Cognitive rehabilitation: attention and neglect

Cognitive neuroscience can make a significant contribution towards the development of a scientific basis for the practice of brain rehabilitation. Though rehabilitation is a vast worldwide industry, there is little scientific basis for the training and therapy that are designed to help damaged brain circuits to recover. The systematic application of cognitive neuroscience models to rehabilitation can not only foster better, more theoretically grounded rehabilitation, but the models themselves can be tested and modified by data generated in rehabilitation-oriented research. The example of unilateral spatial neglect is used here to show how non-intuitive but clinically tractable methods can emerge out of systematic application of cognitive neuroscience to the problem of how to foster dynamic change and recovery in the damaged brain. Examples are given of recently developed rehabilitation methods for unilateral spatial neglect that are both derived from theoretical models of cognitive function, and that feed back into these models. These include dorsal–ventral stream interactions, perceptuo–motor interactions, interhemispheric inhibitory dynamics, and arousal–spatial attention interactions. It will be to the mutual benefit of basic cognitive neuroscience and rehabilitation if this type of research is expanded into other domains of cognitive function, in which similar theory–practice interactions exist.     

Rehabilitation Treatments for Adults with Behavioral and Psychosocial Disorders Following Acquired Brain Injury: A Systematic Review

This review was aimed at systematically investigating the treatment efficacy and clinical effectiveness of neurobehavioral rehabilitation programs for adults with acquired brain injury and making evidence-based recommendations for the adoption of these rehabilitation trainings. Using a variety of search procedures, 63 studies were identified and reviewed using a set of questions about research methods, treatments, results and outcomes for the 1,094 participants. The 63 studies included treatments falling into three general categories: approaches based on applied behavior analysis, interventions based on cognitive-behavior therapy (CBT), and comprehensive-holistic rehabilitation programs (CHRPs). Considerable heterogeneity exists in the reviewed literature among treatment methods and within reported sample subjects. Despite the variety of methodological concerns, results indicate that the greatest overall improvement in psychosocial functioning is achieved by CHRP that can be considered a treatment standard for adults with behavioral and psychosocial disorders following acquired brain injury. Both approaches based on applied behavior analysis and CBT can be said to be evidence-based treatment options. However, findings raise questions about the role of uncontrolled factors in determining treatment effects and suggest the need for rigorous inclusion/exclusion criteria, with greater specification of theoretical basis, design, and contents of treatments for both interdisciplinary-comprehensive approaches and single-case methodologies.     

The impact of enhanced incentives on vocational rehabilitation outcomes for dually diagnosed veterans

This study evaluated the efficacy of adding contingency management techniques to vocational rehabilitation (VR) to improve treatment outcome as measured by entry into competitive employment. Nineteen dually diagnosed veterans who entered VR in the Veterans' Administration's compensated work therapy (CWT) program were randomly assigned to CWT (n = 8) or to CWT with enhanced incentives (n = 11). Over the first 16 weeks of rehabilitation, those in the incentives condition could earn up to dollar 1,006 in cash for meeting two sets of clinical goals: (a) remaining abstinent from drugs and alcohol and (b) taking steps to obtain and maintain a competitive job. Results indicate that relative to participants in the CWT-only group, those in the incentives condition engaged in more job-search activities, were more likely to remain abstinent from drugs and alcohol, were more likely to obtain competitive employment, and earned an average of 68% more in wages. These results suggest that rehabilitation outcomes may be enhanced by restructuring traditional work-for-pay contingencies to include direct financial rewards for meeting clinical goals.     

Proportion of schizophrenia in inpatient treatment morbidity of a defined catchment area

The results of a survey performed on a specific date and an analysis of the discharge files are used as a starting point to discuss the large proportion of schizophrenics among the patients receiving ward treatment at hospitals. Many of these are chronic, long-term patients whose chances of being discharged decrease with increasing duration of hospitalisation. In contrast, instances of hospitalisation of acute schizophrenia cases in the region concerned has decreased considerably during the past 20 years as a result of the more consistent use of psychopharmaceutics and improved dispensary treatment. These modern forms of therapy can only yield optimal results, however, if all those concerned with rehabilitation show a good portion of sociopsychiatric involvement and nonmedical institutions also help with the therapy scheme.     

