3.0 CE Credits - JINS Special Issue on Rehabilitation (JINS 26:1, 2020) CE Bundle 1

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Educational Objectives
  1. Explain the rationale for providing trauma-focused treatment to those with comorbid PTSD and history of TBI in the context of invalid performance on neuropsychological assessment or before engaging in neuropsychological assessment.
  2. List the potential benefits of providing psychoeducation regarding TBI and cognitive rehabilitation in addition to trauma-focused treatment in those with chronic post-concussive symptoms.
  3. List the four main factors influencing the uptake of videoconferencing in community-based rehabilitation for people with brain injury.
  4. Explain the potential benefits and problems associated with using videoconferencing for remote delivery of brain injury rehabilitation.
  5. List the potential predictors of anxiety and depression symptom improvement in CBT adapted for TBI related cognitive impairment.
  6. Design ways to potentially enhance the effectiveness of TBI-adapted CBT.
  7. Describe the goals of and approaches to community-based neuropsychological rehabilitation for people with Acquired Brain Injuries.
  8. Discuss the long-term maintenance patterns for outcomes of community-based neuropsychological rehabilitation.
  9. Demonstrate knowledge of and distinctions between treatment fidelity, treatment receipt, and treatment enactment.
  10. List three ways in which treatment enactment may be measured.
  11. Describe key methodological and ethical issues confounding our current understanding of the efficacy of neurofeedback interventions for remediating brain injury-related cognitive impairments.
  12. Design more methodologically sound and potentially impactful research to evaluate the true potential for neurofeedback interventions as a form of cognitive remediation.

Course Information
Target Audience:Intermediate
Availability:Date Available: 2020-05-04
You may obtain CE for this JINS package at any time.
Offered for CEYes
CostMembers $10
Non-Members $15
Refund PolicyThis JINS package is not eligible for refunds
CE Credits3.0
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Introduction

Cognitive and behavioral impairments arguably represent the greatest impediment to independence and participation in work, study, social, and leisure activities for individuals with brain injury. Despite this, research on remediation of cognitive, behavioral, and emotional consequences still lags far behind that on physical functions in rehabilitation of individuals with neurological dysfunction. Nevertheless, in the last few decades, there has been exponential growth both in practice and research on the rehabilitation of these disorders.

There are many definitions, but Wilson (1989, p. 117) defined cognitive rehabilitation as “any intervention strategy or technique which intends to enable clients or patients, and their families, to live with, manage, by-pass, reduce or come to terms with cognitive deficits precipitated by injury to the brain.” We prefer the broader term neuropsychological rehabilitation, which, according to Shany-Ur et al. in this issue, may be conceived as interventions aimed at mitigating or compensating for cognitive, behavioral, and psychosocial deficits, and enhancing independence and integration into employment and society.

Creating the science to underpin these practices represents a significant challenge. Guidelines have been developed for the treatment of specific acquired cognitive impairments in domains including attention, language, memory, visuo-spatial, and executive functions, as a result of traumatic brain injury or stroke (Bayley et al.,2014; Cicerone,2000,2005,2011; Ponsford et al.,2014; Tate et al.,2014; Togher et al.,2014; Velikonja et al.,2014). Although there is evidence in support of interventions across each of these domains of impairment, these guidelines have identified very few rigorous controlled trials and, as a consequence, guidelines for clinical practice are limited. Most outcomes have been assessed on neuropsychological measures, with limited assessment of generalization to meaningful everyday activities. This criticism is equally applicable to cognitive rehabilitation efforts in individuals with psychiatric disorders, specifically schizophrenia (Bryce, Sloan, Lee, Ponsford, & Rossell,2016). There has also been limited evaluation of psychotherapeutic interventions in these groups.

A survey of international practice in cognitive rehabilitation (Nowell, Downing, Bragge, & Ponsford, in press) recently reported that clinicians don’t just want to know whether an intervention works, but how it works and in what contexts. Clearly, brain injuries are complex and not everyone responds in the same way. There is a need to identify the factors that impact an individual’s capacity to respond to treatment. There has been limited comparison of modes of therapy delivery – for example, individualversusgroup; in person orviatelehealth. There is growing use of exciting new technologies in a rehabilitation context, but limited evaluation of the functional impacts of these.

