengthen their problem-solving skills during occupational therapy not only to solve current occupational performance issues but also to maintain their improvements and deal with new such issues a later point in time. This systematic review and meta-analysis aims to identify, analyse and present current scientific knowledge about the effectiveness and contents of occupational therapy interventions aimed at improving older adults’ occupational performance by strengthening their problem-solving skills.
Methods: MEDLINE, EMBASE, CINAHL and PsykINFO will be searched systematically to identify trials of occupational therapy interventions aimed at improving older adults’ occupational performance by strengthening their problem-solving skills. We will include randomised controlled trials and quasi-experimental trials in populations aged 65+. Three reviewers will independently screen and select references, extract data and assess the quality of included studies using the Cochrane Collaboration’s risk of bias tool.
Discussion: The findings can inform and inspire clinical practice and will help to identify the need for further research.
... Bertisch et al. (2011) and Langenbahn et al. (1999) discussed adapting traditional psychotherapy group approaches for individuals with reduced cognitive functioning following ABI. CBT-based psychotherapy groups conducted within D'Zurilla and Goldfried's (1971) seminal social problem-solving framework, have empirical support in outpatient ABI rehabilitation (Rath, Simon, Langenbahn, Sherr, & Diller, 2003). In a randomized clinical trial, Diller and colleagues (Rath et al., 2003) evaluated a two-phase group intervention grounded in the social problem-solving model. ...
... CBT-based psychotherapy groups conducted within D'Zurilla and Goldfried's (1971) seminal social problem-solving framework, have empirical support in outpatient ABI rehabilitation (Rath, Simon, Langenbahn, Sherr, & Diller, 2003). In a randomized clinical trial, Diller and colleagues (Rath et al., 2003) evaluated a two-phase group intervention grounded in the social problem-solving model. The first phase targeted group members' emotional reactions and maladaptive beliefs about their ability to manage everyday problems (see Rath, Hradil, Litke, & Diller, 2011). ...
... Rusk re searchers formulated an innovative treatment program combining training in emotional regulation techniques with strategies developed to train "clear thinking." The resulting integrated treatment program produced better problem-solving skills, as assessed by a role-play interview format and self-ratings (Rath, Simon, Langenbahn, Sherr, & Diller, 2003). Clinician researchers at Mount Sinai in New York City set forth a protocol that al so included combined treatment of emotional self-regulation difficulties and problem-solv ing, along with a precursor treatment aimed at attention training (Cantor et al., 2014;Gordon, Cantor, Ashman, & Brown, 2006). ...
... To be maximally effective, NR must address maladaptive attitudes, beliefs, and expecta tions about individuals' cognitive abilities , especially among those whose difficulties have become chronic (Neipert et al., 2014). The explicit management of negative self-efficacy beliefs, such as a tendency to attribute difficulties to stable, inter nal, and uncontrollable factors (Uomoto & Fann, 2004), is an important target for thera peutic intervention, with well-established connections to motivation and goal pursuit (Chen & Loya, 2014;Rath et al., 2011) Contemporary integrated interventions emphasize the role of metacognition (Cicerone et al., 2011) and emotional self-regulation skills (Cantor et al., 2014;Rath et al., 2003), as well as an appreciation of the role of subjective experience and beliefs about cognitive functioning, as central to the rehabilitation process (Chen & Loya, 2014;Diller, 2005;Neipert et al., 2014;Rath et al., 2011). Nonetheless, the effects of an individual's aware ness of strengths and limitations and emotional responses to cognitive dysfunction have not been studied systematically. ...
and Keywords Psychologists who understand the nuances of impaired cognitive abilities, especially with in the context of personality and emotional factors, are uniquely qualified to provide in terventions for cognitive and psychosocial difficulties following brain injury. Such inter ventions fall under the labels cognitive rehabilitation and neuropsychological rehabilita tion. Following a brief overview of the historical precursors of neuropsychological rehabil itation, the chapter focuses upon developments in the 20th century through the present, some European, mostly German and Russian, and primarily those in the United States. The manner in which the fields of clinical neuropsychology and rehabilitation medicine provided context and complemented the development of neuropsychological rehabilita tion is highlighted. Current trends and future implications are addressed, with an empha sis on the examination of individual patient characteristics and therapy factors to opti mize clinical outcomes.
... Rusk re searchers formulated an innovative treatment program combining training in emotional regulation techniques with strategies developed to train "clear thinking." The resulting integrated treatment program produced better problem-solving skills, as assessed by a role-play interview format and self-ratings (Rath, Simon, Langenbahn, Sherr, & Diller, 2003). Clinician researchers at Mount Sinai in New York City set forth a protocol that al so included combined treatment of emotional self-regulation difficulties and problem-solv ing, along with a precursor treatment aimed at attention training (Cantor et al., 2014;Gordon, Cantor, Ashman, & Brown, 2006). ...
... To be maximally effective, NR must address maladaptive attitudes, beliefs, and expecta tions about individuals' cognitive abilities , especially among those whose difficulties have become chronic (Neipert et al., 2014). The explicit management of negative self-efficacy beliefs, such as a tendency to attribute difficulties to stable, inter nal, and uncontrollable factors (Uomoto & Fann, 2004), is an important target for thera peutic intervention, with well-established connections to motivation and goal pursuit (Chen & Loya, 2014;Rath et al., 2011) Contemporary integrated interventions emphasize the role of metacognition (Cicerone et al., 2011) and emotional self-regulation skills (Cantor et al., 2014;Rath et al., 2003), as well as an appreciation of the role of subjective experience and beliefs about cognitive functioning, as central to the rehabilitation process (Chen & Loya, 2014;Diller, 2005;Neipert et al., 2014;Rath et al., 2011). Nonetheless, the effects of an individual's aware ness of strengths and limitations and emotional responses to cognitive dysfunction have not been studied systematically. ...
Psychologists who understand the nuances of impaired cognitive abilities, especially with in the context of personality and emotional factors, are uniquely qualified to provide in terventions for cognitive and psychosocial difficulties following brain injury. Such inter ventions fall under the labels cognitive rehabilitation and neuropsychological rehabilita tion. Following a brief overview of the historical precursors of neuropsychological rehabil itation, the chapter focuses upon developments in the 20th century through the present, some European, mostly German and Russian, and primarily those in the United States. The manner in which the fields of clinical neuropsychology and rehabilitation medicine provided context and complemented the development of neuropsychological rehabilita tion is highlighted. Current trends and future implications are addressed, with an empha sis on the examination of individual patient characteristics and therapy factors to opti mize clinical outcomes.
... After 25 therapy sessions the experimental group scored better on measures of action planning than a control group receiving memory training and was given better ratings of everyday problem-solving capacities. In a more recent study [104] chronic headinjury patients received problem-solving training in small groups that focused on the systematic recognition, anticipation, and analysis of reallife problems, often within an interpersonal context. The intervention also emphasized self-observation of emotional and behavioural reactions of participants during problem solving in order to anticipate emotional overreactions. ...
In the new edition of the Oxford Textbook of Neurorehabilitation all chapters have been updated to reflect advances in knowledge in the field of neurorehabilitation. It will be supplemented by additional chapters that reflect novel developments in the field of neurorehabilitation. During recent years there has been a strong evolution in the field of vocational rehabilitation with the aim of helping people after an injury of the nervous system to overcome the barriers and return to employment. A new chapter on self-management strategies deals with building confidence in individuals to manage the medical and emotional aspects of their condition. Furthermore, today the scientific basis for music supported therapy is a much broader to introduce it in this edition. New guidelines and consensus statements became established concerning preclinical research, biomarkers, and outcome measures, in both animal models and human beings. There are new data on attempts (e.g. using stem cells or Nogo antibodies) to restore function after spinal cord injury and stroke. Not all of these therapies and clinical trials have had positive outcomes. One particular area of rapid expansion reflects the use of technology in neurorehabilitation and several chapters remain devoted to this topic in various forms. Still a better understanding of the interactions of technology led therapies and conventional approaches in patients with neurodisability is required. There is still work to be done in defining key components of all neurorehabilitation interventions in order to understand how they might best be delivered for maximum benefit.
... [24] This evidence of generalized benefits to top-down training to daily-life relevant skills comes from several randomized control trials of cognitive training programs in adults with TBI. Some examples of the programs include goal management training, [25] executive plus program, [8] problem-solving therapy, [26,27] goal oriented attention self-regulation, [28] strategic memory advanced reasoning training, [29] and cognitive orientation to daily occupational performance. [30] ...
