Traumatic brain injury: Implications for practice

This article presents a brief overview of the prevalence and history of traumatic brain injury (TBI), discusses the multidimensional effects of TBI, describes the current focus of TBI rehabilitation, and summarizes outcomes from (re)habilitation work with individuals with traumatic brain injury. The importance of this critical area to rehabilitation personnel is discussed, along with suggestions for future research and evaluation studies.     

Neuropsychology in Denmark

The origins and development of neuropsychology in Denmark are briefly overviewed, as are the education and training opportunities for Danish neuropsychologists. Areas of application and research are presented, and the role of the rehabilitation of brain injury is emphasized, with specific reference being made to the Center for the Rehabilitation of Brain Injury at Copenhagen University, wherein the rehabilitation program and pertinent research ensuing from the center is presented. Future trends in Danish neuropsychology are also considered.     

Psychological injury rehabilitation lags behind physical rehabilitation: Elite athletes’ experiences and support within Chinese context

This qualitative study was focused on two objectives: to explore (a) Chinese elite athletes' perceptions of their rehabilitation experiences after severe acute injuries, and (b) support strategies facilitating their return to competition. We interviewed 10 Chinese elite athletes through a semi-structured interview guide consisting of open questions and requests for information about the participants’ injury and rehabilitation experiences. We utilized a reflexive thematic analysis to interpret participants’ accounts. Two themes are presented to reveal the Chinese elite athletes’ perceptions: (a) psychological injury rehabilitation lags behind physical rehabilitation and (b) post-injury psychological support within the CWNS.This study contributes to athlete rehabilitation scholarship by providing a unique Eastern, collective perspective embedded with the Chinese Whole Nation System (CWNS).     

I AM FAMILY: Understanding the adapted sport experiences of family members of military personnel with physical and psychological illnesses and injuries through the lens of the Invictus Games

Family are influential actors in adapted sport participation. However, little is known about their experiences with adapted sport. The current study sought to explore the experiences of families in adapted sport through the context of the Invictus Games, an international adapted sport competition for military personnel with physical and psychological illnesses and injuries that is unique in its inclusion of family programming. Family members (n = 21; partners, parents, siblings, and children) of Invictus Games Toronto 2017 competitors participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis. Three themes were identified: recognition of family experiences during service and after onset of disability; creating a sense of belonging; and improving family knowledge and perceptions. This study provides insight regarding how adapted sport events can support the well-being of both individuals with illnesses and injuries and their families.     

Aerobic exercise training ameliorates craving and inhibitory control in methamphetamine dependencies: A randomized controlled trial and event-related potential study

ObjectiveMethamphetamine (MA) usage has been recognized as a prominent substance-abuse issue. While exercise training reportedly improves fitness and mental status in the MA-dependent, how exercise training affects addiction and cognitive deficiency has yet to be established. The current study aimed to determine the effects of aerobic exercise training on both MA-associated cravings and inhibitory control among those with MA dependencies.DesignA 12-week randomized controlled trial.MethodSixty-two people with MA dependencies recruited through the Drug Rehabilitation Bureau were assigned to either an aerobic exercise or attentional control group, with 50 participants completing the trial. The aerobic exercise program involved three 30-min sessions of moderate-intensity exercise per week. Along with a pre-test assessment, craving levels were evaluated every three weeks, and data on neutral and MA-related inhibitory control as well as its elicited neuroelectric activation were collected at the end of the intervention.ResultsCompared with the control group, the exercise group experienced attenuated MA craving levels after 6 weeks of the exercise program, and the decreased trend was maintained until the termination of treatment. In the post-test, the exercise group also demonstrated more accuracy in behavioral inhibitory control as well as greater N2 amplitude in the Nogo condition of both the standard and MA-related tasks than those in the control group or pre-test.ConclusionsThe current study provides the first evidence that aerobic exercise training may be efficacious for MA-associated cravings and inhibitory control from behavioral and neuroelectric perspectives among MA-dependent individuals.     

Functional MRI of Language in Aphasia: A Review of the Literature and the Methodological Challenges

Animal analogue studies show that damaged adult brains reorganize to accommodate compromised functions. In the human arena, functional magnetic resonance imaging (fMRI) and other functional neuroimaging techniques have been used to study reorganization of language substrates in aphasia. The resulting controversy regarding whether the right or the left hemisphere supports language recovery and treatment progress must be reframed. A more appropriate question is when left-hemisphere mechanisms and when right-hemisphere mechanisms support recovery of language functions. Small lesions generally lead to good recoveries supported by left-hemisphere mechanisms. However, when too much language eloquent cortex is damaged, right-hemisphere structures may provide the better substrate for recovery of language. Some studies suggest that recovery is particularly supported by homologues of damaged left-hemisphere structures. Evidence also suggests that under some circumstances, activity in both the left and right hemispheres can interfere with recovery of function. Further research will be needed to address these issues. However, daunting methodological problems must be managed to maximize the yield of future fMRI research in aphasia, especially in the area of language production. In this review, we cover six challenges for imaging language functions in aphasia with fMRI, with an emphasis on language production: (1) selection of a baseline task, (2) structure of language production trials, (3) mitigation of motion-related artifacts, (4) the use of stimulus onset versus response onset in fMRI analyses, (5) use of trials with correct responses and errors in analyses, and (6) reliability and stability of fMRI images across sessions. However, this list of methodological challenges is not exhaustive. Once methodology is advanced, knowledge from conceptually driven fMRI studies can be used to develop theoretically driven, mechanism-based treatments that will result in more effective therapy and to identify the best patient candidates for specific treatments. While the promise of fMRI in the study of aphasia is great, there is much work to be done before this technique will be a useful clinical tool.     

