[Show description][Hide description] DESCRIPTION: Abstract accepted for poster presentation at the 18th annual meeting of APA Division 22 Rehabilitation Psychology and the American Board of Rehabilitation Psychology on February 11-14, 2016 in Atlanta, GA.
[Show abstract][Hide abstract] ABSTRACT: Processing speed, working memory, and attention deficits are some of the most common cognitive deficits associated with traumatic brain injury (TBI). Cognitive rehabilitation has been proven to be an effective method to remediate cognitive deficits in adults with TBI; however, little research has considered the effects of TBI severity on such interventions. The present study examines changes in cognition following a computerized training program in adults with mild/moderate TBI and adults with severe TBI. Fourteen participants (ages 26-68; M = 45, SD = 13.95) with a history of TBI were separated into a mild/moderate group (n = 6) and a severe group (n = 8). Over a period of 12 weeks, participants underwent 40 hours of computerized cognitive training using Brain Fitness Program (POSIT Science) software. Baseline and follow-up neuropsychological assessments were administered to all participants. Neuropsychological scores were submitted to a 2x2 mixed design ANOVA, in which severity group (mild/moderate versus severe) served as the between-subjects variable and time (baseline versus follow-up) served as the within-subjects variable. Results indicate significant group differences on various cognitive measures including increased performance on a memory composite, F(1,11)= 7.58, p = .019; visual memory, F(1,12) = 8.99, p = .011; working memory, F(1,12) = 4.86, p = .048; and shifting attention, F(1,12) = 9.32, p = .01. Our findings suggest that cognitive rehabilitation techniques may be especially beneficial to adults with severe TBI. Following administration of a computerized training program, adults with severe TBI showed significant improvements in cognitive performance relative to adults with mild/moderate TBI.
[Show abstract][Hide abstract] ABSTRACT: One of the most frequent cognitive sequelae of traumatic brain injury (TBI) are deficits in processing speed. Processing speed deficits are theorized to mediate deficits of other higher order cognitive abilities, such as attention, learning and memory, working memory, and executive functions, and have been demonstrated to negatively impact everyday functioning, emotional status, and overall quality of life. Therefore, improvements in processing speed may positive impact multiple areas of cognition and quality of life. This study examines the effect of a neuroplasticity-based computerized training program (i.e., Brain Fitness Program, BFP; Posit Science) that targets the auditory system to improve processing speed in adults with a TBI. Thirty-four adults with a mean age of 44.39 (SD = 14.13) years old, and mild, moderate or severe TBI were assigned to experimental (n = 14) or control (n = 20) groups. Participants in the experimental group underwent 40-hours of BFP training over 10-12 weeks, and all participants underwent baseline and follow-up neuropsychological testing to assess processing speed, executive function, learning and memory, working memory, and attention; self-reported measures of cognitive and emotional functioning were also included. The results demonstrated improvements in the experimental group on measures of auditory and visual processing speed, executive functioning, attention, and verbal memory as well as reported increases in perception of cognitive functioning. Further, preliminary diffusion tensor imaging data suggesting associated changes in white matter tract integrity are discussed.
[Show abstract][Hide abstract] ABSTRACT: This study examines the effects of auditory processing training in adults with a traumatic brain injury (TBI). The experimental group showed significant improvements on measures of verbal memory, attention, information processing speed and perseverative errors. The effect size for the experimental group were medium to large and were much smaller for the control group. The results suggest the computerized auditory training program has cognitive benefits in adults with a TBI. One of the most frequent cognitive deficits associated with traumatic brain injury (TBI) is processing speed (PS) deficits (Rassovsky et al., 2006). Recent studies indicate that PS deficits form the basis for deficits of other higher order cognitive abilities such as verbal learning and memory, working memory and executive functions (Salthouse, 1996; Voelbel et al., 2011). Therefore, improvements in auditory PS will likely positively impact multiple areas of cognition, including verbal learning and memory, working memory and executive functions. This study examines the effect of a computerized training program to improve processing speed in adults with a TBI.
