Dysexecutive symptoms and carer strain following acquired brain injury: Changes measured before and after holistic neuropsychological rehabilitation

Abstract

Abstract. BACKGROUND:Following acquired brain injury (ABI), deficits in executive functioning (EF) are common. As a result many brain-injured patients encounter problems in every-day functioning, and their families experience significant strain. Previous research has documented the benefits of cognitive rehabilitation for executive dysfunction, and rehabilitation programmes designed to ameliorate functional problems associated with ABI. OBJECTIVES: This study primarily aims to evaluate whether a neuropsychological rehabilitation programme reduces reported symptoms of everyday dysexecutive behaviour and carer strain. METHODS: In this study 66 ABI outpatients attended comprehensive holistic neuropsychological rehabilitation programme. A repeated-measures design was employed to determine the effect of rehabilitation on EF and carer strain, as part of a service evaluation. Outcome measures comprised the dysexecutive questionnaire (DEX/DEX-I) and carer strain index (CSI), applied pre-and post-rehabilitation. RESULTS: Results indicate rehabilitation benefited clients and carers in 5 of 6 DEX/DEX-I subscales, and 2 of 3 CSI subscales, (p < 0.05). An effect of aetiology on rehabilitation was found on the metacognitive scale of the DEX-I. CONCLUSIONS: Therefore, this study supports a comprehensive holistic neuropsychological rehabilitation programme as effective in reducing reported symptoms of dysexecutive behaviour and carer strain following ABI.

Client experiences with holistic neuropsychological rehabilitation: “It is an ongoing process”

“…In general, the programme was considered effective for increasing everyday functioning, which is in line with previous effectiveness studies into holistic neuropsychological rehabilitation (Cicerone et al, 2008;Goodwin et al, 2016;Holleman et al, 2016;Malec, 2001). Corresponding with the findings of Nilsson et al (2011), this study emphasizes the process of change over time.…”

“…The approach focusses on increasing awareness and acceptance of the consequences of the injury, developing strategies or compensatory skills to reduce cognitive, emotional, and communicative problems, and applying these strategies within functionally relevant settings in the pursuit of personally relevant goals (Wilson et al, 2017). The effectiveness of this type of rehabilitation has been established in a number of previous studies which found increases in cognitive and emotional functioning, participation, and life satisfaction, while decreasing caregiver burden (Cicerone et al, 2008;Goodwin et al, 2016;Holleman et al, 2016;Malec, 2001). Further, evidence suggests these effects are maintained in the long-term (Shany- Ur et al, 2020).…”

Metacognitive Treatment in Acquired Brain Injury and Its Applicability to Aphasia: A Systematic Review

“…A wide range of study designs are included in this systematic review. The most frequently used research designs among studies were repeated measures ( 12 , 61 , 64 ) and single subject study designs [see Table 4 ; ( 2 , 3 , 15 , 18 , 25 , 37 , 38 , 54 , 62 )].…”

“…Metacognitive deficits are a common sequelae of ABI and reflect altered executive processes. Common areas of impairment include: initiation, flexibility, problem solving, self-monitoring, and self-regulation (12)(13)(14). Executive dysfunction can lead to significant life challenges including an inability to identify goals, pursue goals, apply learned strategies to different situations, and function independently within daily environment (12,15,16).…”

“…Common areas of impairment include: initiation, flexibility, problem solving, self-monitoring, and self-regulation ( 12 – 14 ). Executive dysfunction can lead to significant life challenges including an inability to identify goals, pursue goals, apply learned strategies to different situations, and function independently within daily environment ( 12 , 15 , 16 ). Furthermore, deficits within these areas are also observed in language processing such as an inability to plan what to say, decreased success in delivering the message, and reduced ability with respect to inhibiting unwanted responses ( 17 – 19 ).…”