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Communities of practice can facilitate the sharing and translation of knowledge. BRAINSPaN is a multidisciplinary community of practice of clinicians, researchers and students in the brain impairment field that was launched in Australia in June 2017. We aimed to investigate the impact of BRAINSPaN on multidisciplinary collaboration and on knowledge, skills and confidence in domains of practice of interest to members.
We surveyed BRAINSPaN members over three time points at 1-month (n = 117), 7-months (n = 69) and 14-months (n = 46) post-launch. Content analysis of posts to the BRAINSPaN listserv was also conducted to identify their purpose and content.
Increasing access to new research findings and increasing interaction with others in the brain impairment field were the two main goals for survey respondents’ participation in BRAINSPaN. At 7- and 14-months post-launch, these were also the most commonly achieved goals and most frequently cited benefits of BRAINSPaN participation. Cognitive rehabilitation and behaviour management were the most frequently reported practice domains of interest, as well as being two of the five most common topics of BRAINSPaN posts over the survey period. There was a significant increase in self-reported knowledge for participants’ top two domains of interest, but no change in skills or confidence.
BRAINSPaN has the potential to serve as a vehicle for the sharing and translation of knowledge in the brain impairment field. Combining other forms of dissemination with communities of practice, such as workshops and clinical mentoring, may be needed to also influence the development of skills and confidence in practice areas.
Accumulating evidence suggests that wakeful rest (a period of minimal cognitive stimulation) enhances memory in clinical populations with memory impairment. However, no study has previously examined the efficacy of this technique in stroke survivors, despite the high prevalence of post-stroke memory difficulties. We aimed to investigate whether wakeful rest enhances verbal memory in stroke survivors and healthy controls.
Twenty-four stroke survivors and 24 healthy controls were presented with two short stories; one story was followed by a 10-minute period of wakeful rest and the other was followed by a 10-minute visual interference task. A mixed factorial analysis of variance (ANOVA) with pairwise comparisons was used to compare participants’ story retention at two time points.
After 15–30 minutes, stroke survivors (p = .002, d = .73), and healthy controls (p = .001, d = .76) retained more information from the story followed by wakeful rest, compared with the story followed by an interference task. While wakeful rest remained the superior condition in healthy controls after 7 days (p = .01, d = .58), the beneficial effect was not maintained in stroke survivors (p = .35, d = .19).
Wakeful rest is a promising technique, which significantly enhanced verbal memory after 15–30 minutes in both groups; however, no significant benefit of wakeful rest was observed after 7 days in stroke survivors. Preliminary findings suggest that wakeful rest enhances early memory consolidation processes by protecting against the effects of interference after learning in stroke survivors.
The uptake of smartphones as external compensatory memory aids following an acquired brain injury (ABI) in rehabilitation settings is low. Potential reasons for this include professionals not having evidence-based guidelines regarding the best methods to train smartphone use and prospective users not being familiar with technology and/or having memory and learning difficulties. This paper describes the protocol of a study that aims to compare the efficacy of three training methods (Systematic Instruction, Error-based Learning and Trial-and-Error) for training the use of a smartphone reminder app, in people with ABI presenting with memory complaints.
This is a three-armed, assessor-blinded, Phase II randomised controlled trial. The estimated sample size is 51 participants aged >18 years, who are equally randomised to one of the three training groups. They are seen across four sessions: one to conduct baseline measures; one for training the use of an app and two for follow-up assessments (1- and 6-weeks post-training). The main outcome measure is proficiency of performance in tasks with the trained app. Secondary outcomes include generalisation of skills to other apps, number of errors committed while attempting the tasks, frequency of smartphone usage in general and as a memory aid and confidence in smartphone use and memory self-efficacy. Outcome measures are collected by an independent blinded assessor. Proficiency of performance, generalisation of skills and error commission are measured immediately post-training and at the two follow-up sessions. The other secondary measures are taken pre-intervention and at the two follow-up sessions.
This study will provide initial evidence regarding the efficacy of three different methods to train ABI survivors with memory difficulties in how to use smartphone apps as compensatory memory aids. The results could inform a larger Phase III trial and advance knowledge concerning the advantages or disadvantages of using error-reducing and trial-and-error techniques. Further, the findings could determine the potential of error-based learning as an emerging training method for people with memory impairment within rehabilitation.
Rehabilitation of memory after stroke remains an unmet need. Telehealth delivery may overcome barriers to accessing rehabilitation services.
We conducted a non-randomized intervention trial to investigate feasibility and effectiveness of individual telehealth (internet videoconferencing) and face-to-face delivery methods for a six-week compensatory memory rehabilitation program. Supplementary analyses investigated non-inferiority to an existing group-based intervention, and the role of booster sessions in maintaining functional gains. The primary outcome measure was functional attainment of participants’ goals. Secondary measures included subjective reports of lapses in everyday memory and prospective memory, reported use of internal and external memory strategies, and objective measures of memory functioning.
