The purpose of this study was to examine the effects of song-based music therapy interventions on psychosocial factors for people who have had Acquired Brain Injuries (ABI) or Spinal Cord injuries (SCI) and their caregivers during acute rehabilitation. The psychosocial factors in this study involve mood states, caregiving experiences, and dyadic relationships. The study also examined the correlation between care recipients and caregivers on mood states and the dyadic relationship. A quasi-experimental, two-group pretest-posttest design without a control group was used to investigate the psychosocial factors. A total of 10 dyads were recruited for the study. Group A in this study were care recipients; Group B were caregivers of Group A. The dyad attended four individual music therapy sessions of approximately 45-minute duration over a period of 14 days. During the song-based music therapy protocol, the participants were empowered to choose between singing along or listening to their preferred music. Caregiver participants had the option to participate in either in-person or virtual sessions. Three measures were used to investigate psychosocial factors: Visual Analogue Mood States (VAMS), Positive Aspects of Caregiving (PAC), and Dyadic Relationship Scale (DRS). VAMS was used pre and post each intervention while PAC and DRS were only used before the first session and the last session. All statistical analyses were conducted in R, a statistical program. The Wilcoxon test and Kendall’s rank correlations were used to examine the pre- and post-intervention changes and the correlation between Group A and Group B on mood states and the dyadic relationship. The findings of the study indicated that there were significant changes in mood states for both Group A and Group B. There were four strong correlations in the dyadic relationship between caregivers and care recipients, including feeling closer to each other, feeling angry toward the other, having more patience than they have had in the past, and feeling relationships with each other were strained. Implications for music therapy practice and recommendations for the field and future research are also presented. / Music Therapy

Music therapists have utilized technology in their clinical work for decades. Yet music therapy delivered in a telehealth model – telemusic therapy – has rarely been described in the literature until recently. This study stems from telemusic therapy services the researcher-interventionist was contracted to provide to adult acquired brain injury (ABI) survivors. The existing literature has primarily reported on synchronous telemusic therapy conducted via internet-based videoconference platforms with individual clients or groups who were colocated but not face-to-face with the clinician. Technological issues were cited as limitations. Only one article described small group telemusic therapy where participants were each located at their individual homes; no literature was found for large groups of non-colocated participants. Further, the telemusic therapy literature very rarely reports empirical data. This thesis presents the results of a pilot study exploring the feasibility and effectiveness of telemusic therapy on well-being for adult brain injury survivors who participate independently from their homes. This retrospective study utilized a quasi-experimental, pre/post-session repeated measures design to examine data from a 20-session, 10-week, group telemusic therapy program (N = 15). Clinician-developed pre/post measures of well-being were administered each session. A Qualtrics Likert scale survey exploring audiovisual quality, emotional support, the therapeutic relationship, and social-emotional connection between participants was issued during the 5th and 10th weeks. Results: Mean and median difference of pre/post measures were significant for increasing well-being at α = 0.5. Frequency distributions of the survey ratings of more than or very much adequate for quality of audio and video: 78.6% – 85.7%; ratings of more than or very much adequate for emotional support, formation of a therapeutic relationship and creating connections with other participants, respectively: 85.7%, 78.6%, 92.9 %. The results support the feasibility and effectiveness of group telemusic therapy for increasing well-being in adult ABI survivors who attend from their individual homes. Study limitations include small N, low return rate for surveys, and unvalidated measures.It is noteworthy that in each session, the music therapy group successfully engaged in real-time active music making with all members playing and all microphones on. No audio delay was detected. This phenomenon has been described in the literature as improbable. The cause of such low latency is unknown. These findings demonstrate that participants using personal computers or laptops and residential broadband Internet experience the audio and visual components of synchronous music therapy as more than adequate. A real-time telehealth model is a viable means for providing group music therapy. / Music Therapy

Traumatic brain injury (TBI) contributes to global mortality and disability more than any other traumatic injury. Individuals who sustained a TBI undergo profound changes in their cognitive, physical, and emotional functions. Noticeable behavioral changes include irritability, aggression, low self-awareness, impulsivity, rumination, and more. These contribute to the individual's inability to control emotions and thus participate in interactions and activities, naturally influencing the person, their environment, and the community. While traditional therapy approaches are beneficial for some of the mentioned challenges, extensive evidence shows that emotional regulation is not effectively addressed, often resulting in behavioral outcomes in the therapeutic environment alone. Mindfulness interventions focus on the present moment's thoughts, sensations, and surroundings with an open and curious mindset, helping participants cope with stressors that often lead to anxiety and problematic behavioral patterns. Nevertheless, the standard Mindfulness does not accommodate the TBI-related challenges. Cultivating Awareness by Living Mindfully (CALM), is a Mindfulness-based group intervention for adults who sustained a TBI. It aims to increase self-awareness and improve emotional regulation by practicing mindfulness techniques and implementing them in everyday activities and interactions. This 12-week program is low-cost and easily applicable to a variety of practice and community settings. The program incorporates principles from the latest evidence-based therapy approaches and is designed specifically to accommodate TBI-related challenges. The theoretical foundations consist of complementing knowledge bases including Mindfulness, the occupational therapy framework - the multi-context approach, and brain-based learning, which are principles from the latest research on optimizing learning for this population. This combination of frameworks aims to makes Mindfulness and its many associated health benefits accessible for individuals post-TBI. This doctoral paper includes a plan for program evaluation, funding, and dissemination

