DOCSLIB.ORG

Cognitive Rehabilitation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cognitive Rehabilitation Chapter 12: Cognitive Rehabilitation Abstract Vascular cognitive impairment is the current term that reflects the range of cognitive deficits due to the impact of cerebrovascular disease, including stroke. According to the Canadian Study of Health and Aging (2000), it is estimated that 5% of all people over the age of 65 years have evidence of vascular cognitive impairment. The risk for cognitive impairment or decline is augmented by a history of stroke. As many as two-thirds of patients experience cognitive impairment or decline following stroke and approximately one third develop dementia. Risk for developing dementia may be up to 10 times greater among individuals with stroke than for those without. In this review, we examine issues regarding the definition, prevalence, and natural history of post-stroke cognitive impairment as well as its clinical consequences. Treatment interventions are identified, including cognitive rehabilitation strategies for remediation of deficits in attention, memory, executive function, and problem solving; nerve and brain stimulation; exercise programs; music listening; and pharmacotherapy. Marcus Saikaley, BSc Jerome Iruthayarajah, MSc Magdalena Mirkowski, MSc MScOT OT Reg. (Ont.) Steven Macaluso, MD Katherine Salter, PhD Alex Badour, MD candidate Gail Eskes Phd Robert Teasell, MD www.ebrsr.com Page 1 Chapter 12: Cognitive Rehabilitation Interventions Table of contents Key points ................................................................................................................................ 4 Modified Sackett Scale ............................................................................................................ 6 New to the 19th edition of the Evidence-based Review of Stroke Rehabilitation ................. 7 Outcome measures definitions ............................................................................................... 9 Attention ....................................................................................................................... 9 Executive function ...................................................................................................... 11 Learning and Memory ................................................................................................. 14 Visuospatial Perception and Orientation ..................................................................... 17 Global Cognition ......................................................................................................... 18 Amusia........................................................................................................................ 21 Activities of Daily Living .............................................................................................. 22 Introduction .............................................................................................................................24 Defining cognitive impairment post-stroke .................................................................. 24 Issues in diagnosis and assessment of cognitive impairment..................................... 26 Prevalence and natural history of cognitive impairment post-stroke ........................... 27 Impact of cognitive impairment on rehabilitation outcomes ........................................ 28 Cognitive rehabilitation ............................................................................................... 29 Cognitive Remediation ...........................................................................................................30 Attentional Training ..................................................................................................... 30 Memory Training ......................................................................................................... 33 Mental Imagery ........................................................................................................... 36 Therapy-based Interventions .................................................................................................39 Cognitive-motor Interference ...................................................................................... 39 Exercise Programs ..................................................................................................... 43 Multimodal .................................................................................................................. 48 Music Therapy ............................................................................................................ 52 Social and behavioural strategies .........................................................................................55 Board Games ............................................................................................................. 55 Pager Prompting System ............................................................................................ 57 Occupational Workplace Intervention ......................................................................... 59 Error and Errorless training ......................................................................................... 61 Problem solving therapy ............................................................................................. 63 Technological Interventions ...................................................................................................65 Computer-based Cognitive Training ........................................................................... 65 Virtual Reality Training ............................................................................................... 70 Non-invasive brain stimulation ..............................................................................................74 Repetitive Transcranial Magnetic Stimulation (rTMS) ................................................. 74 Transcranial Direct-current Stimulation (tDCS) ........................................................... 78 Pharmaceuticals .....................................................................................................................80 Antihypertensives ....................................................................................................... 80 Actovegin .................................................................................................................... 85 www.ebrsr.com Page 2 Gaba Agonists ............................................................................................................ 