... Although not specifically assessed in the present study, it is important to mention that difficulties in emotional regulation are among the most common consequences of ABI, with potential detrimental effects in all life domains [e.g., (5,(94)(95)(96)]. Emotional regulation can be described as an important aspect of EF (97). In our study, EF did not emerge as a significant predictor for any of the functional school outcomes. ...
Objective
Among the variety of domains that may be impacted after pediatric acquired brain injury (pABI) are functional school outcomes. The purpose of this study was to identify demographic, medical, and psychological factors associated with impairments in functional school outcomes, defined as school absence, need of educational and psychological services, quality of life (QoL) in the school setting, and academic performance in children with pABI, with a specific emphasis on the significance of fatigue.
Materials and Method
We used baseline data from a randomized controlled trial. The sample consisted of seventy-six children aged 10 to 17 (M = 13 yrs) with pABI in the chronic phase (>1 year). All completed assessments of school-related QoL, academic performance, global functioning, fatigue, IQ, behavioral problems, and executive function.
Results
Fatigue, IQ, global functioning, behavioral problems, and sex emerged as potential predictors for functional school outcomes. Of note, overall fatigue emerged as the strongest potential predictor for parent-reported QoL in school (β = 0.548; p < 0.001) and self-reported QoL in school (β = 0.532; p < 0.001).
Conclusions
Following pABI, specific psychological, medical, and demographic factors are associated with functional school outcomes. Neither of the injury-related variables age at insult and time since insult were associated with functional school outcomes. Overall, our findings may suggest that a reintroduction to school with personalized accommodations tailored to the child's specific function and symptoms, such as fatigue, is recommended.
... That is why the ETAPP program comprised six sessions only while others studies on metacognitive strategy training of EF recommend between 20 and 24 sessions. 31,54,55 Considering the low incidence of the PWS, we included a large number of patients. But the sample size may still be too small to detect small effects on others tests. ...
Prader-Willi Syndrome (PWS) is a neurodevelopmental genetic disorder with executive deficits. Planning is one of the impaired executive functions implied in the regulation of behavior and everyday actions. We aimed to explore the feasibility and the effectiveness of a metacognitive strategy training designed to improve planning in adults with PWS using a double-blind between-group (training versus usual care) randomized controlled trial, with computerized tests and paper-pencil ecological outcome measures targeting planning, other executive functions, and achievement of personalized goal. Results showed better performances in several executive tasks and in achievement of personalized goals after both interventions, but better improvement for the experimental group (n = 27) compared to control (n = 26) only on the task assessing planning abilities. Interviews with occupational therapists demonstrated the feasibility of this training with this population. Despite a small number of sessions, the metacognitive strategy training showed encouraging results on planning abilities of patients.
... This has informed the development of a standardized and validated tool called Goal Management Training (GMT) (Levine et al., 2000(Levine et al., , 2011. The overall efficacy of meta-cognitive strategy instructions has been investigated in several randomized controlled trials (RCTs) including adults suffering from executive dysfunction (Levine et al., 2000;McPherson et al., 2009;Rath et al., 2003;Spikman et al., 2010;Stamenova & Levine, 2019) as well as problems with memory (Kaschel et al., 2002;Ryan & Ruff, 1988;Shum et al., 2011) and attention (Fasotti et al., 2000). The use of environmental supports such as external memory aids and reminders, e.g., mobiles/smartphones, notebooks, virtual digital assistants, have also been evaluated in RCTs (Fish et al., 2008;Wilson et al., 2001) and is clinically recommended for use with adults who have memory difficulties . ...
Improvements in patient outcomes and mortality after brain injury alongside increasing ageing population have resulted in an increasing need to develop cognitive interventions for individuals experiencing changes in their cognitive function. One topic of increasing research interest is whether cognitive functions such as attention, memory and executive functioning can be improved through the use of working memory training interventions. Both clinical and neuroimaging researchers are working to evidence this, but their efforts rarely come together. We discuss here several issues that may be hindering progress in this area, including the tools researchers utilize to measure cognition, the choice between employing active or passive control groups, the focus on transfer effects at the expense of well-characterized training effects, and the overall lack of neuroimaging studies in individuals with neurological disorders. We argue that the only way to advance the field is to build bridges between the disciplines of clinical neuropsychology and cognitive neuroscience. We suggest a multi-level framework to validate the efficacy of working memory interventions and other forms of cognitive training that combine both clinical and neuroimaging approaches. We conclude that in order to move forward we need to form multidisciplinary teams, employ interdisciplinary methods, brain imaging quality rating tools and build national and international collaborations based on open science principles.
... This study adds novel findings to the available literature demonstrating the efficacy of metacognitive, problem solving, and goal management strategies also included in several other interventions. [45][46][47][48][49][50] The GOALS intervention places larger emphasis on applied mindfulness-based attention regulation, with the hypothesis that improving goal-directed attention regulation would benefit subsequent stages of goal management. The particular emphasis in GOALS training is on application and integration of trained strategies in personal life, with actual work on selection and execution of individual and group projects. ...
Difficulties in executive-control functions are common sequelae of both Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD). The goal of this study was to assess whether a cognitive rehabilitation training that was successfully applied in civilian and military TBI would be effective for military Veterans with comorbid PTSD and mild TBI (mTBI). In the prior study, Veterans with history of mild to severe TBI significantly improved after Goal-Oriented Attentional Self-Regulation (GOALS) training on measures of attention/executive function, functional task performance, and emotional regulation. The objective of this study was to assess effects of GOALS training in Veterans with comorbid PTSD and mTBI. Forty Veterans with current PTSD diagnosis and history of mTBI (6+ months post) were randomized to either five weeks of GOALS or Brain-Health Education (BHE) training matched in time and intensity. Evaluator-blinded assessments at baseline and post-training included neuropsychological and complex functional task performance, and self-report measures of emotional functioning/regulation. After GOALS, but not BHE training, participants significantly improved from baseline on primary outcome measures of: Overall Complex Attention/Executive Function neuropsychological performance composite [F = 12.35, p =.001; Cohen's d = .48], and Overall Mood Disturbance -POMS emotional regulation self-report [F=4.29, p=.05, Cohen's d = .41]. Additionally, GOALS, but not BHE participants indicated significant decrease in PTSD symptoms (PCL-M Total Score) [F=4.80, p=.05, Cohen's d =.60], and demonstrated improvement on complex functional task performance -GPS Learning and Memory [F=5.06, p=.05, Cohen's d =.56]. Training in attentional self-regulation applied to participant defined goals may improve cognitive functioning in Veterans with comorbid PTSD and mTBI. Improving cognitive control functioning may also improve functioning in other domains such as emotional regulation and functional performance, potentially making it particularly relevant for Veterans with history of mTBI and co-morbid psychiatric symptoms.
... Cognitive rehabilitation literature supports systematically training metacognitive strategies-particularly problem-solving strategies-to support executive functioning in people with TBI [1][2][3][4]. The literature supports use of a comprehensive, formal model of problem-solving [3][4][5][6]. ...
This paper describes the research and development of the SwapMyMood smartphone application designed to support use of evidence-based executive function strategies by people with traumatic brain injury. Executive dysfunction is a common sequela of traumatic brain injury (TBI) resulting in diminished cognitive-behavioral functioning. Problem-solving and emotion regulation are cognitive-behavioral functions that are often disrupted by changes in the executive control system. SwapMyMood is an electronic version of the Executive Plus/STEP program, a set of clinical techniques taught to people living with brain injury to help them 1) identify and implement solutions to problems encountered in daily life and 2) to utilize the emotion cycle to understand and regulate emotional responses to these problems. The Executive Plus/STEP program has until now relied on paper-based instruction and use. Input from target users – people with brain injury and clinical professionals who teach this program to their patients – has contributed to key refinements of features and functioning of the mobile app. Data gathered from target user participation in the user-centered design process are presented. Future directions for ongoing development of technologies to support executive function strategies are also discussed.
... Of the remaining five studies, authors of two studies responded that the requested data were no longer available, but both the studies were still included for reported data analyses [25,26]. The other three studies were excluded because the author of one study did not reply [27], and the authors of two studies stated that they no longer had ready access to the data [28,29]. ...
Objective
Although the mechanism of post-concussion syndrome remains unclear, psychological factors are thought to be associated with its development. Cognitive behavioral therapy is the gold standard for psychological disorders; however, its effects on post-concussion syndrome remain unclear. Through this meta-analysis, we assessed the effects of cognitive behavioral therapy on post-concussion syndrome following traumatic brain injury.
