Cognitive rehabilitation for executive dysfunction in adults with stroke or other adult non-progressive acquired brain damage

Chung, Charlie SY; Pollock, Alex; Campbell, Tanya; Durward, Brian R; Hagen, Suzanne

doi:10.1002/14651858.cd008391.pub2

Cited by 169 publications

(146 citation statements)

References 52 publications

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“…• That a direct comparison of memory training in virtual environments versus nonvirtual environments is still lacking and no recommendation can be made as to the specificity of the technique An updated review of the literature (2003-2008) 418 concluded that (1) for individuals with mild memory impairments, memory strategy training, including the use of internalized strategies (eg, visual imagery) and external memory compensations (eg, notebooks), is recommended as a practice standard; (2) for individuals with severe memory deficits, the use of external compensations, including assistive technology, with direct application to functional activities is recommended as a practice guideline; and (3) for individuals with severe memory impairments, errorless learning techniques may be effective for learning specific skills or knowledge, although with limited transfer to novel tasks or reduction in overall functional memory problems However, a recent Cochrane meta-analysis 425 with 13 cognitive rehabilitation RCTs reported no benefit to executive functioning after stroke, whereas other systematic reviews using a broader range of evidence have suggested some limited evidence. 426,427 Current studies are small and have highly varied content, making comparisons difficult.…”

Section: Nondrug Therapies For Cognitive Impairment Including Memorymentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,169

840

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e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

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Section: Nondrug Therapies For Cognitive Impairment Including Memorymentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,169

840

View full text Add to dashboard Cite

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“…However, the requirement that a patient must be able to produce brain responses as prescribed by study instructions to demonstrate that he/she is aware is likely too stringent for many patients who are aware but, due to the effects of brain injury, fail to comply with structured instructions (35,46,47). Up to 43% of patients, who on the basis of routine bedside assessment are declared to be in a vegetative state (34), show inconsistent but reproducible behavioral signs of awareness to more careful/intensive bedside assessments (48) and are reclassified as being in a minimally conscious state (35).…”

Section: Discussionmentioning

confidence: 99%

A common neural code for similar conscious experiences in different individuals

Naçi¹,

Cusack²,

Anello

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

179

208

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The interpretation of human consciousness from brain activity, without recourse to speech or action, is one of the most provoking and challenging frontiers of modern neuroscience. We asked whether there is a common neural code that underpins similar conscious experiences, which could be used to decode these experiences in the absence of behavior. To this end, we used richly evocative stimulation (an engaging movie) portraying real-world events to elicit a similar conscious experience in different people. Common neural correlates of conscious experience were quantified and related to measurable, quantitative and qualitative, executive components of the movie through two additional behavioral investigations. The movie's executive demands drove synchronized brain activity across healthy participants' frontal and parietal cortices in regions known to support executive function. Moreover, the timing of activity in these regions was predicted by participants' highly similar qualitative experience of the movie's moment-to-moment executive demands, suggesting that synchronization of activity across participants underpinned their similar experience. Thus we demonstrate, for the first time to our knowledge, that a neural index based on executive function reliably predicted every healthy individual's similar conscious experience in response to real-world events unfolding over time. This approach provided strong evidence for the conscious experience of a brain-injured patient, who had remained entirely behaviorally nonresponsive for 16 y. The patient's executive engagement and moment-to-moment perception of the movie content were highly similar to that of every healthy participant. These findings shed light on the common basis of human consciousness and enable the interpretation of conscious experience in the absence of behavior.fMRI | brain injury | disorders of consciousness A lthough consciousness is a part of all of our lives, we are not privy to the conscious experiences of others. Indeed, our ability to understand and appreciate their experiences depends largely on their self-report, or ability to describe those experiences (1). However, in recent years a population of patients has been identified who are demonstrably conscious, but entirely unable to speak or move willfully in any way, precluding any systematic investigation of their conscious experience of the world (2-8). It remains unknown whether there is a common neural code that can account for how different individuals might form similar conscious experiences and, if so, whether it could be used to interpret those experiences without recourse to self-report.The "executive" function of the brain refers to those processes that coordinate and schedule a host of other more basic cognitive operations, such as monitoring and analyzing information from the environment and integrating it with internally generated goals, as well as planning and adapting new behavioral schemas to take account of this information (9-11). As such, executive function is integral to our con...

