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Blog, Brain Injury, mental health, Neuropsychological, NPsychPick, NPsychTeamResearch, Research

#NPsychPick of the Month – Developing an understanding of the Frontal Lobe Paradox through clinical group discussions. Copstick, Sue Turnbull, Lorraine Bobbie Tibbles, Jennifer Ashworth, Sarah Swanepoel, Henk J. Kinch, Julianne Moffitt, Jenna. The Neuropsychologist November 2023 via NPsych

The Neuropsychologist 16

Developing an understanding of the Frontal Lobe Paradox through clinical group discussions.

Copstick, Sue Turnbull, Lorraine Bobbie Tibbles, Jennifer Ashworth, Sarah Swanepoel, Henk J. Kinch, Julianne Moffitt, Jenna.

#NPsychPick of the Month

Abstract

This discussion paper presents reflections from a group of clinical, forensic and neuropsychologists on their clinical caseloads in brain injury rehabilitation services at Cygnet Healthcare. These services specialise in working with people with coexisting mental health or behavioural difficulties where the work involves frequent staff discussions on interpreting an individual’s behaviour, considering its functions and whether it is part of an involuntary neuro-psychological disorder related to their brain injury, specifically the Frontal Lobe Paradox. Through consideration of six patients, the cognitive mechanisms that may relate to, or underlie apparent Frontal Lobe Paradox were highlighted. Several additional reasons were found to explain why people might show this paradox, including testing conditions, slowed processing, reduced attention, disinhibition, self-monitoring problems, and premorbid difficulties. The authors also discuss interventions, which could be used to support these individuals, with the aim of broadening clinical understanding and discussion surrounding the causes of, and treatment approaches for individuals presenting with potential Frontal Lobe Paradox.

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HCPC registered psychologists with expertise and experience in neurorehabilitation. We offer services such as neuropsychological assessment NPsych
Blog, Diagnosis, Health, Memory, NPsychPick, Rehabilitation, Research, Trauma

#NPsychPick of the Month: Applying EMDR therapy with clients who have impaired cognitive abilities, EMDR Therapy Quarterly, Summer 2023

Neuro EMDR: Applying EMDR therapy with clients who have impaired cognitive abilities

Author: Dr Jonathan Hutchins Simon Proudlock

EMDR therapy has been shown to be highly effective and time efficient in addressing trauma memories in both adults and children. However, there are questions about how EMDR can be effective with adults who have experienced a brain injury or are experiencing other cognitive difficulties. This article summarises some of the recent research within the area and proposes adaptations to the standard protocol that can be made to make best use of EMDR therapy in this population.

Introduction

Within the UK in 2019-2020 there were 356,669 UK admissions to hospital with acquired brain injury (ABI), or any brain injury that has occurred after birth including traumatic brain injury (TBI), stroke or brain tumours, which is a 12% increase since 2005-2006 (Headway, 2023). In 2019, there were approximately 977 TBI admissions per day to UK hospitals, one every 90 seconds. The diagnostic criteria for TBI on the DSM V states that there must be an “impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull with one or more of the following: loss of consciousness, posttraumatic amnesia, disorientation and confusion, neurological signs such as neuroimaging demonstrating injury or a worsening of a pre-existing seizure disorder” (American Psychiatric Association, 2013).

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Brain Injury, eTechnologies, NPsychPick, Rehabilitation, Research

#NPsychPick of the Month: Use of smartphones and tablets after acquired brain injury to support cognition. Disabil. Rehabil.: Assist. Technol. April 2023

NPsych Pick of the Month: April 2023

Use of smartphones and tablets after acquired brain injury to support cognition

Journal: Disability and Rehabilitation: Assistive Technology, 2023

Authors: Simon Beaulieu-Bonneau and Laurie Dubois and Sarah-Jeanne Lafond-Desmarais and Seena Fortin and Gabrielle Forest-Dionne and Marie-Christine Ouellet and others.

Abstract

Objectives

To describe the use of mobile devices after acquired brain injury (ABI), from the perspectives of injured individuals and significant others, and to examine factors associated with mobile device use for cognition.

Methods

Cross-sectional study with 50 adults with moderate/severe traumatic brain injury or stroke (42% women; mean of 50.7 years old, 4.6 years post-ABI), and 24 significant others. Participants completed questionnaires on mobile technology, cognitive functioning and the impact of technology.

Results

Of 45/50 adults with ABI who owned a smartphone/tablet, 31% reported difficulties in using their device post-injury, 44% had received support, and 46% were interested in further training. Significant others reported motor/visual impairments and the fear of becoming dependent on technology as barriers for mobile device use, and 65% mentioned that their injured relative needed additional support. Mobile device use for cognition was common (64%), predicted in a regression model by lower subjective memory and more positive perception of the psychosocial impacts of technology, and also associated in univariate analyses with younger age, lower executive functioning, and greater use of memory strategies.

