This study investigates the combined effects of multi-modality therapy, including mild hyperbaric therapy (mHBT), photobiomodulation (PBM), and molecular hydrogen therapy (MH), on cognitive rehabilitation in individua...This study investigates the combined effects of multi-modality therapy, including mild hyperbaric therapy (mHBT), photobiomodulation (PBM), and molecular hydrogen therapy (MH), on cognitive rehabilitation in individuals with mild-to-moderate traumatic brain injury (TBI). A total of 15 participants (7 males, 8 females, ages ranging from 20 to 78 years) diagnosed with mild-to-moderate TBI underwent 10 sessions of combined therapy. Cognitive performance was assessed using standardized neuropsychological tests before and after treatment, measuring cognitive processing speed, neural responsiveness, and executive function. The results demonstrated significant improvements across all metrics, including a 28.3 ms reduction in P300 latency, a 1.2 mV increase in P300 voltage, and reductions in completion times for the Trail-Making Tests A (14 seconds) and B (19 seconds). These findings suggest that multi-modality therapy may enhance cognitive recovery in TBI patients, with notable benefits across age and gender groups. Further research with larger sample sizes and extended follow-up is required to validate these results and explore their broader clinical applications.展开更多
BACKGROUND Cognitive impairment is a major cause of disability in patients who have suffered from a stroke,and cognitive rehabilitation interventions show promise for improving memory.AIM To examine the effectiveness ...BACKGROUND Cognitive impairment is a major cause of disability in patients who have suffered from a stroke,and cognitive rehabilitation interventions show promise for improving memory.AIM To examine the effectiveness of virtual reality(VR)and non-VR(NVR)cognitive rehabilitation techniques for improving memory in patients after stroke.METHODS An extensive and thorough search was executed across five pertinent electronic databases:Cumulative Index to Nursing and Allied Health Literature;MEDLINE(PubMed);Scopus;ProQuest Central;and Google Scholar.This systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses guideline.Studies that recruited participants who experienced a stroke,utilized cognitive rehabilitation interventions,and published in the last 10 years were included in the review.RESULTS Thirty studies met the inclusion criteria.VR interventions significantly improved memory and cognitive function(mean difference:4.2±1.3,P<0.05),whereas NVR(including cognitive training,music,and exercise)moderately improved memory.Compared with traditional methods,technology-driven VR approaches were particularly beneficial for enhancing daily cognitive tasks.CONCLUSION VR and NVR reality interventions are beneficial for post-stroke cognitive recovery,with VR providing enhanced immersive experiences.Both approaches hold transformative potential for post-stroke rehabilitation.展开更多
Background: Stroke survivors who exhibit impaired cognition at admission to inpatient rehabilitation may experience participation challenges and poorer functional outcomes than those without impaired cognition. Differ...Background: Stroke survivors who exhibit impaired cognition at admission to inpatient rehabilitation may experience participation challenges and poorer functional outcomes than those without impaired cognition. Differences in functional outcomes between stroke survivors with and without impaired cognition may be attributed to age, level of cognitive impairment, and severity of stroke. Materials and Methods: A retrospective secondary data analysis was conducted using health-related administrative data acquired from a Southwestern Ontario hospital’s stroke rehabilitation database. The aim was to explore potential linkages between post-stroke impaired cognition and functional gains, rehabilitation stays, and living settings after discharge from rehabilitation. Results: An aggregate sample of 393 males and 314 females subclassified as experiencing mild, moderate, and severe stroke was analyzed. At inpatient rehabilitation admission, 21.5% (n = 152) of these patients had no impaired cognition, 33.7% (n = 238) had mild impaired cognition, 22.2% (n = 157) had moderate impaired cognition, and 22.6% (n = 160) had severe impaired cognition. Cognitively impaired stroke patients were significantly (p 0.001) older, had (mostly) moderate to severe stroke with significantly (p = 0.012) more moderate cognitive impairment, had significantly (p 0.001) longer rehabilitation stays, and a high propensity for being discharged to longer-term care facilities compared to non-cognitively impaired patients. Conclusion: Presence of significant dissimilarity in rehabilitation stays and post-discharge destinations among stroke survivors with and without cognitive impairment is attributed to the age of the patient, level of cognitive impairment, and rigorous rehabilitation interventions.展开更多
AIM To investigate factors predicting treatment completion and treatment outcome of the Reasoning and Rehabilitation Mental Health Programme(R&R2MHP) cognitive skills programme for mentally disordered offenders. M...AIM To investigate factors predicting treatment completion and treatment outcome of the Reasoning and Rehabilitation Mental Health Programme(R&R2MHP) cognitive skills programme for mentally disordered offenders. METHODS Secondary analysis of data previously obtained from 97 male patients who were sectioned and detained under the United Kingdom Mental Health Act in low, medium and high security hospitals and who had completed R&R2MHP. Predictors of treatment completion included background variables and five outcome measures: Four self-reported measures of violent attitudes, social problem-solving skills, reactive anger and locus of control and an objective measure of behaviour on theward that was completed by staff. Completion of the 16 session programme, which was delivered on a weekly basis, was classified as ≥ 12 sessions.RESULTS It was found that the R&R2MHP is appropriate for delivery to participants of different ages, ethnic background, and at different levels of security without the completion rate or treatment effectiveness being compromised. Participants taking oral typical psychotropic medication were over seven times more likely to complete the programme than other participants. Behavioural disturbance on the ward prior to commencing the programme predicted non-completion(medium effect size). As far as treatment completion was concerned, none of the background factors predicted treatment effectiveness(age, ethnic background, level of security, number of previous convictions and number of previous hospital admissions). The best predictor of treatment effectiveness was attitude towards violence suggesting that this should be the primary outcome measure in future research evaluating outcomes of the R&R2MHP cognitive skills program. CONCLUSION The findings suggest that a stable mental state is a key factor that predicts treatment completion.展开更多
Cognitive rehabilitation is a potential and promising treatment for cognitive impairment in Parkinson＇s disease （PD） that has shown efficacy in diverse studies. In addition, some few studies have found brain change...Cognitive rehabilitation is a potential and promising treatment for cognitive impairment in Parkinson＇s disease （PD） that has shown efficacy in diverse studies. In addition, some few studies have found brain changes after cognitive rehabilitation in PD, which supports the existence of brain plasticity associated to cognitive training in a degen- erative disease.展开更多
