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AQUATIC THERAPY
Abstract
Spinal muscular atrophy (SMA) is a neuromuscular disorder characterized by degeneration of alpha motor neurons. This case report describes an aquatic therapy program and the outcomes for a 3-year-old girl with type III SMA. Motor skills were examined using the 88-item Gross Motor Function Measure (GMFM), the Peabody Developmental Motor Scales (PDMS-2), and the GAITRite system. The child received aquatic therapy twice per week for 45-min sessions, for 14 weeks. The intervention included aquatic activities designed to improve gross motor skills and age-appropriate functional mobility. The GMFM total score improved by 11% following the intervention. The Standing Dimension score improved by 28% and the Walking, Running, and Jumping Dimension score improved by 18%. The gross motor quotient for the PDMS-2 improved from 66 to 74. The child's gait showed improvement in walking velocity, stride length, and single-limb support time as a percentage of the gait cycle. The outcomes of this case report demonstrate the successful improvement of gross motor function and gait in a 3-year-old child with SMA. This study provides clinical information for therapists utilizing aquatic therapy as a modality for children with neuromuscular disorders.
Abstract
Background and Objective(s): The purpose of this systematic review was to analyze the current scope of literature regarding the effectiveness of aquatic therapy or aquatic exercises as an intervention for children with cerebral palsy (CP), and to assess the feasibility of incorporating aquatic exercises into the physical therapy management of this specific population.
Study Design: A literature search in 3 electronic databases – PubMed, CINAHL, and Academic Search Complete – was performed, using the following search terms: ‘cerebral palsy,’ ‘children with disabilities,’ ‘aquatics,’ ‘aquatic therapy,’ and ‘hydrotherapy.’ Articles published between 1984 and 2016 were selected. Inclusion criteria for study selection included publication in the English language (or publication in any other language with available English translation); recruitment of participants with CP ages 0–21; and the use of aquatic therapy or aquatic exercises as the main experimental intervention. Studies were excluded if they were not written in English or had no easily accessible translation, and if they recruited subjects older than age 21.
Study Participants & Setting: The target population included children with CP of all five GMFCS classification levels and any type of spasticity, ages 0–21 years.
Materials/Methods: The initial search resulted in 280 potential articles, which were screened for the stated inclusion and exclusion criteria as well as for duplicates.
Results: Fourteen articles satisfied the inclusion criteria. There were two case reports, one case series, one pilot study, three cohort studies, five quasi-experimental studies, and two randomized controlled trials. A total of 294 children with cerebral palsy participated in these investigations. Sample size across the research studies varied from 1 to 46 children. The ages of the participants varied from 3 to 21 years old.
Conclusions/Significance: The evidence suggests that aquatic therapy interventions and/or aquatic exercises are effective in the short term for improving gross movement and gait parameters as well as social function and self-esteem in children with CP ages 0–21, and that aquatic therapy or exercises are feasible, safe, and fun for this population. However, the overall body of evidence is inconclusive due to a lack of high-quality evidence, small sample sizes, and variability in intervention parameters (frequency, duration, intensity, etc.), severity of disease, and outcome measures. More research must be conducted with larger sample sizes, higher quality study design, and more consistent outcome measures to determine effective exercise parameters and to further support the success of aquatic exercises as a physical therapy intervention for this population.
ASSISTIVE TECHNOLOGY
Abstract
Assistive technologies that are tailored to individuals’ health, wellness, and safety concerns can help people with traumatic brain injury (TBI) and their family caregivers meet their goals. The purpose of this study was to investigate views of technology in the context of managing one’s everyday life from the perspectives of persons with TBI and their family caregivers. We conducted 27 in-person, semi-structured interviews with persons with TBI (n = 15) and family caregivers (n = 12) and used conventional content analysis to analyze our data. The major themes that emerged were: 1) views of technology, 2) influence of technology on daily life, 3) desired technology solutions to address health, wellness, and safety concerns, and 4) barriers to adopting technology solutions. To address ongoing concerns, persons with TBI and family caregivers expressed a desire to have a patient portal to share information and communicate with providers, motion sensing devices to provide guidance for mobility, on-demand access to in-home rehabilitation therapy, access to a “social gym” where the persons with TBI could virtually exercise and interact with others, and technologies that help with sleep and facilitate peer support. These findings provide direction for implementation, design, or adaptation of technologies to address the concerns of this population.