87 Nimodipine .................................................................................................................. 89 Vinpocetine ................................................................................................................. 91 Citicoline ..................................................................................................................... 93 Antidepressants .......................................................................................................... 96 Selegiline .................................................................................................................... 99 Rivastigmine ............................................................................................................. 102 Alternative and complementary medicine ........................................................................... 105 Traditional Chinese Medicine ................................................................................... 105 Acupuncture ............................................................................................................. 108 Electroacupuncture ................................................................................................... 111 References ............................................................................................................................ 114 www.ebrsr.com Page 3 Key points Attentional training may not be helpful for improving cognitive rehabilitation. The literature is mixed regarding memory training for cognitive rehabilitation. Mental imagery may be beneficial for improving attention, and activities of daily living. Mental imagery may not be beneficial for improving learning and memory. The literature is mixed regarding cognitive-motor interference for cognitive rehabilitation. Exercise may be beneficial for improving learning and memory, and overall cognitive abilities. Exercise may not be beneficial for improving attention or executive function. Higher intensity exercises may not be more beneficial than lower intensity exercises for improving cognition. The literature is mixed regarding multimodal interventions for improving cognitive rehabilitation. Music therapy may not be helpful for improving cognitive rehabilitation. Board games and puzzles may not be helpful for improving global cognition. Pager prompting systems may be beneficial for improving activities of daily living. Occupational workplace intervention may be beneficial for improving activities of daily living, but not global cognition. Trial and error training may not have greater efficacy than errorless training for improving cognitive rehabilitation. Problem solving therapy may not be beneficial for improving activities of daily living. The literature is mixed regarding computer-based training for improving attention. Computer -based training may not be helpful for improving executive function or global cognition. Virtual reality may not be beneficial for improving
Load more

Recommended publications
  • Assessing Executive Function in Preschoolers
    Neuropsychol Rev (2012) 22:345–360 DOI 10.1007/s11065-012-9220-3 REVIEW Assessing Executive Function in Preschoolers Peter J. Anderson & Natalie Reidy Received: 2 August 2012 /Accepted: 19 October 2012 /Published online: 30 October 2012 # Springer Science+Business Media New York 2012 Abstract Executive function develops at an unprecedented 1989; Diamond and Goldman-Rakic 1989). An appreciation rate during the preschool period, yet few clinicians attempt of the goal directed behaviors of infants and toddlers in the to assess executive processes in young children. The prima- 1980s initiated a substantial body of research examining the ry objective of this article is to demonstrate that executive development of executive function in early childhood, pre- function can be assessed in preschoolers, and to highlight dominantly from developmental psychology and develop- the importance of detecting executive dysfunction as early mental neuroscience fields. Certainly our understanding of as possible. Following a description of executive function executive function development in preschoolers is now far and the underlying neural systems, this article outlines some more advanced than it was a few decades ago. of the challenges in assessing executive function in young Despite these advances in knowledge, pediatric neuro- children. The various assessment paradigms used for assess- psychologists continue to avoid detailed assessments of ing executive function in preschoolers are presented, and executive function until clients reach school-age. Even in based on studies that have applied these measurement tools research of brain injured clinical populations, executive normal development of executive domains is described. function is rarely a focus before children are deemed school Finally, the benefits and opportunities for executive function ready.
    [Show full text]
  • Short-Term Memory
    Factsheet 2. Making Working Memory Work for Educational Psychologists. Short-Term Memory Written by Debbora Hall and Chris Jarrold, March 2015 Theoretical background In Factsheet 1, we discussed Baddeley’s (1986) model of working memory, and how it has served as a useful framework for thinking about domain specific stores for verbal and visuo-spatial material, with general ‘executive’ resources. We added speed of processing to this model, and the ability to resist distraction. Here we will focus on the short-term memory aspect of working memory. Short-term memory is a core component of working memory (Colom et al., 2014). Short-term memory for verbal information is often measured using digit span, in which individuals are presented with increasing lists of digits, until they can no longer recall the list in correct serial order. The last point at which recall was perfect is called their span level. To measure a child’s visuo-spatial short-term memory, tasks like the Corsi span task can be used (Milner, 1971). In this procedure, children are presented with an array of randomly arranged blocks, and the psychologist points to a sequence of blocks. The child must recall the blocks in the order presented. Again, their span is the maximum number of blocks that they correctly tap in the correct sequence. Our game ‘Capacity Limits’ provides a computer analogue of the digit span task and the Corsi span task. In the verbal memory game, children can be presented with increasing lists of digits. In the visual memory game, they need to remember the sequence of lily pads a frog hopped to and from.