Purpose: The aim of the present study is to evaluate the effectiveness of cognitive rehabilitation on improving selective attention in patients with mild cognitive impairment. Methods: It was a quasi-experimental stud...Purpose: The aim of the present study is to evaluate the effectiveness of cognitive rehabilitation on improving selective attention in patients with mild cognitive impairment. Methods: It was a quasi-experimental study with pre-test and post-test. The population in this study was all individuals referred to a neurology clinic in Tehran in 2012. The group was comprised of 40 patients with mild cognitive impairment who were evaluated with early detection and assessment by a medical psychologist (MMSE score lower than 25 and Wechsler memory test) and were selected by available sampling. They were also older than 55 years and had a minimum education at degree level, together with a lack of neurological and psychiatric comorbidities and impaired sensory and motor retardation, according to their nursing history and medical records. They were randomly divided into experimental and control groups (20 patients in each group). The experimental group was given 12 sessions (two hours each section) of cognitive rehabilitation with Neurocognitive Joyful Attentive Training Intervention (NEJATI). The control group, as expected with this group, did not receive any trial period. The selective attention of both groups was evaluated, before and after receiving intervention, by a Strop computer programme. Data were analysed using the covariance statistical test, MANCOVA. Results: The results show an increase in selective attention scores in the experimental group compared with the control group. Therefore, we can conclude that cognitive rehabilitation leads to improvement in the performance of selective attention (F = 4/97;展开更多
Until recently, older adults with a cognitive impairment (CI) who experienced a hip fracture were filtered from being admitted into active rehabilitation units. The increased complexity of care required for older adul...Until recently, older adults with a cognitive impairment (CI) who experienced a hip fracture were filtered from being admitted into active rehabilitation units. The increased complexity of care required for older adults with a CI may negatively influence the attitudes and job satisfaction of healthcare practitioners working with this population. The current study is a part of a larger intervention study allowing patients with CI following a hip fracture access to rehabilitation care and implementing a patient-centred model to facilitate caring for this new population. This new model required a substantial change in the skillset and knowledge of healthcare practitioners. The focus of this study was to explore the impact on the healthcare practitioners of adopting this new model for providing care to older adults with a CI following a hip fracture. The attitudes, dementia knowledge, job satisfaction, and work stress of healthcare practitioners were the focus of evaluation. Key study findings showed that stress due to relationships with coworkers, workloads and scheduling, and the physical design and conditions at work were moderated post-intervention. Staff responses also improved for job satisfaction, biomedical knowledge of dementia, and degree of hopefulness about dementia. Although we cannot state conclusively that the our model was solely responsible for all the staff improvements observed post-intervention, our findings provide further support to the argument that patients with CI should be allowed access to rehabilitation care. Rehabilitation units need to provide education that utilizes a person-centred approach accepting of patients with CI, and focuses on areas that can bolster staff’s positive, dementia-sensitive attitudes. Ultimately, the aim is to create a culture that provides the highest standard of care for all patients, reduces work-related stress, increases job satisfaction, and leads to the highest quality of life for patients during and after rehabilitation.展开更多
BACKGROUND People suffering from chronic mental illness are sensitive to stressful stimuli,lack coping skills,and have low self-esteem due to problems such as social situations.They also experience depression,isolatio...BACKGROUND People suffering from chronic mental illness are sensitive to stressful stimuli,lack coping skills,and have low self-esteem due to problems such as social situations.They also experience depression,isolation,fear,and frustration.Due to cognitive dysfunction,people suffering from chronic mental illness have inadequate cognitive processes that lead to distorted thinking.AIM To confirm the effectiveness of cognitive rehabilitation therapy in improving cognitive function and alleviating behavioral and psychological symptoms in patients with chronic mental illness,and to identify the cognitive function that had the main effect.METHODS The quality of the studies was evaluated using the Assessment of Multiple Systematic Reviews criteria,and data published from 2011 to December 2022 were searched using PubMed,Cochrane,RISS,KISS,and DBpia.The keywords used in the search were“mental illness,”“cognitive rehabilitation,”“cognition,”and“mental.”A meta-analysis was conducted on the 12 selected papers.RESULTS The level of evidence for the 12 documents was that of a randomized experimental study.Intervention types in cognitive rehabilitation can be divided into cognitive behavior,cognitive training,cognitive rehabilitation,and computerized cognitive programs.Most of the studies were on schizophrenia,and the measurement areas were cognitive functions(e.g.,concentration,memory,and executive function)as well as depression,sociability,and quality of life.As a result of the meta-analysis of each variable,the effect size for cognitive rehabilitation treatment was in the following order:Sociability,memory,concentration,executive function,quality of life,and depression.Particularly,sociability and memory exhibited significant effects.CONCLUSION Cognitive rehabilitation aids cognitive function and sociability in patients with chronic mental illness and can be used as evidence for cognitive rehabilitation in mental health and occupational therapy.展开更多
Cognitive deficits related to tumour or treatment are estimated to be present in the majority of patients diagnosed with a primary brain tumour, with a large variation based on tumour site, extent, and grade, as well ...Cognitive deficits related to tumour or treatment are estimated to be present in the majority of patients diagnosed with a primary brain tumour, with a large variation based on tumour site, extent, and grade, as well as nature of intervention. These deficits have a significant impact on patient’s quality of life and functional status. The improved patient survival duration in recent years has increased the need to detect, understand and intervene on these cognitive deficits, and optimise patient pathways for treatment. This article reviews the nature of deficits arising in patients with primary brain tumour, and the association of the deficits with neuroanatomical site of tumour. The approach to interventions through adaptation and remediation is outlined, with aim of improving function, promoting generalization of outcomes and optimizing any neuroplasticity that may arise. The evidence for pharmacological therapies and cognitive rehabilitation is presented, and a framework for implementation is provided.展开更多