Abstract
Background and aim: Cognitive impairments following brain injury, including difficulty with problem solving, can pose significant barriers to successful community reintegration. Problem-solving strategy training is well-supported in the cognitive rehabilitation literature. However, limitations in insurance reimbursement have resulted in fewer services to train such skills to mastery and to support generalization of those skills into everyday environments. The purpose of this project was to develop and evaluate an integrated, web-based programme, ProSolv, which uses a small number of coaching sessions to support problem solving in everyday life following brain injury.
Method: We used participatory action research to guide the iterative development, usability testing, and within-subject pilot testing of the ProSolv programme. The finalized programme was then evaluated in a between-subjects group study and a non-experimental single case study.
Results: Results were mixed across studies. Participants demonstrated that it was feasible to learn and use the ProSolv programme for support in problem solving. They highly recommended the programme to others and singled out the importance of the coach. Limitations in app design were cited as a major reason for infrequent use of the app outside of coaching sessions.
Conclusions: Results provide mixed evidence regarding the utility of web-based mobile apps, such as ProSolv to support problem solving following brain injury.
Implications for Rehabilitation:
- People with cognitive impairments following brain injury often struggle with problem solving in everyday contexts.
- Research supports problem solving skills training following brain injury.
- Assistive technology for cognition (smartphones, selected apps) offers a means of supporting problem solving for this population.
- This project demonstrated the feasibility of a web-based programme to address this need.
BRAIN-BASED THERAPIES
Abstract
Post-Concussion Syndrome (PCS) is a relatively prevalent condition that emerges after sustaining a head injury. Individuals with PCS experience prolonged impairments and distress associated with the injury which can impact the individuals’ quality of life experiences. In this retrospective chart review of refractory adult patients diagnosed with PCS and mild Traumatic Brain Injury (mTBI), the effectiveness of Cortical Integrative Therapy (PedroCIT®) was investigated by comparing measures of postural stability, brain sequencing and timing, and self-reports of physical and psychosocial symptoms of PCS obtained before and after PedroCIT®. Multivariate and Repeated Measures General Linear Models showed improvements across the measures from before to after treatment in all subjects, highlighting the effectiveness of PedroCIT®. To further underscore the capacity of PedroCIT® to elicit improvements in patients who have been resistant to treatment prior to PedroCIT®, the duration of time that the subjects underwent PedroCIT® was compared to the duration of time since the injury to the subjects’ first PedroCIT® intervention session. The findings of this study showed significant improvements from pre- to post-treatment in postural stability, brain sequencing and timing, and self-reported symptoms for patients affected by PCS and mTBI, and treatment outcomes were largely not contingent upon the severity of the condition at the beginning of treatment. Altogether, this retrospective study suggests that refractory individuals affected by PCS and mTBI can benefit from undergoing PedroCIT® and their treatment outcomes may not be related to the degree of impairment presented at the beginning of treatment.
Abstract
Migraine is a common neurological disorder that is characterized by a host of symptoms including severe throbbing headaches. In this retrospective chart review, the effectiveness of Cortical Integrative Therapy (PedroCIT®) was examined in adults with migraines. Multivariate General Linear Model (M-GLM) was utilized to determine if the emotional, functional, and overall difficulties, as well as the intensity of pain experienced with headaches decreased from before to after PedroCIT® treatment in individuals with mild to complete disability resulting from headaches. Repeated Measures General Linear Model (RM-GLM) was also used to investigate if postural stability increased from pre- to post-treatment. The results of the M-GLM showed that PedroCIT® was effective in reducing emotional, functional, overall disability, and intensity of pain resulting from headaches. Furthermore, RM-GLM indicated that patients who underwent PedroCIT® improved their postural stability from pre- to post-treatment. Finally, the findings also showed that the duration of the treatment did not have any effect among patients with varied degrees of headache disability. This study illustrates the effectiveness of PedroCIT® in the treatment of headaches and postural instability in migraine patients.
