Science-Based Neurorehabilitation: Recommendations for Neurorehabilitation From Basic Science

ABSTRACT

Neuroscience has fundamentally changed the understanding of learning and memory within recent years. Here, the authors discuss a number of specific areas where they believe new understanding of the CNS from basic science is having a fundamental impact on neurorehabilitation and is leading to new therapeutic approaches. These areas have constituted a basis for development of some basic principles for neurorehabilitation: Optimal rehabilitation should involve (a) active (patient) participation in the training, (b) training that does not only involve many repetitions, but also continues to challenge the skill of the training person, (c) motivation and reward, (d) intensive training and practice over a long time, (e) careful organization of the training in relation to other activities, and (f) incorporation of other potentially beneficial parameters such as sleep and diet. It should in this relation also be pointed out that albeit neurorehabilitation may be predicted to have the most optimal effect early in life and as soon after injury as possible, there is no reason to believe that beneficial effects of training may not be obtained late in life or several years after injury.     

A Fully Automated,Quantitative Test of Upper Limb Function

ABSTRACT. The Rehabilitation Joystick for Computerized Exercise (ReJoyce, Rehabtronics Inc., Edmonton, Alberta, Canada), is a workstation on which participants exercise dexterous movement tasks in the guise of computer games. The system incorporates the ReJoyce Arm and Hand Function Test (RAHFT). Here the authors evaluate the RAHFT against the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FMA). All 3 tests were performed in 36 separate sessions in 13 tetraplegic individuals. Concurrent and criterion validities of the RAHFT were supported by a high level of correlation with the ARAT (r² = .88). Regarding responsiveness, the effect size of the RAHFT at week 6 of 1 hr/day exercise training was 1.8. Regarding reliability, the mean test–retest difference in RAHFT baseline scores was 0.67% ± 3.6%, which was not statistically significant. The RAHFT showed less ceiling effect than either ARAT or FMA. These data help validate the RAHFT as a quantitative, automated alternative to the ARAT and FMA. The RAHFT is the first comprehensive test of arm and dexterous hand function that does not depend on human judgment. It offers a standardized, quantitative outcome evaluation, which can be performed not only in the clinic, but also in the participant's home, administered by a remote therapist over the Internet.     

Rhizomatic affective spaces and the therapeutic potential of music in prison: a qualitative meta-synthesis

Research literature supports that music programmes in prisons can have a therapeutic effect in prisoners’ lives that could promote personal development and assist the process toward desistance. The authors use a meta-synthetic approach to examine 12 qualitative articles published worldwide to explore the therapeutic potential of such programmes. The findings suggest that music programmes in prison are perceived by participating prisoners as a liberating process, which encourages participation and allows for noncoercive personal development. The therapeutic potential of music programmes is located in the combination of the benefits emanating from the effect and practice of music and the creation of mental, spatial and temporal zones of free expression and those that derive from the egalitarian and nonauthoritative approach employed by the facilitators. These findings are discussed along with aspects involved in the provision of offender treatment as well as factors that affect treatment response and engagement.     

Community reintegrating former child soldiers in Northern Uganda: A qualitative study on the road to recovery

This study aimed to profile the qualities of a holistic community reintegration program for former child soldiers (FCS) in the Lira region of Northern Uganda. Informants were a convenience sample of 37 FCS (age range 17 to 34, mean age 23.86, SD = 4.715 years; females = 29.73%). FCS completed semi-structured interviews on their current living situations and existing resources. This was aimed at assessing how they were transitioning back into the community and identifying gaps in resources. About 24% of FCS reported feeling unwelcome in their communities, suggesting a need for additional support and resources through the community integration models. Thematic analysis of the data suggests that the FCS would benefit from a holistic community reintegration program with the following qualities: psychosocial support, workforce development training, and job placement. FCS emphasised the need for skills training and employment opportunities over health and wellness; suggesting that mental health support and health care are not sufficient alone for them to successfully reintegrate into the community. FCS community integration policies and practices should prioritise holistic approaches.     