<p><strong>Introduction:</strong> Children with acquired brain injury (ABI) receive physiotherapy interventions to promote motor skill relearning. Theoretically-driven motor learning strategies (MLS) may support therapists in this goal, but their use with this complex population is unexplored. Virtual reality (VR) games are popular interventions that may influence therapist use of MLS. A valid, reliable method to examine MLS during usual and VR-based interventions is required.</p> <p><strong>Purpose: </strong>To: 1) identify the active ingredients of VR interventions; 2) develop and examine the psychometric properties of an instrument to measure MLS use; and 3) explore physiotherapists’ perspectives on promoting motor learning within usual and VR-based interventions for children with ABI.</p> <p><strong>Methods:</strong> A scoping review methodology was used to identify the active ingredients of VR interventions. Nineteen experts and clinicians participated in a content validation process to develop an instrument to measure MLS. Inter-rater reliability of the instrument was evaluated within 22 videotaped usual and VR-based physiotherapy sessions with children with ABI. Six therapists participated in qualitative interviews about these interventions.</p> <p><strong>Results:</strong> The scoping review identified<em> </em>11 active ingredients of VR; 6 related to motor learning theory. The Motor Learning Strategy Rating Instrument (MLSRI) was developed. Inter-rater reliability was high (0.81) for usual interventions but low (0.28) for VR-based interventions. Therapists described the importance of considering intervention goals and child characteristics when promoting motor learning; VR was viewed as a complex, motivating intervention that influenced their use of verbal strategies.</p> <p><strong>Conclusions:</strong> A motor learning theoretical framework may be relevant to clinicians and researchers using VR in pediatric rehabilitation. Qualitative findings enhance understanding of how therapists promote motor learning in usual and VR-based physiotherapy interventions for children withABI. The use of MLS can be measured reliably within usual interventions, but further instrument refinements are required to rate MLS use within VR-based physiotherapy for children with ABI.</p> / Doctor of Philosophy (PhD)

Acquired brain injury (ABI) and long-term neurological conditions (such as multiple sclerosis, Parkinson’s disease), are major causes of disability in the UK, and can lead to significant physical, cognitive, neuro-behavioural, psychological and social difficulties for sufferers. Individuals affected by an ABI or neurological conditions commonly report difficulties around emotional adjustment, reduced attention, mental control, and self-efficacy and their health-related quality of life also often appears to be much reduced. Whilst conventional neuro-rehabilitation has tended to address physical and cognitive impairments and deficits rather than psychological sequelae, recently a growing trend for more holistic approaches appears to have emerged (e.g., Wilson et al., 2000, 2013). Amongst these approaches, mindfulness-based interventions (collectively known as MBIs) have sought to address this gap in terms of therapeutic intervention. There is a growing body of research evidence pointing to the utility of MBIs in the rehabilitation and support of these populations in improving perceived quality of life and increasing self-management of these conditions. However, the research still remains limited and debate persists in terms of the conceptual and theoretical framework of mindfulness. The present study sought to evaluate the effectiveness of an adapted, short-form MBI group programme for a mixed population of patients (n = 22) currently offered in a local neuro-rehabilitation service. A specific pre-post control group design was adopted in order to investigate whether the intervention produced improvements in mindfulness skills, and whether these would in turn lead to improvements in measures associated with self-efficacy and perceived quality of life. Results indicated participants completing the MBI group programme showed significantly higher mean scores across measures of mindfulness. The results also indicated that these improvements were predictive of improvements across self-efficacy and quality of life measures, with large effect sizes observed. The findings would appear to support the research hypothesis that a suitably modified MBI is beneficial for a mixed ABI population. Findings, study limitations, clinical relevance and implications, as well as methodological and theoretical considerations and directions for future research are discussed in light of the main research questions.

