CBT Improves Sleep Outcomes in Acquired Brain Injury

 What is your competent? doctor's EXACT SLEEP PROTOCOL?

CBT Improves Sleep Outcomes in Acquired Brain Injury

Cognitive behavioral therapy significantly improves sleep disturbances in adults with acquired brain injury, with benefits observed in sleep quality, insomnia severity, and sleep efficiency. Cognitive behavioral therapy (CBT) may improve sleep disturbances among individuals with acquired brain injury, according to study findings published in Sleep Medicine Sleep disturbances are common among individuals with acquired brain injury — including those recovering from traumatic brain injury or stroke — and may negatively affect recovery and quality of life. Researchers conducted a systematic review and meta-analysis assessing the effect of CBT-based interventions on sleep disturbances following acquired brain injury. Overall, CBT offers multidimensional therapeutic benefits for sleep disturbances, enhancing both subjective sleep perception and the efficiency of sleep architecture. Eligible studies enrolled adults aged 18 years and older with a diagnosis of acquired brain injury who experienced sleep disturbances. Participants in the intervention groups received CBT-based therapies, incorporating components such as sleep hygiene education, stimulus control, sleep restriction, cognitive restructuring, and relaxation techniques. Participants in the control groups received usual care or health education. Sleep-related outcomes included measures such as sleep quality, insomnia severity, and objective sleep parameters. A total of 8 randomized controlled trials were included in the meta-analysis, representing a combined sample of 387 participants. The included studies were published between 2017 and 2025. Across the included trials, intervention durations ranged from 6 to 9 weeks. According to pooled analyses, CBT was associated with significant improvements in overall sleep outcomes among individuals with acquired brain injury (standardized mean difference [SMD], −0.95; 95% CI, −1.47 to −0.43;P=.0003). Further analyses examining specific sleep domains demonstrated that CBT significantly improved subjective sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI; mean difference [MD], −2.34; 95% CI, −3.23 to −1.45;P<.00001). In addition, CBT significantly reduced insomnia severity scores on the Insomnia Severity Index (ISI; MD, −3.46; 95% CI, −4.27 to −2.64; P <.00001), suggesting a meaningful reduction in insomnia symptoms among individuals receiving CBT-based interventions. CBT was also associated with a statistically significant improvement in sleep efficiency (SMD, −0.38; 95% CI, −0.67 to −0.09;P=.01). Subgroup analyses demonstrated that traditional face-to-face CBT and electronically delivered CBT were associated with significant improvements in sleep outcomes. No statistically significant differences in treatment efficacy were observed between these modalities. Study limitations include the relatively small number of randomized trials, limited sample sizes, and reliance on self-reported sleep outcomes. In addition, variability in intervention intensity and control conditions across studies may have contributed to heterogeneity in the pooled results. “Overall, CBT offers multidimensional therapeutic benefits for sleep disturbances, enhancing both subjective sleep perception and the efficiency of sleep architecture,” the researchers concluded. Disclosures: This research was supported by the National Natural Science Foundation of China and Guizhou Province Traditional Chinese Medicine Project. Please see the original reference for a full list of disclosures. References:Zhu H, Wen Q, Zhang F, Li S, Wang X, Li J. The efficacy of cognitive behavioral therapy for sleep disorders following acquired brain injury: a systematic review and meta-analysis. Sleep Med. 2026;138:108678. doi:10.1016/j.sleep.2025.108678

Transfusion in Acute Brain Injury: Is Less Still More?

 Ask your competent? doctor how this informs your recovery.

Transfusion in Acute Brain Injury: Is Less Still More?

Blood transfusions are commonly given to patients with acute brain injury, but there is ongoing debate over whether a restrictive or liberal transfusion strategy is preferable. 

Results of the TRICC trial published more than two decades ago favored a restrictive strategy, which has largely guided transfusion practice. But results of the TRAIN study, recently published in JAMA, favor a more liberal transfusion strategy. 