Enhancing quality of life in medical populations: a vision for body image assessment and rehabilitation as standards of care

This article presents a vision and framework for establishing body image assessment and rehabilitation as a standard of care for patients with medical disorders. Making this vision a reality depends upon: (1) a thorough understanding of the body image construct; (2) application of many new forms of body image assessment; (3) refined understanding of body image disorder and dysfunction in the context of medical conditions; and (4) a clear plan to implement and evaluate prevention, rehabilitation, and treatment programs. Applying the many important developments that have occurred in body image theory, assessment, and intervention over the past decade holds promise for enhancing the quality of life of many individuals with medical conditions.     

Evaluating Single-Subject Treatment Research: Lessons Learned from the Aphasia Literature

The mandate for evidence-based practice has prompted careful consideration of the weight of the scientific evidence regarding the therapeutic value of various clinical treatments. In the field of aphasia, a large number of single-subject research studies have been conducted, providing clinical outcome data that are potentially useful for clinicians and researchers; however, it has been difficult to discern the relative potency of these treatments in a standardized manner. In this paper we describe an approach to quantify treatment outcomes for single-subject research studies using effect sizes. These values provide a means to compare treatment outcomes within and between individuals, as well as to compare the relative strength of various treatments. Effect sizes also can be aggregated in order to conduct meta-analyses of specific treatment approaches. Consideration is given to optimizing research designs and providing adequate data so that the value of treatment research is maximized.     

Older adults demonstrate greater accuracy in joint position matching using self-guided movements

Greater proprioceptive accuracy has been found with active compared to passive movement. Therapeutic approaches in rehabilitation include varying levels of assistance with arm movements. This assistance may impact proprioceptive acuity. Eighteen older adults participated in a joint repositioning study. The ability to independently reproduce a shoulder flexion angle was investigated when the reference angle was set under the following conditions: (1) the examiner actively assisted participant’s motion to the reference angle chosen by the examiner, (2) the participant moved independently, but the examiner provided tactile cueing to stop at the reference angle chosen by the examiner, and (3) the participant independently moved to a self-selected reference angle. Participants were most accurate in the self-guided condition compared to the active assisted or tactile cueing conditions. Both the self-guided and tactilely cued conditions involved active movement, yet accuracy differed. In contrast, there was no difference in accuracy between the active assisted and tactile cueing conditions despite one involving more active movement. The results demonstrate active movement alone does not determine accuracy. External stimuli, either tactile input and/or a reference angle chosen by the examiner may diminish accuracy. This can be clinically relevant as proprioceptive performance has been linked to improved motor performance.     

Rhythmic Auditory Music Stimulation increases task-distraction during exercise among cardiac rehabilitation patients: A secondary analysis of a randomized controlled trial

ObjectiveThe aim of this study was to determine the mechanisms by which Rhythmic Auditory Music Stimulation (RAMS) improves exercise among patients participating in cardiac rehabilitation.Methods168 English speaking patients over the age of 18 years, were recruited from the Cardiac Rehabilitation and Prevention Program. Participants were randomly assigned to one of three groups (n = 56 each) as part of a 12-week intervention: (1) RAMS (2) preference-based audiobooks, or (3) white noise or silence audio-controls. All participants received an iPod with the audio intervention to maintain blinding. Study outcomes included pace-deviation between actual vs. prescribed exercise, self-reported arousal, perceived exertion, task-attentiveness during exercise and perceptual experiences associated with the audio-content itself.Trial registryClinicaltrials. gov NCT02946060.ResultsAn individual's actual exercise pace was highly correlated with their prescribed exercise pace, with no significant differences in pace deviation across interventions (P = 0.61). Patients randomized to RAMS or audiobooks reported significantly lower arousal scores during exercise (P = 0.01), lower exercise-attentiveness (P < 0.001), and modestly lower perceived exertion (P = 0.06) during exercise than did controls. Participants assigned to RAMS and audiobooks reported being more attentive to, and happy with, their overall audio-experiences during exercise than controls (P < 0.001).ConclusionsRAMS playlists and audiobooks induced a mood-enhancing task-distraction effect during exercise. Such findings may underscore the potential benefits of preference-based audio-content during exercise.