People with a diagnosis of schizophrenia have been found to perform poorly on tasks assessing semantic memory, and these impairments have been proposed to be related to certain symptoms, in particular Formal Thought Disorder (FTD). A systematic literature review and meta-analysis identified the need a) to determine whether semantic memory is a primary impairment in schizophrenia and not secondary to other cognitive impairments and b) what cognitive models could provide the best explanation for the impairment. With these aims, Studies One and Two compared the performance of a group of people with schizophrenia across a battery of semantic memory tests (Hodges, Salmon and Butters, 1992). In order to eliminate confounding variables, two clinical control groups were recruited for comparison, one with a probable degraded semantic memory arising from Alzheimer‘s Dementia (AD) and the other with a primary dysexecutive syndrome caused by acquired brain injury (ABI). From these comparisons, it was possible to profile the semantic memory impairment in schizophrenia with the conclusion that any deficits are task-specific. Unlike the AD group, the impairment did not seem to arise from a loss of stored knowledge but nor did a retrieval problem, in its simplest terms, offer the best explanation. Since the ABI group performed normally on the battery it is clear that a dysexecutive syndrome does not necessarily explain poor semantic memory performance. Qualitatively, the associations and categories formed by people with schizophrenia on tasks of semantic categorisation e.g. the Category Generation Test (CGT) (Green, Done, Anthony, McKenna and Ochocki, 2004) often resemble loosening of associations and psychotic speech. In order to understand more about the processes involved in the formation of these bizarre categories, I compared performance on the CGT of groups of people with schizophrenia, AD and ABI. I found that the people with AD performed fairly similarly to the people with schizophrenia in that they sorted cards in an idiosyncratic way but the ABI group performed normally, adhering to taxonomic categories. Although this result might suggest that the bizarre associations on the CGT in people with schizophrenia are caused by a deficit in semantic memory (and not a dysexecutive syndrome), further analysis found important differences between the AD and the schizophrenia group in the way the card sorts were formed. In addition, both these groups showed intact semantic memory knowledge of the items they mis-sorted, indicating that categorisation problems do not necessarily arise from a degraded memory store. The difficulties people with schizophrenia appear to have on tests of associations and categorisation (e.g. CGT) could arise from a disorganised semantic memory i.e. differences in the way in which concepts are interconnected. On the CGT, patients with schizophrenia were far more likely to sort items on the basis of thematic (situational) information suggesting a preference for thematic over taxonomic associations. To test this, participants were tested using a triadic comparison task which requires choosing whether an item is best associated with a taxonomic, thematic or perceptually related item. On this test patients performed comparably to controls suggesting that their semantic memory is organised normally and that the abnormalities in the way in which items are associated on some semantic memory tests, including the CGT, are task-specific. It has been proposed that one of the core problems in schizophrenia is that there is ―an aberrant assignment of salience‖ (Kapur 2003) to contextually inappropriate concepts due to a dysregulated dopamine system (Kapur 2003; Kapur et al 2005). It is possible that this could also explain the semantic memory impairments in schizophrenia i.e. certain less relevant concepts/ associations are chosen because they are experienced as more salient. To test this, a group of patients with schizophrenia were assessed using a test of semantic salience. Compared to controls, the patients made significantly more errors of salience including significantly more errors where large aberrant attributions of importance were given to items. The tendency to make errors on the salience test was highly correlated with errors on the CGT and also the semantic association tests, indicating a common underlying mechanism. Therefore, it can be concluded that the semantic memory impairments in schizophrenia are task-specific, not caused by a loss of semantic knowledge or a dysexecutive syndrome, but due to an aberrant assignment of salience to less relevant semantic concepts. More work is needed to understand the cognitive processes underlying this aberrant attribution process, and also the biological substrates involved.

Home environment should be accesible, barrier free and safe for people with disabilities. There is one possibility how to achieve these conditions the possibility is to let an occupational therapist to assess your home environment. The main parts of occupational therapy are: evaluation of home environment, suggesting of reconstrucitons needed and recommendations about helping aids. Environment is according to the International Classification of Functioning, Disability and Health one of the factors which are very important. The main goal of this diploma thesis was to design new evaluation of home environment of people with acquired brain injury made according to the International Classification of Functioning, Disability and Health. Partial goals were: to identify barriers of home environment, to determine facilitators which are already existing and to suggest helping aids and reconstructions if it is necessary. All for achieving the best quality of self-sufficiency of client. Theoretical part is about acquired brain injury, International Classification of Functioning, Disability and Health, issues of evaluation of home environment and assessments which are already existing. Practical part describes the proces of creation of evaluation and intervetions in home environment. Both described by case...

