NeuroRehabilitation

Brain injury is considered a chronic condition and the medical model has long been the traditional paradigm underlying rehabilitation programs for people after acquired brain injury (ABI). In recent years, strengths-based approaches have been increasingly proposed, but little has been written about specific psychotherapeutic application in ABI rehabilitation.

To describe a strengths-based model, Solution-Focused Brief Therapy (SFBT) and its clinical application to individuals with ABI and their families.

The author describes the assumptions, tenets, and principles of SFBT, a competency-based and resource-based model that orients to the future and focuses on strengths and successes. A direct comparison is made between the traditional medical paradigm and the solution-focused paradigm.

Key ingredients of SFBT are described, including specific strategies, techniques, and its clinical application with individuals with ABI and their families. Limitations around using SFBT and the need for further research with ABI populations are reported.

SFBT is a welcome shift away from the problem-saturated stories that underlie traditional rehabilitation approaches. The strengths-based underpinning of SFBT is a promising psychotherapeutic intervention that merits further investigation with ABI populations.

Traumatic brain injury (TBI) remains a silent and global epidemic which creates an aftermath of convoluted dynamics. Despite significant incidence rates and increasing awareness over the long-term catastrophic implications, there remain marked contrasts between acute vs. post-acute rehabilitation processes in the United States.

To explore existing research and highlight the complexity of TBIs to inform vital changes needed to reduce the significant differences and inconsistencies across post-acute treatment settings. To highlight how psychologists/neuropsychologists and other rehabilitation professionals maintain a prominent operational presence in post-acute settings resulting in key leadership opportunities to support a more efficient longitudinal continuation of care model.

Literature search of various health science databases was completed for articles between 1987 to 2019 to explore the range and depth of post-acute treatment, model, and outcomes research.

Despite progressive medical advancements, translation of relevant rehabilitation research and practices into post-acute treatment settings remains inconsistent.

Significant barriers remain for objective and comprehensive evaluation(s) of post-acute program quality and purported patient outcomes in the United States. There remains a lack of consensually relevant and objective metrics. Further investigation is recommended for: consensus on longitudinal post-acute brain injury outcome measures; functional relevance of program accreditations/certifications; outcome differences based on team composition and program resources; and patient/stakeholder variables/input to support optimal post-acute service access and delivery.

Persistent Sport-Related Post-Concussion Syndrome is often diagnosed with any type of prolonged PCS symptoms. However, there are not specific diagnostic criteria for PPCS such that misdiagnosis often occurs. Further, the signs and symptoms of PCS overlap with other common illnesses such as depression, anxiety, migraines, ADHD and others. Misdiagnosis may lead to less than efficacious treatment, resulting in prolonged symptoms.

This article will review relevant evidence-based literature on PCS, pointing out the lack of a systemic diagnostic framework. It will also provide evidence that highlights the multiple conflicting findings in the literature. This article will posit the BioPsychoSocial framework as the best diagnostic framework for understanding the impact of concussions on the person and to generate individualized and personal interventions.

A narrative review of sport concussion-related articles was conducted, after extensive searches of relevant and non-relevant literature by each author, as well as articles recommended by colleagues. Articles varied from American Academy of Neurology Class I to IV for evaluation and critique. Class IV articles were reviewed, as there is much public misconception regarding sport and other concussion treatment that needed identification and discussion.

Articles reviewed varied by quality of research design and methodology. Multiple symptoms, recovery patterns and rehabilitation treatment approaches are purported in the sport-related concussion literature. Current consensus data as well as the mixed and contradictory findings were explored.

Persistent Sport-Related Post-Concussion Syndrome is a topic of great interest to both professionals and the general public. There is much misunderstanding about the etiology, causation, diagnostic formulations, symptom presentation, prolonging factors and treatment involved in this syndrome. This article posits an individualized multi-system diagnostic formulation, examining all relevant factors, as generating the best interventions for neurorehabilitation of Persistent Sport-Related Post-Concussion Syndrome.

The utility of neuropsychology in the treatment and evaluation of neuropsychological disorders and neurodegenerative diseases is supported by scientific study. As a discipline, neuropsychology’s value and efficacy when applied to the dementia spectrum are rooted in its inherent adaptability as a practical, cost-effective, and scientifically based resource for differential diagnosis, treatment planning, and forensic decision making.

This article provides a framework for conceptualizing dementia as a spectrum of disorders and outlines a rationale for preferential reliance upon neuropsychological tenets. The function of neuropsychology in differential diagnosis, clinical management, integrative care, and forensic applications is delineated for use as a contemporary interdisciplinary reference.

An overview of the literature on dementia as a spectrum of disorders has been integrated with the science and practice of neuropsychology.