Methods
Six electronic databases were searched from inception to September 15, 2019, for randomized controlled trials evaluating the effects of cognitive behavioral therapy for adults with post-concussion syndrome. Primary outcomes included the severity of symptoms of post-concussion syndrome, depression, anxiety, and social integration. Secondary outcomes were fatigue, cognitive function, and quality of life. Effects were estimated through the calculation of Hedge's g and 95% confidence interval using a random effects model. Sensitivity analyses were conducted by excluding studies in which an intention-to-treat analysis was not employed.
Results
In total, 24 studies were included. Most studies had risk of bias. Significant effects were found for most outcomes, except for severity of symptoms of post-concussion syndrome, fatigue, executive function, and problem solving. After sensitivity analyses, the effects of cognitive behavioral therapy remained significant for immediate and mid-term effects on depression, anxiety, and social integration.
Conclusions
This study does not support the effectiveness of cognitive behavioral therapy for severity of symptoms of post-concussion syndrome; however, it might be an effective treatment option for improving depression, anxiety, and social integration in individuals with traumatic brain injury.
... After 25 therapy sessions the experimental group scored better on measures of action-planning than a control group receiving memory training and received better ratings of everyday problem-solving capacities. In a more recent study [104] chronic head-injury patients received problemsolving training in small groups that focused on the systematic recognition, anticipation and analysis of reallife problems, often within an interpersonal context. The intervention also emphasized self-observation of emotional and behavioural reactions of participants during problem solving in order to anticipate emotional overreactions. ...
Neuropsychological interventions for impairments of higher cognitive functions can be divided into four different approaches: restoration of function, compensation, physiological stimulations, and metacognitive strategies. Training that aims to restore an impaired function or to increase processing speed or capacity is repetitive and often stereotyped. Such training may lead to task-specific learning with little generalization, as may be observed in particular in the domain of attention rehabilitation. However, it remains a matter of debate whether such practice effects really reflect the restoration of function or improved processing due to preserved procedural learning skills. For some cognitive domains (such as memory), restoration of function is mostly impossible; consequently, training mainly relies on compensatory strategies. For example, enhancement of learning may be achieved by improving memory encoding with mental imagery, while everyday memory is supported with systematic training of external aids, such as, memory notebooks. A third approach is applied in neglect rehabilitation and uses physiological stimulations to bias attention and sensory representations (e.g. optokinetic stimulation) or decrease interhemispheric inhibition (transcranial magnetic stimulation). Finally, the fourth approach is to structure behaviour and to enhance metacognitive abilities; this strategy is applied in the rehabilitation of complex problem-solving skills and impaired emotional regulation. Although it is difficult to control experimental biases in intervention studies targeting cognitive and behavioural disturbances, an increasing number of controlled clinical trials provide evidence for the efficacy of each of the four therapeutic approaches.
... Single test scores (Binder et al., 2016;Harvey et al., 2003;Mahableshwarkar et al., 2015) and composite scores (Biederman et al., 2011;McIntyre et al., 2014;Rostamian et al., 2015) have been used as the primary endpoint in past clinical trials with older adults, people with ADHD, with psychiatric problems, and with medical problems. In some clinical trials in TBI, multiple neuropsychological test scores were analyzed (Fasotti et al., 2000;Rath et al., 2003). Moreover, in systematic reviews that examined clinical trials to determine the effectiveness of executive functioning interventions following TBI (Kennedy et al., 2008) and stroke (Poulin et al., 2012), none of the primary studies included a composite score of executive functioning, and many evaluated changes in multiple single scores from a diverse set of executive functioning tests. ...
Objective:
Executive functioning encompasses interactive cognitive processes such as planning, organization, set-shifting, inhibition, self-monitoring, working memory, and initiating and sustaining motor and mental activity. Researchers therefore typically assess executive functioning with multiple tests, each yielding multiple scores. A single composite score of executive functioning, which summarizes deficits across a battery of tests, would be useful in research and clinical trials. This study examines multiple candidate composite scores of executive functioning using tests from the Delis-Kaplan Executive Function System (D-KEFS).
Method:
Participants were 875 adults between the ages of 20 and 89 years from the D-KEFS standardization sample. Seven Total Achievement scores were used from three tests (i.e., Trail Making, Verbal Fluency, and Color-Word Interference) to form eight composite scores that were compared based on their psychometric properties and association with intelligence (IQ).
Results:
The distributions of most composite scores were mildly to severely skewed, and some had a pronounced ceiling effect. The composite scores all showed a medium positive correlation with IQ. The composite scores were highly intercorrelated in the total sample and in four IQ subgroups (i.e., IQ <89, 90-99, 100-109, 110+), with some being so highly correlated that they appear redundant.
Conclusions:
This study is part of a larger research program developing a cognition endpoint for research and clinical trials with sound psychometric properties and utility across discrepant test batteries. Future research is needed to examine the reliability and ecological validity of these composite scores.
... During initial treatment, psychoeducation about possible changes in sociocognitive functions after surgery might be helpful for both patients and their caregivers. Since training of social skills has proved to be effective in patients with traumatic brain injuries (Dahlberg et al., 2007;Rath et al., 2003) and psychiatric patients (Habel et al., 2010;Horan et al., 2011), it can be assumed that similar approaches could also be beneficial in brain tumour patients. Roberts et al. (2014) observed improvements in overall functional status and on each domain of the functional independence measure separately (e.g. ...
The ability to decode mental states and to come up with effective solutions for interpersonal problems aids successful initiation and maintenance of social interactions and contributes to participation and mental health. Since these abilities of social cognition are challenged in highly demanding situations, such as diagnosis and treatment of a life-threatening illness, this article reviews the literature on emotion recognition, empathy, Theory of Mind and socially skilled behaviour in brain tumour patients. The data available suggest that patients are affected by a slight but consistent impairment of emotion recognition, empathy and Theory of Mind before and immediately after brain tumour treatment, with the degree of impairment being influenced by tumour histology and localization. Impairments mostly decrease a few months after surgery due to assumed neuroplasticity. Future research may address more complex sociocognitive functions, such as social problem solving, and may investigate to which degree sociocognitive difficulties act as risk factors for poor or failed reintegration into occupational and social life following successful brain tumour treatment.
... Total of 9 studies were classified with the main differences between the intervention arms in the categories of the Delivery dimension and with variations in Team structure, Aspects of time, Intensity and Peer involvement ( Table 2). The Team structure variations were related to the group or more individually based service delivery (41). As expected, Target groups were kept constant across the intervention arms. ...
Background and aims: There is a gap in knowledge regarding effective rehabilitation service delivery in the post-acute phase after traumatic brain injury (TBI). Recently, Gutenbrunner et al. proposed a classification system for health-related rehabilitation services (International Classification System for Service Organization in Health-related Rehabilitation, ICSO-R) that could be useful for contrasting and comparing rehabilitation services. The ICSO-R describes the dimensions of Provision (i.e., context of delivered services), Funding (i.e., sources of income and refunding), and Delivery (i.e., mode, structure and intensity) at the meso-level of services.
We aim to:
-Provide an overview of randomized, controlled trials (RCTs) with rehabilitation service relevance provided to patients with moderate and severe TBI in the post-acute phase using the ICSO-R as a framework; and
-Evaluate the extent to which the provision, funding and delivery dimensions of rehabilitation services were addressed and differed between the intervention arms in these studies.
Materials and methods: A systematic literature search was performed in OVID MEDLINE, EMBASE, CINHAL, PsychINFO, and CENTRAL, including multidisciplinary rehabilitation interventions with RCT designs and service relevance targeting moderate and severe TBI in the post-acute phase.
Results: 23 studies with 4,644 TBI patients were included. More than two-thirds of the studies were conducted in a hospital-based rehabilitation setting. The contrast in Context between the intervention arms often co-varied with Resources. The funding of the services was explicitly described in only one study. Aspects of the Delivery dimension were described in all of the studies, and the Mode of Production, Intensity, Aspects of Time and Peer Support were contrasted in the intervention arms in several of the studies. A wide variety of outcome measures were applied often covering Body function, as well as the Activities and Participation domains of the International Classification of Functioning, Disability, and Health (ICF).