    [Show full text]
  • I CONFIRMATORY FACTOR ANALYSIS of the NEPSY: A
    CONFIRMATORY FACTOR ANALYSIS OF THE NEPSY: A DEVELOPMENTAL NEUROPSYCHOLOGICAL ASSESSMENT, SECOND EDITION IN A MIXED CLINICAL SAMPLE OF CHILDREN A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE GRADUATE SCHOOL OF THE TEXAS WOMAN’S UNIVERSITY COLLEGE OF ARTS AND SCIENCES TEXAS WOMAN’S UNIVERSITY BY CRISTINA SEVADJIAN, B.A., M.A. DENTON, TEXAS AUGUST 2014 i Copyright © Cristina Sevadjian, 2014 rights reserved. iii DEDICATION This dissertation is dedicated to my father, Dale Petrini, whose steadfast love, support, guidance, and encouragement has profoundly impacted the woman I have become. Thank you for reminding me that I could do anything I set my mind to. iv ACKNOWLEDGEMENTS This dissertation is the culmination of years of support, encouragement, and guidance from many individuals; therefore, I would like to take this opportunity to express my utmost gratitude. I would like to first and foremost thank Him who makes all things possible and blessed me in a multitude of ways. Greg, you have provided amazing stability, sacrifice, and support which has allowed my dreams and aspirations to become our reality. I would like to thank my grandparents for valuing and providing opportunities for higher education. To my family (Beth, Bruce, Grandma Mary Louise, Dale, Rita, Michael, Kristen, Thomas, Christopher, Allison, Jonathan, Karis, Jan, Aimee, Clint, Maddie, Lily Claire, Sutton, Emile, Becky, Bryant, Bradley, and Blake) I cannot express how much your love has meant to me throughout this process. My best friends (Leslie, Carin, Jenny, Emily, Lindsay, Mckenzie, Shellie, Alicia, Rebecca, Jennifer, Chris, and Angie) thank you for years of support, patience, and interest in all my endeavors.
    [Show full text]
  • Cognitive Functions of the Brain: Perception, Attention and Memory
    IFM LAB TUTORIAL SERIES # 6, COPYRIGHT c IFM LAB Cognitive Functions of the Brain: Perception, Attention and Memory Jiawei Zhang [email protected] Founder and Director Information Fusion and Mining Laboratory (First Version: May 2019; Revision: May 2019.) Abstract This is a follow-up tutorial article of [17] and [16], in this paper, we will introduce several important cognitive functions of the brain. Brain cognitive functions are the mental processes that allow us to receive, select, store, transform, develop, and recover information that we've received from external stimuli. This process allows us to understand and to relate to the world more effectively. Cognitive functions are brain-based skills we need to carry out any task from the simplest to the most complex. They are related with the mechanisms of how we learn, remember, problem-solve, and pay attention, etc. To be more specific, in this paper, we will talk about the perception, attention and memory functions of the human brain. Several other brain cognitive functions, e.g., arousal, decision making, natural language, motor coordination, planning, problem solving and thinking, will be added to this paper in the later versions, respectively. Many of the materials used in this paper are from wikipedia and several other neuroscience introductory articles, which will be properly cited in this paper. This is the last of the three tutorial articles about the brain. The readers are suggested to read this paper after the previous two tutorial articles on brain structure and functions [17] as well as the brain basic neural units [16]. Keywords: The Brain; Cognitive Function; Consciousness; Attention; Learning; Memory Contents 1 Introduction 2 2 Perception 3 2.1 Detailed Process of Perception .