Stationäre Rehabilitation alkoholabhängiger Patienten

Systemic therapy concepts are widely used in therapy and rehabilitation of alcohol addictive patients. Although very useful in practice, evaluation studies are rare. Adequate evaluation strategies should be developed and implemented. This study was realized in a clinical rehabilitation centre (Hirtenstein, Allgäu/Germany), whose systemic concept is characterized by patient's wideranged possibilities of choice concerning therapy measures and therapy goals, the activation of social and personal resources, the development of an individually appropriate life-style, the training of desired competencies, and an offer for marital and family therapy. The evaluation is based on a repeated measures design without control group. The instruments and constructs of the evaluation are: F-SOZU (perceived social support), IIP (perceived interpersonal problems), MLDL (quality of life), SOC (sense of coherence), and an assessment sheet for personal resources (RI). Patients (n= 44) reported increased personal ressources as well as an increased level of quality of life. Perceived social support and the sense of coherence changed only moderately. Scaling of treatment satisfaction and goal attainment at the end of the rehabilitation program resulted in high positive scores. Patients reported only positive, no negative treatment side effects. The results indicate the usefulness of systemic and resource oriented concepts in the rehabilitation of alcohol addictive patients.     

布托啡诺预处理对减轻精神病患者MECT肌痛的作用

探讨对精神病人无抽搐电休克治疗（modified electroconvulsive therapy,MECT）后肌痛的治疗效果。选择我院MECT病人120人次,随机分为对照组和治疗组,于异丙酚复合琥珀胆碱静脉麻醉下进行MECT。治疗组病人在麻醉前5min静注布托啡诺1mg,结果显示,布托啡诺预处理可有效减轻精神病人MECT后的肌痛程度。     

The Effectiveness of Schema Therapy Integrated with Rehabilitation on Cognitive Emotion Regulation and Existential Anxiety in Patients with Congestive Heart Failure

Patients with congestive heart failure (CHF) are faced with various physical and psychological stressful factors, which ?leads to decreased quality of life. Considering the relationship between cognitive emotion regulation (CER) and existential anxiety with early maladaptive schemas, one of the methods capable of assisting the rehabilitation of the patients with CHF is the schema therapy. The current study aimed at determining the effectiveness of schema therapy integrated with rehabilitation on CER and existential anxiety in patients with CHF. The study was a true experimental with pretest/posttest design and a control group. The study sample was consisted of 25 patients with CHF in Guilan Province, Iran, 2017, selected by the convenience sampling method and assigned into two groups (one experimental and one control). To collect the data, cognitive emotion regulation questionnaire (CERQ) and existential anxiety inventory (EAI) were used before and after the intervention. A ten-session young schema therapy was implemented for the experimental group. Two-way ANOVA was used for data analysis and Cohen’s d test measured effect extent. The results of analysis showed that the group schema therapy integrated with rehabilitation improved CER and existential anxiety in patients with CHF (p?<?0.001). According to the findings of the research, schema therapy can improve the cognitive and emotional symptoms in patients with CHF.     

Jugenddelinquenz - Aktuelle Präventions - und Interventionskonzepte

This article presents an overview on the concepts and the outcomes of current prevention and intervention measures for juvenile delinquency and offender rehabilitation. The main focus is on a discussion of recent evaluation results. Social skills training, parent training programs, family-oriented early intervention, and multimodal school-based programs are discussed as prevention measures. Cognitive-behavioral and family therapy as well as diverse concepts of offender rehabilitation (e.g., boot camps) are delineated as intervention measures. The article concludes with an integrated evaluation of these results and a discussion of general theoretical and strategic issues.     

