Doctor of Philosphy (PhD) / Agitation following traumatic brain injury (TBI) is characterised by a heightened state of activity with disorganised information processing that interferes with learning and achieving functional goals. This thesis outlines a series of studies across four research phases, investigating how occupational performance of adults with TBI is affected by agitated behaviour and information processing difficulties. Clinicians report the presence of agitation interferes with engagement in therapy and achievement of rehabilitation goals. Research Phase One used a retrospective chart review of 80 adults with severe TBI to identify a high incidence of agitated behaviour during inpatient TBI rehabilitation. Agitated behaviour was associated with lengthier rehabilitation admission, prolonged duration of post-traumatic amnesia (PTA), and poor cognitive functioning at discharge. The association between agitation and poor cognition persisted for at least two years after discharge, highlighting the significant impact of agitated behaviour on people’s ability to relearn cognitive skills for daily function. These initial research findings directed subsequent research phases, in which an information processing model was adopted to examine application of cognitive strategies during occupational performance. An emerging occupational therapy assessment, The Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis, was selected as the primary method for evaluating how application of cognitive strategies during occupational performance is affected in agitated patients. Clinical utility of this measure was established in a case study of an adult demonstrating severely agitated behaviour during inpatient TBI rehabilitation, followed by examination of instrument reliability and validity with ten experienced occupational therapists and five adults with agitated behaviour following brain injury. The PRPP System of Task Analysis emerged as a valid and reliable method for determining strategy application deficits during occupational performance of adults with agitated behaviour, in acute stages of TBI rehabilitation. Consistent patterns of processing deficits were related to the Perceive and Recall Quadrants of the PRPP System. The assessment tool forms part of a dynamic, interactive assessment and intervention system. The PRPP System of Intervention was evaluated in the final research phase, using an experimental single case design with replication across eight adults. The effectiveness of PRPP Intervention was examined in comparison to conventional occupational therapy in an ABAB design. Efficacy of the PRPP Intervention was demonstrated, with patients applying significantly more information processing strategies to occupational performance tasks during PRPP Intervention than during conventional occupational therapy sessions. Agitated behaviour concurrently reduced over the period of the study. Relationships between information processing and agitated behaviour are hypothesised.

Cognitive rehabilitation has been shown to have beneficial effects on functional recovery following traumatic brain injury. In the present study, the rehabilitative effects of cognitive training in the T-maze on functional recovery of behavior and cortical sparing following a cortical impact injury (CCI) were examined. T-maze alternation has a widespread application in detecting cognitive dysfunction, and alternation in particular utilizes working memory. 47 male Sprague-Dawley rats were divided into six groups (sham trained, sham yoked, sham control, injured trained, injured yoked, injured control). Injured animals received a bilateral frontal craniotomy (1.0 A/P, 0.0 M/L from Bregma). The cortices were depressed at a depth of 2.5 mm at a velocity of 3 m/s. T-maze training began on post surgery day 2 and continued daily through post surgery day 19. Following this rehabilitative T-maze training, cognition was assessed using two different memory tasks in the Morris water maze (MWM).

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第19179号 / 人健博第27号 / 新制||人健||3(附属図書館) / 32171 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 三谷 章, 教授 村井 俊哉, 教授 精山 明敏 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Virtual environment (VE) design for cognitive rehabilitation necessitates a new methodology to ensure the validity of the resulting rehabilitation assessment. We propose that benchmarking the VE system technology utilizing a user-centered approach should precede the VE construction. Further, user performance baselines should be measured throughout testing as a control for adaptive effects that may confound the metrics chosen to evaluate the rehabilitation treatment. To support these claims we present data obtained from two modules of a user-centered head-mounted display (HMD) assessment battery, specifically resolution visual acuity and stereoacuity. Resolution visual acuity and stereoacuity assessments provide information about the image quality achieved by an HMD based upon its unique system parameters. When applying a user-centered approach, we were able to quantify limitations in the VE system components (e.g., low microdisplay resolution) and separately point to user characteristics (e.g., changes in dark focus) that may introduce error in the evaluation of VE based rehabilitation protocols. Based on these results, we provide guidelines for calibrating and benchmarking HMDs. In addition, we discuss potential extensions of the assessment to address higher level usability issues. We intend to test the proposed framework within the Human Experience Modeler (HEM), a testbed created at the University of Central Florida to evaluate technologies that may enhance cognitive rehabilitation effectiveness. Preliminary results of a feasibility pilot study conducted with a memory impaired participant showed that the HEM provides the control and repeatability needed to conduct such technology comparisons. Further, the HEM affords the opportunity to integrate new brain imaging technologies (i.e., functional Near Infrared Imaging) to evaluate brain plasticity associated with VE based cognitive rehabilitation.

No description available.