    [Show full text]
  • N-Back Versus Complex Span Working Memory Training
    JCognEnhanc https://doi.org/10.1007/s41465-017-0044-1 ORIGINAL ARTICLE N-back Versus Complex Span Working Memory Training Kara J. Blacker1 & Serban Negoita1 & Joshua B. Ewen1,2,3 & Susan M. Courtney 1,4,5 Received: 19 April 2017 /Accepted: 5 October 2017 # Springer International Publishing AG 2017 Abstract Working memory (WM) is the ability to maintain but not complex span task training. Participants completed and manipulate task-relevant information in the absence of adaptive training on either a dual n-back task, a symmetry sensory input. While its improvement through training is of span task, or on a non-WM active control task. We found great interest, the degree to which WM training transfers to evidence of near transfer for the dual n-back group; however, untrained WM tasks (near transfer) and other untrained cog- far transfer to a measure of fluid intelligence did not emerge. nitive skills (far transfer) remains debated and the mecha- Recording EEG during a separate WM transfer task, we ex- nism(s) underlying transfer are unclear. Here we hypothesized amined group-specific, training-related changes in alpha pow- that a critical feature of dual n-back training is its reliance on er, which are proposed to be sensitive to WM demands and maintaining relational information in WM. In experiment 1, top-down modulation of WM. Results indicated that the dual using an individual differences approach, we found evidence n-back group showed significantly greater frontal alpha power that performance on an n-back task was predicted by perfor- after training compared to before training, more so than both mance on a measure of relational WM (i.e., WM for vertical other groups.
    [Show full text]
  • NIMHANS Neuropsychological Battery
    NEUROCOGNITIVE FUNCTION AFTER CHEMO- RADIOTHERAPY FOR HEAD AND NECK CANCER - PROSPECTIVE STUDY A dissertation submitted to The Tamilnadu Dr. M.G.R. Medical University, Chennai, In partial fulfillment of the requirements for the award of the degree of DOCTOR OF MEDICINE (M.D.) IN RADIOTHERAPY - April 2016 CERTIFICATE This is to certify that this dissertation titled, “NEUROCOGNITIVE FUNCTION AFTER CHEMO-RADIOTHERAPY FOR HEAD AND NECK CANCER PROSPECTIVE STUDY” is a bonafide record of the work done by DR.HARIPRIYA.K, in the Division of Radiation Oncology, Cancer Institute (W. I. A.), Chennai, during the period of her postgraduate study for the degree of M.D. (Branch XI – Radiotherapy) from 2014-2015 under my direct guidance and supervision. Date: Dr.G.Selvaluxmy, Place: Chennai Professor and Head of Department, Division of Radiation Oncology, Cancer Institute, (WIA), Chennai . ACKNOWLEDGEMENT I am ever-grateful to Late. Dr. S. Krishnamurthi, Advisor, Dr. V. Shanta, Chairman, Cancer Institute (WIA), Adyar, for providing me all the facilities for this study. I express my gratitude to Dr. G.Selvaluxmy, Professor and H.O.D, Division of Radiation Oncology, for her encouragement, constant support and guidance throughout my postgraduate career and during this study. I also thank Dr. A.Vasanthan, Professor and chairman, Division of Radiation Oncology, for his support and advice throughout my post-graduate days and in this study. I am thankful to Dr.Vidhubala, Dr.Surendran, Ms.Deepika for their guidance and help with the neuropsychological assessment of patients included in the study. I am also thankful to Dr. Alexander John, Dr.M.N.Arun Kumar, Dr.C.Vasanth Christopher, Dr.Subha Vasanth for their support.
    [Show full text]
  • Working Memory Training: Assessing the Efficiency of Mnemonic Strategies
    entropy Article Working Memory Training: Assessing the Efficiency of Mnemonic Strategies 1, 2 1 1, Serena Di Santo y, Vanni De Luca , Alessio Isaja and Sara Andreetta * 1 Cognitive Neuroscience, Scuola Internazionale Superiore di Studi Avanzati, I-34136 Trieste, Italy; [email protected] (S.D.S.); [email protected] (A.I.) 2 Scuola Peripatetica d’Arte Mnemonica (S.P.A.M.), 10125 Turin, Italy; [email protected] * Correspondence: [email protected] Current address: Center for Theoretical Neuroscience, Columbia University, New York, NY 10027, USA. y Received: 6 April 2020; Accepted: 18 May 2020; Published: 20 May 2020 Abstract: Recently, there has been increasing interest in techniques for enhancing working memory (WM), casting a new light on the classical picture of a rigid system. One reason is that WM performance has been associated with intelligence and reasoning, while its impairment showed correlations with cognitive deficits, hence the possibility of training it is highly appealing. However, results on WM changes following training are controversial, leaving it unclear whether it can really be potentiated. This study aims at assessing changes in WM performance by comparing it with and without training by a professional mnemonist. Two groups, experimental and control, participated in the study, organized in two phases. In the morning, both groups were familiarized with stimuli through an N-back task, and then attended a 2-hour lecture. For the experimental group, the lecture, given by the mnemonist, introduced memory encoding techniques; for the control group, it was a standard academic lecture about memory systems. In the afternoon, both groups were administered five tests, in which they had to remember the position of 16 items, when asked in random order.