The utility of neuropsychology emanates from its focus on brain functioning and the discipline’s appreciation for the relationship between brain functioning and cognition, mental state, and behavior. Early and routine referral for neuropsychological assessment allows for the objective determination of normal versus abnormal neurocognitive functioning, provides a baseline for serial reassessment, and leads to the more rapid deployment of effective treatments. Beyond the hospital and clinic, neuropsychological expertise is increasingly sought after as integral to the legal system when decisions regarding eligibility for long term care and questions about capacity require objective and reliable measurement.

A stroke event, sometimes referred to as a cerebrovascular accident (CVA), is a sudden and often traumatic life event that results in life-changing consequences with which affected people must cope. There are nearly 800,000 instances of stroke annually in the U.S. (American Heart Association, 2018). Stroke is the leading cause of disability in adults, and more than one-third of people who survive a stroke will have severe disability in the U.S. (Mayo, 2005). Between 35% and 75% of stroke survivors will have significant cognitive impairment (Tatemichi et al., 1994; Nys et al., 2007). An estimated one-third of people suffer depression after stroke (Hackett et al., 2005), about one-fourth experience significant anxiety (Barker-Collo, 2007), and about one-fifth suffer from insomnia (Leppavuoria et al., 2002). These and other stroke-related psychological issues negatively influence rehabilitation and outcomes through a variety of mechanisms. For example, post-stroke depression has been shown to be related to more negative functional consequences (Kneebone et al., 2000; Matsuzaki et al., 2015). Psychological disturbances may affect rehabilitation outcomes through a reduction in adherence to home exercise programs, reduced energy level, increased fatigue, reduced frustration tolerance, and potentially less motivation and hope about the future.

This manuscript aims to identify and describe the role of rehabilitation psychology in treating these common post-stroke complaints and, ultimately, optimizing post-stroke outcomes via two case examples.

This manuscript describes two cases of individuals in post-acute rehabilitation who had psychological issues which were negatively affecting outcomes.

Given the abrupt and significant life-changing nature of stroke, it is often necessary to manage a diverse array of psychological issues that often cannot be simply managed via psychotropic medications. Moreover, an understanding of the patients’ emotional adjustment and issues can help them maximize their rehabilitation, recovery, and community integration. For the cases discussed, psychology consultations were central in helping optimize their rehabilitation and functional outcomes.

Latin America has exceptionally high rates of traumatic brain injury (TBI), but very little research has been conducted on longitudinal TBI outcomes in this global region.

This study examined whether cognitive dysfunction and social disadaptation in individuals with TBI in Latin America at hospital discharge predict longitudinal trajectories of depression at baseline, 2 months, and 4 months.

A sample of 109 people with a new TBI was recruited from three hospitals: Mexico City, Mexico, Cali, Colombia and Neiva, Colombia. Participants completed measures of cognitive dysfunction and social disadaptation before hospital discharge and measures of depression at baseline, 2 months, and 4 months.

Results suggested that depression scores were found to decrease over time in a quadratic (or U-shaped) fashion, and more significant cognitive dysfunction at hospital discharge was associated with higher longitudinal depression trajectories. Social disadaptation did not exert a unique effect on depression trajectories after controlling for cognitive dysfunction. Depression trajectories changed differentially over time as a function of baseline cognitive dysfunction, such that for those with high cognitive impairment, depression scores started high and then dropped to a moderated range and plateaued, but for individuals with low cognitive dysfunction, depression scores started lower and decreased linearly but moderately.

The results suggest a strong need for neuropsychological assessments and evidence-based cognitive rehabilitation strategies to be implemented immediately after TBI in Latin America, which could exert salubrious effects on depression trajectories over time.

Today, there exists a need for a practical counseling approach for patients with brain disorders based on an empirical measure that can be used to objectify procedural adequacy. Clinical neuropsychology, which focuses on developing knowledge about human brain-behavioral relationships and applying this information to clinical problems, is the ideal discipline to address this issue. Unlike other methods of appraisal and current counseling approaches, medical adjustment counseling (MAC) for patients with cognitive and behavioral changes due to brain disorders is based on the application of neuropsychological principles and evidence-based practices.

In this review, I discuss the neuropsychological principles underlying MAC, differentiation from conventional clinical psychology systems, and the specifics of the treatment stages. Transtheoretical analytic points of inclusion and a clinical case example are also discussed.

MAC involves an interactive exchange between the neuropsychologist and patient based on the neuropsychological examination (NPE). The resulting neuropsychological profile facilitates the conversion of empirical objective evidence into practical biopsychosocial adaptive strategies that can be modified according to each patient’s diagnosis and level of impairment. MAC is delivered in four stages (validation, education, accommodation, and reintegration) that require an understanding of the ecological applicability of the NPE to the real-life situation of the patient, a knowledge base of the neurobehavioral consequences of the medical diagnosis, integration of medical disciplines regarding additional diagnostics, psychological crisis systems and patient/family reactions.