Conclusion: Aspects of service organization and resources as well as delivery may clearly influence outcome of rehabilitation. Presently, lack of uniformity of data and collection methods, the heterogeneity of structures and processes of rehabilitation services, and a lack of common outcome measurements make comparisons between the studies difficult. Standardized descriptions of services by ICSO-R, offer the possibility to improve comparability in the future and thus enhance the relevance of rehabilitation studies.
... These findings suggest that deficits in emotional regulation may play a critical role in patients' ability to apply a strategy for the planning and regulation of complex tasks, and may require specific interventions. 59,60 Although treatment for difficulties in emotional regulation has been incorporated into some multifaceted interventions for executive dysfunction 68,70,83,[117][118][119] this requires additional research. Several class III studies 103-105 evaluated group-based interventions for emotional regulation, specifically directed at self-management of anger and aggression. ...
... La generalización de los aprendizajes suele ser muy pequeña, aunque algunos autores encuentran una mejoría extensible a otros procesos, como la memoria operativa [30], otros sistemas de memoria y la inteligencia [33]. En cualquier caso, los programas rehabilitadores que abordan desde diferentes enfoques el tratamiento del paciente (enfoque multidimensional) han mostrado una mayor efectividad [34]. ...
Background
Between 25–75% of people with persistent post-acute sequelae of SARS-CoV-2 infection (PASC) experience cognitive difficulties, compromising functional ability, quality of life, and activities of daily living, including work. However, despite this significant morbidity, there is a paucity of interventions for this disorder that have undergone evaluation within a formal trial setting. Therefore, we have developed a cognitive rehabilitation programme, specifically designed to address the cognitive symptoms of PASC, notably impaired attention and processing speed, while also accounting for other PASC symptoms (fatigue, post-exertional malaise) that may aggravate the cognitive impairment. This study protocol outlines a randomised controlled trial (RCT) designed to evaluate the effectiveness of this programme compared to standard clinical care.
Methods
This is a multi-centre, parallel-group, individually randomised control trial, comparing standard clinical care with and without cognitive rehabilitation. We will recruit 120 non-hospitalised adults (aged 30–60 years) from three NHS sites in England with a history of COVID-19 infection and cognitive impairment persisting more than three months after the acute infection. Participants will be randomised (1:1) to the intervention or control groups, with the latter represented as a provision of standard clinical care without cognitive rehabilitation. The cognitive rehabilitation programme consists of ten one-hour sessions, delivered weekly. Outcomes will be collected at baseline, three and six months, with participant-defined goal-attainment scores, relating to functional goals, at three months as the primary outcome measure. Secondary outcomes will be cognitive function, measures of quality of life, social functioning, mental health, fatigue, sleep, post-exertional malaise, and social and health care service use. We will also evaluate the health-economic benefits of cognitive rehabilitation in this population.
Discussion
Cognitive impairment in PASC is a major cause of functional disability with no effective treatment. Accordingly, we will undertake an RCT of cognitive rehabilitation, the protocol of which is published here. If this trial is successful in delivering improvements in trial outcomes, it will address a major unmet need relating to this emergent disorder, with a significant impact on affected individuals and the wider health economy.
Trial registration
NCT05731570.
Purpose:
To examine health-related self-efficacy for individuals following acquired brain or spinal cord injury prior to enrollment in a weight-loss intervention and associations with demographics, injury characteristics, and additional physiologic variables.
Materials and methods:
Cross-sectional analysis of baseline data for community-dwelling adults following stroke (CVA), traumatic brain injury (TBI), or spinal cord injury (SCI) across three disability-adapted weight-loss interventions.
Results:
Overall results suggest a significant difference between injury type and self-efficacy as measured by the Self Rated Abilities for Health Practices (SRAHP) scale. On average, individuals with SCI had the lowest overall perceived self-efficacy of the three groups (11.2-unit difference; (CI: -17.4, -5.0), followed by those with TBI (9.5-unit difference; (CI: -16.7, -2.4). There were also differences between groups in age, number of household members, time since injury, sex, race, marital status, physiological measures, and employment status.
Conclusions:
Results suggest that individuals with different disabilities following neurological injuries have different baseline perceptions in their ability to eat a healthy diet and exercise regularly. Health interventions should be tailored for these groups based on disability-specific barriers and should include components to enhance health-related self-efficacy to address weight management among these populations.IMPLICATIONS FOR REHABILITATIONEvidence suggests that health-related self-efficacy may differ following different injury types and level of disability may impact one's ability to maintain health-related behaviorsResults suggest that individuals with a spinal cord injury may have different baseline perceptions of self-efficacy related to their ability to eat a healthy diet and exercise regularly compared to those with a traumatic brain injury or stroke.Health interventions should be tailored to encompass disability-specific barriers which may impact an individual's health-related self-efficacy.
Objective:
This study evaluated the factors that led to enrollment in, and satisfaction with, behavioral interventions for Veterans living with Gulf War Illness (GWI).
Methods:
One-on-one interviews were conducted pre- and post-intervention with participants randomized to receive either telephone delivered problem-solving treatment (n = 51) or health education (N = 49). A total of 99 Veterans were interviewed pre-intervention and 60 post-intervention. Qualitative data were thematically coded and similarities in themes across the two interventions were examined.
Results:
Before the study began, participants reported desiring to learn new information about their GWI, learn symptom-management strategies, and support improvements to care for other patients with GWI. After the intervention, Veterans felt positively about both interventions because they built strong therapeutic relationships with providers, their experiences were validated by providers, and they were provided GWI information and symptom-management strategies. Results also suggested that interventions do not have to be designed to meet all of the needs held by patients to be acceptable. A minority of participants described that they did not benefit from the interventions.
Conclusion:
The results suggest that satisfaction with behavioral interventions for GWI is driven by a strong therapeutic relationship, validating patient's experiences with GWI, and the intervention meeting some of the patient's needs, particularly increasing knowledge of GWI and improving symptom management.
The executive functions (EFs) comprise an interrelated set of higher-order cognitive abilities associated with goal-oriented behavior and emotional and social functioning. The present chapter considers a spectrum of issues related to EFs, beginning with theoretical foundations and concluding with practical strategies for promoting the EFs in daily life. In particular, we review theoretical, clinical, and empirical frameworks of EFs and examine EF assessment approaches and related dilemmas. We clarify EF assessment use patterns among practitioners in the context of ecological validity. We then discuss research on interventions designed to support or promote the EFs and consider evidence-based external and internal strategies useful in clinical practice. A final section considers future directions that may lead to more effective EF assessment and promotion.
In two freestanding volumes, Textbook of Neural Repair and Rehabilitation provides comprehensive coverage of the science and practice of neurological rehabilitation. Revised throughout, bringing the book fully up to date, this volume, Medical Neurorehabilitation, can stand alone as a clinical handbook for neurorehabilitation. It covers the practical applications of the basic science principles presented in Volume 1, provides authoritative guidelines on the management of disabling symptoms, and describes comprehensive rehabilitation approaches for the major categories of disabling neurological disorders. New chapters have been added covering genetics in neurorehabilitation, the rehabilitation team and the economics of neurological rehabilitation, and brain stimulation, along with numerous others. Emphasizing the integration of basic and clinical knowledge, this book and its companion are edited and written by leading international authorities. Together they are an essential resource for neuroscientists and provide a foundation of the work of clinical neurorehabilitation professionals.
Traumatic brain injury (TBI) is a highly complex phenomenon involving a cascade of disruptions across biomechanical, neurochemical, neurological, cognitive, emotional, and social systems. Researchers and clinicians urgently need a rigorous conceptualization of brain injury that encompasses nonlinear and mutually causal relations among the factors involved, as well as sources of individual variation in recovery trajectories. System dynamics, an approach from systems science, has been used for decades in fields such as management and ecology to model nonlinear feedback dynamics in complex systems. In this mini-review, we summarize some recent uses of this approach to better understand acute injury mechanisms, recovery dynamics, and care delivery for TBI. We conclude that diagram-based approaches like causal-loop diagramming have the potential to support the development of a shared paradigm of TBI that incorporates social support aspects of recovery. When developed using adequate data from large-scale studies, simulation modeling presents opportunities for improving individualized treatment and care delivery.
Importance: Fatigue is a chronic and distressing sequela of traumatic brain injury (TBI). Little evidence exists for the efficacy of interventions that address post-TBI fatigue.
Objective: To evaluate the preliminary efficacy of a self-management intervention (Maximizing Energy; MAX) for reducing the impact (primary outcome) and severity of fatigue on daily life, improving fatigue experience, and increasing participation compared with a health education (HE) intervention.
Design: Pilot randomized controlled trial (RCT).