[Purpose] This study aimed to evaluation of the Tokyo cognitive assessment (Toca) for predicting cognitive impairment in rehabilitation users. [Method] The variables of age, BMI, educational background, Toca for 36 re...[Purpose] This study aimed to evaluation of the Tokyo cognitive assessment (Toca) for predicting cognitive impairment in rehabilitation users. [Method] The variables of age, BMI, educational background, Toca for 36 rehabilitation users and 22 healthy elder were assessed. We compared cognitive functions in rehabilitation users who need support and healthy elders. [Results] Of the Toca 1 to 11 trials, there was a significant difference other than 9, 10 rials. The Toca scores with 8 points higher were significantly higher in healthy elders than in rehabilitation users. The area under the receiver-operator curve (AUC) for predicting mild cognitive impairment (MCI) by the Toca was 0.874. Using a cut-off point of 19/20, the Toca demonstrated a sensitivity of 83.9% and a sensitivity of 85.0% in diagnosing MCI. [Conclusion] The Toca is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in rehabilitation users.展开更多
We report a case of a 21-year-old man who had severe traumatic brain injury as a result of an accident at the age of 16 years. Two years and 4 months after the trauma, at the age of 19 years, he still had severe right...We report a case of a 21-year-old man who had severe traumatic brain injury as a result of an accident at the age of 16 years. Two years and 4 months after the trauma, at the age of 19 years, he still had severe right hemiplegia and cognitive dysfunction including aphasia and attention and memory disturbance. Conventional rehabilitation programs cou（d not resolve all of the neuropsychological problems. He started receiving Goshinjo therapy over a period of 22 months. Following the therapy, significant improvements in verbal intelligence quotient （assessed by the Wechsler Adult Intelligence Scale-Third Edition） and attention and concentration function （using the Wechsler Memory Scale-Revised）, and remission of traumatic epilepsy were observed. Goshinjo therapy is suspected to be effective in the treatment of cognitive dysfunction in the chronic stage after severe traumatic brain injury.展开更多
Rehabilitation of episodic memory declines typically focuses on alleviating the demand for recall and improving the retrieval process. Modulating the encoding is not commonly practiced, but may nevertheless be importa...Rehabilitation of episodic memory declines typically focuses on alleviating the demand for recall and improving the retrieval process. Modulating the encoding is not commonly practiced, but may nevertheless be important. Seventeen event-related potential (ERP) studies interpreted using the subsequent memory effect, an index of successful encoding, are reviewed and the factors involved in encoding are discussed. The nature of the materials used for testing, modes of encoding, and the nature of the retrieval task are highlighted as important factors. Meaningful materials and processing information semantically enhance encoding to episodic memory. The stud-ies reviewed reveal that older persons process information more uniformly without elaboration compared with their younger counterparts. Although people with mild cognitive impairment have encoding and retrieval deficits, an elaborative type of encoding training that draws on successful encoding factors may help to improve memory performance.展开更多
Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, und...Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, underwent early rehabilitation in combination with neuroprotective drug therapy. Limb movement, cognitive functions and daily life self-care ability in elderly patients upon admission and discharge were assessed using the Hunt-Hess scale, functional independence measures and mini-mental state examination. The mean duration of hospital stay among the 60 patients was 35 days. Upon discharge, 42 （75%） of the patients exhibited cognitive impairment to varying degrees, and 25 （45%） of the 56 stroke patients who underwent rehabilitation evaluation attained independence in daily living activities, 11 （20%） required intermittent supervision, and 20 （36%） required 24-hour constant supervision during performance of these activities. Results demonstrated that early rehabilitation treatment in combination with neuroprotective therapy for acute stroke was effective.展开更多
Research indicates that individuals with schizophrenia recover. Recovery, however means different things to different individuals and regardless of what kind of experiences define recovery, the individual diagnosed wi...Research indicates that individuals with schizophrenia recover. Recovery, however means different things to different individuals and regardless of what kind of experiences define recovery, the individual diagnosed with the serious mental illness must feel ownership of their recovery. This raises the issue of how mental health services should systematically promote recovery. This paper explores the practical implications for research on metacognition in schizophrenia for this issue. First, we present the integrated model of metacognition, which defines metacognition as the spectrum of activities which allow individual to have available to themselves an integrated sense of self and others as they appraise and respond to the unique challenges they face. Second, we present research suggesting that many with schizophrenia experience deficits in metacognition and that those deficits compromise individuals' abilities to manage their lives and mental health challenges. Third, we discuss a form of psychotherapy inspired by this research, Metacognitive Reflection and Insight Therapy which assists individuals to recapture the ability to form integrated ideas about themselves and others and so direct their own recovery. The need for recovery oriented interventions to focus on process and on patient's purposes, assess metacognition and consider the intersubjective contexts in which this occurres is discussed.展开更多
Self-rated health is a valuable outcome in geriatric rehabilitation besides objective results. The present work aims at measuring and analyzing overall health as it is perceived at admission into and at discharge from...Self-rated health is a valuable outcome in geriatric rehabilitation besides objective results. The present work aims at measuring and analyzing overall health as it is perceived at admission into and at discharge from a geriatric rehabilitation ward. Overall health was self-appraised through a visual-analogue scale (VAS), spanning from 0 (worst) to 10 (best). We studied 1997 patients (70% females), aged 79 (standard deviation, s.d. 8.7) years;most were frail, either functionally, clinically and cognitively. 80% of patients were discharged to home after a length of stay lasting 47.5 (s.d. 22.7) days. At admission, 3/5 patients appraised favorably their overall health (VAS ≥ 6/10): at discharge, the proportion rose to 3/4, with a mean (s.d.) gain = 2 (2) points. The improvement in self-perceived health score positively correlates with the grade expressing clients’ overall satisfaction for the stay (p 0.001), and with discharge versus admission differences in: Barthel Index (BI) total score (p < 0.001), Tinetti total score, Mini Mental State Examination (MMSE), Geriatric Depression Scale (5?items GDS), pain (VAS 0 to 10). A Linear regression model predicting the changes in self-perceived health included changes in BI, MMSE, GDS, pain, dropping Tinetti test. Changes in self-rated health were positively correlated to functional gain adjusted for pre-morbid level, and to relative functional gain. By analysis of variance, health self-appraisal changed more favorably in patients discharged to home than for other social outcomes (all p < 0.001). As expected, trends in self-perceived health parallel improvements in objective functional gauges and subjective indicators.展开更多