This JINS Special Edition on Rehabilitation takes some steps toward addressing many of these issues. It includes papers representing the application of specific rehabilitation treatments to impairments in a broad range of domains, including language and communication, memory, attention, and challenging behavior, as well as depression, anxiety, and posttraumatic stress disorder (PTSD). These interventions have been applied across diverse populations, including groups with stroke, traumatic brain injury, mild cognitive impairment, and schizophrenia. The papers in this issue can be categorised into four thematic areas: application of technology to cognitive rehabilitation; comparison of modes of treatment delivery; factors impacting response to treatment; and maintenance of treatment gains.


Individual Titles, Authors, and Articles:

Psychological Symptoms and Rates of Performance Validity Improve Following Trauma-Focused Treatment in Veterans with PTSD and History of Mild-to-Moderate TBI
Author(s)
  • Sarah M. Jurick | VA San Diego Healthcare System (VASDHS), San Diego, CA, USA, Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
  • Laura D. Crocker | VA San Diego Healthcare System (VASDHS), San Diego, CA, USA, Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
  • Victoria C. Merritt | VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
  • Samantha N. Hoffman | VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
  • Amber V. Keller | VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
  • Graham M. L. Eglit | VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
  • Kelsey R. Thomas | Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
  • Sonya B. Norman | VA San Diego Healthcare System (VASDHS), San Diego, CA, USA, Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA, Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA, National Center for PTSD, White River Junction, VT, USA
  • Dawn M. Schiehser | VA San Diego Healthcare System (VASDHS), San Diego, CA, USA, Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA, Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
  • Carie S. Rodgers | PsychArmor Institute, San Diego, CA, USA
  • Elizabeth W. Twamley | VA San Diego Healthcare System (VASDHS), San Diego, CA, USA, Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA, Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
  • Amy J. Jak | VA San Diego Healthcare System (VASDHS), San Diego, CA, USA, Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA, Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA

Correspondence
E-mail address | sjurick@ucsd.edu

Disclosures
The authors have nothing to disclose.

Abstract
Objective:

Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT)failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit frompsychotherapy and if psychotherapy improves PVT performance.

Method:

Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline,post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPTwith TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standardcutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was consideredvalid (PVT-Pass).

Results:

Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Failgroup. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rateof valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.

Conclusion:

Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement followingtreatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit fromneuropsychological assessment after, rather than before, treatment.

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Perceived Usability and Acceptability of Videoconferencing for Delivering Community-Based Rehabilitation to Individuals with Acquired Brain Injury: A Qualitative Investigation
Author(s)
  • Tamara Ownsworth | School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD 4122, Australia
  • Deborah Theodoros | RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
  • Louise Cahill | RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
  • Atiyeh Vaezipour | RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
  • Ray Quinn | Acquired Brain Injury Outreach Service, The Hopkins Centre, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
  • Melissa Kendall | School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD 4122, Australia
  • Acquired Brain Injury Outreach Service, The Hopkins Centre, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
  • Wendy Moyle | School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD 4122, Australia
  • Karen Lucas | Telehealth Centre, Metro South Health, Brisbane, QLD 4102, Australia

Correspondence
E-mail address | t.ownsworth@griffith.edu.au

Disclosures
The authors have nothing to disclose.

Abstract
Objectives:

There is limited research on the use of telerehabilitation platforms in service delivery for people with acquired brain injury (ABI), especially technologies thatsupport delivery of services into the home. This qualitative study aimed to explore the perspectives of rehabilitation coordinators, individuals with ABI, andfamily caregivers on the usability and acceptability of videoconferencing (VC) in community-based rehabilitation. Participants’ experiences and perceptions oftelerehabilitation and their impressions of a particular VC system were investigated.

Methods:

Guided by a theory on technology acceptance, semi-structured interviews were conducted with 30 participants from a community-based ABI service, including 13 multidisciplinaryrehabilitation coordinators, 9 individuals with ABI, and 8 family caregivers. During the interview, they were shown a paper prototype of a telehealth portal forVC that was available for use. Interview transcripts were coded by two researchers and analysed thematically.

Results:

The VC was used on average for 2% of client consultations. Four major themes depicted factors influencing the uptake of VC platforms; namely, the context or impetusfor use, perceived benefits, potential problems and parameters around use, and balancing the service and user needs. Participants identified beneficial uses ofVC in service delivery and strategies for promoting a positive user experience.

Conclusions:

Perceptions of the usability of VC to provide services in the home were largely positive; however, consideration of use on a case-by-case basis and a trial implementationwas recommended to enhance successful uptake into service delivery.