Context-sensitive cognitive rehabilitation aims to address the specific deficits of patients by taking into account the unique strengths and weaknesses of each brain-injured individual. However, this approach requires customized assessments and trainings that are difficult to validate, time-consuming or simply unavailable for daily clinical use. Given the currently struggling economy and an increasing number of patients with brain injuries, a feasible and efficient solution for this individualized rehabilitation concept is needed. This dissertation addresses the development and evaluation of a VE-based training and assessment for context-sensitive cognitive rehabilitation. The proposed application is designed to closely resemble real-world places that are relevant to each individual neurological patient. Despite such an ecologically valid approach to rehabilitation, the application also integrates traditional process-specific tasks that offer potential for standardization and collection of normative data across patient populations. Three cognitive tasks (navigation, orientation, spatial memory) have been identified for use in individualized VEs. In three experimental trials the feasibility and validity of the technological implementation and theoretical foundation of these tasks has been assessed. In a fourth trial one of the tasks has been used for the rehabilitation of a brain-injured patient. Based on the results of these studies a workflow for the rapid development of VEs has been established which allows a VR developer to provide clinicians with individualized cognitive tasks. In addition, promising results for the clinical use and validation of the proposed system form the basis for future randomized controlled clinical trials. In conclusion, this dissertation elaborates how context-sensitive and process-specific rehabilitation approaches each offer a unique perspective on cognitive rehabilitation and how combining both through the means of VR technology may offer new opportunities to further this clinical discipline.

Prior research suggests that aspects of self-knowledge are relatively intact in many memory-impaired patients with acquired brain injury. Therefore, cognitive strategies that rely on preserved mechanisms of the self may be particularly effective in this population. The three studies presented in this dissertation investigated the practical utility and mnemonic mechanisms of a novel cognitive strategy designed to capitalize on self-referential processing: self-imagination. Study 1 investigated the effect of self-imagining on cued recall in memory-impaired patients with acquired brain injury and healthy controls. Sixteen patients and sixteen healthy controls intentionally encoded word pairs under four separate conditions: visual imagery, semantic elaboration, other person imagining, and self-imagining. The results revealed that self-imagining enhanced cued recall more than the other encoding conditions in patients and healthy controls. Study 2 was an initial investigation of the effect of self-imagining on free recall. Twenty healthy adults intentionally encoded word pairs under four conditions: self-imagining, a self-descriptiveness task thought to rely on access to semantic information in self-knowledge, an autobiographical memory task requiring retrieval of a self-relevant episodic memory, and a structural processing task. The results demonstrated that self-imagining improved free recall more than the other encoding conditions in healthy adults. Study 3 investigated the effect of self-imagining on free recall in memory-impaired patients with acquired brain injury and healthy controls. Fifteen patients and fifteen healthy controls intentionally encoded personality trait adjectives under five conditions: a self-imagining task, a self-descriptiveness task, an episodic autobiographical memory task, a semantic elaboration task, and a phonemic processing task. The results revealed that the advantage of self-imagining over the other cognitive strategies extended to free recall in patients. Furthermore, the results indicated that the mnemonic benefit of self-imagining was partly attributable to preserved mechanisms associated with the retrieval of semantic information in self-knowledge. The findings from this dissertation indicate that self-imagining is a self-referential cognitive strategy that generates robust and reliable mnemonic improvement in memory-impaired patients with acquired brain injury and healthy controls. Cognitive strategies that involve preserved mnemonic mechanisms of the self, such as self-imagination, may provide a new direction in cognitive rehabilitation.

Purpose: This study aimed to understand the effects of the Cognitive Orientation to daily Occupational Performance (CO-OP) on successful engagement in desired occupations (goals), health-related quality of life, and caregiver stress for individuals with Parkinson’s Disease (PD)-related cognitive impairment and their caregivers. Methods: A mixed methods single-subject design was used. Quantitative and qualitative data were combined to gain a comprehensive understanding of results. Results: Participants successfully engaged in all three trained goals and both untrained goals, generalized CO-OP strategies to perform trained goals outside of treatment sessions, and transferred CO-OP strategies to perform untrained goals independently. Conclusions: Individuals with PD-related cognitive impairment are capable of successfully engaging in self-selected treatment goals that are trained during CO-OP sessions, generalizing CO-OP strategies they have learned in treatment in order to perform the same goals outside of treatment, and transferring CO-OP strategies in order to perform untrained goals independently. / October 2016

Background: The current study investigated the efficacy of a novel virtual reality-cognitive rehabilitation (VR-CR) intervention to improve contextual processing of objects in children with autism. Contextual processing is a cognitive ability thought to underlie the social and communication deficits of autism. Previous research supports that children with autism show deficits in contextual processing, as well as deficits in its basic component abilities: abstraction and cognitive flexibility. Methods: Four children with autism participated in a multiple baseline single-subject study. The children were taught how to see objects in context by reinforcing attention to pivotal contextual information. One-on-one teaching sessions occurred three times per week for approximately two weeks. Results: All children demonstrated significant improvements in contextual processing and cognitive flexibility. Mixed results were found on the control test. Changes in context-related behaviours were reported. Conclusions: Further studies using virtual reality to target specific cognitive impairments in children with autism are warranted.

Background: The current study investigated the efficacy of a novel virtual reality-cognitive rehabilitation (VR-CR) intervention to improve contextual processing of objects in children with autism. Contextual processing is a cognitive ability thought to underlie the social and communication deficits of autism. Previous research supports that children with autism show deficits in contextual processing, as well as deficits in its basic component abilities: abstraction and cognitive flexibility. Methods: Four children with autism participated in a multiple baseline single-subject study. The children were taught how to see objects in context by reinforcing attention to pivotal contextual information. One-on-one teaching sessions occurred three times per week for approximately two weeks. Results: All children demonstrated significant improvements in contextual processing and cognitive flexibility. Mixed results were found on the control test. Changes in context-related behaviours were reported. Conclusions: Further studies using virtual reality to target specific cognitive impairments in children with autism are warranted.