Forty-six stroke survivors were allocated to telehealth and face-to-face intervention delivery conditions. Feasibility of delivery methods was supported, and participants in both conditions demonstrated treatment-related improvements in goal attainment, and key subjective outcomes of everyday memory, and prospective memory. Gains on these measures were maintained at six-week follow-up. Short-term gains in use of internal strategies were also seen. Non-inferiority to group-based delivery was established only on the primary measure for the telehealth delivery condition. Booster sessions were associated with greater maintenance of gains on subjective measures of everyday memory and prospective memory.
This exploratory study supports the feasibility and potential effectiveness of telehealth options for remote delivery of compensatory memory skills training after a stroke. These results are also encouraging of a role for booster sessions in prolonging functional gains over time.
The current study examined the association of demographic/preinjury, injury-related, and cognitive behavior therapy (CBT) process variables, with anxiety and depression symptom change in traumatic brain injury (TBI)-adapted CBT (CBT-ABI).
The audio recordings of 177 CBT-ABI sessions representing 31 therapist–client dyads were assessed from the independent observer perspective on measures of working alliance, homework engagement, and therapist competency in using homework.
Linear regressions showed that older client age, longer post-TBI recovery period, better executive functioning, higher levels of client homework engagement, as well as higher levels of therapist competence in reviewing homework were associated with greater improvement in anxiety and/or depression symptoms.
CBT-ABI is a promising treatment for post-TBI depression and anxiety. The current study highlights how therapists can enhance CBT-ABI effectiveness, specifically: comprehensive facilitation of client homework engagement with emphasis on homework review, and accommodation of executive deficits. The current study also suggests that the role of client age and the length of post-TBI recovery period require further investigation.
Objectives: People with Huntington’s disease (HD) experience poor social quality of life, relationship breakdown, and social withdrawal, which are mediated to some extent by socially debilitating neuropsychiatric symptoms, such as apathy and disinhibition. Social cognitive symptoms, such as impaired emotion recognition, also occur in HD, however, the extent of their association with these socially debilitating neuropsychiatric symptoms is unknown. Our study examined the relationship between emotion recognition and symptom ratings of apathy and disinhibition in HD. Methods: Thirty-two people with premanifest or symptomatic-HD completed Part 1 of The Awareness of Social Inference Test (TASIT), which is a facial emotion recognition task. In addition, we obtained severity ratings for apathy and disinhibition on the Frontal Systems Behavior Scale (FrSBe) from a close family member. Our analyses used motor symptom severity as a proxy for disease progression. Results: Emotion recognition performance was significantly associated with family-ratings of apathy, above and beyond their shared association with disease severity. We found a similar pattern for disinhibition ratings, which fell short of statistical significance. As expected, worse emotion recognition performance was correlated with higher severity in FrSBe symptom ratings. Conclusions: Our findings suggest that emotion recognition abilities relate to key socially debilitating neuropsychiatric symptoms in HD. Our results help to understand the functional significance of emotion recognition impairments in HD, and may have implications for the development of remediation programs aimed at improving patients’ social quality of life. (JINS, 2018, 24, 417–423)
Management of cognitive difficulties is a significant unmet need for individuals with stroke. Incorporating multiple functions, including memory aids and communication tools, smartphones have potential to improve everyday cognitive function and independence in daily activities post-stroke. We aimed to investigate patterns of smartphone use, facilitators and barriers to use, and relationships between smartphone use and daily functioning. Twenty-nine participants with stroke and 29 comparison participants with no history of neurological conditions completed measures of smartphone use, objective and subjective cognitive function, mood and community integration. The majority of participants used smartphones, though the proportion of users was lower in the stroke group (62%) than the comparison group (86%). Older participants were less likely to use smartphones. Using apps that support memory was a main benefit of smartphone use post-stroke. In the stroke group, frequent users of memory apps had significantly fewer motor symptoms (d = 1.20), and higher productivity (d = 0.84). Stroke survivors identified difficulty learning how to use smartphones, but only one participant had assistance with this from a clinician. These results suggest that smartphones have potential as assistive technology post-stroke, however, support in using them is essential, particularly for older individuals with motor dysfunction.
Objectives: Deficits in the recognition of negative emotions emerge before clinical diagnosis in Huntington’s disease (HD). To address emotion recognition deficits, which have been shown in schizophrenia to be improved by computerized training, we conducted a study of the feasibility and efficacy of computerized training of emotion recognition in HD. Methods: We randomly assigned 22 individuals with premanifest or early symptomatic HD to the training or control group. The training group used a self-guided online training program, MicroExpression Training Tool (METT), twice weekly for 4 weeks. All participants completed measures of emotion recognition at baseline and post-training time-points. Participants in the training group also completed training adherence measures. Results: Participants in the training group completed seven of the eight sessions on average. Results showed a significant group by time interaction, indicating that METT training was associated with improved accuracy in emotion recognition. Conclusions: Although sample size was small, our study demonstrates that emotion recognition remediation using the METT is feasible in terms of training adherence. The evidence also suggests METT may be effective in premanifest or early-symptomatic HD, opening up a potential new avenue for intervention. Further study with a larger sample size is needed to replicate these findings, and to characterize the durability and generalizability of these improvements, and their impact on functional outcomes in HD. (JINS, 2017, 23, 314–321)