“Overall, with the TRAIN results, I think practice will probably shift more toward consideration of a liberal transfusion strategy,” Nina Massad, MD, assistant professor of clinical neurology, Division of Neurocritical Care, University of Miami Miller School of Medicine, Miami, Florida, told Medscape Medical News. Massad was not involved in either study. 

TRICCed Into Restrictive Strategy?

Published in 1999, the landmark Transfusion Requirements in Critical Care (TRICC) trial, suggested that a restrictive strategy of red-cell transfusion is at least as effective as, and possibly superior, to a liberal transfusion strategy in critically ill patients.

The trial enrolled more than 800 critically ill but stable ICU patients with hemoglobin concentrations < 9.0 g/dL, with patients randomly allocated to either a conservative trigger for transfusion of < 7.0 g/dL or a liberal threshold of < 10.0 g/dL. 

Overall, mortality at 30 days was lower with the restrictive strategy (18.7% vs 23.3%), but the difference was not statistically significant (P = .11). Inpatient mortality was also lower in the restrictive group (22.2% vs 28.1%; P = .05) as was ICU mortality (13.9% vs 16.2%; P = .29).

The results led to shift in transfusion practice, with restrictive thresholds being widely adopted to avoid inappropriate use of a scarce resource, Alexis Turgeon, MD and Francois Lauzier, MD, Quebec University Hospital Center — Laval University Research Center, noted in a JAMA editorial. 

Yet, the TRICC trial has been called the most misinterpreted study in medicine. 

Among the concerns raised, the trial enrolled few neurocritically ill patients, did not include a subgroup analysis of those with acute brain injury and did not assess long-term functional outcomes, which are “more relevant to these patients than mortality and more impactful for clinical practice,” Turgeon and Lauzier pointed out. 

From TRICC to TRAIN

Enter the TRAIN trial, which showed that liberal transfusion was associated with better neurological outcomes in patients with acute brain injury. 

The trial was conducted at 72 ICUs across 22 countries and included 850 patients with acute traumatic brain injury (TBI), aneurysmal subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH). All participants had a hemoglobin level below 9.0 g/dL within the first 10 days after injury and were expected to stay in the ICU for at least 72 hours. 

They were randomly assigned to liberal transfusion (triggered by hemoglobin < 9.0 g/dL) or restrictive transfusion (triggered by hemoglobin < 7.0 g/dL).

Patients receiving the liberal transfusion strategy had a significantly lower rate of unfavorable neurological outcomes (the primary outcome) at 6 months than those in the restrictive group (62.6% vs 72.6%; adjusted relative risk: 0.86; P = .002). 

The findings were consistent across all subgroups of brain injury and post hoc analyses, reported Fabio Silvio Taccone, MD, PhD, with the Free University of Brussels, Belgium, and colleagues. 

There were also fewer cerebral ischemic events in the liberal group (8.8% vs 13.5%; relative risk, 0.65). There was no effect on ICU or hospital length of stay, organ failure at 28 days or mortality. The liberal group required more transfusions than the restrictive group (median, 2 vs 0 units). 

HEMOTION Consistent With TRAIN 

The main findings of the TRAIN trial are consistent with those of the HEMOTION trial, a large-scale, multicenter international trial of 742 adults with moderate or severe TBI and anemia. 

In contrast to TRAIN, HEMOTION included only patients with TBI, used a higher liberal transfusion threshold (10 g/dL), and assessed brain injury severity in the emergency department following stabilization. 

Fewer patients in the liberal than restrictive group had an unfavorable neurological outcome (68.4% vs 73.5%).

However, a separate study published last spring found that a liberal (vs restrictive) transfusion strategy did not decrease the risk for an unfavorable neurologic outcome at 6 months in critically ill TBI patients.

Nonetheless, the weight of the new evidence shows that liberal transfusion thresholds appear “widely beneficial,” Turgeon and Lauzier note in their editorial. 