COMT and DAT1 polymorphisms moderate the indirect effect of parenting behavior on youth ADHD symptoms through neurocognitive functioning

Although gene × environment interactions contribute to youth attention-deficit/hyperactivity disorder (ADHD) symptoms, the pathways mediating these influences are unknown. We tested genetic moderation of indirect effects from parenting behavior to youth ADHD symptoms through multiple neurocognitive factors. Two hundred and twenty-nine youth with and without ADHD were assessed at baseline (Wave 1; ages 5–10) and at a 2-year follow-up (Wave 2; ages 7–13). At Wave 1, youth completed a neurocognitive battery including measures of response inhibition, visuospatial working memory, and fluid reasoning, and a standardized parent–child interaction task yielding observational measures of positive and negative parenting. At Wave 2, youth psychopathology was rated by parents and teachers using multiple methods (i.e., structured interview, rating scale). We employed moderated multiple mediation and compared conditional indirect effects across youth genotypes at two biologically plausible genetic loci. Controlling for parent ADHD symptoms as well as youth demographic factors and co-occurring externalizing symptoms, these genetic factors moderated the indirect effect from Wave 1 parenting to multi-method/informant Wave 2 ADHD symptoms through Wave 1 neurocognitive functioning. This preliminary study is the first to identify genetic moderation of mediated effects underlying ADHD symptoms and suggests that specific gene × parenting interactions may underlie neurocognitive functioning deficits and subsequent ADHD.     

Event-Based Prospective Memory in Children with Sickle Cell Disease: Effect of Cue Distinctiveness

Event-based prospective memory (EB-PM) is the formation of an intention and remembering to perform it in response to a specific event. Currently, EB-PM performance in children with sickle cell disease (SCD) is unknown. In this study, we designed a computer-based task of EB-PM; No-Stroke, Silent-Infarct, and Overt-Stroke groups performed significantly below the demographically similar control group without SCD. Cue distinctiveness was varied to determine if EB-PM could be improved. All groups, with the exception of the Overt-Stroke group, performed significantly better with a perceptually distinctive cue. Overall, these results suggest that EB-PM can be improved significantly in many children with SCD.     

Editorial

No abstract available for this article.     

Active Recreation and Well-Being: The Reconstruction of the Self Identity of Women With Spinal Cord Injury

This qualitative study obtained the viewpoints of four women with spinal cord injury about the meaning of active recreation in their lives. Using the constant comparison method, common points of view were revealed within the narratives, leading to the finding that active recreation contributed to a positive self-concept. This facilitated the reconstruction of participants' identities as fit, confident, and social women actively engaged in their communities. Since participation in active recreation was found to be important to the self-identity of women who value physical activity, integrating this role into occupational therapy can facilitate the recovery of a desired self.     

Predicting Successful Employment in the Community for People with a History of Chronic Mental Illness

Much work has been done to prepare people with a history of chronic mental illness for vocational placement. Evaluation tools can select some who are likely to be successful in competitive or sheltered work. Many whose psychiatric disability is so severe it interferes seriously with their capacity for work have need for more pre-vocational or vocational skills training. A literature survey shows many programs designed to help this population but little specific outcome data. Other articles state the need for empirical research. With limited funds and a large underserved population, further research is important.     

Error monitoring recovery after abstinence and treatment in cocaine addicts / Recuperación del procesamiento de errores tras abstinencia y tratamiento en adictos a cocaína

Abstract

Cocaine addiction is associated with different cognitive functions. Error monitoring and inhibition of behaviour are of great significance, they are specifically relevant because of their connection with problems in decision making and relapse. The aim of this work is to not only study the deficits but also to see if recovery is possible after treatment and abstinence. We evaluated 23 participants with cocaine dependence and 23 control subject with a modification of the Eriksen Flanker Task. Participants with addiction showed lower scores than control subjects in congruent and incongruent conditions. As treatment time increased the number of correct responses improved, especially in post-error hits. We conclude that the processes of rehabilitation and detoxification could improve the ability to monitor errors and inhibiting behaviour.