[Show abstract][Hide abstract] ABSTRACT: Objective: Recent studies indicate that processing speed deficits form the basis for deficits of other higher order cognitive
abilities. Therefore, improvements in auditory processing speed will likely positively impact multiple areas of cognition,
including verbal learning and memory, working memory, and executive functions. This study examines the effect of a computerized
training program to improve processing speed in adults with a TBI. Method: Twenty adults (mean age = 43.33, SD = 14.4) with a mild, moderate, or severe TBI were assigned to an experimental (n = 10) or control group (n = 10), and were matched on age and level of education. All participants underwent a baseline and follow-up neuropsychological
testing. The neuropsychological battery assessed processing speed, executive functions, verbal memory, visual memory, working
memory, and attention. Participants assigned to the experimental group underwent 40 hours of a structured computerized cognitive
training with six separate training modules (Brain Fitness Program, Posit Science) over 10–12 weeks. Results: The results
demonstrated that the experimental group had significant improvement on measures of auditory and visual processing speed (d
= .89 and .56, respectively), set-shifting (d = .76), following verbal directions (d = .47), and non-verbal reasoning correct
responses and reaction time (d = .44 and .50, respectively). Conclusion(s): The computerized neuroplasticity training program
demonstrated moderate to large effect sizes in the changes in performance from pre- and post-intervention assessments in the
experimental group compared to control group. As expected, the majority of the improvement was on measures of verbal skills
due to the nature of the intervention.
No preview · Article · Sep 2014 · Archives of Clinical Neuropsychology
[Show abstract][Hide abstract] ABSTRACT: Objective: During the acute and post acute period following a mild traumatic brain injury (mTBI) multiple cognitive processes
are negatively affected. Prior studies have reported numerous cognitive domains affected during the acute and post-acute period.
Studies have demonstrated cognitive recovery, with subjective and objective assessments, that within days to weeks these cognitive
abilities are recovered. This study examines the recovery of neurocognitive functions longitudinally. Method: In this study,
we compared 12 adults entering an emergency department that met the criteria for a mTBI to a healthy control group of 13 adults.
The neuropsychological evaluation for the mTBI group was performed within 10 days of the injury and 4 months following the
injury. Results: The results demonstrate the mTBI group has significant deficits in processing speed, attention and concentration,
as well as verbal and visual memory compared to the control group at baseline. The mTBI group showed cognitive recovery in
most cognitive areas at the four month follow-up. Processing speed and visual memory were still significantly below the performance
of the control group at the 4-month post-assessment. Conclusion(s): The results support prior studies that processing speed
and memory may be the most sensitive cognitive domains affected by a mTBI. Furthermore, this study reveals individuals that
experience a mTBI may still experience impairment in these cognitive domains 4-months post injury.
No preview · Article · Sep 2014 · Archives of Clinical Neuropsychology
[Show abstract][Hide abstract] ABSTRACT: Verbal memory is one of the most common cognitive deficits following a traumatic brain injury (TBI). Cognitive rehabilitation techniques have been proven to be effective methods to remediate verbal memory in TBI. The present investigation aims to determine whether verbal memory can be remediated with a computerized auditory training program as a cognitive remediation technique. Following comprehensive baseline neuropsychological assessments, 32 participants (18 males, 14 females; ages 24-68, M = 45.81, SD = 13.81) with a history of TBI were placed into the experimental or control group. Fifteen experimental participants were administered 40 hours of cognitive training using the Brain Fitness Program software over eight weeks, and 17 participants were in a no treatment control group. All participants in experimental and control groups were administered follow-up neuropsychological assessments identical to the baseline tests to determine changes in performance of verbal memory. The results demonstrate that the experimental group compared to the control group, showed higher improvement in verbal memory. The impact of cognitive training on verbal memory is indicated by large effect size of baseline and follow-up difference scores for Logical Memory (d = 4.33 for immediate; d = 3.43 for delayed recall), CVLT-II (d = 2.09 for delayed recall; d = 4.68 for delayed recognition), and a composite verbal memory index (d = 2.70) determined by the CNS Vital Signs program. Our results demonstrate that verbal memory impairments in individuals with a TBI can be remediated by employing a systematically recurrent auditory training program.
[Show abstract][Hide abstract] ABSTRACT: Verbal Memory (VM) deﬁcit is common following traumatic brain injury (TBI), and cognitive rehabilitation techniques (CRTs) have proven effective as remediation methods. This study investigates whether computerized auditory training CRTs can remediate VM deﬁcits in adults with TBI. Here 32 participants with TBI were randomly placed into an experimental or control group: the experimental group underwent 40 hours of computerized training. Results from baseline to follow-up neuropsychological testing demonstrate VM improvement in the CRT-trained experimental group, with large effect sizes (d > 2.09). This study demonstrates TBI-related VM deﬁcits can be remediated based on principles of neuroplasticity via cognitive remediation training.