They added that blood products are now “safer than ever” and the rationale for advocating a restrictive strategy in the TRICC trial era — to “save precious resources without harming patients” — no longer holds.

“Fortunately, the weight of sparing precious resources has now been lifted from the shoulders of neurocritically ill patients, in whom serious concerns about the safety of a restrictive strategy have been raised by the TRAIN and HEMOTION trials. Based on the best available evidence, it is prudent to advocate a liberal transfusion strategy for these neurocritically ill patients,” Turgeon and Lauzier concluded. 

Practice Changing? 

Massad told Medscape Medical News the TRAIN study results “will likely change practice for many providers. I will probably consider a more liberal transfusion goal, particularly who seem to be at higher risk of tissue hypoxia — for example, vasospasm; concern for delayed cerebral ischemia; low brain tissue oxygenation on brain tissue oxygen monitoring.” 

Massad said it remains to be seen whether a liberal strategy helps prevent cerebral ischemia specifically. Another unanswered question concerns the optimal transfusion threshold in acute ischemic stroke.

She also noted that current guidelines from the Neurocritical Care Society for SAH state there is insufficient evidence to provide a recommendation to transfuse for a threshold higher than hemoglobin > 7.0 g/dL in SAH. 

There have been no guidelines to support a liberal transfusion strategy in ICH either, as there are limited studies on this. 

For TBI, the most recent Brain Trauma Foundation guidelines from 2016 do not address transfusion thresholds, although there have been suggestions from other groups to transfuse red-blood cells in the setting of low oxygen on brain tissue oxygenation monitoring, Massad noted. 

“My feeling is that a liberal strategy is going to start being reconsidered for subsequent guideline updates in acute brain injury. More definitive guideline recommendations are probably going to depend on further studies to corroborate these findings,” Massad said.

“Additional studies are currently ongoing, including one investigating this question specifically in SAH patients (SAHaRA trial), so this will hopefully help clarify the question in the SAH population,” she said. 

The TRAIN study was funded by the ESICM NeXT grant and La Fondation des Geules Cassées. Taccone had no relevant disclosures. Turgeon served as chief investigator, and Lauzier as co-principal investigator, of the HEMOTION trial. Massad had no relevant disclosures.

Estimating highest capacity propulsion performance using backward-directed force during walking evaluation for individuals with acquired brain injury

NOTHING HERE gets survivors recovered! Useless. It is just measurements. NO PROTOCOLS!

Estimating highest capacity propulsion performance using backward-directed force during walking evaluation for individuals with acquired brain injury

• Kelli LaCroix,
• Lauren Horelka,
• Clif Hung &
• David A. Brown 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 134 (2024) Cite this article

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Abstract

There are over 5.3 million Americans who face acquired brain injury (ABI)-related disability as well as almost 800,000 who suffer from stroke each year. To improve mobility and quality of life, rehabilitation professionals often focus on walking recovery soon after hospital discharge for ABI. Reduced propulsion capacity (force output of the lower limbs to counteract ground reaction forces) negatively impacts walking ability and complicates recovery during rehabilitation for brain injured people. We describe a method, using backward-directed resistance (BDR) in a robotic-based treadmill device, to allow measurement of maximum walking propulsion force (MWPF) that is not otherwise possible during overground walking assessment. Our objective was to test the construct validity of a maximum walking propulsion force (MWPF) measure that reflects a person’s propulsive strength against applied BDR, while walking on a robotic treadmill-based device for participants with acquired brain injury (ABI). Our study enrolled 14 participants with ABI at an in inpatient rehabilitation in Galveston, TX from 8/1/21 − 4/31/22. The range of weight-adjusted MWPF was 2.6–27.1% body weight (%BW), mean 16.5 ± 8.4%BW, reflecting a wide range of propulsive force capability. The strongest correlation with overground tests was between the 6-minute walk test (6-MWT) distance and the MWPF values (r = 0.83, p < 0.001) with moderate correlations between the 10-meter walk tests at comfortable (CWS) and fast speeds (FWS). The Five Times Sit-to-Stand (used as a standard clinical measure of functional lower extremity strength) and MWPF tests were poorly correlated (r = 0.26, p = 0.4). Forward model selection included 6-MWT distance, age, and overground CWS as significant partial predictors of MWPF. We conclude that this novel MWPF measure is a valid representation of maximum propulsive force effort during walking for people post-ABI. Additional research could help determine the impact of interventions designed to increase propulsive force generation during rehabilitation training to improve overground walking performance.