    [Show full text]
  • Comparing Methods to Evaluate Cognitive Deficits in Commercial Airline Pilots
    Comparing Methods to Evaluate Cognitive Deficits in Commercial Airline Pilots Joshua Potocko, MD/MPH UCSF Occupational and Environmental Medicine Residency 30 Min Background Philosophy Scope Comparisons Evidence Review: Example Questions for the Group BACKGROUND LCDR Joshua R. Potocko, MC (FS/FMF), USN “The views expressed in this presentation reflect the results of research conducted by the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government.” Potocko’s 6 Proclamations: Certain baseline cognitive functions decline with age. Within an individual, these declines are difficult to predict. Between individuals, different types of decline are variable. Understanding the following are critically important to aviation safety: Age-related declines Temporary disturbances in cognitive function, Stable (or progressive) baseline disturbances due to injury, illness, disease, medication, and substance use. When does cognitive dysfunction become unsafe? Cognitive Function Typical, Normal, Adequate, Average Cognitive Inefficiency Circadian, Fatigue, Mood, Stress Cognitive Deficiency Injury, Illness, Meds, Substances Cognitive Disability Above plus regulatory decisions => requires safety factor Baseline New Baseline Unfit Period Injury Illness Meds Baseline Progressive Decline Age XX? Permanently Unfit Disease? PHILOSOPHY Research Question: What is the “best” way to evaluate cognitive deficits in airline pilots? Best: historical? expert opinion?...or
    [Show full text]
  • The Development of Problem-Solving Abilities in Typical and Atypical Development
    The Development of Problem-Solving Abilities in Typical and Atypical Development Joanne Sara Camp Submitted for the degree of Doctor of Philosophy Institute of Education, University of London 1 Abstract Throughout our lives we engage in problem solving, which is thought to depend on executive functions (EFs) e.g., inhibition, shifting and working memory. Previous work has identified the need to consider these abilities in an everyday context. EF skills are known to be impaired in Williams syndrome (WS) and Down syndrome (DS). This thesis aims to investigate experimental and real-life problem solving in WS and DS, and how these groups use EF skills to solve problems, through experimental and questionnaire-based cross-syndrome comparisons. Participants with WS and DS aged 12-24 years (Ns=20) and typically developing (TD) controls (N=56; nonverbal matched subset = 20) completed the Tower of London (TOL) problem-solving task and a battery of EF tests. In a separate study, parents (WS, DS, TD; total N=112) completed the BRIEF (Behavioral Rating Inventory of Executive Functioning) and a novel Problem-Solving Questionnaire. The WS group, but not the DS group, scored more poorly on the TOL than the nonverbal-matched controls. In WS, developmental trajectory analysis indicated over- reliance on planning for TOL performance for low planning scores. For the DS group only speed of picture matching was associated with TOL performance, while more rule violations were exhibited than for the WS group. Questionnaire scores were poor for the WS group in relation to DS and TD groups. Asking for help for the DS group, and becoming emotional for the WS group, was related to reaching the solution.