Prosody is the melody and rhythm of speech and language. Prosodic ability is of great importance for communication, and has been shown to be affected in adults with acquired brain injury. Studies have shown that Swedish children with specific language impairment have prosodic  difficulties to a greater extent than e.g. English speaking peers. It is thereby possible that prosodic ability is more vulnerable also in Swedish speaking adults with acquired brain injury. The aim of the present study was to assess prosodic ability in adults with acquired brain injury, and to evaluate the prosodic assessment procedure that was used. The relationship between prosodic ability and general language ability, location of injury and post-onset time was examined. Fifteen adults with acquired brain injury participated, six women and nine men, aged between 30 and 82 years. The participants were tested with an assessment procedure for prosody and parts of Neurolinguistic Assessment of Aphasia (A-ning). Prosodic problems were found at word, phrase and discourse level. No clear links between prosodic ability and location of injury or time post-onset were found. However, a deviant usage of focal accents with a preserved ability to produce word accents as a result of right hemisphere injuries was found. Furthermore, a relationship between prosodic ability and general language ability was found. The prosodic procedure was proven useful for assessment of adults with acquired brain injury, but it needs additional revision. The present study contributes with additional knowledge of prosodic ability in native Swedish speaking adults with acquired brain injury. / Prosodi är talets och språkets melodi och rytm. Den prosodiska förmågan är av stor betydelse för kommunikationen, och är ofta påverkad hos vuxna personer med förvärvad hjärnskada. Forskning har visat att svenska barn med språkstörning har prosodiska svårigheter i större utsträckning än exempelvis engelsktalande barn med språkstörning. Därför är det möjligt att den prosodiska förmågan är mer sårbar även hos vuxna personer med förvärvad hjärnskada och svenska som modersmål. Syftet med föreliggande studie var att kartlägga prosodisk förmåga hos vuxna personer med förvärvad hjärnskada, samt att utvärdera det undersökningsmaterial för prosodi som användes. Sambandet mellan prosodisk förmåga och språkförmåga, skadelokalisation och tid sedan skada undersöktes. I studien deltog 15 vuxna personer, 6 kvinnor och 9 män, mellan 30 och 82 år med förvärvad hjärnskada. Deltagarna testades avseende prosodi samt med delar ur Neurolingvistisk afasiundersökning (A-ning). Resultatet visade att prosodiska avvikelser förekom hos deltagarna på ord- fras- och diskursnivå. Inga tydliga samband fanns mellan prosodisk förmåga och skadelokalisation eller tid sedan skada. Högersidiga skador föreföll dock ge svårigheter att använda fokal accent, trots bevarad förmåga att använda ordaccenter. Vidare sågs ett samband mellan prosodisk och språklig förmåga. Undersökningsmaterialet för prosodi var användbart för testning av personer med förvärvad hjärnskada, men behöver utarbetas ytterligare. Föreliggande studie bidrar till kunskapen om prosodisk förmåga hos vuxna personer med förvärvad hjärnskada och svenska som modersmål.

The thesis deals with the issue of executive functions in patients with acquired brain injury and possibilies of executive deficit detection in real life circumstances. The thesis is divided into theoretical and empirical part.The theoretical part consists of three chapters. In the first chapterthe definition, localization and different disorders of executive functions are mentioned. The second chapter presents some neuropsychological methods suitable for executive functions assessment and their limits. In the final chapter the Multiple Errands Test method and its various modifications are introduced. The main purpose of the empirical part was to evaluate the ability of the Multiple Errands Test method - hospital version (MET - HV) to detect deficits in executive functions related to daily life functioning. The research group consisted of patients with acquired brain injury (N = 20) and neurologically healthy adults (N = 20) hospitalized in the Rehabilitation Center Kladruby. The results proved the ability of the method MET - HV to distinguish well between patients with acquired brain damage and healthy adults. The second hypothesis concerning the ability of the method to distinguish between patients with frontal and nonfrontal injury wasn't confirmed. Another purpose of the empirical part was to...

This thesis deals with speech therapy for people with acquired brain injury. The theoretical part consists of three chapters that acquaint readers with the theoretical framework necessary to understand the range of problems examined. It approximates the issue of origin and effects of this disease and refers to attitude in therapy that can be realized to people with this impairment. The research part of the work puts a goal to analyze the possibilities of speech therapy of selected persons with aphasia. The resulting data agree on the fact that for effective speech therapy is necessary on the one hand an individual approach but also motivation of patient is very important. The thesis also includes creating a custom set of exercises which has confirmed the effectivness of the development of cognitive functions in persons with aphasia. The empirical part is based on the qualitative research which was realized by techniques of participant observing, interviewing, questionnaire survey, analysing progress and outcomes of activities, documentation and literature.