Possibilities and limits of rehabilitation in a young girl with total (global) aphasia

In the case discussed, the faculties retained and lost are described, and the aims and tasks of rehabilitation set out. The mode of procedure is elucidated by means of examples, the results achieved given, and the possible basis for the effectivity of the rehabilitation measures discussed.     

Out of the Ashes

SUMMARY

From the aftermath of a failed suicide attempt, a consumer describes her painful journey through a long course of psychosocial rehabilitation in a day treatment program, culminating in the cherished goal of emptoyment. As an individual with multiple disabilities, her past experience with occupational therapy in physical rehabilitation only addressed the presenting body part, not the whole person. Her feelings and need to learn emotional coping skills were not acknowledged until her desperate call for help through an overdose. In the process of becoming whole, she deals with the new stigma of an even more disabling label-mental illness.     

Occupational Therapy Intervention in the Treatment of Alcoholics

The first section of this article will provide the rationale for all occupational therapists to learn extensively about the isease of alcoholism regardless of area of practice or type of agency where employed. It will offer su estions on how this learning can take place. The second section will take an historic look at occupational therapy literature documenting the use of occupational therapy in alcoholism rehabilitation from 1941 to the present. It will describe modalities currently being used by occupational therapists in alcoholism rehabilitation and discuss expansion of occupational therapy in this practice area.     

A family-based approach to adult mental disorders

Recent research studies have provided strong support for a collaborative approach between families and mental health services in the clinical management of major mental disorders. A comprehensive approach to adult mental health care that employs cognitive-behavioural family therapy as the basis for clinical assessment and treatment is described. This model emphasizes home-based intervention, collaboration with primary care, targeted specific interventions, achievement of the personal goals of index patients and their family members, long-term rehabilitation, and assessment of benefits and costs.     

The early history of the behavior modification of stuttering: From laboratory to clinic

The knowledge of and attitudes toward stuttering of 152 Alabama vocational rehabilitation counselors were studied using the Alabama Rehabilitation Counselors' Attitudes Toward Stuttering (ARCATS) Inventory consisting of 25 true- false statements designed to assess knowledge of stuttering and 15 statements designed to assess attitudes toward stuttering. Counselors were found to perceive stuttering as being significantly vocationally handicapping and amenable to therapy and to perceive stutterers as almost always benefiting from therapy and as being good candidates for vocational rehabilitation. It was concluded that the vocational rehabilitation counselors studied hold attitudes facilitative to the rehabilitation of stutterers.     

Dominance and Dialogue in Couple Therapy for Psychological Intimate Partner Violence

Although there is controversy concerning indications for conjoint therapy in Intimate Partner Violence (IPV), both research and practice have come to recognize that it has some important benefits. This study analyzes issues of dominance and dialogue in a conjoint therapy for psychological IPV within a naturalistic setting, in which the spouses sought couple therapy on a voluntary basis. The method used to analyze the therapy was Dialogical Investigations of Happenings of Change (DIHC). Results on dominance indicated that the male client showed more quantitative dominance, whereas semantic dominance was more present in the female client, and therapists used more interactional dominance. Results on dialogue analysis showed that dialogical dialogue might help to construct a new-shared meaning of the issue of violence. In the Discussion section some research and clinical implications of the results are derived.     

Time use by inpatients receiving neurorehabilitation

Inpatients with stroke spend the vast majority of their time in non-therapeutic activities. Their engagement in more therapeutic time seems warranted on the basis of research on skill development and intensity of rehabilitation. Means of providing such time, although challenging, should be pursued and their benefits investigated.     

The Power of Perception: Toward a Model of Cultural Oppression and Liberation

Oppression is defined and identified as the basis of a considerable range of psychopathology. An exploratory transcultural model of counseling based on oppression is introduced with the goal of serving both oppressed and oppressive clients. Perception, as perspicacity, is the key to this exploratory model. The authors suggest that oppressed persons generally possess a considerable degree of perception of their oppressors even though they may be unaware of it. Research from the literature on depressive realism is used to infer support. Counseling approaches to oppressed persons are introduced including a new approach to cognitive therapy and an emphasis on liberation rather than adjustment. Counseling approaches to oppressors are also discussed based on the rehabilitation of empathy and perception.     