Setting: Community.
Participants: Forty-one participants randomly assigned to the MAX (n = 20) or HE (n = 21) intervention.
Interventions: The MAX intervention included problem-solving therapy with energy conservation education to teach participants fatigue management. The HE intervention included diet, exercise, and energy conservation education. Both interventions (30 min/day, 2 days/wk for 8 wk) were delivered online by occupational therapists.
Outcome and Measures: The primary outcome was the modified Fatigue Impact Scale (mFIS). Outcome measures were collected at baseline, postintervention, and 4- and 8-wk postintervention.
Results: At 8 wk postintervention, participants in the MAX group reported significantly lower levels of fatigue impact (mFIS) than those in the HE group, F(1, 107) = 29.54, p = .01; Cohen’s d = 0.87; 95% confidence interval [0.18, 1.55].
Conclusions and Relevance: These findings provide preliminary evidence that the MAX intervention may decrease the impact of fatigue on daily life among people with post-TBI fatigue.
What This Article Adds: An internet-based, self-management intervention combining occupational therapy– delivered energy conservation education with cognitive–behavioral therapy seems to reduce fatigue impact and severity among people with post-TBI fatigue. Future appropriately powered RCTs could positively contribute to the evidence available to occupational therapy practitioners for this chronic, debilitating, and often overlooked symptom.
Objective:
To characterize the intervention elements associated with improvements in activity and participation outcomes for adults with brain injury.
Data sources:
PubMed and PsycINFO/Ovid.
Study selection:
We included RCTs that examined interventions for adults with acquired brain injury with an activity or participation outcome measure.
Data extraction:
We classified intervention elements and extracted effect sizes. We examined patterns of effect sizes associated with each intervention element based on time of follow-up and level of outcome (home versus community).
Data synthesis:
Thirty-nine articles were included. Outcomes focused on the performance of home and community activities. There was wide variation in effect sizes across all intervention elements, as well as by time and by outcome level (home versus community). Metacognitive interventions and daily life skills interventions showed the greatest promise for improving performance of home and community activities. Additionally, cognitive training interventions may play a role in improving home activity performance and social skills training interventions may play a role in community activity performance. Physical activity interventions showed the least promise for improving home and community activity performance.
Conclusion:
This study highlights the importance of interventions that incorporate explicit strategies and task-specific training, rather than only addressing specific injury-related impairments.
Le Syndrome de Prader-Willi (SPW) est une maladie neuro-développementale rare d’origine génétique associée à des troubles comportementaux (obsession pour la nourriture, labilité émotionnelle) et cognitifs. La pathologie est généralement associée à un faible niveau intellectuel, ainsi qu’un fonctionnement exécutif altéré. Les patients ont notamment un déficit dans la fonction de planification, ce qui conduit à des difficultés pour anticiper et organiser leurs actions. La remédiation cognitive a pour objectif de proposer des exercices d’entrainement ou des techniques compensatoires pour pallier ces difficultés. À l’aide des connaissances sur le fonctionnement exécutif, l’un des objectifs de ce travail de thèse était de développer un programme de remédiation cognitive de la planification, en tant que fonction exécutive de haut niveau, pour des adultes atteints du SPW. Un autre objectif était d’évaluer la faisabilité d’un tel programme auprès d’une population avec déficit intellectuel, comme dans le SPW. Enfin, le dernier objectif était d’évaluer l’efficacité de ce programme de remédiation de la planification, ainsi que l’effet de l’entrainement de cette fonction sur d’autres fonctions exécutives (mise à jour des informations, alternance et inhibition). Un essai randomisé contrôlé en double-aveugle a été réalisé sur les performances d’un groupe expérimental (n = 27) et celles d’un groupe contrôle (n = 26) pour répondre à ces objectifs. Une étude en cas uniques expérimentaux auprès de 4 patients a été conduite par la suite pour évaluer les effets d’une intervention plus soutenue. Les résultats ont globalement montré la faisabilité du programme de remédiation cognitive auprès d’adultes atteints du SPW. Les performances en planification des patients, évaluées au travers de tests neuropsychologiques, de mesures qualitatives et de mesures quantitatives répétées, se sont améliorées après l’intervention. L’évaluation des autres fonctions exécutives n’a pas montré d’évolution significative, ne permettant pas de conclure sur leurs liens avec la planification chez les patients atteints du SPW. Enfin, ce travail a montré l’importance d’utiliser un programme adapté à la population d’intérêt afin de permettre une meilleure compréhension des enjeux de la remédiation et d’impliquer les patients dans leur rééducation, avec des méthodes variées et personnalisées pour en évaluer les effets.
Die neuropsychologische Behandlungsstrategie ist grundsätzlich ein sehr individuelles Vorgehen auf der Grundlage der diagnostischen Ergebnisse. Während der Therapie soll über gezielte Aktivierung der geschädigten neuronalen Netzwerke sowie Kompensation funktioneller Defizite durch die Nutzung intakter Fähigkeiten und das Erlernen neuer Fähigkeiten und Strategien, die soziale, berufliche und schulische Integration des Betroffenen verbessert werden.
Goal-Oriented Attentional Self-Regulation (GOALS) is a cognitive rehabilitation training program that combines mindfulness-based attention regulation with individualized goal management strategies to improve functioning in daily life after traumatic brain injury (TBI). While not a specific target of GOALS training, previous research has indicated improvements in emotional functioning following GOALS training, specifically symptoms related to depression and posttraumatic stress disorder (PTSD). The current study is based on the hypothesis that improvements in cognitive control processes related to executive functioning and attention after GOALS training generalize to improvements in emotional functioning, thereby resulting in reductions in emotional distress. The current study analyzed archival data from 33 Veteran participants with a confirmed diagnosis of PTSD and a history of mild TBI who received either GOALS training or a psychoeducational intervention matched for time, therapist attention, and participation format. Regression analysis was used to assess the strength of the relationship between improvements in Overall Attention/Executive Functioning and decreases in hyperarousal symptoms associated with PTSD. Results from the regression analysis revealed that improvements in Overall Attention/Executive Functioning after GOALS was significantly associated with reductions in hyperarousal symptoms associated with PTSD (R² = 0.26, F(1,15) = 5.01, β = −.51, p < .05). The current findings suggest that cognitive improvements after GOALS training may lead to changes in emotional functioning, resulting in decreased emotional distress. This is important, particularly in VA settings, because the results potentially highlight additional areas of research and focus on the treatment of comorbid mild TBI and PTSD among Veterans.
Objectives: Traumatic brain injury (TCE) is trauma caused by an external force that can result in reduced consciousness. Following TCE, cognitive, emotional, and behavioral changes may occur as soon as the patient gradually begins to regain consciousness. The objective of this work is to provide a theoretical and applicative insight into the assessment and treatment tools for emotional and/or neurobehavioral aspects following TCE. Methodology: The current article is a recent update of the analysis of the literature and the possible effects on the implementation of clinical interventions, which takes its cue from initial theoretical reflections arising from the Field Training Group "Behavioral Disorders following Cranial Trauma" (2012- SSA Psychology), and from the clinical experience of the following years. Results: The work led to the description of the methodologies of assessment and intervention of these issues in the different stages of evolution of the disease. In addition, the final part describes the applicative experience of psychoeducational intervention groups, with the person with severe acquired brain injury. Conclusions: In TCE, the emotional-behavioral and disease awareness aspects play a decisive role in the rehabilitation process. It is, therefore, important to make appropriate assessments and intervene promptly to facilitate the rehabilitation process.
Een probleemanalyse bij een patiënt kan een stoornis als boosdoener opleveren. Dan ligt het voor de hand te bezien of een op deze stoornis gerichte therapie of training ingezet kan worden. Wanneer dit niet lukt of niet mogelijk is, kan men zoeken naar compensaties of aanpassingen van de omgeving. Neurorevalidatie is veel meer dan motorische revalidatie. In dit hoofdstuk wordt daarom de aanpak bij uiteenlopende stoornissen besproken: van parese, sensibiliteit en hemianopsie via apraxie, agnosie, afasie en neglect tot geheugen, aandacht, ziekte-inzicht en denken. Veel kunnen we leren van de historische ontwikkeling, bijvoorbeeld in het geval van afasietherapie. Ook hier blijkt overduidelijk dat die ene superieure standaardtherapie niet bestaat. De te hanteren methode moet toegesneden zijn op de individuele patiënt. De meeste onderliggende concepten zijn logisch en theoretisch helder. Dit betekent echter niet automatisch dat alle methodes ook effectief zijn. De veelheid van mogelijkheden staat in schril contrast met de schaarste van effectonderzoek. Toch is er reden tot optimisme: het schaarse effectonderzoek wijst wel in een positieve richting: therapie is mogelijk en kan effectief zijn, ook jaren na het optreden van de hersenbeschadiging.