Cognitive impairments are commonly observed in patients with multiple sclerosis and are associated with lower levels of quality of life.No consensus has been reached on how to tackle effectively cognitive decline in t...Cognitive impairments are commonly observed in patients with multiple sclerosis and are associated with lower levels of quality of life.No consensus has been reached on how to tackle effectively cognitive decline in this clinical population non-pharmacologically.This exploratory case-control study aims to investigate the effectiveness of a hypothesis-based cognitive training designed to target multiple domains by promoting the synchronous co-activation of different brain areas and thereby improve cognition and induce changes in functional connectivity in patients with relapsing-remitting multiple sclerosis.Forty-five patients(36 females and 9 males,mean age 44.62±8.80 years)with clinically stable relapsing-remitting multiple sclerosis were assigned to either a standard cognitive training or to control groups(sham training and nonactive control).The standard training included twenty sessions of computerized exercises involving various cognitive functions supported by distinct brain networks.The sham training was a modified version of the standard training that comprised the same exercises and number of sessions but with increased processing speed load.The non-active control group received no cognitive training.All patients underwent comprehensive neuropsychological and magnetic resonance imaging assessments at baseline and after 5 weeks.Cognitive and resting-state magnetic resonance imaging data were analyzed using repeated measures models.At reassessment,the standard training group showed significant cognitive improvements compared to both control groups in memory tasks not specifically targeted by the training:the Buschke Selective Reminding Test and the Semantic Fluency test.The standard training group showed reductions in functional connectivity of the salience network,in the anterior cingulate cortex,associated with improvements on the Buschke Selective Reminding Test.No changes were observed in the sham training group.These findings suggest that multi-domain training that stimulates multiple brain areas synchronously may improve cognition in people with relapsing-remitting multiple sclerosis if sufficient time to process training material is allowed.The associated reduction in functional connectivity of the salience network suggests that training-induced neuroplastic functional reorganization may be the mechanism supporting performance gains.This study was approved by the Regional Ethics Committee of Yorkshire and Humber(approval No.12/YH/0474)on November 20,2013.展开更多
Background:Reading enables us to obtain information,to engage in leisure,educational,business and other activities,and fosters cognitive stimulation.Acquired vision loss can have a negative effect on an individual’s ...Background:Reading enables us to obtain information,to engage in leisure,educational,business and other activities,and fosters cognitive stimulation.Acquired vision loss can have a negative effect on an individual’s ability to read,and,by extension,reduce overall quality of life.In addition,a growing body of research on the association between reading and cognition has linked a decrease in reading ability with negative changes in cognitive function.Therefore,the purpose of the current study is to test the feasibility of a research protocol that will be used to study the association between reduced reading ability and cognitive impairment,specifically in older adults with acquired vision loss.Methods:Seven participants(age range,27-60 years,Mage=44,4 males)completed a series of questionnaires and assessments that measured their cognitive,hearing,and reading abilities.All participants had normal hearing,vision and cognition,with the exception of one(two pre-existing hearing conditions).Cognition was tested using the Rey Auditory Verbal Learning Test(RAVLT),the RAVLT 50-word Recognition test,the Verbal Fluency Test,an auditory Trail-Making task,and an auditory 1-N-back memory task.Otoscopy was used to assess ear health,and hearing was measured with self-administered computerized audiometry(Home Hearing Test)and a speech-in-noise test(Canadian Digit Triplet Test).Questionnaires included the Hearing Handicap Inventory for the Elderly,and a multiple-choice questionnaire on subjective reading ability and reading habits.Finally,reading acuity,speed and comprehension were assessed using the International Reading Speed Texts and the MNRead.Results:In testing the feasibility of this protocol,the uninterrupted length of testing time,including obtaining consent,was determined to be between 60-90 min.Several of the assessments and tests(RAVLT,MNRead,audiogram)were reported to be mentally taxing.However,all pilot participants were able to complete all tasks.With the exception of standardized tests,some of the instructions required refinement and clarification,in order to better explain the tasks for each test.Conclusions:Anticipating that the protocol will be more demanding for the ultimate target population,who will be older adults with sensory impairment,these pilot results were used to guide a strategy for collecting the dependent measures.It was decided to administer the most important measure in each of the domains(e.g.,MNRead,audiogram,RAVLT)to ensure that data on vision,hearing,reading and cognition are collected.Depending on the level of fatigue and motivation of the participants,secondary measures in each domain(the International Reading Speed Texts,CDTT,the 1-N-back task)will be administered afterward.Multiple sessions and breaks will be offered as needed.Data collection with novice vision rehabilitation clients will begin at the end of January 2019.展开更多