Conjunctive measurement of aquatic exercise in an office setting.

The Hydrotrack, a treadmill immersed in a water bath, is designed to provide an in-office approach to aquatic therapy. 24 clinical clients in an outpatient sports medicine practice were invited to use the Hydrotrack as part of their rehabilitation treatment. Our purpose was to describe the way(s) in which the Hydrotrack is useful in rehabilitation treatment. Exercise protocols designed by a physical therapist were used for each subject. We monitored an external criterion, heart rate, to measure the subjects' exertion during the exercise process. Self-reported ratings of exercise efficacy and exertion were also used to quantify the subjects' performance on the Hydrotrack. Heart-rate values and self-report ratings supported the usefulness of this device in physical therapy.     

Specificity in rehabilitation of word production: a meta-analysis and a case study

Speech production impairment is a frequent deficit observed in aphasic patients and rehabilitation programs have been extensively developed. Nevertheless, there is still no agreement on the type of rehabilitation that yields the most successful outcomes. Here, we ran a detailed meta-analysis of 39 studies of word production rehabilitation involving 124 patients. We used a model-driven approach for analyzing each rehabilitation task by identifying which levels of our model each task tapped into. We found that (1) all rehabilitation tasks are not equally efficient and the most efficient ones involved the activation of the two levels of the word production system: the phonological output lexicon and the phonological output, and (2) the activation of the speech perception system as it occurs in many tasks used in rehabilitation is not successful in rehabilitating word production. In this meta-analysis, the effect of the activation of the phonological output lexicon and the phonological output cannot be assessed separately. We further conducted a rehabilitation study with DPI, a patient who suffers from a damage of the phonological output lexicon. Our results confirm that rehabilitation is more efficient, in terms of time and performance, when specifically addressing the impaired level of word production.     

Training-based interventions in motor rehabilitation after stroke: theoretical and clinical considerations

Basic neuroscience research on brain plasticity, motor learning and recovery has stimulated new concepts in neurological rehabilitation. Combined with the development of set methodological standards in clinical outcome research, these findings have led to a double-paradigm shift in motor rehabilitation: (a) the move towards evidence-based procedures for the assessment of clinical outcome & the employment of disablement models to anchor outcome parameters, and (b) the introduction of practice-based concepts that are derived from testable models that specify treatment mechanisms. In this context, constraint-induced movement therapy (CIT) has played a catalytic role in taking motor rehabilitation forward into the scientific arena. As a theoretically founded and hypothesis-driven intervention, CIT research focuses on two main issues. The first issue is the assessment of long-term clinical benefits in an increasing range of patient groups, and the second issue is the investigation of neuronal and behavioural treatment mechanisms and their interactive contribution to treatment success. These studies are mainly conducted in the research environment and will eventually lead to increased treatment benefits for patients in standard health care. However, gradual but presumably more immediate benefits for patients may be achieved by introducing and testing derivates of the CIT concept that are more compatible with current clinical practice. Here, we summarize the theoretical and empirical issues related to the translation of research-based CIT work into the clinical context of standard health care.     

The adjunctive role of imagery on the functional rehabilitation of a grade II ankle sprain

The purpose of the present study was to examine the effectiveness of imagery on muscular endurance, dynamic balance, and functional stability in athletes who sustained a grade II ankle sprain. The sample consisted of 20 active athletes (aged from 18 to 30 years) with a grade II ankle sprain, as confirmed by ultrasound testing. The participants were randomly divided into two groups of 10 participants each; one experimental and one control group. The experimental group received 12 individual sessions of imagery rehearsal in addition to a normal course of physical therapy, while the control group followed only the physical therapy treatment. Results revealed significant differences only in the variable of muscular endurance. This study partly supports the contribution of imagery to the functional rehabilitation of grade II ankle sprain. Further research should be conducted to examine the effect of imagery on the functional rehabilitation of sport injuries using other tests of functional rehabilitation along with larger sample sizes.