Primary Objective
This study examined the mediating role of perceived social support and mastery on quality of life (QOL) among adults with brain injury.
Research Design
An a priori structural model hypothesizing the relationships among symptom severity, mastery, social support, and QOL variables were tested.
Methods and Procedures
Individuals with brain injury across the United States participated in an online survey (N = 183). Structural equation modeling (SEM) was used to examine the model fit.
Main Outcomes and Results
The model fit the data well (χ² (15) = 13.68). The Normed Bentler-Bonnet Fit Index (NFI) was.97; Goodness-of-Fit Statistic (GFI) was .98; Adjusted-Goodness-of-Fit (AGFI) was.96; and the Comparative Fit Index (CFI) was 1.00. The direct effects supported all expected relationships among the study variables. Social support and mastery fully mediated the relationship between symptom severity and QOL. Mastery partially mediated the relationship between social support and QOL.
Conclusions
These findings underscore the importance of incorporating psychosocial factors into interventions, with attention on increasing levels of perceived social support and mastery skills to foster greater QOL.
Traumatic injury to the brain can affect the core of what makes us human—our cognition and emotion. The injuries are acute but may result in chronic burdens for individuals and families as well as society. Effective approaches to improving functioning are needed, and the benefits may be far-reaching. We discuss some basic principles to guide current practice, as well as directions for continuing advancement of ways to improve functioning after injury. Interventions are more likely to be effective when we take into account multiple levels of brain functioning, from neurons to pharmacological systems to social networks. Significant benefits can be gained by addressing important modulators of functioning. The potential to improve cognitive functioning via training is of special importance, and benefits may synergize with pharmacologic and other approaches. The combination of physical and experiential trauma deserves special consideration, with effects on cognition, emotion, and other substrates of behavior. Directing further research toward key frontiers that bridge neuroscience and rehabilitation will advance the development of clinically effective interventions.
Traumatic brain injury (TBI) can cause a wide variety of motor, cognitive, behavioral, emotional, and medical problems. Rehabilitation following TBI is, therefore, a complex endeavor requiring a team approach involving physicians, nurses, neuropsychologists, psychotherapists (e.g., psychologists, social workers, or mental health counselors), speech and language pathologists (SLPs), occupational therapists (OTs), physical therapists (PTs), vocational counselors, recreational therapists, and case managers. This entails the need for strong communication among team members and considerable flexibility on the part of the team. Therapists often have to take roles that may not be required in other settings. For instance, physical therapists will treat the physical mobility issues, including community navigation skills and safety. However, they have to be tuned into how cognitive dysfunction will affect mobility and how best to address it. They will also be confronted with the behavioral disorders that are prominent among people with TBI: disinhibited behavior, including aggression, but also apathy. OTs will work on activities of daily living (ADLs) and upper limb mobility, but will do so in the context of cognitive disability as well. Home and community skills, such as balancing a checkbook, meal preparation, and shopping, will take on greater importance in the rehabilitation of people with TBI because of the cognitive dimension. OTs, too, will have to treat behavioral disorders. SLPs will treat not only language, swallowing, and speech deficits among people with TBI but also cognitively based communication deficits. They will also treat problems with memory, attention, and executive skills and may overlap with OTs in the areas of home and community skills, such as scheduling and money management. Of course, SLPs will have to know how to manage behavioral issues as well. Nurses and the nurses’ aides will have to deal with every dimension: medical, mobility, cognitive, and behavioral. Most TBI programs have neuropsychologists and/or behavioral psychologists who do neuropsychological assessments; guide the team with respect to cognitive, emotional, and behavioral treatments; and sometimes do counseling. The neuropsychologist has to apply his or her understanding of the cognitive and behavioral issues to pharmacology, mobility, ADLs, and home and community rehabilitation. Although important in all areas of rehabilitation, in rehabilitation following TBI, it is crucial that the physician listens to all team members, as well as family members. The physician is not going to learn all the details of what a patient is doing and saying with respect to emotional, behavioral, and cognitive status directly from the patient. The therapy and nursing staff, as well as family, will be the ones who observe the intricacies of the patient’s inattention, disinhibition, and apathy and hear about the patient’s despairing thoughts and so forth. At the same time, if the physician starts the patient on a medication for a cognitive, emotional, or behavioral issue, he or she will get a more complete perspective on the patient’s response by hearing from other team members.
The primary aim of this prospective pilot study was to assess feasibility of implementing goal-oriented attentional self-regulation (GOALS) training in Slovenia with patients with multiple cognitive deficits after acquired brain injury in acute phase of recovery. Seven patients with acquired brain injury (i.e. stroke, traumatic brain injury, and subarachnoid hemorrhage) with a mean postinjury time of 4.3 months (SD = 1.25) and mean age of 34.5 years (SD = 18.6) were recruited for the study. The group program consisted of 10 sessions twice a week and included cognitive strategy training, social skills training, and psychoeducation. Structured interviews and neuropsychological tests were used before and after the training to determine the influence of the interventions on daily life tasks and attentional networks performance involving cognitive and behavioral domains. GOALS influenced self-reports of positive effect on the individual goals set by the patients. Training had a positive influence on executive control and memory. The results from the present study suggest that it is feasible to implement GOALS manualized executive function training in Slovenia, with the patients in a somewhat more acute stage than in previous studies, and that GOALS training may be a promising nonpharmacological treatment for cognitive and behavioral difficulties after acquired brain injury. Further research is needed to extend these findings in a larger sample.
Acute trauma to the brain can lead to chronic changes in an individual's neurologic functioning, with some of the most debilitating and far-reaching consequences leading to compromised goal-directed functioning. Underlying sources of dysfunction can be dynamic, complex, and challenging to effectively address. This chapter delineates key principles that can be valuable for improving goal-directed functioning. The chapter is grounded in neuroscience and theoretical underpinnings while emphasizing practical approaches to maximizing functional improvements in an individual's personal life. Rehabilitation efforts can be maximized by taking into account multiple levels and facets of goal-directed functioning in cohesive, individualized treatments. Core functions subserved by prefrontal cortical networks may be targeted and strengthened through specific approaches to training. Optimization of functioning may require unraveling and addressing some of the many factors that can modulate brain processes. We dedicate special emphasis to considering the regulation of cognitive-emotional functioning during goal pursuit, especially pertinent to treatment of combined physical and experiential trauma that is a hallmark of military service injuries. These foundations point to frontiers for innovation in strengthening goal-directed functioning after brain injury.
Military members endure a variety of stressors (e.g., transitioning from military culture to college culture), which may be associated with mental health distress. College counselors must be aware of the unique clinical needs of student Veterans. College counselors can increase military cultural competence and adopt effective clinical approaches to better serve the unique mental health needs of student Veterans. This article provides a review of the common transitional stressors and mental health concerns experienced by student Veterans. Additionally, considerations for college counselors (developing military cultural competence, using effective clinical approaches) to serve student Veteran clients are discussed.
Objective: To investigate long-term effects of GOALS executive function training in Veterans with chronic TBI. In a recently completed study Veterans with chronic TBI showed improvement immediately post-GOALS but not control training on measures of executive function, functional task performance, and emotion regulation. We now examine the long-term maintenance of post-GOALS training changes in the same sample.
Setting: San Francisco VA Health Care System (SFVAHCS), and VA Northern California Health-Care System (VANCHS) in Martinez.
Participants and Design: 24 Veterans with chronic TBI were assessed at baseline, post-GOALS training, and long-term follow-up 6+ months following completion of training with a structured telephone interview, neuropsychological and complex functional performance measures, and self-report measures of daily and emotional functioning.
Results: Participants reported an increased likelihood of involvement in competitive employment/volunteering at follow-up (61%) compared to baseline (26%; χ2 = 5.66, p < .01, ѱ = .35). Repeated measures MANOVAS indicated improvement on attention/executive function (F = 13.85, p < .01, partial η2 = .42), complex functional task performance (GPS Total: F = 9.12, p < .01, partial η2 = .38) and daily functioning (MPAI Total: F = 3.23, p < .05, partial η2 = .21), and reduction in overall mood disturbance (POMS Total: F = 3.42, p < .05, partial η2 = .22) at follow-up relative to baseline.