Background: Cognitive impairments as sequelae of brain injury are common and can negatively affect activities of everyday life, participation and quality of life. Thus, finding ways to reduce cognitive impairments and...Background: Cognitive impairments as sequelae of brain injury are common and can negatively affect activities of everyday life, participation and quality of life. Thus, finding ways to reduce cognitive impairments and ameliorate their negative impact on everyday life is an important focus of research. Aim: The aim of this pilot study was to analyse the effects of a combination of guided mindfulness and aerobic exercise on cognitive ability and mental fatigue in patients with acquired brain injury (ABI). Design: Pilot study, with a before-after design. Setting: Outpatient. Population: Twenty-one patients suffering from ABI, former patients of three rehabilitation medicine departments. Methods: The intervention comprised a structured combination of guided mindfulness program and outdoor walking, three times/week for 12 weeks. The outcome measures included assessment of information processing speed, working memory, oxygen uptake and self-reported mental fatigue. Results: The main results showed improvements in cognitive abilities related to information processing speed, perceived mental fatigue and physical capacity. Conclusions: A combination of mindfulness and physical activity can increase information processing speed and ameliorate mental fatigue. Further studies are needed to confirm our findings. Clinical Rehabilitation Impact: The combination of guided mindfulness and physical activity shows promise as a treatment modality in rehabilitation of impaired information processing speed and mental fatigue following ABI.展开更多
文摘This study investigates the combined effects of multi-modality therapy, including mild hyperbaric therapy (mHBT), photobiomodulation (PBM), and molecular hydrogen therapy (MH), on cognitive rehabilitation in individuals with mild-to-moderate traumatic brain injury (TBI). A total of 15 participants (7 males, 8 females, ages ranging from 20 to 78 years) diagnosed with mild-to-moderate TBI underwent 10 sessions of combined therapy. Cognitive performance was assessed using standardized neuropsychological tests before and after treatment, measuring cognitive processing speed, neural responsiveness, and executive function. The results demonstrated significant improvements across all metrics, including a 28.3 ms reduction in P300 latency, a 1.2 mV increase in P300 voltage, and reductions in completion times for the Trail-Making Tests A (14 seconds) and B (19 seconds). These findings suggest that multi-modality therapy may enhance cognitive recovery in TBI patients, with notable benefits across age and gender groups. Further research with larger sample sizes and extended follow-up is required to validate these results and explore their broader clinical applications.
文摘BACKGROUND Cognitive impairment is a major cause of disability in patients who have suffered from a stroke,and cognitive rehabilitation interventions show promise for improving memory.AIM To examine the effectiveness of virtual reality(VR)and non-VR(NVR)cognitive rehabilitation techniques for improving memory in patients after stroke.METHODS An extensive and thorough search was executed across five pertinent electronic databases:Cumulative Index to Nursing and Allied Health Literature;MEDLINE(PubMed);Scopus;ProQuest Central;and Google Scholar.This systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses guideline.Studies that recruited participants who experienced a stroke,utilized cognitive rehabilitation interventions,and published in the last 10 years were included in the review.RESULTS Thirty studies met the inclusion criteria.VR interventions significantly improved memory and cognitive function(mean difference:4.2±1.3,P<0.05),whereas NVR(including cognitive training,music,and exercise)moderately improved memory.Compared with traditional methods,technology-driven VR approaches were particularly beneficial for enhancing daily cognitive tasks.CONCLUSION VR and NVR reality interventions are beneficial for post-stroke cognitive recovery,with VR providing enhanced immersive experiences.Both approaches hold transformative potential for post-stroke rehabilitation.
文摘Background: Stroke survivors who exhibit impaired cognition at admission to inpatient rehabilitation may experience participation challenges and poorer functional outcomes than those without impaired cognition. Differences in functional outcomes between stroke survivors with and without impaired cognition may be attributed to age, level of cognitive impairment, and severity of stroke. Materials and Methods: A retrospective secondary data analysis was conducted using health-related administrative data acquired from a Southwestern Ontario hospital’s stroke rehabilitation database. The aim was to explore potential linkages between post-stroke impaired cognition and functional gains, rehabilitation stays, and living settings after discharge from rehabilitation. Results: An aggregate sample of 393 males and 314 females subclassified as experiencing mild, moderate, and severe stroke was analyzed. At inpatient rehabilitation admission, 21.5% (n = 152) of these patients had no impaired cognition, 33.7% (n = 238) had mild impaired cognition, 22.2% (n = 157) had moderate impaired cognition, and 22.6% (n = 160) had severe impaired cognition. Cognitively impaired stroke patients were significantly (p 0.001) older, had (mostly) moderate to severe stroke with significantly (p = 0.012) more moderate cognitive impairment, had significantly (p 0.001) longer rehabilitation stays, and a high propensity for being discharged to longer-term care facilities compared to non-cognitively impaired patients. Conclusion: Presence of significant dissimilarity in rehabilitation stays and post-discharge destinations among stroke survivors with and without cognitive impairment is attributed to the age of the patient, level of cognitive impairment, and rigorous rehabilitation interventions.
基金supported by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre
文摘AIM To investigate factors predicting treatment completion and treatment outcome of the Reasoning and Rehabilitation Mental Health Programme(R&R2MHP) cognitive skills programme for mentally disordered offenders. METHODS Secondary analysis of data previously obtained from 97 male patients who were sectioned and detained under the United Kingdom Mental Health Act in low, medium and high security hospitals and who had completed R&R2MHP. Predictors of treatment completion included background variables and five outcome measures: Four self-reported measures of violent attitudes, social problem-solving skills, reactive anger and locus of control and an objective measure of behaviour on theward that was completed by staff. Completion of the 16 session programme, which was delivered on a weekly basis, was classified as ≥ 12 sessions.RESULTS It was found that the R&R2MHP is appropriate for delivery to participants of different ages, ethnic background, and at different levels of security without the completion rate or treatment effectiveness being compromised. Participants taking oral typical psychotropic medication were over seven times more likely to complete the programme than other participants. Behavioural disturbance on the ward prior to commencing the programme predicted non-completion(medium effect size). As far as treatment completion was concerned, none of the background factors predicted treatment effectiveness(age, ethnic background, level of security, number of previous convictions and number of previous hospital admissions). The best predictor of treatment effectiveness was attitude towards violence suggesting that this should be the primary outcome measure in future research evaluating outcomes of the R&R2MHP cognitive skills program. CONCLUSION The findings suggest that a stable mental state is a key factor that predicts treatment completion.