CEREBRAL PALSY
Abstract
Cerebral palsy results in the progressive loss of motor functions, with a negative impact on daily activities and participation. Despite the well described benefits of aquatic therapy in children, little is known about the effects of the same in school settings. This study aimed to describe the experience of children and youth with cerebral palsy participating in an aquatic therapy program within a special education school considering their educational and therapeutic perspectives. A qualitative descriptive case study with embedded units was developed, comprising 27 participants. This study employed purposeful sampling to include children and youth with cerebral palsy from the Asociación Ayuda a la Paralisis Cerebral (APACE) special education school, together with their parents, the special education teachers, and health care professionals. Data were collected via non-participant observation, semi-structured and informal interviews, focus groups, and researcher field notes. A thematic analysis was conducted, revealing the following themes: (a) the connection with the environment; (b) postural improvements and mobility; (c) the opportunity to perform tasks; (d) learning and transfer. A motivating environment leads to physical, cognitive and social benefits, both at school and in the home. Aquatic therapy was viewed as a means for learning and participation. These findings may enhance understanding regarding the potential benefits of implementing multidisciplinary aquatic therapy programs in specialist school settings.
Abstract
Objectives: Support needs refer to the type, intensity and time necessary for a person to participate in the activities of daily living. The aim of this paper is to show the profile of support needs for children with cerebral palsy with regards to the level of functional ability of the upper and lower extremities.
Methods: The sample comprised 40 respondents diagnosed with spastic cerebral palsy (23 girls (57.5%) and 17 boys (42.5%). The age range was from 7 to 14 years (Mean age = 10.33; SD = 3.31). The instruments used in the present study include the Supports Intensity Scale – Children’s Version (SIS-C), The Gross Motor Function Classification System and Manual Ability Classification System for Children with Cerebral Palsy.
Results: The reliability of the SIS– C was α = 0.97. The highest level of support needs was within the four domains. Support Needs Indexing showed significant differences in relation to the development of manual ability levels (F = 2.56; p = 0.05) and gross motor function levels (F = 3.25; p = 0.03).
Conclusions: The results obtained indicate that children with cerebral palsy need support in individual life domains, in which, a model for planning interventions could be provided.
CORTICAL VISUAL IMPAIRMENT
Abstract
Cortical Visual Impairment (CVI) is resultant from neurological injury and damage to visual pathways or vision centers in the brain. CVI is sometimes undiagnosed in individuals with brain injuries due to the complexity of the human visual system. The International Institute for the Brain (iBrain) is a specialized school for students ages 5 to 21 who have a brain disorder or an acquired brain injury. They often present with noticeable CVI. While there are various metrics and interventions for the pediatric population, the adequacy has been lacking in terms of the vulnerability of this non-verbal population. Assessing the safety and effectiveness of rehabilitative interventions for this fragile student population can be challenging as most traditional metrics cannot be used. In this methodological review paper, available metrics were investigated and their applicability for this specific population is discussed with the end goal of identifying the best metrics that could be used to determine treatment effectiveness and providing a way for monitoring adverse effects. Combining pulse oximetry, cortisol response sensor, and galvanic skin response as biometrics theoretically offers a comprehensive assessment of autonomic activity and responses and establishes objective measures to identify treatment outcomes and adverse reactions. However, future experimental studies are needed to verify if the proposed protocol is feasible and if it is well tolerated by the iBrain students before it can be implemented to monitor adverse reaction to intervention and as a potential treatment outcome measure for children affected by CVI.
Abstract
Purpose: Cortical visual impairment (CVI) is the most common cause of visual impairment in children today and can impact the outcomes of children who rely on augmentative and alternative communication (AAC). This study provides baseline data of 13 children with CVI who used AAC during their first year of participation in an integrated CVI program. One purpose was to describe similarities and differences in the student's demographic, functional vision, communication, and educational profiles. A second purpose was to examine differences in students described with different communicator profiles.
Method: Archived student records were de-identified and reviewed using a systematic coding scheme. Two researchers independently reviewed and coded all student records. Reliability was established. Measures included CVI Range scores; supports for positioning, mobility, vision, and writing; AAC systems, including modes, access methods, and language representation; communicative competence; self-determination; literacy; and mathematics.
Results: The study yielded a rich description of similarities and differences among students at baseline and led to careful consideration of differences among the participants with emergent communicator and context-dependent communicator profiles.
Conclusions: Currently, limited evidence exists that informs practice regarding AAC assessment and intervention for children with CVI. This article describes a small sample of children with CVI who use AAC. Results underscore the need for educators and practitioners to ensure that vision functioning in students with CVI is evaluated carefully and regularly when conducting AAC assessment and intervention and formulating communication or education goals.