Introduction

There are over 5.3 million Americans who face brain injury-related disability [1] as well as almost 800,000 who suffer from stroke each year [2]. To improve mobility and quality of life, rehabilitation professionals often focus on walking recovery soon after hospital discharge for such acquired brain injuries (ABI). One goal of physical rehabilitation is to attain optimal functional outcomes such as independent community walking, but therapists are tasked with determining how challenging a training environment should be to match therapy goals with the person’s capacity to realistically achieve them, a concept that been explored by the challenge point framework in research [3, 4]. Intensive mobility training, specifically in adults who have had a brain injury, can significantly improve gait speed, balance, and mobility [5], but diminished walking strength due to reduced lower limb power generation and/or poor distribution of lower limb power [6] is a barrier to attaining faster, more appropriate walking speeds. ABI is also associated with hemiparesis and abnormal muscle pattern activation [7] muscle weakness due to gross muscle atrophy, particularly of hip extensors and plantar flexors [8], and neural changes of the motor cortex that result in reduced motor neuron recruitment and rate coding [9]. These factors all contribute to propulsive deficits that are essential to address during rehabilitation.

Studies commonly use the FXSTS as a measure of functional lower extremity strength [10, 11], but biomechanical factors are unique in those who have experienced a head injury. Slower FXSTS times are associated with lower peak whole-body center of mass velocity in a vertical direction, which reflects a decreased ability to perform functional transitional movements and activities such as stair ambulation [12]. However, this ability may not reflect the capability to generate horizontal forward propulsive force during walking. In fact, no studies to date have validated the FXSTS test in people with ABI as a measure of forward propulsion force generation. Overground walking tests such as the 10-Meter Walk Test (comfortable and fast 10MWT) [13] and 6-Minute Walk Test (6-MWT) [14] are the gold standard for measuring walking impairments. These tests provide insight into an individual’s capacity for improvement during rehabilitation and help clinicians set realistic patient goals, track progress, and assess outcomes.

Modern robotic-based treadmills allow the clinician to manipulate the walking force requirements of their clients, which provides a way to analyze forward propulsion force generation in a way that is not feasible in the standard overground environment. Previous research demonstrated a walking assessment based on overcoming horizontal force resistance generated by a robotic assistance treadmill belt in the post-stroke population [15]. This test was performed by applying increased magnitudes of backward horizontal resistance to the treadmill belt while instructing individuals to walk comfortably until they reached a level of resistance that prevented them from moving the treadmill belt forward [15, 16]. This test could be further applied to examine upper limits of force generation as an estimate of propulsive force. The KineAssist-MX used in this study can apply backward-directed force to create a precise amount of resistance against forward walking while the participant is walking in the device. A precise amount of resistance can be applied in the opposite direction of walking; when incrementally increased, it is possible to determine a propulsion threshold, referred to as the maximum walking propulsion force (MWPF), for each user.

We developed a MWPF test to examine the forward propulsion generation capability of individuals post-ABI. Our approach was to provide a walking environment with progressive levels of backward-directed resistance (BDR) until the person was no longer able to overcome the forces; this threshold measurement can be used to estimate the potential MWPF that a person could theoretically move at if they were to utilize the propulsive forces during normal (unresisted) walking conditions.