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Predictors of Anxiety and Depression Symptom Improvement in CBT Adapted for Traumatic Brain Injury: Pre/Post-Injury and Therapy Process Factors
Author(s)
  • Leah M. Zelencich | School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia
  • Dana Wong | School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria 3800, Australia , Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Victoria 3121, Australia
  • Nikolaos Kazantzis | School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia
  • Dean P. McKenzie | Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Victoria 3121, Australia, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria 3800, Australia
  • Marina Downing | Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Victoria 3121, Australia
  • Jennie L. Ponsford | School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia
  • Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Victoria 3121, Australia

Correspondence
E-mail address | jennie.ponsford@monash.edu

Disclosures
The authors have nothing to disclose.

Abstract
Objectives:

The current study examined the association of demographic/preinjury, injury-related, and cognitive behavior therapy (CBT) process variables, with anxiety and depressionsymptom change in traumatic brain injury (TBI)-adapted CBT (CBT-ABI).

Methods:

The audio recordings of 177 CBT-ABI sessions representing 31 therapist–client dyads were assessed from the independent observer perspective on measures of workingalliance, homework engagement, and therapist competency in using homework.

Results:

Linear regressions showed that older client age, longer post-TBI recovery period, better executive functioning, higher levels of client homework engagement, as wellas higher levels of therapist competence in reviewing homework were associated with greater improvement in anxiety and/or depression symptoms.

Conclusions:

CBT-ABI is a promising treatment for post-TBI depression and anxiety. The current study highlights how therapists can enhance CBT-ABI effectiveness, specifically:comprehensive facilitation of client homework engagement with emphasis on homework review, and accommodation of executive deficits. The current study also suggeststhat the role of client age and the length of post-TBI recovery period require further investigation.