基金supported by the Department of Health of the Basque Government(2011111117)Spanish Ministry of Economy and Competitiveness(PSI2012-32441)Department of Education and Science of the Basque Government(Equipo A)(IT946-16).
文摘Cognitive rehabilitation is a potential and promising treatment for cognitive impairment in Parkinson＇s disease （PD） that has shown efficacy in diverse studies. In addition, some few studies have found brain changes after cognitive rehabilitation in PD, which supports the existence of brain plasticity associated to cognitive training in a degen- erative disease.
文摘Purpose: The aim of the present study is to evaluate the effectiveness of cognitive rehabilitation on improving selective attention in patients with mild cognitive impairment. Methods: It was a quasi-experimental study with pre-test and post-test. The population in this study was all individuals referred to a neurology clinic in Tehran in 2012. The group was comprised of 40 patients with mild cognitive impairment who were evaluated with early detection and assessment by a medical psychologist (MMSE score lower than 25 and Wechsler memory test) and were selected by available sampling. They were also older than 55 years and had a minimum education at degree level, together with a lack of neurological and psychiatric comorbidities and impaired sensory and motor retardation, according to their nursing history and medical records. They were randomly divided into experimental and control groups (20 patients in each group). The experimental group was given 12 sessions (two hours each section) of cognitive rehabilitation with Neurocognitive Joyful Attentive Training Intervention (NEJATI). The control group, as expected with this group, did not receive any trial period. The selective attention of both groups was evaluated, before and after receiving intervention, by a Strop computer programme. Data were analysed using the covariance statistical test, MANCOVA. Results: The results show an increase in selective attention scores in the experimental group compared with the control group. Therefore, we can conclude that cognitive rehabilitation leads to improvement in the performance of selective attention (F = 4/97;
文摘Until recently, older adults with a cognitive impairment (CI) who experienced a hip fracture were filtered from being admitted into active rehabilitation units. The increased complexity of care required for older adults with a CI may negatively influence the attitudes and job satisfaction of healthcare practitioners working with this population. The current study is a part of a larger intervention study allowing patients with CI following a hip fracture access to rehabilitation care and implementing a patient-centred model to facilitate caring for this new population. This new model required a substantial change in the skillset and knowledge of healthcare practitioners. The focus of this study was to explore the impact on the healthcare practitioners of adopting this new model for providing care to older adults with a CI following a hip fracture. The attitudes, dementia knowledge, job satisfaction, and work stress of healthcare practitioners were the focus of evaluation. Key study findings showed that stress due to relationships with coworkers, workloads and scheduling, and the physical design and conditions at work were moderated post-intervention. Staff responses also improved for job satisfaction, biomedical knowledge of dementia, and degree of hopefulness about dementia. Although we cannot state conclusively that the our model was solely responsible for all the staff improvements observed post-intervention, our findings provide further support to the argument that patients with CI should be allowed access to rehabilitation care. Rehabilitation units need to provide education that utilizes a person-centred approach accepting of patients with CI, and focuses on areas that can bolster staff’s positive, dementia-sensitive attitudes. Ultimately, the aim is to create a culture that provides the highest standard of care for all patients, reduces work-related stress, increases job satisfaction, and leads to the highest quality of life for patients during and after rehabilitation.
文摘BACKGROUND People suffering from chronic mental illness are sensitive to stressful stimuli,lack coping skills,and have low self-esteem due to problems such as social situations.They also experience depression,isolation,fear,and frustration.Due to cognitive dysfunction,people suffering from chronic mental illness have inadequate cognitive processes that lead to distorted thinking.AIM To confirm the effectiveness of cognitive rehabilitation therapy in improving cognitive function and alleviating behavioral and psychological symptoms in patients with chronic mental illness,and to identify the cognitive function that had the main effect.METHODS The quality of the studies was evaluated using the Assessment of Multiple Systematic Reviews criteria,and data published from 2011 to December 2022 were searched using PubMed,Cochrane,RISS,KISS,and DBpia.The keywords used in the search were“mental illness,”“cognitive rehabilitation,”“cognition,”and“mental.”A meta-analysis was conducted on the 12 selected papers.RESULTS The level of evidence for the 12 documents was that of a randomized experimental study.Intervention types in cognitive rehabilitation can be divided into cognitive behavior,cognitive training,cognitive rehabilitation,and computerized cognitive programs.Most of the studies were on schizophrenia,and the measurement areas were cognitive functions(e.g.,concentration,memory,and executive function)as well as depression,sociability,and quality of life.As a result of the meta-analysis of each variable,the effect size for cognitive rehabilitation treatment was in the following order:Sociability,memory,concentration,executive function,quality of life,and depression.Particularly,sociability and memory exhibited significant effects.CONCLUSION Cognitive rehabilitation aids cognitive function and sociability in patients with chronic mental illness and can be used as evidence for cognitive rehabilitation in mental health and occupational therapy.