We used the robotic treadmill to explore the use of BDR to determine a MWPF value for participants with ABI. To validate the MWPF measure, we assessed the validity between overground walking tests and MWPF values. We hypothesized the MWPF measure would be positively correlated with overground FWS and the 6-MWT distance. We also hypothesized that MWPF could be used to predict CWS, FWS, and 6-MWT distance overground to potentially explain why some people post-ABI have less endurance compared to others post-ABI. Finally, since we propose that MWPF would be more strongly correlated than the FXSTS with walking performance (e.g., endurance, comfortable walking speed, fast walking speed), we hypothesized there would be a poor correlation between the FXSTS and MWPF measure, reflecting divergent construct validity. Support of these hypotheses would demonstrate that measuring propulsive forces capability can provide useful information about the role of propulsive force generation in walking performance.

Evaluating social rehabilitation of aggression for persons with Acquired Brain Injury: a systematic review

FYI. Acquired brain injury refers to any type of brain damage that happens after birth.

 Evaluating social rehabilitation of aggression for persons with Acquired Brain Injury: a systematic review

Tahnee Guala

,

Travis Harries

,

Kira Button

,

Dominique de Andrade

,

Peter Miller

,

Lorraine Tonner

, show all

Received 22 Mar 2024, Accepted 09 Jul 2024, Published online: 21 Jul 2024

• Cite this article
• https://doi.org/10.1080/09638288.2024.2380475
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• Abstract
• IMPLICATIONS FOR REHABILITATION
• Introduction
• Method
• Results
• Discussion
• Conclusion
• Disclosure statement
• Additional information
• References
• Appendixes

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Abstract

Purpose

Social rehabilitation of aggression following an Acquired Brain Injury (ABI) is critically important for persons with ABI due to increased vulnerability of criminal behaviour related to post-injury changes in functioning. This review presents findings from studies that evaluated aggression interventions in both community and forensic populations of people with ABI.

Methods

We searched PsycINFO, EMBASE, SocINDEX, CINAHL and Medline databases for studies published between 1^st January 2000 and 15^th October 2023.

Results

There were 15 studies (14 community-based, one forensic) that met inclusion criteria. Pharmacological management (6) was largely ineffective and anger management interventions (6) presented with inconsistent effectiveness. Emotion regulation (1) may be effective for externalised aggression. Both mindfulness and transcranial direct current stimulation (1) were effective, and the results of a forensic peer group approach (1) were not tested for statistical significance. There was variability in the measurement of aggression, injury severity, and cognitive impairment.

Conclusions

Whilst community interventions for aggression in persons with ABI are prevalent, findings for effectiveness have been mixed and there is a paucity of evaluated interventions in forensic samples. Further research is needed to unravel the complex interplay of factors contributing to aggression and develop effective social rehabilitation for persons with ABI.

IMPLICATIONS FOR REHABILITATION

• Social rehabilitation is critical following an Acquired Brain Injury (ABI) due to increased risk of displaying challenging behaviours, such as aggression, that may significantly reduce an individual's quality of life.

• The current review highlights a lack of suitable interventions targeting aggression for individuals with ABI that account for injury-related impairments which impact capacity to engage in intervention.

• Findings emphasise the need to develop appropriate and relevant social rehabilitation interventions for aggression in ABI populations, particularly forensic populations, to prevent negative outcomes.

How do people with acquired brain injury interpret the Valued Living Questionnaire? A cognitive interviewing study

 This does nothing to get survivors recovered. Useless.

How do people with acquired brain injury interpret the Valued Living Questionnaire? A cognitive interviewing study

Author links open overlay panelHannahMiller^a

DavidLawson^aEmmaPower^bRoshandas Nair^cdNickSathananthan^aDanaWong^a

https://doi.org/10.1016/j.jcbs.2022.01.003Get rights and content

Highlights

•

Key problems with the comprehension of the VLQ in an ABI sample were identified.

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The VLQ needs to be adapted to accommodate cognitive difficulties.

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Researchers and clinicians can support people with ABI to understand VLQ items.

