Cognitive Rehabilitation Interventions for Executive Function: Moving from Bench to Bedside in Patients with Traumatic Brain Injury

University of Toronto, Toronto, Ontario, Canada
Journal of Cognitive Neuroscience (Impact Factor: 4.09). 08/2006; 18(7):1212-22. DOI: 10.1162/jocn.2006.18.7.1212
Source: PubMed


Executive function mediated by prefrontally driven distributed networks is frequently impaired by traumatic brain injury (TBI) as a result of diffuse axonal injury and focal lesions. In addition to executive cognitive functions such as planning and working memory, the effects of TBI impact social cognition and motivation processes. To encourage application of cognitive neuroscience methods to studying recovery from TBI, associated reorganization of function, and development of interventions, this article reviews the pathophysiology of TBI, critiques currently employed methods of assessing executive function, and evaluates promising interventions that reflect advances in cognitive neuroscience. Brain imaging to identify neural mechanisms mediating executive dysfunction and response to interventions following TBI is also discussed.

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Available from: Keith D Cicerone
    • "The Dysexecutive Questionnaire (DEX;Burgess, Alderman, Evans, Emslie, & Wilson, 1998) has been introduced as one such tool (Simblett & Bateman, 2010). A valid and reliable three-dimensional structure for the DEX has been proposed (Simblett et al., 2012;Simblett & Bateman, 2010) that is in keeping with current theoretical conceptualisations of domain-general processes associated with frontal lobe or executive functions (Cicerone et al., 2006;Stuss, 2007). However, previous research carried out bySimblett and Bateman (2010)on the psychometric properties of the DEX has highlighted some ways in which the measure could be improved. "
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    ABSTRACT: The Dysexecutive Questionnaire (DEX) is a tool for measuring everyday problems experienced with the dysexecutive syndrome. This study investigated the psychometric properties of a revised version of the measure (DEX-R), a comprehensive tool, grounded in current theoretical conceptualisations of frontal lobe function and dysexecutive problems. The aim was to improve measurement of dysexecutive problems following acquired brain injury (ABI). Responses to the DEX-R were collected from 136 men and women who had experienced an ABI (the majority of whom had experienced a stroke or subarachnoid haemorrhage) and where possible, one of their carers or family members (n = 71), who acted as an informant. Rasch analysis techniques were employed to explore the psychometric properties of four newly developed, theoretically distinct subscales based on Stuss model of frontal lobe function and to evaluate the comparative validity and reliability of self and informant ratings of these four subscales. The newly developed subscales were well targeted to the range of dysexecutive problems reported by the current sample and each displayed a good level of internal validity. Both self- and independent-ratings were found to be performing reliably as outcome measures for at least a group-level. This new version of the tool could help guide selection of interventions for different types of dysexecutive problems and provide accurate measurement in neurorehabilitation services.
    No preview · Article · Jan 2016 · Neuropsychological Rehabilitation
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    • "Remediation approaches OTs might adopt for improving EF include using metacognitive strategies, classic neuroscience research—including working memory training, improving EF using intact cognitive abilities, use of the GMT protocol, and adopting virtual reality environments to prepare for community reintegration. For more detail on deficits , assessment, and treatment, please see recent reviews specific to EF (Chung, Pollock, Campbell, Durward, & Hagen, 2013; Cicerone, Levin, Malec, Stuss, & Whyte, 2006). "
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    ABSTRACT: Nearly 1.7 million Americans sustain a traumatic brain injury (TBI) each year. These injuries can result in physical, emotional, and cognitive consequences. While many individuals receive cognitive rehabilitation from occupational therapists (OTs), the interdisciplinary nature of TBI research makes it difficult to remain up-to-date on relevant findings. We conducted a literature review to identify and summarize interdisciplinary evidence-based practice targeting cognitive rehabilitation for civilian adults with TBI. Our review summarizes TBI background, and our cognitive remediation section focuses on the findings from 37 recent (since 2006) empirical articles directly related to cognitive rehabilitation for individuals (i.e., excluding special populations such as veterans or athletes). This manuscript is offered as a tool for OTs engaged in cognitive rehabilitation and as a means to highlight arenas where more empirical, interdisciplinary research is needed.
    Full-text · Article · Feb 2015 · OTJR Occupation Participation Health
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    • "Cognitive and behavioral deficits seem to be especially deleterious impacting overall functional outcomes and quality of life of patients and their families [8]–[15]. The extent of these deficits following TBI is broad and includes information processing [16], attention [17], memory [18], executive function [19], computation, and discrimination of probabilities [20]. They can occur singly or in combination, can change in severity over time, and often remain greatly impaired despite rehabilitation [10], [21]–[23]. "
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    ABSTRACT: Rehabilitation can improve cognitive deficits observed in patients with traumatic brain injury (TBI). However, despite rehabilitation, the ability of making a choice often remains impaired. Risk taking is a daily activity involving numerous cognitive processes subserved by a complex neural network. In this work we investigated risk taking using the Balloon Analogue Risk Task (BART) in patients with acute TBI and healthy controls. We hypothesized that individuals with TBI will take less risk at the BART as compared to healthy individuals. We also predicted that within the TBI group factors such as the number of days since the injury, severity of the injury, and sites of the lesion will play a role in risk taking as assessed with the BART. Main findings revealed that participants with TBI displayed abnormally cautious risk taking at the BART as compared to healthy subjects. Moreover, healthy individuals showed increased risk taking throughout the task which is in line with previous work. However, individuals with TBI did not show this increased risk taking during the task. We also investigated the influence of three patients' characteristics on their performance at the BART: Number of days post injury, Severity of the head injury, and Status of the frontal lobe. Results indicate that performance at the BART was influenced by the number of days post injury and the status of the frontal lobe, but not by the severity of the head injury. Reported findings are encouraging for risk taking seems to naturally improve with time postinjury. They support the need of conducting longitudinal prospective studies to ultimately identify impaired and intact cognitive skills that should be trained postinjury.
    Full-text · Article · Dec 2013 · PLoS ONE
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