EDUCATING STUDENTS WITH BRAIN INJURIES
Abstract
Background: Chronic and complex medical issues, including traumatic brain injuries (TBIs), have significant educational implications. The purpose of this study was to identify and summarize the literature on care coordination strategies among health care professionals, educators, and caregivers for children with special health care needs (CSHCN). Clarifying factors that influence care coordination for CSHCN can inform future studies on care coordination for students with TBI. Improved understanding of these factors may lead to better communication, reduction of unmet needs, more efficient service access, and improved long-term outcomes for children.
Methods: A scoping review was conducted, guided by PRISMA-ScR methodology. Five databases (CINAHL, PSYCINFO, EMBASE, ERIC, PubMed) were searched to identify relevant studies that focused on care coordination and educational settings.
Results: Twelve articles met inclusion criteria. Care coordination interventions for CSHCN used in educational settings focused on relationship-building strategies, clear procedures and roles, and education of members of the school community.
Conclusions: Findings highlight strategies to coordinate care for CSHCN and factors that may moderate effects of these interventions. Key stakeholders should now study these strategies specifically in children with TBI.
Abstract
Purpose: The aim of this study was to examine the relationship between functional communication skills, underlying speech, language, and cognitive impairments and school-based speech pathology services in students with cerebral palsy (CP).
Method: Thirty-five participants with CP who had Individualized Education Programs (IEPs) were classified according to the Communication Function Classification System (CFCS). Participants completed laboratory assessments of speech, receptive language, executive functioning, and nonverbal cognition. Each participants speech and language IEP goals were coded into treatment units and then categorized into seven, mutually exclusive target goal areas. Nonparametric analyses were employed to examine differences among CFCS groups in the number of deficit areas and the number of goal areas from the IEP. Descriptive analyses were used to evaluate the extent to which deficit and goal areas in the IEP co-occurred by CFCS level.
Results: Those in more involved CFCS levels demonstrated more severe speech, receptive language, and cognitive impairments. However, there were no significant differences in the number of deficit areas across CFCS groups.
Abstract
The purpose of this study is to replicate a study conducted by Hux, Marquardt, Skinner, and Bond (1999) in which the researchers explored the frequency of traumatic brain injuries (TBI) in the special education population as compared to the frequency of TBI among students in general education. Hux and colleagues (1999) found that roughly one-quarter of their sample received evaluations for special education services at some point, and that almost half their sample had sustained at least one TBI. Similarly, the current study explored the frequency of TBI in both general education and special education groups in a kindergarten through twelfth grade school. Results indicated that the sample in the current study reported a lower incidence rate of TBI than the general population as well as that in the 1999 study by Hux and colleagues. Additionally, only one student in the current sample (5% of TBI group) reported a history of TBI along with receiving special education services. Discrepancies between the current study and the Hux and colleagues (1999) study are explored, and possible reasons for the discrepancies are discussed.
EPILEPSY
Abstract
Objective: Epilepsy is one of the most common chronic neurological disorders in children. The caregivers of these children bear heavy burden of care in the process of taking care of them. The objective of this metasynthesis was to explore the experiences and needs of caregivers of children with epilepsy.
Methods and data sources: Eight databases (PubMed, CINAHL, EMBASE, Web of Science, CNKI, Wanfang Data, VIP database, and CBM) were searched for qualitative studies from each database's inception to 31 June 2021. Studies were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Qualitative data were extracted, summarized, and meta-synthesized.
Results: 13 studies were included, covering the data of 316 participants. 36 research results were extracted from these studies, which were combined into 11 categories, and finally formed 4 themes: (a) heavy burden of care; (b) emotional experience; (c) coping strategies; (d) care needs.
Conclusion: Caregivers beared a heavy burden of care and psychological burden. Despite the adoption of different coping strategies, their emotional distress was still very serious. Caregivers had unmet care needs. In order to improve caregivers' care capacity, the society and healthcare workers need to provide them with information support, psychological support, and take measures to create a friendly medical and living environment for them.