Abstract

Background

The accurate evaluation of valued living in people with acquired brain injury (ABI) is important for measuring the outcome of interventions targeting valued living. The Valued Living Questionnaire (VLQ) is one of the most widely used measures, however its validity in an ABI cohort may be affected by the cognitive demands associated with evaluating the value-consistency of actions in the past week.

Objectives

We aimed to systematically identify common difficulties or errors associated with the comprehension and completion of the VLQ in people with ABI in order to guide a potential adaptation of the measure.

Methods

Adults with an ABI (traumatic brain injury, stroke, tumour), experiencing cognitive difficulties and/or emotional distress impacting participation in valued activities, were invited to participate in a cognitive interview which probed their understanding of the VLQ. Concurrent verbal probing was used, whereby scripted verbal probes were asked alongside each questionnaire item as it was being rated by participants. Interviews were transcribed and analysed by combining data pertaining to each item and aggregating these across interviews to highlight common comprehension errors or difficulties.

Results

There were 11 participants (mean age = 59.55 years, SD = 12.84; mean education = 14.73 years, SD = 2.87) with a range of ABI aetiologies (7 stroke, 2 TBI, 2 tumour). Common difficulties with the VLQ included confusion caused by question phrasing and structure of the measure, errors due to the cognitive demands associated with rating the importance of abstract values and value-consistency of actions in the last week, and problems with the rating scale.

Conclusions

Key problems with the validity of the VLQ within an ABI sample were identified due to comprehension errors relating to its structure and content. Findings will inform an adapted version, suited to the needs of individuals with ABI-associated cognitive difficulties.

 

Bioinformatic Analysis of Co-Expressed Differentially Expressed Genes and Potential Targets for Intracerebral and Subarachnoid Hemorrhage

 WHOM did you contact to get the stroke strategy updated and further research initiated? No contact, then this was a waste of time and money.

Bioinformatic Analysis of Co-Expressed Differentially Expressed Genes and Potential Targets for Intracerebral and Subarachnoid Hemorrhage

Author links open overlay panelFeiYe¹²JieLiang¹²TianzhuWang³XiaoxinWu¹JiaoxingLi¹KaiLan⁴⁵WenliSheng¹²

https://doi.org/10.1016/j.wneu.2021.12.070Get rights and content

ABSTRACT

BACKGROUND

Intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) are serious subtypes of hemorrhagic stroke that affect adults and have a high risk of morbidity and mortality; both share certain identical risk factors and clinical features. Recent studies have shown that secondary brain injury (SBI) following ICH and SAH is more life-threatening and lacks effective therapeutic strategies. The aim of this study is to understand the molecular pathogenesis of ICH- or SAH-induced SBI and provide insights to the potential therapeutic options.

METHODS

The original gene expression profile data of tissue microarray studies (GSE24265, GSE13353) was downloaded from the Gene Expression Omnibus (GEO) database. We identified the differentially expressed genes (DEGs) for each disease and co-DEGs between ICH and SAH. The functional enrichment analyses were then analyzed and a protein-protein interaction (PPI) network was constructed to strictly select hub genes via the maximal clique centrality (MCC) method. Additionally, immune infiltration analyses were used to identify the common differently distributed cells in both diseases. Finally, potential target microRNAs (miRNAs) and related targeted drugs were predicted for further studies. The animal model microarrays were used for external validation.

RESULTS

A total of 614 ICH-DEGs, 1272 SAH-DEGs, and 158 co-DEGs were identified in our study. The co-DEGs were significantly enriched in cytotoxicity and inflammation pathways. The top 10 hub genes (CCL20, CXCL1, CXCL3, CXCL8, CXCL16, CXCR2, CXCR4, CCR7, PF4, and PPBP) were then filtered through the PPI networks. Moreover, nTreg, Th17, and dendritic cells and monocytes and macrophages were identified as the common differentially distributed immune cells between ICH and SAH. Additionally, the target miRNAs (e.g., miR-21-5p, miR-590-5p, miR-6834-3p) and related drugs (e.g., ABX-IL8, HUMAX-IL8, Rivanicline) of hub genes were predicted.