Discussion: Training in attention regulation applied to participant-defined goals is associated with meaningful long-term improvement in cognitive skills, emotion regulation, and daily functioning in Veterans with chronic TBI.
We compared two treatments for depression and/ or anxiety in chronic moderate to severe traumatic brain injury (TBI) (Clinicaltrials.gov NCT02061553). Fifty-nine participants were randomized 2:1 to a single session of Behavioural Activation followed by 8 weeks of daily SMS (text) messages in the form of implementation intentions supporting individualized goals for increased rewarding/ meaningful activities (INT), or a single (attention control) session focused on the importance of motivation followed by 8 weeks of motivational SMS messages (MOT). Both conditions resulted in modestly improved emotional status. The INT condition led to more exposure to environmental reward and greater productivity. Gains in both conditions were of questionable clinical significance but suggested different mechanisms of action, which should be confirmed by further research. The delivery of frequent text messages proved to be a very feasible means of supporting treatment in this population.
Tests for experiments with matched groups or repeated measures designs use error terms that involve the correlation between the measures as well as the variance of the data. The larger the correlation between the measures, the smaller the error and the larger the test statistic. If an effect size is computed from the test statistic without taking the correlation between the measures into account, effect size will be overestimated. Procedures for computing effect size appropriately from matched groups or repeated measures designs are discussed.
Following severe closed head injury, deficits in speed of information processing are common. As a result, many head-injured patients experience a feeling of “information overload” in daily tasks that once were relatively easy. Many remedial programmes have been designed that treat different aspects of attention (often including mental speed requirements) by repetitive exercises. In the present study, a different approach to slow information processing has been taken, namely Time Pressure Management (TPM). TPM consists of a set of alternative cognitive strategies that allow head-injured patients in real-life tasks to compensate for their mental slowness. In a randomised pre-training vs. post-training vs. follow-up group study, the effectiveness of TPM training was compared with concentration training in which verbal instruction was the key element. The results indicate that specific TPM strategies are learned by the experimental subjects but that both treatments improve task performance significantly for an information intake task. TPM, however, produces greater gains than concentration training and also appears to generalise to other measures of speed and memory function.
Several promising instruments are currently available to researchers and clinicians who require a reliable and valid measure of social problem-solving abilities. However, all of these measures have shortcomings and none has definitive, unequivocal support for its construct validity at the present time. The conceptual and methodological issues that are most directly related to the validity of social problem-solving measures were discussed. The strengths and weaknesses of the major current instruments were examined with respect to these issues. Empirical evidence related to convergent and discriminant validity was also reviewed. Recommendations were made for the improvement of these measures as well as the future development of new and better measures of social problem-solving processes and outcomes.
Discusses applications of the Problem Solving Inventory (PSI; P. P. Heppner, 1988) in psychological health. The PSI assesses an individual's awareness and evaluation of his or her problem-solving abilities or styles. The PSI is a self-report measure, and thus assesses perceptions of problem solving as opposed to actual problem-solving skills. The PSI consist of 32 six-point Likert items, which constitute 3 factors: problem solving confidence, approach-avoidance style, and personal control. Administration of the PSI, its implications for counseling and managed health care, its use as a training tool, and its applications in school settings are provided. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Tests for experiments with matched groups or repeated measures designs use error terms that involve the correlation between the measures as well as the variance of the data. The larger the correlation between the measures, the smaller the error and the larger the test statistic. If an effect size is computed from the test statistic without taking the correlation between the measures into account, effect size will be overestimated. Procedures for computing effect size appropriately from matched groups or repeated measures designs are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objective: To enhance understanding of the role that social problem solving (SPS) plays in community integration following traumatic brain injury (TBI). Study Design: Regression analysis. Participants: Forty-five adults with TBI participating in higher level outpatient cognitive rehabilitation and 15 uninjured adults. Main Outcome Measures: Measures of community integration, problem-solving ability, and SPS self-appraisal and performance. Results: Individuals with TBI demonstrated poorer problem-solving as measured by both neuropsychological and SPS methods; however, the largest effect' size was observed for SPS self-appraisal. Only SPS self-appraisal predicted a significant proportion of the variance in community integration. Conclusions: It is important to assess brain-injured persons' confidence in their ability to cope with problems. A focus on objective test scores alone may lead to underdetection of disabling problem-solving deficits. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents the Rusk Institute of Rehabilitation Medicine Adult Outpatient Neuropsychology Section's approach to providing multifaceted neuropsychological treatment to large numbers of patients within a major, urban, general rehabilitation facility. Discussed are techniques for circumventing the obstacles posed by limited financial resources and social and institutional restrictions and techniques for providing cognitive remediation, psychotherapy, and family and coordination services. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
: Community integration is defined as integration into a home-like setting, integration into a social network, and integration into productive activities such as employment, school, or volunteer work. For the purpose of evaluating outcomes for individuals with traumatic brain injury (TBI) who are provided with rehabilitation services in model systems programs, community integration was assessed using the Community Integration Questionnaire (CIQ). The CIQ was found to have good test-retest reliability and internal consistency. It could also discriminate between individuals with TBI and individuals who have no apparent disabilities. Individuals treated in model systems programs revealed significantly better scores on home integration and social integration when compared to a large community sample of individuals with TBI. Although these findings are preliminary, it appears that the CIQ is a useful measure for rehabilitation program evaluation.
(C) Williams & Wilkins 1993. All Rights Reserved.
Describes a research program on the efficacy of self-instructional training procedures with clinical populations such as schizophrenics, hyperactive children, neurotics, low creativity college students, and cigarette smokers. Studies indicate that it might be useful to combine the clinical concerns of semantic therapists with the armamentarium of behavior therapists. A number of behavior therapy procedures including desensitization, modeling, and operant and aversive conditioning were altered in order to include the client's self-statements in the treatment regimen. Results indicate that when standard behavior therapy was augmented with self-instruction, greater treatment efficacy, more generalization, and greater persistence of treatment effects were obtained. It is concluded that the environmental consequences per se are not of primary importance in modifying maladaptive behaviors, but rather what the S says to himself about those consequences.
This book first appeared in 1970 and has gone into two further editions, one in 1975 and this one in 1985. Yalom is also the author of Existential Psychotherapy (1980), In-patient Group Psychotherapy (1983), the co-author with Lieberman of Encounter Groups: First Facts (1973) and with Elkin of Every Day Gets a Little Closer: A Twice-Told Therapy (1974) (which recounts the course of therapy from the patient's and the therapist's viewpoint). The present book is the central work of the set and seems to me the most substantial. It is also one of the most readable of his works because of its straightforward style and the liberal use of clinical examples.
Presents the Rusk Institute of Rehabilitation Medicine Adult Outpatient Neuropsychology Section's approach to providing multifaceted neuropsychological treatment to large numbers of patients within a major, urban, general rehabilitation facility. Discussed are techniques for circumventing the obstacles posed by limited financial resources and social and institutional restrictions and techniques for providing cognitive remediation, psychotherapy, and family and coordination services.
Human problem-solving performance (i.e., the challenge to accomplish a specified result, often under prescribed conditions; cf. Oxford English Dictionary) is very often disturbed in brain-injured people. However, the term “impaired problem solving” is very broad and so indefinite that it does not really help to explain what is wrong with the complex cognitive process after brain damage.
Examines the difference between abstract and concrete behavior without statistical methods at this phase of the authors' work and knowledge, believing it to be the preliminary task, especially of psychopathology, to ascertain data on a descriptive, qualitative level. The distinction between an abstract and concrete attitude in the characterized sense of two different behavioral ranges is of such a preliminary descriptive nature. The methods of testing used, especially the Sorting Tests for determining the impairment of abstract behavior, have also proven fruitful in the study of mental deterioration of other kinds. The performance tests in common usage do this too, but mainly because one tries to avoid the positive effects of verbal training or the negative effects of its absence upon results in verbal testing. In other words the objective of the routine performance test is to determine the actual capacity of a subject which may not express itself in die same clear-cut manner on a verbal test. The authors' tests share this advantage of the performance tests. In these tests the task is so elementary and simple that there can be no doubt about such a condition: a patient cannot sort colors or equally shaped figures together on request; nor can he accept such groupings; neither does he understand the given explanation; nor can he give an account of his concrete grouping; he also fails on request to shift this grouping to another form.