Full-text · Article · Jun 2014 · The Clinical Neuropsychologist
[Show abstract][Hide abstract] ABSTRACT: The present study utilized functional near infrared spectroscopy (fNIRS) to detect neural activation differences in the orbitofrontal brain region between individuals with multiple sclerosis (MS) and healthy controls (HCs) during a working memory (WM) task. Thirteen individuals with MS and 12 HCs underwent fNIRS recording while performing the n-back WM task with four levels of difficulty (0-, 1-, 2-, and 3-back). Subjects were fitted with the fNIRS cap consisting of 30 'optodes' positioned over the forehead. The results revealed different patterns of brain activation in MS and HCs. The MS group showed an increase in brain activation, as measured by the concentration of oxygenated hemoglobin (oxyHb), in the left superior frontal gyrus (LSFG) at lower task difficulty levels (i.e. 1-back), followed by a decrease at higher task difficulty (2- and 3-back) as compared with the HC group. HC group achieved higher accuracy than the MS group on the lower task loads (i.e. 0- and 1-back), however there were no performance differences between the groups at the higher task loads (i.e. 2- and 3-back). Taken together, the results suggest that individuals with MS experience a task with the lower cognitive load as more difficult than the HC group, and the brain activation patterns observed during the task confirm some of the previous findings from functional magnetic resonance imaging (fMRI) studies. This study is the first to investigate brain activation by utilizing the method of fNIRS in MS during the performance of a cognitive task.
Full-text · Article · Jun 2014 · Brain Imaging and Behavior
[Show abstract][Hide abstract] ABSTRACT: Neuropsychological and cognitive deficits are observed in the majority of persons with alcohol and drug use disorders and may interfere with treatment processes and outcomes. Although, on average, the brain and cognition improve with abstinence or markedly reduced substance use, better understanding of the heterogeneity in the time-course and extent of cognitive recovery at the individual level is useful to promote bench-to-bedside translation and inform clinical decision making. This study integrated a variable-centered and a person-centered approach to characterize diversity in cognitive recovery in 197 patients in treatment for a substance use disorder. We assessed executive function, verbal ability, memory, and complex information processing speed at treatment entry, and then 6, 26, and 52 weeks later. Structural equation modeling was used to define underlying ability constructs and determine the mean level of cognitive changes in the sample while minimizing measurement error and practice effects on specific tests. Individual-level empirical growth plots of latent factor scores were used to explore prototypical trajectories of cognitive change. At the level of the mean, small to medium effect size gains in cognitive abilities were observed over 1 year. At the level of the individual, the mean trajectory of change was also the modal individual recovery trajectory shown by about half the sample. Other prototypical cognitive change trajectories observed in all four cognitive domains included Delayed Gain, Loss of Gain, and Continuous Gain. Together these trajectories encompassed between 86 and 94% of individual growth plots across the four latent abilities. Further research is needed to replicate and predict trajectory membership. Replication of the present findings would have useful implications for targeted treatment planning and the new cognitive interventions being developed to enhance treatment outcomes.
Full-text · Article · Dec 2013 · Frontiers in Psychiatry
[Show abstract][Hide abstract] ABSTRACT: Diffusion tensor imaging (DTI) has widely been used to investigate the microstructural damage of white matter tracts that occur in individuals with traumatic brain injury (TBI). In the current review, we discuss the white matter regions which are commonly affected in adults with TBI. We also describe the current literature that has utilized DTI to investigate the relationship between microstructural integrity with neuropsychological performance and clinical outcome measures. Finally, a model is presented of the potential utilization of DTI as a biomarker of efficacy in neurorehabilitation for individuals with TBI.
No preview · Article · Oct 2012 · Neurorehabilitation
[Show abstract][Hide abstract] ABSTRACT: This study examined the contribution of tactile and kinesthetic perceptions to handwriting legibility and speed of 177 Taiwanese children in first and second grade. Five standardized instruments assessed tactile and kinesthetic perceptions using handwriting legibility and speed as outcome measures. Fine motor coordination, mental processing speed, age, and gender were measured and served as covariates. Pearson correlations and regression analyses examined the relationship between handwriting and tactile and kinesthetic perceptions. Handwriting speed and legibility both significantly correlated with tactile perception, kinesthetic perception, and covariates. Results from the regression analysis supported tactile and kinesthetic perceptions as being significant predictors of both handwriting speed (F (6,170) = 25.87, p < .001, R-2 = .477) and legibility (F (6,170). = 11.043, p < .001, R-2 = .280). Tactile perception contributed more to handwriting speed and legibility than kinesthetic perception. Tactile and kinesthetic perception should be assessed when evaluating handwriting. When children have difficulty writing quickly or legibly, professionals should assess children's tactile and kinesthetic abilities.
No preview · Article · Jul 2012 · OTJR Occupation Participation Health
[Show abstract][Hide abstract] ABSTRACT: The current study examined the relationship between two separate but complementary methods of assessing executive functions in individuals with multiple sclerosis (MS): (1) a neurocognitive approach with the Tower of London(-DX) (TOL-DX) test and (2) a functional top-down approach with the Executive Function Performance Test (EFPT). Sixty-eight individuals with MS (79% female) and 38 healthy controls (68% female) were administered both the TOL-DX test and the EFPT. For the group with MS, significant differences were found on the TOL-DX test and the EFPT executive components and functional tasks. For the group with MS, the number of moves to complete the TOL-DX tasks was significantly positively correlated to the Organization and Sequencing executive components of the EFPT and the Simple Cooking and Bill Payment tasks of the EFPT. The results demonstrate the relationship of executive function behavior and performance of instrumental activities of daily living tasks.