文摘Cognitive deficits related to tumour or treatment are estimated to be present in the majority of patients diagnosed with a primary brain tumour, with a large variation based on tumour site, extent, and grade, as well as nature of intervention. These deficits have a significant impact on patient’s quality of life and functional status. The improved patient survival duration in recent years has increased the need to detect, understand and intervene on these cognitive deficits, and optimise patient pathways for treatment. This article reviews the nature of deficits arising in patients with primary brain tumour, and the association of the deficits with neuroanatomical site of tumour. The approach to interventions through adaptation and remediation is outlined, with aim of improving function, promoting generalization of outcomes and optimizing any neuroplasticity that may arise. The evidence for pharmacological therapies and cognitive rehabilitation is presented, and a framework for implementation is provided.
文摘[Purpose] This study aimed to evaluation of the Tokyo cognitive assessment (Toca) for predicting cognitive impairment in rehabilitation users. [Method] The variables of age, BMI, educational background, Toca for 36 rehabilitation users and 22 healthy elder were assessed. We compared cognitive functions in rehabilitation users who need support and healthy elders. [Results] Of the Toca 1 to 11 trials, there was a significant difference other than 9, 10 rials. The Toca scores with 8 points higher were significantly higher in healthy elders than in rehabilitation users. The area under the receiver-operator curve (AUC) for predicting mild cognitive impairment (MCI) by the Toca was 0.874. Using a cut-off point of 19/20, the Toca demonstrated a sensitivity of 83.9% and a sensitivity of 85.0% in diagnosing MCI. [Conclusion] The Toca is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in rehabilitation users.
文摘We report a case of a 21-year-old man who had severe traumatic brain injury as a result of an accident at the age of 16 years. Two years and 4 months after the trauma, at the age of 19 years, he still had severe right hemiplegia and cognitive dysfunction including aphasia and attention and memory disturbance. Conventional rehabilitation programs cou（d not resolve all of the neuropsychological problems. He started receiving Goshinjo therapy over a period of 22 months. Following the therapy, significant improvements in verbal intelligence quotient （assessed by the Wechsler Adult Intelligence Scale-Third Edition） and attention and concentration function （using the Wechsler Memory Scale-Revised）, and remission of traumatic epilepsy were observed. Goshinjo therapy is suspected to be effective in the treatment of cognitive dysfunction in the chronic stage after severe traumatic brain injury.
文摘Rehabilitation of episodic memory declines typically focuses on alleviating the demand for recall and improving the retrieval process. Modulating the encoding is not commonly practiced, but may nevertheless be important. Seventeen event-related potential (ERP) studies interpreted using the subsequent memory effect, an index of successful encoding, are reviewed and the factors involved in encoding are discussed. The nature of the materials used for testing, modes of encoding, and the nature of the retrieval task are highlighted as important factors. Meaningful materials and processing information semantically enhance encoding to episodic memory. The stud-ies reviewed reveal that older persons process information more uniformly without elaboration compared with their younger counterparts. Although people with mild cognitive impairment have encoding and retrieval deficits, an elaborative type of encoding training that draws on successful encoding factors may help to improve memory performance.
基金the Science and Technology Foundation of Shanghai Railway Bureau of China, No. B340406052
文摘Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, underwent early rehabilitation in combination with neuroprotective drug therapy. Limb movement, cognitive functions and daily life self-care ability in elderly patients upon admission and discharge were assessed using the Hunt-Hess scale, functional independence measures and mini-mental state examination. The mean duration of hospital stay among the 60 patients was 35 days. Upon discharge, 42 （75%） of the patients exhibited cognitive impairment to varying degrees, and 25 （45%） of the 56 stroke patients who underwent rehabilitation evaluation attained independence in daily living activities, 11 （20%） required intermittent supervision, and 20 （36%） required 24-hour constant supervision during performance of these activities. Results demonstrated that early rehabilitation treatment in combination with neuroprotective therapy for acute stroke was effective.
文摘Research indicates that individuals with schizophrenia recover. Recovery, however means different things to different individuals and regardless of what kind of experiences define recovery, the individual diagnosed with the serious mental illness must feel ownership of their recovery. This raises the issue of how mental health services should systematically promote recovery. This paper explores the practical implications for research on metacognition in schizophrenia for this issue. First, we present the integrated model of metacognition, which defines metacognition as the spectrum of activities which allow individual to have available to themselves an integrated sense of self and others as they appraise and respond to the unique challenges they face. Second, we present research suggesting that many with schizophrenia experience deficits in metacognition and that those deficits compromise individuals' abilities to manage their lives and mental health challenges. Third, we discuss a form of psychotherapy inspired by this research, Metacognitive Reflection and Insight Therapy which assists individuals to recapture the ability to form integrated ideas about themselves and others and so direct their own recovery. The need for recovery oriented interventions to focus on process and on patient's purposes, assess metacognition and consider the intersubjective contexts in which this occurres is discussed.
文摘Self-rated health is a valuable outcome in geriatric rehabilitation besides objective results. The present work aims at measuring and analyzing overall health as it is perceived at admission into and at discharge from a geriatric rehabilitation ward. Overall health was self-appraised through a visual-analogue scale (VAS), spanning from 0 (worst) to 10 (best). We studied 1997 patients (70% females), aged 79 (standard deviation, s.d. 8.7) years;most were frail, either functionally, clinically and cognitively. 80% of patients were discharged to home after a length of stay lasting 47.5 (s.d. 22.7) days. At admission, 3/5 patients appraised favorably their overall health (VAS ≥ 6/10): at discharge, the proportion rose to 3/4, with a mean (s.d.) gain = 2 (2) points. The improvement in self-perceived health score positively correlates with the grade expressing clients’ overall satisfaction for the stay (p 0.001), and with discharge versus admission differences in: Barthel Index (BI) total score (p < 0.001), Tinetti total score, Mini Mental State Examination (MMSE), Geriatric Depression Scale (5?items GDS), pain (VAS 0 to 10). A Linear regression model predicting the changes in self-perceived health included changes in BI, MMSE, GDS, pain, dropping Tinetti test. Changes in self-rated health were positively correlated to functional gain adjusted for pre-morbid level, and to relative functional gain. By analysis of variance, health self-appraisal changed more favorably in patients discharged to home than for other social outcomes (all p < 0.001). As expected, trends in self-perceived health parallel improvements in objective functional gauges and subjective indicators.