    [Show full text]
  • Cognitive Factors and Gender Related to Self-Reported Difficulties in Older Drivers
    PROCEEDINGS of the Fourth International Driving Symposium on Human Factors in Driver Assessment, Training and Vehicle Design COGNITIVE FACTORS AND GENDER RELATED TO SELF-REPORTED DIFFICULTIES IN OLDER DRIVERS Inês S. Ferreira,1 José F. Marmeleira,2 Mário B. Godinho,3 Mário R. Simões1 1 Faculdade de Psicologia e de Ciências da Educação University of Coimbra, Portugal E-mail: [email protected] 2 Departamento de Desporto e Saúde University of Évora, Portugal 3 Faculdade de Motricidade Humana Technical University of Lisbon, Portugal Summary: The purpose of this study is to determine the association between self- reported driving difficulties among older drivers and scores on specific cognitive tests. A cross-sectional study of 38 car drivers (22 men and 16 women), aged 61- 81 was carried out. The participants were volunteers recruited from two senior universities and a university health program for older drivers, in the area of Lisbon, Portugal. A battery of visual, psychomotor and cognitive measures was undertaken with a questionnaire about driving difficulties in a sample of healthy older adults. Difficulties in driving were the dependent variable in this study, defined as any reported difficulty in ≥ 4 driving situations. After a multivariate analysis, the independent factors significantly associated with driving difficulties were divided attention subtest of UFOV® (p=0.013), number of trials with success in the Tower of London (p=0.015) and gender (p=0.021). The drivers that reported difficulties in ≥ 4 driving situations made significantly less trials with success in the Tower of London test, had lower performances in divided attention between central and peripheral targets, and were more frequently females.
    [Show full text]
  • Training and Transfer Effects with a Complex Working Memory Span Task
    Psychonomic Bulletin & Review 2010, 17 (2), 193-199 doi:10.3758/PBR.17.2.193 BRIEF REPORTS Expanding the mind’s workspace: Training and transfer effects with a complex working memory span task JASON M. CHEIN AND A LEXANDRA B. MORRISON Temple University, Philadelphia, Pennsylvania In the present study, a novel working memory (WM) training paradigm was used to test the malleability of WM capacity and to determine the extent to which the benefits of this training could be transferred to other cognitive skills. Training involved verbal and spatial versions of a complex WM span task designed to emphasize simultaneous storage and processing requirements. Participants who completed 4 weeks of WM training demon- strated significant improvements on measures of temporary memory. These WM training benefits generalized to performance on the Stroop task and, in a novel finding, promoted significant increases in reading comprehen- sion. The results are discussed in relation to the hypothesis that WM training affects domain-general attention control mechanisms and can thereby elicit far-reaching cognitive benefits. Implications include the use of WM training as a general tool for enhancing important cognitive skills. Practice can yield remarkable levels of achievement fluence recall from WM by expanding the capacity of atten- but little generalization. For example, Ericsson and Chase tion. Likewise, others have demonstrated that WM training (1982) reported the illustrative case of a college student can impact domain- general cognitive control mechanisms who, following many hours of practice on a digit-span task (Klingberg et al., 2005; Klingberg, Forssberg, & Wester- (an often used measure of short-term memory [STM]), berg, 2002), interference resolution processes (Persson & could successfully recall over 80 randomly ordered digits.
    [Show full text]
  • Introducing Neuropsychology, Second Edition
    Introducing Neuropsychology Introducing Neuropsychology, second edition investi- edition, key topics are dealt with in separate focus gates the functions of the brain and explores the boxes, and “interim comment” sections allow the relationships between brain systems and human reader a chance to “take stock” at regular intervals. behaviour. The material is presented in a jargon-free, The book assumes no particular expertise on easy to understand manner and aims to guide the reader’s part in either psychology or brain students new to the field through current areas of physiology. Thus, it will be of great interest not only research. to those studying neuropsychology and cognitive Following a brief history of the discipline and a neuroscience, but also to medical and nursing description of methods in neuropsychology, the students, and indeed anyone who is interested in remaining chapters review traditional and recent learning about recent progress in understanding research findings. Both cognitive and clinical aspects brain–behaviour relationships. of neuropsychology are addressed to illustrate the advances scientists are making (on many fronts) in John Stirling has worked at Manchester Polytechnic/ their quest to understand brain–behaviour relation- MMU for over 30 years, teaching Bio- and Neuro- ships in both normal and disturbed functioning. The psychology, Psychopathology and Experimental rapid developments in neuropsychology and cogni- Design and Statistics. He has published over 30 tive neuroscience resulting from traditional research scientific journal articles, and three books. methods as well as new brain-imaging techniques are presented in a clear and straightforward way. Each Rebecca Elliott has worked at the University of chapter has been fully revised and updated and new Manchester for 8 years, using brain-imaging tech- brain-imaging data are incorporated throughout, niques to study emotion and cognition in psychiatric especially in the later chapters on Emotion and disorders.
    [Show full text]