CONCLUSIONS

This study identified a variety of key genes and their respective molecular functions involved in both ICH and SAH for better understanding of the cytotoxic and inflammatory pathogenesis of SBI. The predicted targeted miRNAs and related drugs of hub genes not only provide insights into the novel therapeutic strategies but also aid in future studies and drug discovery.

 

Integrated neuropsychological and cognitive behavioural therapy after acquired brain injury: A pragmatic randomized clinical trial

Someplace in here is something but you'll have to decipher it yourself.

Integrated neuropsychological and cognitive behavioural therapy after acquired brain injury: A pragmatic randomized clinical trial

Cornelia Exner, Bettina K. Doering, Nico Conrad, Anna Künemund, Sarah Zwick, Kerstin Kühl, show all

Received 16 Oct 2020, Accepted 22 Mar 2021, Published online: 05 Apr 2021

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• https://doi.org/10.1080/09602011.2021.1908902

 

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ABSTRACT

After acquired brain injury (ABI) many patients suffer from persistent cognitive and emotional disturbances. The aim of this study was to investigate the treatment outcome of an integrated intervention, combining neuropsychological and cognitive behavioural therapy (nCBT), against waitlist (WL) in outpatients with ABI. Individuals seeking outpatient treatment for cognitive and emotional problems after ABI were randomly allocated to nCBT (n = 27) or WL (n = 29) and completed assessments at baseline, post-treatment/WL and at six-month follow-up. The primary outcome measures were general psychopathology and functional activity in daily life. The nCBT group showed significant improvement for general psychopathology post-treatment when compared to WL. nCBT was also superior to WL regarding the secondary outcomes, i.e., the reduction of negative affect and the improvement of quality of life. No significant differences for functional activity and community integration were observed. Significant pre–post effect sizes ranged between small for functional activity and medium for quality of life. The positive effects were maintained at follow-up. The majority of patients with cognitive and emotional problems after ABI benefit from an integrated approach that offers cognitive remediation and psychotherapy. However, the heterogeneous sequelae of ABI and the moderate sample sizes in clinical trials present a methodological challenge to ABI research

 

A new scale for measuring quality of life in acquired brain injury

I can't find the CAVIDACE scale to see what my quality of life is. 

A new scale for measuring quality of life in acquired brain injury

Fernández M^1,2, Gómez LE^3,4, Arias VB^5,4, Aguayo V^5,4, Amor AM^5,4, Andelic N^6,7, Verdugo MA^5,4.

Author information

Abstract

PURPOSE:

A common and frequent consequence of an acquired brain injury (ABI) is the diminished quality of life (QoL) of affected people. Because the majority of existing QoL instruments assess health-related domains, new instruments that allow for the evaluation of the QoL from an integral perspective that considers the context and personal factors of the individual are warranted. Hence, the purpose of this study is to develop and validate an instrument with these characteristics.

METHODS:

The CAVIDACE scale is a new 64-item specific instrument to assess QoL in people with ABI based on a third-person perspective. The validation sample comprises 421 adults with ABI, with ages ranging from 17 to 90 years (M = 53.12; SD = 14.87). The scale was completed by 97 professionals and 58 family members. Validity evidence based on the internal structure of the scale was provided through confirmatory factor analyses. Reliability was analyzed in terms of internal consistency and inter-rater reliability.

RESULTS:

The results supported the internal structure of the scale, based on the theoretical and assessment framework in which QoL is composed of eight intercorrelated first-order domains (CFI = 0.890, RMSEA = 0.065, SRMR = 0.071). The internal consistency was good or excellent for the eight domains (ordinal alpha ranging from 0.77 to 0.93). The inter-rater reliability was very high (0.97).

CONCLUSIONS:

The CAVIDACE scale is found to be a specific instrument with excellent psychometric properties that is helpful for the assessment of QoL in people with ABI, both in clinical practice and for research purposes.