Without the objective neuropsychological evidence provided by the NPE and MAC, the clinical judgment of the psychologist is based on something more akin to witchcraft and magic than science.

Traumatic brain injury (TBI) has an estimated prevalence rate of 1.7 million occurrences a year in the United States with over 75% of traumatic brain injuries classified as ‘mild.’ The majority of individuals with mild traumatic brain injuries resume their daily functioning fairly quickly, and many fully within the first year. However, a minority of persons with mild TBI (mTBI), with estimates ranging between 1% and 20%, develop persistent cognitive, emotional, behavioral, and physical symptoms. Clinicians vary considerably in their clinical opinions regarding these individuals and there is no consensus on the treatment protocol for this population.

This manuscript presents four case studies of mild TBI with persistent symptoms treated by a transdisciplinary team in an outpatient neurorehabilitation setting based on community reintegration. Clinical challenges and insights involved in conceptualizing and effectively treating these individuals are discussed to facilitate future direction.

Four different mild TBI cases, each with persistent symptoms, but different injury mechanisms, dynamics, and factors affecting symptom persistence, expression, course, and outcome were included in the analysis of their treatment course and outcome. The treatment protocol included: brain injury education combined with supportive counseling for cultivation of positive expectancy effects, symptom-based, graded treatment involving most disciplines, frequent treatment team consultations, collaborations, and planning, and consistent team messages about post-injury recovery and expected return to community activities. Treatment outcomes were assessed with self and family reports, as well as the Mayo Portland Adaptability Inventory (MPAI-4) at admission and at discharge.

Each of the individuals made functional progress during rehabilitation, as evidenced by self and family reports and the MAPI-4. The cases posed various challenges to the treatment team, though a transdisciplinary team under the guidance of a rehabilitation physician and rehabilitation neuropsychologist was able to help patients navigate the path to their functional recovery. In addition to the specific treatment protocol, transdisciplinary team collaboration guided by rehabilitation neuropsychology contributed to treatment success.

The primary goal of neurorehabilitation for individuals with acquired brain injury (ABI) is successful community reintegration, which commonly focuses on home independence, productivity, and social engagement. Previous research has demonstrated that holistic treatment approaches have better long-term outcomes than other treatment approaches. Holistic approaches go beyond the fundamental components of neurorehabilitation and address metacognition and self-awareness, as well as interpersonal and functional skills.

The present study aimed to examine community reintegration of individuals with ABI who completed holistic milieu-oriented neurorehabilitation at the Center for Transitional Neuro-Rehabilitation (CTN), Barrow Neurological Institute (BNI) at up to 30-years post-discharge. We evaluated (a) functional independence, (b) productivity and driving status, and (c) psychosocial profiles of the brain injury survivors.

Participants included 107 individuals with ABI with heterogeneous etiologies who attended holistic milieu-oriented neurorehabilitation between 1986 and 2016. These participants completed the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a long-term outcome questionnaire (LOQ) specifically developed for this study.

The results demonstrate that 89% of participants were productive at up to 30 years post-discharge (73% engaged in competitive work and/or school) after excluding the retired participants. Almost all of the participants who were engaged in work and/or school reported using compensatory strategies on a long-term basis. Furthermore, only 14% out of 102 study participants were driving at the time of program admission; whereas 58% out of 96 were driving at the time of discharge; and impressively, 70% out of 107 participants were driving at the time of follow-up. Regression analyses revealed that older age at the time of injury, shorter duration between injury and treatment, and better functionality indicated by lower MPAI-4 Ability Index scores significantly predicted a return to driving status at the time of study participation. Psychosocial data from the LOQ revealed positive findings with respect to patients’ marital status, living situation, income, and quality of social life.

The findings from this study suggest that functional gains made during holistic neurorehabilitation have enduring effects and that patients can benefit highly from holistic milieu therapy beyond the early post-acute phases of their recovery. Additionally, they provide evidence that there is potential to return to driving, years after treatment completion.

Our holistic milieu treatment approach addressing metacognition, self-awareness, social and coping skills training, and actively transitioning to community settings, is thought to have contributed to the exceptional and long-lasting outcomes in this study.

Multiple sclerosis (MS) is one of the major causes of chronic neurologic disability in young adults.

To evaluate the effectiveness of information provision interventions for people with MS that aim to promote informed choice and improve patient-relevant outcomes.

To summarize and to discuss the rehabilitation perspective on the published Cochrane Review “Information provision for people with multiple sclerosis” by Köpke S et al.

11 studies (with 1387 participants) with important clinical heterogeneity on the definitions of interventions and outcomes assessed were included, showing that information provision interventions vs optimized standard care probably slightly increase patients’ knowledge and may make little or no difference to decision making and quality of life.

It is very important to provide information to patients for informed consent and to increase their knowledge and decision-making capacity.