Impact: Understanding the experiences of caregivers of children with epilepsy will inform future research and practice. Healthcare workers could develop interventions to reduce caregiver burden and improve the level of caregivers' mental health. On the other hand, effective programs should be designed to improve caregivers' knowledge of the disease and enhance their ability to care. Society needs to take steps to improve the medical environment and the social stigma that is not friendly to epilepsy.
Abstract
Purpose: The present study aimed at understanding the stress and perceived stigma among parents of children with epilepsy seeking treatment at a tertiary referral center for neurology in South India.
Materials and methods: Parents of sixty children suffering from epilepsy in the age group of 4-15 years were interviewed to explore parental stress and perceived stigma. They were recruited consecutively over a period of 6 months in 2015. Tools administered were Childhood-Illness related Parenting Stress Inventory (Manford in J Neurol 264(8):1811-24, 2017) and the Parent Stigma Scale (Baca et al. in Value Health 13(6):778-786, 2010).
Results: The mean age of parents was 37.2 years, and the majority of parents who used to bring their child to the hospital were male (71.7%) and educated up to the secondary/intermediate level (36%) and were from lower socio-economic status. The mean age of children with epilepsy was 8.4 years with the majority of them being male (66.7%), affected with chronic seizures (58.3%) with most commonly occurring seizure type being generalized seizures (50%), with a co-morbid diagnosis of cerebral palsy (26.7%). A significant number of parents reported difficulty in communicating with medical team (58.3%) and significant others (51.7%) about their child's seizures and difficulty in making decisions related to their child's medical care (43.3%) which strained their financial resources and created difficulty in adequate role functioning. Findings indicated that most of the parents of children with chronic seizures perceived reactions of others to be negative (53.3%) and would limit family social interaction which resulted into emotional reaction in the form of anger, guilt, fear, anxiety, and depression.
Conclusion: Parents are important figures in the process by which children with epilepsy came to acknowledge themselves being different from other children. Parents often feared divulging their child's epilepsy to their friends and relatives because they experienced a sense of shame, self-blame, and rejection which also increased their stress.
LIVING WITH BRAIN INJURY
Abstract
Background: The diagnosis of epilepsy in a child often and understandably causes psychological adjustment difficulties in the parents. To help parents of children with epilepsy cope with stress, it is important to understand how parents cope with the sickness of their child. The objective of this study was to assess factors related to the state of anxiety and depression among parents of children with epilepsy.
Methods: The present study was a cross-sectional study, and the data were collected through an anonymous, Internet-based survey platform between October 2018 and October 2019 from 250 participants aged 22-65 years. Participants were invited to fill questionnaires include socioeconomic questionnaire, anxiety, depression, and coping strategies scale.
Result: Among the parents of children with epilepsy, 48.8% (122/250) had depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score >4) and 46.4% (116/250) had anxiety symptoms (7-item Generalized Anxiety Disorder [GAD-7] score >5). Depression among parents of children with epilepsy was significantly associated with comorbidity (odds ratio [OR] = 0.392, 95% CI = 0.182-0.846), a poor parental relationship (OR = 0.283, 95% CI = 0.130-0.614), positive coping (OR = 0.947, 95% CI = 0.903-0.992), and negative coping (OR = 1.287, 95% CI = 1.179-1.405). Anxiety among parents of children with epilepsy was significantly associated with a poor parental relationship (OR = 0.416, 95% CI = 0.207-0.835) and negative coping (OR = 1.155, 95% CI = 1.087-1.228).
Conclusions: The present study indicates the importance of couple support and providing effective coping to make parents of children with epilepsy more resilient in the presence of negative life events, especially for parents of children with comorbidity with cognitive deficiency.
Abstract
Following traumatic brain injury (TBI), participating in education often provides a pathway for returning to a student's pre-injury life. In this paper, we explore themes related to adjustment and identity that emerged from students’ reflections about their study journey. The data for this project are drawn from a longitudinal, predominantly qualitative investigation. Twelve students (aged: 17–32 years) completed up to three in-depth interviews over a period of 4–15 months, capturing a total of 30 time points. Data were analysed using grounded theory methods. A significant theme of “Is it Me or is it the Injury?” emerged from the context of students’ descriptions of self, “Me” and thoughts about their injury, “The Injury.” This emergent theme was indicative of the complex processes involved in adjusting and reshaping identity that arose from students’ participation in education. The concepts identified in this research suggest that clinicians and educators must adopt a comprehensive, holistic and flexible approach to supporting students that can be adapted to reflect the individual and dynamic processes involved.