遠隔記憶障害を検出する場合，想起された内容の真実性，再学習の有無，興味や関心の個人差，時間的傾斜の検出の可否が問題となる。社会的なことがらを利用した遠隔記憶検査では興味や関心の個人差が，自伝的なことがらを利用した遠隔記憶検査では想起された内容の真実性が特に問題となる。また，比較的やさしい課題で健常群の天井効果を認める場合，または，比較的難しい課題で健忘群の床効果を認める場合には，時間的傾斜の有無に関して確実なことがいえなくなる。流暢性ベースの遠隔記憶検査は，単位時間内に知人の名前や体験した出来事をできるだけたくさん想起する課題であり，検査の構造上，天井効果が起こりえないために時間的傾斜の問題を考える場合には好都合である。また，内容の異なる遠隔記憶でも流暢性ベースで質問することにより，記憶以外の条件を等しくできる利点もある。コルサコフ症候群において，自伝的記憶流暢性検査の成績は，従来までの自伝的記憶検査の成績と有意な相関を認めており，遠隔記憶検査として有用性が高いと思われた。
We present the case of G.L., a 33-year-old medical doctor, who, nine years after traumatic brain injury, was admitted to our department after he had drifted through several jobs. According to his superiors he spent too much time on routine activities and seemed unable to adapt himself to open problems and the requirements of novel or changing situations. From a psychometric perspective we found G.L. rather unremarkable, with largely good attentional, memory, and problem-solving performance. Behavioural analysis, however, revealed that G.L.'s discrete but definite frontal-lobe damage had produced defects in “executive functions”. After 12 months of intensive training G.L.'s mental structure had been modified to incorporate new source schemata, which enabled him to carry out demanding routine thought operations. In creating and practising these higher-level schemata his handicap could be diminished to the point that he now has got a supported employment. His basic cognitive incompetence, however, remained unchanged. This remarkable case fits in with Norman and Shallice's model of cognitive control of action and thought operations.
We developed a specific problem-solving training (PST) and tested it in a small group study. The primary objective of the PST was to provide patients with techniques enabling them to reduce the complexity of a multistage problem by breaking it down to more manageable portions. Thirty-seven “poor” problem solvers were alternately allocated (i.e. in the sequence of their admission) to either a 6-week, 25-session PST (n = 20) or to a memory training (MT; n = 17) of comparable intensity and duration. Treatment effects were evaluated using standard German intelligence tests, the tower-of-Hanoi puzzle, a specifically designed planning test, and a rating of nine aspects of everyday problem-solving behaviour. Data revealed significant prepost effects of the PST in the planning test scores, in all behavioural ratings, and in some intelligence subtests. In comparison, the same tests indicated only minor improvement of the MT.
Traces the development of the cognitive approach to psychopathology and psy hotherapy from common-sense observations and folk wisdom, to a more sophisticated understanding of the emotional disorders, and finally to the application of rational techniques to correct the misconceptions and conceptual distortions that form the matrix of the neuroses. The importance of engaging the patient in exploration of his inner world and of obtaining a sharp delineation of specific thoughts and underlying assumptions is emphasized. (91/4 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This book will be a helpful adjunct to ongoing treatment groups or in individual therapy for psychologists, psychiatrists, nurse specialists, counselors, and social workers. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A problematical situation was arranged so that it could be broken into three parts and presented to the subject as three separate experiences. Under these conditions the subjects could not find a solution. "Thus a selected presentation of the experience is not enough. The parts of the experience must be combined in a certain manner and a 'direction' or way the problem is attacked, seems to be a factor which determines the nature of the combination. 'Trial and error' may be present in the attempts at the solution, but is inadequate to explain the sudden appearance of the correct solution, when such solution requires productive rather than reproductive thinking." These results are oriented with respect to the theories of Ach, Selz, Wertheimer, etc. The author favors an explanation in terms of
Gestalt. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
present the state of the art regarding the understanding and remediation of these disorders
neurological mechanisms will be briefly reviewed / description of models of reasoning/problem-solving
particular deficits identified in the models will be examined (PsycINFO Database Record (c) 2012 APA, all rights reserved)
our understanding of cognitive remediation can best be explained by examining (1) some of the implications of the coming together of rehabilitation and neuropsychology; (2) the role of cognitive remediation in the wider context of the interventions taking place in the rehabilitation process; and (3) the reasons why, in the case of most typical individuals with a closed head injury, the neuropsychological rehabilitation endeavor must follow a holistic, or multifaceted, approach in order to attain optimal functional outcomes
defining cognitive remediation / a rehabilitation-relevant model for cognitive remediation / self-awareness in cognitive remediation / evidence concerning the efficacy of cognitive remediation / typical problems encountered in persons with traumatic brain injury (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The revision of the Wechsler-Bellevue Adult Intelligence Scale retains the type of item categories but has numerous changes in the items. Standardization is based on a stratified sample of 1700 adults ages 16 to 64. Additional norms are given for ages above 64 based on a different group of subjects. Reliabilities for verbal, performance and full scale IQ's are .96, .93, and .97, and for the subtests range from .65 to .96. Manual includes directions for administering, IQ tables, and scaled score tables. Officially the title is to be abbreviated WAIS. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A major contribution to the neuropsychology of man. The first half is a review of theory and data, and the second half describes methods, chiefly developed by the author, for studying changes in behavior after brain damage in man. Translated from the Russian. Harvard Book List (edited) 1971 #152 (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article describes the Head Injury Family Interview (HI-FI), a five-part structured interview designed to gather clinical and research data on persons with head injury and their family members. The HI-FI was developed over a 10-year period at the Research and Training Center on Head Injury and Stroke of New York University Medical Center to track outcomes of persons recovering from traumatic brain injury, with input from both the injured person and significant others, and to document the impact of the injury on the family system. The structure, contents, rationale, and development of the interviews are described, as well as its clinical utility and research potential. In addition, the statistical properties of one particular instrument within the interview, the Problem Checklist, are detailed and data presented from a multicenter study.
(C) Williams & Wilkins 1995. All Rights Reserved.
The present study examined the validity of the Social Problem-Solving Inventory (SPSI) and SPSI—Revised in differentiating 65 high-suicidal from 63 depressed, low-suicidal college students. Results from multivariate analyses indicated overall differences in problem-solving between these two groups as measured by the SPSI but not by the SPSI-R. Further examination of these differences revealed the high-suicidal group was different in problem-solving orientation, rather than problem-solving skills, compared to the depressed, low-suicidal group. However, when depression was statistically controlled in hierarchical regression analyses, none of the problem-solving measures predicted group membership. The superiority of the SPSI to the SPSI-R in differentiating these two groups appears to be accounted for by the elimination of 28 items in the revised version, many of which measure orientation to problem-solving. Also explored was the possibility that objective measures of problem-solving provide a better prediction of adjustment than do self-report measures.
Constructive activity can be disturbed in various local brain lesions; but the structure of that "Constructive apraxia or dispraxia" is different. That can be proved not only by a sophisticated analysis of the structure of the defect, but also by the methods which are adequate to a compensation of the defect. In lesions of the parieto-occipital part of the brain the general factor underlying constructive disturbances is a loss of spatial organization of the elements. That is why special programs providing the necessary spatial organization of the constructive activity result in a compensation of this defect. In lesions of frontal lobes the general factor underlying constructive disturbances is a loss of programming and regulation of sequential behaviour. That is why the defects of the constructive activities are due to an instability of the primary intention or program and to the inability to compare the results with the preliminary intention. In these cases an extended programmizing of sequential links of the patients' behaviour can result in a compensation of the defect.
There are few topics so fascinating both to the research investigator and the research subject as the self-image. It is distinctively characteristic of the human animal that he is able to stand outside himself and to describe, judge, and evaluate the person he is. He is at once the observer and the observed, the judge and the judged, the evaluator and the evaluated. Since the self is probably the most important thing in the world to him, the question of what he is like and how he feels about himself engrosses him deeply. This is especially true during the adolescent stage of development.
Tests the efficacy of social problem-solving therapy for unipolar depression and examines the relative contribution of training in the problem-orientation component of the overall model. This process involves various beliefs, assumptions, appraisals, and expectations concerning life's problems and one's problem-solving ability. It is conceptually distinct from the remaining four problem-solving components that are specific goal-directed tasks. A dismantling research design, involving 39 depressed Ss, provides findings that indicate problem-solving to be an effective cognitive-behavioral treatment approach for depression, thereby extending previous research. Moreover, the results underscore the importance of including problem-orientation training.