Bibliography
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  2. Australian Government: Geoscience Australia. (2018). Area of Australia – States and Territories. Retrieved January 17, 2018 http://www.ga.gov.au/scientific-topics/national-location-information/dimensions/area-of-australia-states-and-territories Google Scholar 
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  4. Braun, V. & Clarke, V. (2013). Successful Qualitative Research: A Practical Guide for Beginners. London: Sage Publications. Google Scholar 
  5. Chen, J., Jin, W., Zhang, X-X., Xu, W., Liu, X-N., & Ren, C-C. (2015). Telerehabilitation approaches for stroke patients: Systematic review and meta-analysis of randomized controlled trials. Journal of Stroke and Cerebrovascular Disorders, 24, 2660–2668. doi: 10.1016/j.jstrokecerebrovasdis.2015.09.014 CrossRef  Google Scholar 
  6. Creswell, J.W. (2009). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches (3rd ed.). California: Sage Publications. Google Scholar 
  7. Davis, F.D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. Management Information Systems Quarterly, 13, 319–340. doi: 10.2307/249008 CrossRef  Google Scholar 
  8. Hines, M., Brunner, M., Poon, S., Lam, M., Tran, V., Yu, D., Togher, L., Shaw, T., & Power, E. (2017). Tribes and tribulations: interdisciplinary eHealth in providing services for people with a traumatic brain injury (TBI). BMC Health Services Research, 17(1), 757. doi: 10.1186/s12913-017-2721-2 CrossRef  Google Scholar 
  9. Holden, R.J. & Karsh, B.T. (2010). The technology acceptance model: its past and its future in health care. Journal of Biomedical Informatics, 43, 159–172. doi: 10.1016/j.jbi.2009.07.002 CrossRef  Google Scholar 
  10. Kilov, A.M., Togher, L., Power, E., & Turkstra, L. (2010). Can teenagers with traumatic brain injury use Internet chatrooms A systematic review of the literature and the Internet. Brain Injury, 24, 1135–1172. doi: 10.3109/02699052.2010.490511 CrossRef  Google Scholar 
  11. Lai, P.C. (2017). The literature review of technology adoption models and theories for the novelty technology. Journal of Information Systems and Technology Management, 14, 21–38. doi: 10.4301/s1807-17752017000100002 CrossRef  Google Scholar 
  12. Lloréns, R., Noé, E., Colomer, C., & Alcañiz, M. (2015). Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: A randomized controlled trial. Archives of Physical Medicine & Rehabilitation, 96, 418–425. doi: 10.1016/j.apmr.2014.10.019 CrossRef  Google Scholar 
  13. McGrath, N., Dowds, M.M. Jr., & Goldstein, R. (2008). Clinical supervision of a client with traumatic brain injury in a host home placement using video teleconferencing: A case study. Journal of Head Trauma Rehabilitation, 23, 388–393. CrossRef  Google Scholar 
  14. Nowell, L.S., Norris, J.M., White, D.E., & Moules, N.J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16, 1–13. doi: 10.1177/1609406917733847 CrossRef  Google Scholar 
  15. Ownsworth, T., Arnautovska, U., Beadle, E., Shum, D.H., & Moyle, W. (2018). Efficacy of telerehabilitation for adults with traumatic brain injury: A systematic review. The Journal of Head Trauma Rehabilitation, 33, E33–E46. doi: 10.1097/HTR.0000000000000350 CrossRef  Google Scholar 
  16. Radhakrishnan, K., Xie, B., & Jacelon, C.S. (2015). Unsustainable home telehealth: A Texas qualitative study. The Gerontologist, 56, 830–840. doi: 10.1093/geront/gnv050 CrossRef  Google Scholar 
  17. Ricker, J.H., Rosenthal, M., Garay, E., DeLuca, J., Germain, A., Abreaham-Fuchs, K., & Schmidt, K.U. (2002). Telerehabilitation needs: A survey of persons with acquired brain injury. Journal of Head Trauma Rehabilitation, 17, 242–250. CrossRef  Google Scholar 
  18. Rietdijk, R., Power, E., Brunner, M., & Togher, L. (2018). A single case experimental design study on improving social communication skills after traumatic brain injury using communication partner telehealth training. Brain Injury, 16, 1–11. doi: 10.1080/02699052.2018.1531313 Google Scholar 
  19. Rietdijk, R., Togher, L., & Power, E. (2012). Supporting family members of people with traumatic brain injury using telehealth: A systematic review. Journal of Rehabilitation Medicine, 44, 913–921. doi: 10.2340/16501977-1058. CrossRef  Google Scholar 
  20. Sander, A.M., Clark, A.N., Atchison, T.B., & Rueda, M. (2009). A web-based videoconferencing approach to training caregivers in rural areas to compensate for problems related to traumatic brain injury. Journal of Head Trauma Rehabilitation, 24, 248–261. doi: 10.1097/HTR.0b013e3181ad593a CrossRef  Google Scholar 
  21. Simpson, S.G. & Reid, C.L. (2014). Therapeutic alliance in videoconferencing psychotherapy: A review. Australian Journal of Rural Health, 22, 280–299. doi: 10.1111/ajr.12149 CrossRef  Google Scholar 
  22. Speyer, R., Denman, D., Wilkes-Gillan, S., Chen, Y.W., Bogaardt, H., Kim, J.H, Heckathorn, D.E., & Cordier, R. (2018). Effects of telehealth by allied health professionals and nurses in rural and remote areas: A systematic review and meta-analysis. Journal of Rehabilitation Medicine, 50, 225–235. doi: 10.2340/16501977-2297 CrossRef  Google Scholar 
  23. Sugarhood, P., Wherton, J., Procter, R., Hinder, S., & Greenhalgh, T. (2014). Technology as system innovation: A key informant interview study of the application of the diffusion of innovation model to telecare. Disability and Rehabilitation: Assistive Technology, 9, 79–87. doi: 10.3109/17483107.2013.823573 Google Scholar 
  24. Tchero, H., Tabue-Teguo, M., Lannuzel, A., & Rusch, E. (2018). Telerehabilitation for stroke survivors: Systematic review and meta-analysis. Journal of Medical Internet Research, 20, e10867. doi: 10.2196/10867 CrossRef  Google Scholar 
  25. Theodoros, D. Russell, T., & Latifi, R. (2008). Telerehabilitation: Current perspectives. Studies in Health Technology and Informatics, 131, 191–210. Google Scholar 
  26. Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19, 349–357. doi: /10.1093/intqhc/mzm042 CrossRef  Google Scholar 
  27. Vaccaro, M., Hart, T., Whyte, J., & Buchhofer, R. (2007). Internet use and interest among individuals with traumatic brain injury: A consumer survey. Disability and Rehabilitation: Assistive Technology, 2, 85–95. doi: 10.1080/17483100601167586 Google Scholar 
  28. Vaezipour, A., Whelan, B., Wall, K., & Theodoros, D. (Published ahead of print: January, 2019). Acceptance of rehabilitation technology in adults with moderate to severe traumatic brain injury, their caregivers, and healthcare professionals: A systematic review. Journal of Head Trauma Rehabilitation. doi: 10.1097/htr.0000000000000462 CrossRef  Google Scholar 
  29. Wade, S.L., Carey, J., & Wolfe, C.R. (2006). An online family intervention to reduce parental distress following pediatric brain injury. Journal of Consulting and Clinical Psychology, 74, 445–454. doi: 10.1037/0022-006X.74.3.445 CrossRef  Google Scholar 
  30. Wade, S.L., Walz, N.C., Carey, J., Williams, K.M., Cass, J., Herren, L., Mark, E., & Yeates, K.O. (2010). A randomized trial of teen online problem solving for improving executive function deficits following pediatric traumatic brain injury. Journal of Head Trauma Rehabilitation, 25, 409–415. doi: 10.1097/HTR.0b013e3181fb900d CrossRef  Google Scholar 
  31. Weyer, J., Fink, R.D., & Adelt, F. (2015). Human–machine cooperation in smart cars. An empirical investigation of the loss-of-control thesis. Safety Science, 72, 199–208. CrossRef  Google Scholar 
  32. World Health Organization. (2016). WHO Global Disability Action Plan 2014–2021. Geneva, Switzerland: World Health Organization. Google Scholar 
Efficacy of Postacute Neuropsychological Rehabilitation for Patients with Acquired Brain Injuries is Maintained in the Long-Term
Author(s)
  • Tal Shany-Ur | The National Institute for the Rehabilitation of the Brain Injured, Recanati Rehabilitation Center, 89 Itzhak Sadeh St. Tel Aviv 6722820, Israel, Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem 91905, Israel
  • Ayala Bloch | The National Institute for the Rehabilitation of the Brain Injured, Recanati Rehabilitation Center, 89 Itzhak Sadeh St. Tel Aviv 6722820, Israel, The Department of Behavioral Sciences, Ariel University, 65 Ramat HaGolan St, Ariel, Israel
  • Tali Salomon-Shushan | The National Institute for the Rehabilitation of the Brain Injured, Recanati Rehabilitation Center, 89 Itzhak Sadeh St. Tel Aviv 6722820, Israel
  • Narkis Bar-Lev | The National Institute for the Rehabilitation of the Brain Injured, Recanati Rehabilitation Center, 89 Itzhak Sadeh St. Tel Aviv 6722820, Israel
  • Limor Sharoni | The National Institute for the Rehabilitation of the Brain Injured, Recanati Rehabilitation Center, 89 Itzhak Sadeh St. Tel Aviv 6722820, Israel
  • Dan Hoofien | The National Institute for the Rehabilitation of the Brain Injured, Recanati Rehabilitation Center, 89 Itzhak Sadeh St. Tel Aviv 6722820, Israel, Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem 91905, Israel, The Israeli Academic College, 87 Pinhas Rotenberg St., Ramat-Gan 52275, Israel