KEYWORDS:

Acquired brain injury; CAVIDACE scale; Evidence-based practices; Outcome measure; Psychometric properties; Quality of life

PMID:

30448910

DOI:

10.1007/s11136-018-2047-5

Evidence for Training-Dependent Structural Neuroplasticity in Brain-Injured Patients: A Critical Review

We don't want guided treatment, we want results you blithering lazy idiots. GET THERE AND NO EXCUSES. 

Evidence for Training-Dependent Structural Neuroplasticity in Brain-Injured Patients: A Critical Review 

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Karen Caeyenberghs, PhD¹

Karen Caeyenberghs

1Australian Catholic University, Melbourne, Victoria, Australia
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, Adam Clemente¹*

Adam Clemente

1Australian Catholic University, Melbourne, Victoria, Australia
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, Phoebe Imms¹

Phoebe Imms

1Australian Catholic University, Melbourne, Victoria, Australia
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,

Gary Egan, PhD²

Gary Egan

2Monash University, Clayton, Victoria, Australia
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, Darren R. Hocking, PhD³

Darren R. Hocking

3La Trobe University, Melbourne, Victoria, Australia
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, Alexander Leemans, PhD⁴

Alexander Leemans

4University Medical Center Utrecht, Utrecht, Netherlands
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, Claudia Metzler-Baddeley, PhD⁵

Claudia Metzler-Baddeley

5Cardiff University, Cardiff, UK
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, Derek K. Jones, PhD⁵

Derek K. Jones

5Cardiff University, Cardiff, UK
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, Peter H. Wilson, PhD¹

Peter H. Wilson

1Australian Catholic University, Melbourne, Victoria, Australia
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...

First Published January 22, 2018 Review Article

https://doi.org/10.1177/1545968317753076

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Article Information

Article first published online: January 22, 2018

https://doi.org/10.1177/1545968317753076

Karen Caeyenberghs, PhD¹, Adam Clemente¹*, Phoebe Imms¹, Gary Egan, PhD², Darren R. Hocking, PhD³, Alexander Leemans, PhD⁴, Claudia Metzler-Baddeley, PhD⁵, Derek K. Jones, PhD⁵, Peter H. Wilson, PhD¹

¹Australian Catholic University, Melbourne, Victoria, Australia

²Monash University, Clayton, Victoria, Australia

³La Trobe University, Melbourne, Victoria, Australia

⁴University Medical Center Utrecht, Utrecht, Netherlands

⁵Cardiff University, Cardiff, UK

Corresponding Author: Karen Caeyenberghs, School of Psychology, Faculty of Health Sciences, Australian Catholic University, 115 Victoria Parade, Melbourne, Victoria 3065, Australia. Email: karen.caeyenberghs@acu.edu.au

*Shared first author.

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Abstract

Acquired brain injury (ABI) is associated with a range of cognitive and motor deficits, and poses a significant personal, societal, and economic burden. Rehabilitation programs are available that target motor skills or cognitive functioning. In this review, we summarize the existing evidence that training may enhance structural neuroplasticity in patients with ABI, as assessed using structural magnetic resonance imaging (MRI)–based techniques that probe microstructure or morphology. Twenty-five research articles met key inclusion criteria. Most trials measured relevant outcomes and had treatment benefits that would justify the risk of potential harm. The rehabilitation program included a variety of task-oriented movement exercises (such as facilitation therapy, postural control training), neurorehabilitation techniques (such as constraint-induced movement therapy) or computer-assisted training programs (eg, Cogmed program). The reviewed studies describe regional alterations in white matter architecture and/or gray matter volume with training. Only weak-to-moderate correlations were observed between improved behavioral function and structural changes. While structural MRI is a powerful tool for detection of longitudinal structural changes, specific measures about the underlying biological mechanisms are lacking. Continued work in this field may potentially see structural MRI metrics used as biomarkers to help guide treatment at the individual patient level.