No preview · Article · Dec 2011 · OTJR Occupation Participation Health
[Show abstract][Hide abstract] ABSTRACT: An essential component for a practical noninvasive brain-computer interface (BCI) system is data recording technology that
can access the information-processing activity of the brain with high fidelity and throughput. Functional near-infrared spectroscopic
(fNIRS) imaging is a methodology that shows promise in meeting this need, having a demonstrated sensitivity to both the slow
hemodynamic response that follows neuroactivation and to the lower amplitude fast optical response that is considered a direct
correlate of neuroactivation. In this report we summarize the technology integration strategy we have developed that permits
detection of both signal types with a single measuring platform, and present results that document the ability to detect these
data types transcranially in response to two different visual paradigms. Also emphasized is the effectiveness of different
data analysis approaches that serve to isolate signals of interest. The findings support the practical utility of NIRS-based
imaging methods for development of BCI applications.
[Show abstract][Hide abstract] ABSTRACT: The premise of this report is that functional Near Infrared Spectroscopy (fNIRS) imaging data contain valuable physiological information that can be extracted by using analysis techniques that simultaneously consider the components of the measured hemodynamic response [i.e., levels of oxygenated, deoxygenated and total hemoglobin (oxyHb, deoxyHb and totalHb, respectively)]. We present an algorithm for examining the spatiotemporal co-variations among the Hb components, and apply it to the data obtained from a demonstrational study that employed a well-established visual stimulation paradigm: a contrast-reversing checkerboard. Our results indicate that the proposed method can identify regions of tissue that participate in the hemodynamic response to neuronal activation, but are distinct from the areas identified by conventional analyses of the oxyHb, deoxyHb and totalHb data. A discussion is provided that compares these findings to other recent studies using fNIRS techniques.
[Show abstract][Hide abstract] ABSTRACT: Multiple Sclerosis (MS) is a disease of the central nervous system affecting millions of people worldwide. In addition to the disabling physical symptoms of MS, roughly 65% of individuals with MS also experience significant cognitive dysfunction, especially in the domains of learning/memory, processing speed (PS) and working memory (WM). The purpose of this review is to examine major topics in research on cognitive dysfunction, as well as review recent functional magnetic resonance imaging (fMRI) studies focusing on cognitive dysfunction in MS. Additionally, directions for future research are discussed.
No preview · Article · Feb 2009 · Frontiers in Bioscience
[Show abstract][Hide abstract] ABSTRACT: Background: A subset of children with autism spectrum disorder (ASD) present with emotional dysregulation that resembles the affective instability (AI) symptoms observed in bipolar disorder (BD). A growing literature suggests co-occurring disorders and possible morbidity or etiologic overlap between ASD and BD. However, this overlap has not been well defined. A better description of AI may help elucidate symptom and etiological similarities between BD and ASD and facilitate the identification of potential biomarkers and treatment targets.
Objectives: To use K-SADS variables to study AI symptoms in children with ASD and children with BD thus delineating a domain of affective instability.
Methods: Children between 7 and 13 years with either DSM-IV ASD or BD, recruited for separate studies, received assessments including: Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS), the Autism Diagnostic Interview (ADI-R), and the DSM-IV Asperger’s/Autism Checklist. Nineteen symptoms from the K-SADS were selected as representative of AI based on face validity. The ASD and BD groups were compared for the frequency of these AI symptoms.
Results: As expected, K-SADS symptoms of AI were more prevalent in the BD group. However, a subset of the ASD group also demonstrated a high frequency of AI symptoms. A cluster of eight symptoms displaying the greatest overlap between the two groups including acts before thinking, distractibility, depressed affect, grandiosity, inappropriate affect, decreased sleep, elated mood, and flight of ideas had an average frequency of 47% in the BD group, 26% in the ASD group, and 3% in the control group. Symptoms of AI were extreme enough in 13% of children with ASD to warrant a secondary lifetime diagnosis of BD.
Conclusions: A subset of children with ASD has significant AI resembling BD. Biomarker research may help identify overlapping etiopathogenesis of AI across DSM disorders.
[Show abstract][Hide abstract] ABSTRACT: We have developed a method for dividing the hemoglobin signal into six discrete categories that correspond to different states of vascular autoregulation. Here we use it to reveal physiologically meaningful differences among three subject groups.