Abstract
Assistive technologies that are tailored to individuals’ health, wellness, and safety concerns can help people with traumatic brain injury (TBI) and their family caregivers meet their goals. The purpose of this study was to investigate views of technology in the context of managing one’s everyday life from the perspectives of persons with TBI and their family caregivers. We conducted 27 in-person, semi-structured interviews with persons with TBI (n = 15) and family caregivers (n = 12) and used conventional content analysis to analyze our data. The major themes that emerged were: 1) views of technology, 2) influence of technology on daily life, 3) desired technology solutions to address health, wellness, and safety concerns, and 4) barriers to adopting technology solutions. To address ongoing concerns, persons with TBI and family caregivers expressed a desire to have a patient portal to share information and communicate with providers, motion sensing devices to provide guidance for mobility, on-demand access to in-home rehabilitation therapy, access to a “social gym” where the persons with TBI could virtually exercise and interact with others, and technologies that help with sleep and facilitate peer support. These findings provide direction for implementation, design, or adaptation of technologies to address the concerns of this population.
PHYSICAL EXERCISE AND BRAIN INJURY REHABILITATION
Abstract
Background: Exercise has proven to be a tool improving health related quality of life in people with acquired brain injury (ABI) as part of multidisciplinary team during the subacute and chronic phase. While intervention studies and revisions have been increased in recent years, there is no consensus about the type, frequency and variables of control in exercise interventions. Besides, this collective need programs that respond to different functional levels, given the heterogeneity of people with ABI, not only because of the etiology, but also because of the severity differences over their deficits. The aim of this systematic review and meta-analysis is to summarize the evidence regarding the relationship between exercise and health related quality of life in subacute and chronic phase.
Methods: A protocol of systematic review and meta-analysis will examine the benefits of physical exercise (PE) toward people with ABI will be conducted. A comprehensive search will be conducted in the following electronic databases: MEDLINE, The Cochrane Library, CINAHL, SportDiscus, and Web of Science from inception to July 2020. Independent review authors will evaluate the title and abstract for each trial and disagreements will be solved by discussion with a third author if necessary. Standard pairwise meta-analysis, including heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using the Stata software. The quality evaluation of this study will be completed using the Cochrane collaboration risk of bias tool and the risk of bias assessment will be conducted by the World Health Organization grading of recommendations, assessment, development, and evaluation. The review will be reported in accordance to the preferred reporting items for systematic reviews and meta-analyses statement.
Results and Conclusion: This systematic review and meta-analysis protocol will provide an overview regarding the benefits of PE on functioning, social participation and quality of life toward people with ABI. The variability of outcomes across PE from the selected studies will provide important information for future trial designs. Results of the proposed review will inform practice and the design of future clinical trials. This study will summarize all the selected trials aimed at estimating the effectiveness of applying physical activity programs to ABI users.
Abstract
Background: Traumatic brain injury (TBI) is a major cause of disability and mortality worldwide. People with TBI exhibit poor quality of life (QOL). Exercise is considered a possible intervention for improving cognitive function and mood, helping improve QOL in patients with TBI. According to our review of the relevant literature, meta-analyses have yet to explore the effect of exercise on QOL in patients with TBI.
Objectives: To determine by meta-analysis of relevant studies whether physical exercise could promote QOL in patients with TBI.
Methods: A systematic review and meta-analysis of intervention studies involving physical exercise for improving QOL outcomes in TBI populations were conducted according to the PRISMA guideline. Our inclusion criteria were as follows: being randomized or nonrandomized controlled trials with quantitative designs that included patients diagnosed with TBI.
Results: Thus, six studies met the inclusion criteria. The interventions in four of the six studies had statistically significant effects on QOL improvement. Our meta-analysis revealed a moderate effect size of physical exercise on QOL promotion in patients with TBI.
Conclusion: For TBI, exercise seems to improve QOL. More research with long-term follow-up should be conducted to assess the effect of exercise on patients with TBI.
SPEECH THERAPY
Acquired Brain Injury Survivor Long-Term Cognitive Exercise Engagement Post–Speech Therapy Discharge
Abstract
Purpose: The purpose of this article is to promote the viewpoint that speech-language pathologists (SLPs) are well positioned to actively encourage individuals with cognitive-communication disorders following acquired brain injury (ABI) to engage in ongoing, long-term, cognitive exercise post-therapy discharge.