Correspondence
E-mail address | shany-ur.tal@mail.huji.ac.il

Disclosures
The authors have nothing to disclose.

Abstract
Objectives:

We examined the long-term maintenance of treatment outcomes in patients with acquired brain injuries who participated in community-based neuropsychological rehabilitation(NR) programs, in a prospective, within-subject, longitudinal, partial double-blind cohort study.

Methods:

One hundred forty-three patients (39 females, mean age 33.5 years) who had experienced a brain injury (BI) (mean time since injury 3.95 years) were referred to a postacutecommunity-based NR institute. Patients participated in one of the three programs aimed at improving their functional outcome: comprehensive–holistic neuropsychologicalrehabilitation, vocational-focused neuropsychological rehabilitation, and individual neuropsychological rehabilitation. Self-reported data regarding employment,community integration, perceived quality of life (PQoL), and mood were collected at program start and end, and annually for 3 years post program completion. Groupplacement was based on clinical considerations, such that the study did not aim to compare the programs, but rather to assess their long-term benefits.

Results:

Employment status and stability, community integration, and PQoL improved significantly after program completion and continued to improve for the following 3 years.The proportion of individuals with mood disturbances did not change during or after the programs.

Conclusions:

A clear consensus regarding BI rehabilitation is that long-term maintenance of treatment outcomes is imperative to its efficacy. Our findings suggest that postacuteNR programs provide participants with various tools, skills, and psychological perspectives that they continue to gain from and generalize to real life after programcompletion, reflecting transformational processes with stable long-term benefits.