文摘Cognitive impairments are commonly observed in patients with multiple sclerosis and are associated with lower levels of quality of life.No consensus has been reached on how to tackle effectively cognitive decline in this clinical population non-pharmacologically.This exploratory case-control study aims to investigate the effectiveness of a hypothesis-based cognitive training designed to target multiple domains by promoting the synchronous co-activation of different brain areas and thereby improve cognition and induce changes in functional connectivity in patients with relapsing-remitting multiple sclerosis.Forty-five patients(36 females and 9 males,mean age 44.62±8.80 years)with clinically stable relapsing-remitting multiple sclerosis were assigned to either a standard cognitive training or to control groups(sham training and nonactive control).The standard training included twenty sessions of computerized exercises involving various cognitive functions supported by distinct brain networks.The sham training was a modified version of the standard training that comprised the same exercises and number of sessions but with increased processing speed load.The non-active control group received no cognitive training.All patients underwent comprehensive neuropsychological and magnetic resonance imaging assessments at baseline and after 5 weeks.Cognitive and resting-state magnetic resonance imaging data were analyzed using repeated measures models.At reassessment,the standard training group showed significant cognitive improvements compared to both control groups in memory tasks not specifically targeted by the training:the Buschke Selective Reminding Test and the Semantic Fluency test.The standard training group showed reductions in functional connectivity of the salience network,in the anterior cingulate cortex,associated with improvements on the Buschke Selective Reminding Test.No changes were observed in the sham training group.These findings suggest that multi-domain training that stimulates multiple brain areas synchronously may improve cognition in people with relapsing-remitting multiple sclerosis if sufficient time to process training material is allowed.The associated reduction in functional connectivity of the salience network suggests that training-induced neuroplastic functional reorganization may be the mechanism supporting performance gains.This study was approved by the Regional Ethics Committee of Yorkshire and Humber(approval No.12/YH/0474)on November 20,2013.
文摘Background:Reading enables us to obtain information,to engage in leisure,educational,business and other activities,and fosters cognitive stimulation.Acquired vision loss can have a negative effect on an individual’s ability to read,and,by extension,reduce overall quality of life.In addition,a growing body of research on the association between reading and cognition has linked a decrease in reading ability with negative changes in cognitive function.Therefore,the purpose of the current study is to test the feasibility of a research protocol that will be used to study the association between reduced reading ability and cognitive impairment,specifically in older adults with acquired vision loss.Methods:Seven participants(age range,27-60 years,Mage=44,4 males)completed a series of questionnaires and assessments that measured their cognitive,hearing,and reading abilities.All participants had normal hearing,vision and cognition,with the exception of one(two pre-existing hearing conditions).Cognition was tested using the Rey Auditory Verbal Learning Test(RAVLT),the RAVLT 50-word Recognition test,the Verbal Fluency Test,an auditory Trail-Making task,and an auditory 1-N-back memory task.Otoscopy was used to assess ear health,and hearing was measured with self-administered computerized audiometry(Home Hearing Test)and a speech-in-noise test(Canadian Digit Triplet Test).Questionnaires included the Hearing Handicap Inventory for the Elderly,and a multiple-choice questionnaire on subjective reading ability and reading habits.Finally,reading acuity,speed and comprehension were assessed using the International Reading Speed Texts and the MNRead.Results:In testing the feasibility of this protocol,the uninterrupted length of testing time,including obtaining consent,was determined to be between 60-90 min.Several of the assessments and tests(RAVLT,MNRead,audiogram)were reported to be mentally taxing.However,all pilot participants were able to complete all tasks.With the exception of standardized tests,some of the instructions required refinement and clarification,in order to better explain the tasks for each test.Conclusions:Anticipating that the protocol will be more demanding for the ultimate target population,who will be older adults with sensory impairment,these pilot results were used to guide a strategy for collecting the dependent measures.It was decided to administer the most important measure in each of the domains(e.g.,MNRead,audiogram,RAVLT)to ensure that data on vision,hearing,reading and cognition are collected.Depending on the level of fatigue and motivation of the participants,secondary measures in each domain(the International Reading Speed Texts,CDTT,the 1-N-back task)will be administered afterward.Multiple sessions and breaks will be offered as needed.Data collection with novice vision rehabilitation clients will begin at the end of January 2019.
文摘Background: Cognitive impairments as sequelae of brain injury are common and can negatively affect activities of everyday life, participation and quality of life. Thus, finding ways to reduce cognitive impairments and ameliorate their negative impact on everyday life is an important focus of research. Aim: The aim of this pilot study was to analyse the effects of a combination of guided mindfulness and aerobic exercise on cognitive ability and mental fatigue in patients with acquired brain injury (ABI). Design: Pilot study, with a before-after design. Setting: Outpatient. Population: Twenty-one patients suffering from ABI, former patients of three rehabilitation medicine departments. Methods: The intervention comprised a structured combination of guided mindfulness program and outdoor walking, three times/week for 12 weeks. The outcome measures included assessment of information processing speed, working memory, oxygen uptake and self-reported mental fatigue. Results: The main results showed improvements in cognitive abilities related to information processing speed, perceived mental fatigue and physical capacity. Conclusions: A combination of mindfulness and physical activity can increase information processing speed and ameliorate mental fatigue. Further studies are needed to confirm our findings. Clinical Rehabilitation Impact: The combination of guided mindfulness and physical activity shows promise as a treatment modality in rehabilitation of impaired information processing speed and mental fatigue following ABI.