Method: This viewpoint article draws on evidence from the well-researched area of physical exercise, reports findings of early-stage research in the much less studied area of cognitive exercise, and highlights relevant aspects of motivational theory informing exercise participation. Informed by these, an evidence-supported model of cognitive exercise engagement is offered to inform ABI-targeted cognitive wellness empowerment efforts, and a case study illustrates clinical application of the model.
Conclusions: Exercise provides an opportunity to sustain or improve long-term health, function, and quality of life outcomes. It is within SLP scope of practice to collaborate with family members and other caregivers to empower individuals post-ABI, especially those with decreased self-management skills, to engage in long-term computerized and noncomputerized cognitive exercise following SLP therapy discharge. Ongoing research will further inform the evidence supporting the scholarly opinion presented in this viewpoint.
Abstract
Introduction: Dysarthria, a neurological motor speech disorder, is regarded as a common sequala of traumatic brain injury (TBI). Palilalia is a speech disorder characterized by involuntary repetition of words, phrases, or sentences. Based on the evidence supporting the effectiveness of transcranial direct current stimulation (tDCS) in some speech disorders, we hypothesized that using tDCS would enhance the expected speech therapy outcome in a case of TBI with dysarthria and palilalia.
Method: The “Be Clear” protocol, a relatively new approach in speech therapy in dysarthria, together with tDCS were employed in this single case investigation. With respect to the tDCS montage, regions of interest (ROIs) were identified based on the comparative analysis of resting-state vs. speech task-concurrent qEEG results.
Results: Measures of intelligibility, an important index in the assessment of dysarthria, were superior to the primary protocol results immediately and 4 months after intervention. We did not find any factor other than the use of tDCS to justify this superiority. Palilalia showed a remarkable improvement immediately after intervention but fell somewhat after 4 months. This might have been justified owing to the subcortical origin of palilalia.
Conclusion: Our present findings suggested that applying tDCS together with speech therapy might be more effective in similar case profiles as compared to traditional speech therapy. This notion needs to be systematically investigated in well-designed parallel arm clinical trials.
TRAUMATIC BRAIN INJURY (TBI)
Abstract
Traumatic brain injury (TBI) has been described to be man’s most complex disease, in man’s most complex organ. Despite this vast complexity, variability, and individuality, we still classify the severity of TBI based on non-specific, often unreliable, and pathophysiologically poorly understood measures. Current classifications are primarily based on clinical evaluations, which are non-specific and poorly predictive of long-term disability. Brain imaging results have also been used, yet there are multiple ways of doing brain imaging, at different timepoints in this very dynamic injury. Severity itself is a vague concept. All prediction models based on combining variables that can be assessed during the acute phase have reached only modest predictive values for later outcome. Yet, these early labels of severity often determine how the patient is treated by the healthcare system at large. This opinion paper examines the problems and provides caveats regarding the use of current severity labels and the many practical and scientific issues that arise from doing so. The objective of this paper is to show the causes and consequences of current practice and propose a new approach based on risk classification. A new approach based on multimodal quantifiable data (including imaging and biomarkers) and risk-labels would be of benefit both for the patients and for TBI clinical research and should be a priority for international efforts in the field.
Abstract
Traumatic brain injury (TBI) presents in various forms ranging from mild alterations of consciousness to an unrelenting comatose state and death. In the most severe form of TBI, the entirety of the brain is affected by a diffuse type of injury and swelling. Treatment modalities vary extensively based on the severity of the injury and range from daily cognitive therapy sessions to radical surgery such as bilateral decompressive craniectomies. Guidelines have been set forth regarding the optimal management of TBI, but they must be taken in context of the situation and cannot be used in every individual circumstance. In this review article, we have summarized the current status of treatment for TBI in both clinical practice and basic research. We have put forth a brief overview of the various subtypes of traumatic injuries, optimal medical management, and both the noninvasive and invasive monitoring modalities, in addition to the surgical interventions necessary in particular instances. We have overviewed the main achievements in searching for therapeutic strategies of TBI in basic science. We have also discussed the future direction for developing TBI treatment from an experimental perspective.