2.5 CE Credits – JINS Special Issue on Rehabilitation (JINS 26:1, 2020) CE Bundle 2

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Educational Objectives

  1. List three types of memory strategies that people with MCI may use to compensate for their cognitive difficulties.
  2. Explain how these memory strategies relate to cognitive functioning as well as how they impact on close family/friends.
  3. Describe how the use of memory strategies may be tailored to an individual’s cognitive and psychosocial profile for maximal benefit.
  4. Explain key issues regarding the use of group treatment as a service delivery model for aphasia treatment.
  5. Describe some of the challenges of assessing language in conversation.
  6. List key approaches to assessment and rehabilitation of memory.
  7. Critique the effectiveness of a telehealth application of a memory rehabilitation program for stroke participants compared to face-to-face methods.
  8. List two factors that differentiate individuals with schizophrenia who were classified as responders and nonresponders to cognitive remediation.
  9. Assess the relationship of near learning and far transfer of learning in response to cognitive remediation in schizophrenia.
  10. Explain the mechanism of tDCS.
  11. List the tDCS applications that can be made for language disorders following an acquired brain injury.
  12. Discuss the use of a language measure to evaluate speech improvement in an aphasic patient.

 

The International Neuropsychological Society is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Neuropsychological Society maintains responsibility for this program and its content.

Course Information

Target Audience: Intermediate
Availability: Date Available: 2020-05-04

You may obtain CE for this JINS package at any time.
Offered for CE Yes
Cost Members $50

Non-Members $62.50
Refund Policy This JINS package is not eligible for refunds
CE Credits 2.5

 

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:

Author(s)

  • Pinghsiu Lin | Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, NSW, Australia
  • Haley M. LaMonica | Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, NSW, Australia | Central Clinical School, The University of Sydney, NSW, Australia
  • Sharon L. Naismith | Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, NSW, Australia | School of Psychology, The University of Sydney, NSW, Australia | Charles Perkins Centre, The University of Sydney, NSW, Australia
  • Loren Mowszowski | Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, NSW, Australia | School of Psychology, The University of Sydney, NSW, Australia

Correspondence

E-mail address: | loren.mowszowski@sydney.edu.au

Disclosures

There are no financial relationships with commercial interests and no conflicts of interest to report.

Abstract

Objectives:

With the rapid growth of the older population worldwide, understanding how older adults with mild cognitive impairment (MCI) use memory strategies to mitigate cognitive decline is important. This study investigates differences between amnestic and nonamnestic MCI subtypes in memory strategy use in daily life, and how factors associated with cognition, general health, and psychological well-being might relate to strategy use.

Methods:

One hundred forty-eight participants with MCI (mean age = 67.9 years, SD = 8.9) completed comprehensive neuropsychological, medical, and psychological assessments, and the self-report ‘Memory Compensation Questionnaire’. Correlational and linear regression analyses were used to explore relationships between memory strategy use and cognition, general health, and psychological well-being.

Results:

Memory strategy use does not differ between MCI subtypes (p > .007) despite higher subjective everyday memory complaints in those with amnestic MCI (p = .03). The most marked finding showed that increased reliance-type strategy use was significantly correlated with more subjective memory complaints and poorer verbal learning and memory (p < .01) in individuals with MCI. Moreover, fewer subjective memory complaints and better working memory significantly predicted (p < .05) less reliance strategy use, respectively, accounting for 10.6% and 5.3% of the variance in the model.

Conclusions:

In general, the type of strategy use in older adults with MCI is related to cognitive functioning. By examining an individual’s profile of cognitive dysfunction, a clinician can provide more personalized clinical recommendations regarding strategy use to individuals with MCI, with the aim of maintaining their day-to-day functioning and self-efficacy in daily life.

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Author(s)

  • Catherine Mason | Department of Cognitive Science, ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney 2113, Australia
  • Lyndsey Nickels | Department of Cognitive Science, ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney 2113, Australia
  • Belinda McDonald | St. Vincent’s Health, Sydney 2010, Australia

Correspondence

E-mail address | catherine.mason@mq.edu.au

Disclosures

The authors have nothing to disclose.

Abstract

Objective:

Group treatment enables people with aphasia to practise communication skills outside the typical clinician–patient dyad. While there is evidence that this treatment format can improve participation in everyday communication, there is little evidence it impacts linguistic abilities. This project aimed to investigate the effects of ‘typical’ group treatment on the communication skills of people with aphasia with a focus on word retrieval in discourse.

Methods:

Three people with aphasia took part in a 6-week group therapy programme. Each week focused on a different topic, and three topics also received a home programme targeting word retrieval. The six treated topics were compared with two control topics, with regard to language production in connected speech. Semistructured interviews were collected twice prior to treatment and twice following the treatment and analysed using (a) word counts; (b) the profile of word errors and retrieval in speech; (c) a measure of propositional idea density, and (d) perceptual discourse ratings.

Results:

Two participants showed no significant improvements; one participant showed significant improvement on discourse ratings.

Conclusions:

This study provides limited support for group treatment, leading to improved communication as measured by semistructured interviews, even when supplemented with a home programme. We suggest that either group treatment, as implemented here, was not an effective approach for improving communication for our participants and/or that outcome measurement was limited by difficulty assessing changes in connected speech.

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Author(s)

  • David W. Lawson | Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia | Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia | School of Psychology and Public Health, La Trobe University, Melbourne, Australia
  • Renerus J. Stolwyk | Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia | Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
  • Jennie L. Ponsford | Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia | Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
  • Dean P. McKenzie | Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia | Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  • Marina G. Downing | Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
  • Dana Wong | Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia | Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia | School of Psychology and Public Health, La Trobe University, Melbourne, Australia

Correspondence

E-mail address | d.wong@latrobe.edu.au

Disclosures

The authors have nothing to disclose.

Abstract

Objective:

Rehabilitation of memory after stroke remains an unmet need. Telehealth delivery may overcome barriers to accessing rehabilitation services.

Method:

We conducted a non-randomized intervention trial to investigate feasibility and effectiveness of individual telehealth (internet videoconferencing) and face-to-face delivery methods for a six-week compensatory memory rehabilitation program. Supplementary analyses investigated non-inferiority to an existing group-based intervention, and the role of booster sessions in maintaining functional gains. The primary outcome measure was functional attainment of participants’ goals. Secondary measures included subjective reports of lapses in everyday memory and prospective memory, reported use of internal and external memory strategies, and objective measures of memory functioning.

Results:

Forty-six stroke survivors were allocated to telehealth and face-to-face intervention delivery conditions. Feasibility of delivery methods was supported, and participants in both conditions demonstrated treatment-related improvements in goal attainment, and key subjective outcomes of everyday memory, and prospective memory. Gains on these measures were maintained at six-week follow-up. Short-term gains in use of internal strategies were also seen. Non-inferiority to group-based delivery was established only on the primary measure for the telehealth delivery condition. Booster sessions were associated with greater maintenance of gains on subjective measures of everyday memory and prospective memory.

Conclusions:

This exploratory study supports the feasibility and potential effectiveness of telehealth options for remote delivery of compensatory memory skills training after a stroke. These results are also encouraging of a role for booster sessions in prolonging functional gains over time.

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