Conclusion

Using mobile devices for cognition is common post-ABI but remains challenging for a significant proportion. Developing training approaches may help supporting technology use.

  • IMPLICATIONS FOR REHABILITATION

  • Using mobile electronic devices (smartphones and tablets) is common after acquired brain injury (ABI) but is challenging for a significant proportion of individuals.

  • After the ABI, close to 50% of individuals receive support in using their mobile device, mostly from family members and friends, but rarely from rehabilitation clinicians or technology specialists.

  • In a sample of 50 adults with ABI, more frequent use of mobile devices to support cognition was associated with poorer subjective memory and executive functioning, greater use of memory strategies, more positive perception of the psychosocial impacts of technology, and younger age.

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ABI, Brain Injury, Neuropsychological, NPsychPick, Outcome assessment, Recovery, Rehabilitation, TBI

Efficacy of Postacute Neuropsychological Rehabilitation for Patients with Acquired Brain Injuries is Maintained in the Long-Term. J Int Neuropsych Soc, Jan 2020

Postacute NR programs provide participants with various tools, skills, and psychological perspectives that they continue to gain from and generalize to real life after program completion, reflecting transformational processes with stable long-term benefits

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Anxiety, Concussion, Depression, Mood, mTBI, NPsychPick, PCS, Recovery, Research, Resilience, Symptoms

Psychological Resilience as a Predictor of Symptom Severity in Adolescents With Poor Recovery Following Concussion. J Int Neuropsychol Soc. 2019

Psychological resilience plays an important role in recovery from concussion, and this relationship may be mediated by anxiety and depressive symptoms.

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Neurofeedback, NPsychPick, Research

Structural and functional connectivity changes in response to short-term neurofeedback training with motor imagery. NeuroImage, 2019.

Structural and functional connectivity changes in response to short-term neurofeedback training with motor imagery

T.Marins, E.C. Rodrigues, T.Bortolini, Bruno Melo, J.Molla, F.Tovar-Molla. Available online 18 March 2019. In Press, Corrected Proof. NeuroImage

https://doi.org/10.1016/j.neuroimage.2019.03.027

Abstract

Recent findings have been challenging current understanding of how fast the human brain change its structural and functional connections in response to training. One powerful way to deepen the inner workings of human brain plasticity is using neurofeedback (NFB) by fMRI, a technique that allows self-induced brain plasticity by means of modulating brain activity in real time. In the present randomized, double-blind and sham-controlled study, we use NFB to train healthy individuals to reinforce brain patterns related to motor execution while performing a motor imagery task, with no overt movement. After 1 h of NFB training, participants displayed increased fractional anisotropy (FA) in the sensorimotor segment of corpus callosum and increased functional connectivity of the sensorimotor resting state network. Increased functional connectivity was also observed in the default mode network. These results were not observed in the control group, which was trained with sham feedback. To our knowledge, this is the first demonstration of white matter FA changes following a very short training schedule (<1 h). Our results suggest that NFB by fMRI can be an interesting tool to explore dynamic aspects of brain plasticity and open new venues for investigating brain plasticity in healthy individuals and in neurological conditions.

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AAT, ABI, AnimalAssisted, Brain Injury, Mood, Research, Therapy

Effects of animal-assisted therapy on social behaviour in patients with acquired brain injury: a randomised controlled trial. Scientific Reports, 2019.

Effects of animal-assisted therapy on social behaviour in patients with acquired brain injury: a randomised controlled trial.

Karin Hediger, Stefan Thommen, Cora Wagner, Jens Gaab & Margret Hund-Georgiadis. Nature: Scientific Reports, volume 9, Published: 09 April 2019.
https://www.nature.com/articles/s41598-019-42280-0

Abstract
Animal-assisted therapy (AAT) is increasingly used to address impaired social competence in patients with acquired brain injury. However, the efficacy of AAT has not been tested in these patients. We used a randomised, controlled within subject trial to determine the effects of AAT on social competence in patients undergoing stationary neurorehabilitation. Participants received both AAT sessions and paralleled conventional therapy sessions. The patients’ social behaviour was systematically coded on the basis of video recordings of therapy sessions. Moreover, mood, treatment motivation and satisfaction was measured during each therapy session. We analysed 222 AAT and 219 control sessions of 19 patients with linear mixed models. Patients showed a significantly higher amount of social behaviour during AAT. Furthermore, patients’ positive emotions, verbal and non-verbal communication, mood, treatment motivation and satisfaction were increased in the presence of an animal. Neutral emotions were reduced but no effect was found regarding negative emotions. Our results show that AAT increases aspects of social competence and leads to higher emotional involvement of patients with acquired brain injury, reflected in higher social engagement, motivation and satisfaction during a therapeutic session.

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