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Psychoeducational Interventions for Problematic Anger in Chronic Moderate to Severe Traumatic Brain Injury: A Study of Treatment Enactment
Author(s)
  • Tessa Hart | Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA
  • Monica J. Vaccaro | Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA
  • Jesse R. Fann | Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
  • Roland D. Maiuro | Private Practice, Seattle, WA, USA
  • Shira Neuberger | Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA
  • Steven Sinfield | Drexel University College of Medicine, Philadelphia, PA 19129, USA

Correspondence
E-mail address | thart@einstein.edu

Disclosures
The authors have nothing to disclose.

Abstract
Objectives:

Treatment enactment, a final stage of treatment implementation, refers to patients’ application of skills and concepts from treatment sessions into everyday life situations.We examined treatment enactment in a two-arm, multicenter trial comparing two psychoeducational treatments for persons with chronic moderate to severe traumaticbrain injury and problematic anger.

Methods:

Seventy-one of 90 participants from the parent trial underwent a telephone enactment interview at least 2 months (median 97 days, range 64–586 days) after cessationof treatment. Enactment, quantified as average frequency of use across seven core treatment components, was compared across treatment arms: anger self-managementtraining (ASMT) and personal readjustment and education (PRE), a structurally equivalent control. Components were also rated for helpfulness when used. Predictorsof, and barriers to, enactment were explored.

Results:

More than 80% of participants reported remembering all seven treatment components when queried using a recognition format. Enactment was equivalent across treatments.Most used/most helpful components concerned normalizing anger and general anger management strategies (ASMT), and normalizing traumatic brain injury-related changeswhile providing hope for improvement (PRE). Higher baseline executive function and IQ were predictive of better enactment, as well as better episodic memory (trend).Poor memory was cited by many participants as a barrier to enactment, as was the reaction of other people to attempted use of strategies.

Conclusions:

Treatment enactment is a neglected component of implementation in neuropsychological clinical trials, but is important both to measure and to help participants achievesustained carryover of core treatment ingredients and learned material to everyday life.

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Efficacy of Neurofeedback Interventions for Cognitive Rehabilitation Following Brain Injury: Systematic Review and Recommendations for Future Research
Author(s)
  • Jordan I. Ali | Department of Psychology, University of Victoria, Victoria, BC V8W 2Y2, Canada, Institute on Aging & Lifelong Health, University of Victoria, Victoria, BC V8P 2Y2, Canada
  • Jeremy Viczko | Department of Psychology, University of Victoria, Victoria, BC V8W 2Y2, Canada
  • Colette M. Smart | Department of Psychology, University of Victoria, Victoria, BC V8W 2Y2, Canada, Institute on Aging & Lifelong Health, University of Victoria, Victoria, BC V8P 2Y2, Canada

Correspondence
E-mail address | jali@uvic.ca

Disclosures
The authors have nothing to disclose.

Abstract
Objectives:

Interest in neurofeedback therapies (NFTs) has grown exponentially in recent years, encouraged both by escalating public interest and the financial support of healthcare funding agencies. Given NFTs’ growing prevalence and anecdotally reported success in treating common effects of acquired brain injury (ABI), a systematicreview of the efficacy of NFTs for the rehabilitation of ABI-related cognitive impairment is warranted.

Methods:

Eligible studies included adult samples (18+ years) with ABI, the use of neurofeedback technology for therapeutic purposes (as opposed to assessment), the inclusionof a meaningful control group/condition, and clear cognitive–neuropsychological outcomes. Initial automated search identified n = 86candidate articles, however, only n = 4 studies met the stated eligibility criteria.

Results:

Results were inconsistent across studies and cognitive domains. Methodological and theoretical limitations precluded robust and coherent conclusions with respect tothe cognitive rehabilitative properties of NFTs. We take the results of these systematic analyses as a reflection of the state of the literature at this time.These results offer a constructive platform to further discuss a number of methodological, theoretical, and ethical considerations relating to current and futureNFT–ABI research and clinical intervention.

Conclusions:

Given the limited quantity and quality of the available research, there appears to be insufficient evidence to comment on the efficacy of NFTs within an ABI rehabilitationcontext at this time. It is imperative that future work increase the level of theoretical and methodological rigour if meaningful advancements are to be made understandingand evaluating NFT–ABI applications.

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