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“…It has been demonstrated that patients benefit from recommendations of physical exercise. 39 They may also benefit from cognitive rehabilitation training 40 and pharmacological therapy with acetylcholinesterase inhibitors. 41 …”

Section: Strokementioning

confidence: 99%

Validating a Pragmatic Approach to Cognitive Screening in Stroke Prevention Clinics Using the Montreal Cognitive Assessment

Swartz

Cayley

Lanctôt

et al. 2016

Stroke

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Cognitive screening in patients with stroke is endorsed by Best Practice Recommendations, 7 and rapid cognitive assessments are widely used in clinic settings to understand patient function and tailor appropriate therapy. The Montreal CognitiveBackground and Purpose-The Montreal Cognitive Assessment (MoCA) is used commonly to identify cognitive impairment (CI), but there are multiple published cut points for normal and abnormal. We seek to validate a pragmatic approach to screening for moderate-severe CI, by classifying patients into high-, intermediate-, and low-risk categories. Methods-A total of 390 participants attending an academic Stroke Prevention Clinic completed the MoCA and more detailed neuropsychological testing. Between April 23, 2012 and April 30, 2014, all consecutive new referrals to the regional Stroke Prevention Clinic who were English-speaking, not severely aphasic, and could see and write well enough to complete neuropsychological testing were assessed for inclusion, and consenting patients were enrolled. CI was defined as ≥2 SDs below normal for age and education on at least 2 cognitive subtests. A single cut point for CI was compared with 2 cut points (high sensitivity and high specificity) generated using receiver operator characteristic and area under the curve analyses. The intermediate-risk group contained those scoring between the 2 cut points. Results-Thirty-four percent of participants had a symptomatic or silent stroke, 34% were seen for possible or probable transient ischemic attack, and 32% were diagnosed with other vascular or nonvascular conditions. Using a single cut point, sensitivity and specificity were optimal with MoCA ≤22, (sensitivity=60.4%, specificity=89.9%, area under the curve=0.801, positive predictive value=48.5%, negative predictive value=93.5%, positive likelihood ratio=6, and negative likelihood ratio=0.4). Using 2 cut points, sensitivity was optimal with MoCA ≥28 (sensitivity=96.2%, negative predictive value =97.6%, and negative likelihood ratio=1.27), and specificity was optimal with MoCA ≤22 (specificity=89.9%, positive predictive value=48.5%, and positive likelihood ratio=6). 9 There is considerable variability in the diagnostic characteristics of the MoCA within the population with stroke (Table I in the online-only Data Supplement); most commonly, a cut point of ≥26 is considered normal, whereas ≤25 is considered impaired. Conclusions-Stratifying8 This dichotomization stems from the statistical approach to receiver-operating curves, but contradicts clinical thought processes in which screening questions are used throughout a clinical encounter to decide serious concern, no concern, or possible concern and guide further questioning or appropriate actions. The MoCA has been shown to be more sensitive to vascular CI than other quick screens (eg, the Folstein Mini-Mental State Examination), but less specific. [10][11][12] However, this reflects the use of a single cut point. In both clinical practice and research, the MoCA is often used as a surrogate for CI...

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Cognitive rehabilitation for executive dysfunction in adults with stroke or other adult non-progressive acquired brain damage

Cited by 169 publications

References 52 publications

Guidelines for Adult Stroke Rehabilitation and Recovery

Guidelines for Adult Stroke Rehabilitation and Recovery

A common neural code for similar conscious experiences in different individuals

Validating a Pragmatic Approach to Cognitive Screening in Stroke Prevention Clinics Using the Montreal Cognitive Assessment

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