The effect of internet-based cognitive rehabilitation in persons with memory impairments after severe traumatic brain injury
ABSTRACT The current study examined whether cognitive rehabilitation delivered over the Internet was associated with improvements in functioning.
A total of 14 individuals with medically documented traumatic brain injury completed this study. Participants completed 30 sessions of an active calendar acquisition intervention and 30 sessions of a control diary intervention in a cross-over study design for a total of 60 online sessions. All sessions were completed using an instant messaging system via the Internet. Measures of cognitive functioning, ratings of memory and mood and frequency of use of common memory and cognitive compensation techniques were gathered from participants and family members.
There were no significant differences between the active and control conditions on the primary outcome measure of memory functioning. However, significant improvements in use of compensatory strategies as well as family reports of improved memory and mood were observed following completion of all sessions. Individuals with less use of compensatory strategies at baseline were significantly less likely to complete the study.
These results suggest that the Internet may be an effective delivering mechanism for compensatory cognitive rehabilitation, particularly among individuals who are already utilizing some basic compensatory strategies.
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- "calendar, planners, cue cards) with each compensatory technique rated on a 7-point Likert scale. Selected questions were used from this instrument based upon our prior research (Bergquist et al, 2009). "
ABSTRACT: Persons with severe functional disabilities are the highest users of health care services. Caring for the needs of this population represents a significant percentage of our national health care costs. A growing body of research has demonstrated the efficacy of self-management strategies and caregiver engagement for effective long-term care for individuals with chronic medical conditions. Economic forces over the past decade have led to new challenges and resulted in major changes in health care delivery resulting in shortened length of inpatient stays and greater limits on the length of outpatient treatment. Telehealth is an innovative method for health care delivery and a means of meeting this new challenge. This article highlights the findings of 3 pilot studies on the use of telecommunications technologies in promoting self-care management and enhancing health care outcomes in persons with severe disabilities and their family caregivers. The importance of matching technology to the needs of this population, lessons learned from these investigations, and future directions for research are addressed.Psychological Services 05/2012; 9(2):144-62. DOI:10.1037/a0028112 · 1.08 Impact Factor
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ABSTRACT: This study looked at patient satisfaction with an Internet-based cognitive rehabilitation program, which has been previously shown to be associated with functional improvements. Fourteen individuals with documented traumatic brain injury and memory impairments completed this study. Participants completed 60 sessions of Internet-based cognitive rehabilitation: 30 sessions of an active calendar intervention and 30 sessions of a control diary intervention. A four-question satisfaction questionnaire (responses were generated using a seven-point Likert scale) was completed after 30 sessions and again after 60 sessions. No significant differences in satisfaction were found between time of assessment and treatment condition. In addition, a higher level of calendar use prior to beginning the study was associated with greater satisfaction at study completion. These results suggest that persons with traumatic brain injury are not only willing to use the Internet to receive cognitive rehabilitation treatment, but are generally highly satisfied with the treatment. Further, individuals with some baseline compensatory strategies may be particularly well suited to this method of treatment.Telemedicine and e-Health 05/2010; 16(4):417-23. DOI:10.1089/tmj.2009.0118 · 1.54 Impact Factor
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ABSTRACT: OPINION STATEMENT: Traumatic brain injury (TBI) is a major public health problem with neurobehavioral sequelae contributing to the long-term disability that is often associated with the moderate to severe levels of injury. Rehabilitation of cognitive skills is central to encouraging the full participation of the individual in home, vocational, and social roles. The review of available evidence points to four major recommendations for the rehabilitation of cognition following brain injury: 1) Access to subacute rehabilitation that is holistic in nature and involves a multidisciplinary or transdisciplinary team to work in an integrated fashion to support physical, cognitive, and social skill retraining is vital to support positive outcome following TBI. The collaborative effort of these individuals allows for continual reinforcement and evaluation of treatment goals and will often involve the family and/or important others in the individual's life to prepare for community re-entry. 2) Trials of medication, especially methylphenidate, to assist individuals with significant attention and memory impairment appear well supported by the available evidence. Though some data suggest that the use of cholinesterase inhibitors may be of use for individuals with memory impairments, there is less support for this practice and there are indications that it may worsen the behavioral sequelae of the injury. 3) Randomized controlled trials demonstrate the utility of specific rehabilitation approaches to attention retraining and retraining of executive functioning skills. Future research is needed on rehabilitation techniques in other domains of cognition. 4) Training in the use of supportive devices (either a memory book or more technologically enhanced compensatory devices) to support the individual's daily activities remains central to the independent function of the individual in the community. Though emerging treatments (eg, virtual reality environments) show relative degrees of promise for inclusion in the rehabilitation of the individual with TBI, these need further evaluation in systematic trials.Current Treatment Options in Neurology 09/2010; 12(5):412-23. DOI:10.1007/s11940-010-0085-6 · 2.18 Impact Factor