Background Dementia is a national priority for Scotland, and as such, fast and accurate diagnosis plus responsive and well-evidenced interventions post-diagnosis are key. Accurately estimating an individual’s level of premorbid functioning can be a crucial part of establishing that cognitive decline has taken place, enabling clinicians to be more confident and accurate in their diagnosis. Measures that assess premorbid ability should be able to 1) capture current ability in healthy controls and 2) resist the effects of cognitive decline when used in individuals with dementia. At the post-diagnostic stage, there is a growing evidence base for non-pharmacological, tailored interventions for individuals with dementia. However, the evidence base is limited, particularly so for Cognitive Rehabilitation. Objectives An empirical study was conducted in order to assess whether a newly developed measure that aims to capture lifelong cognitive reserve (the brain’s ability to withstand pathological change), the Cognitive Reserve Index Questionnaire (CRIq), can capture premorbid ability. Three research questions were addressed; 1) does the CRIq capture current ability in healthy controls? 2) is it resistant to cognitive decline when used with a patient group with dementia? and 3) how does the CRIq compare to a traditional measure of premorbid ability, the NART (National Adult Reading Test)? Another focus of development and innovation in dementia research is that of post-diagnostic interventions. A systematic review was therefore conducted in order to evaluate the effectiveness of Cognitive Rehabilitation for mild-moderate dementia (Alzheimer disease or mixed dementia) in relation to cognitive and functional outcomes. Due to the limited number of RCTs in this field precluding a clear understanding of the evidence base, the additional contribution of non-RCTs was also evaluated. Method For the empirical study N=20 healthy older controls and N=13 patients with dementia were recruited. In order to appropriately address the three research questions both groups were assessed using the NART, the CRIq and the MOCA (Montreal Cognitive Assessment). In addition, the control group were assessed on a measure of current ability, the WAIS-IV Perceptual Reasoning Index. For the systematic review of Cognitive Rehabilitation the CDCIG Specialised Register, ALOIS, was searched in order to identify relevant studies. In addition, previous reviews were searched to identify studies excluded on the basis that they were not an RCT. Results Results for the empirical study show both CRIq and NART were strongly correlated to current ability (performance on WAIS-IV PRI) in controls, although both significantly overestimated ability. CRIq performance was not affected by the presence of dementia whereas NART predicted premorbid ability was. CRIq and NART showed a different pattern of results between controls and patients, indicating that CRIq may more resistant to the effects of cognitive decline. Ten studies were identified for the systematic review; five RCT and five non-RCT. Study quality was assessed using a well-validated quality assessment tool, and indicated large variability. Eight of the ten studies reported a positive effect of Cognitive Rehabilitation. However, several studies were of poor quality and included aspects of other approaches in their intervention (e.g. Cognitive Training, Cognitive-Behaviour Therapy). Conclusions The empirical study found that CRIq over-estimated current ability in controls, but was resistant to cognitive decline in patients. The over-estimation of current ability may be accounted for by the CRIq being normed on an Italian population, thus not reflecting UK cultural norms (e.g. for length of schooling). When the NART and the CRIq were directly compared, the two measures were found to be related, but yet produced significantly different estimates of premorbid ability. This suggests that they may capture different facets of premorbid functioning, with the NART being primarily a verbal performance-based measure, and the CRIq capturing aspects of global cognitive functioning. Clinical implications include the potential utility of the CRIq for patients with language impairment. However the study conclusions are limited by a low N, and therefore have restricted generalisability. In the systematic review, the literature was exhaustively searched and evidence was found for the effectiveness of Cognitive Rehabilitation for mild-moderate Alzheimer disease and mixed dementia. Methodological limitations of the included studies are discussed, and clinical implications are identified. Both the empirical study and the systematic review highlight the need for greater research and development of methods by which dementia care is supported; through more effective methods of diagnosis, to a better evidence base for post-diagnostic interventions.

xv, 162 p. ; ill. (some col.) A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Each year, over 65,000 brain injury survivors are discharged home from hospitals with ongoing rehabilitation needs due to acquired impairments, such as dysphagia. Emerging empirical evidence supports the benefits of intensive swallowing exercise programs when dysphagia results from muscle weakness. However, many of these survivors cannot complete intensive home exercise programs due to co-occurring cognitive impairments in memory or initiation. This project investigated the potential benefits of a new experimental assistive technology device, the Television Assisted Prompting (TAP) system to increase completion of home swallowing exercises. The TAP system was designed as a treatment package to provide both automated prompts and multimedia motivational instructional exercise videos via a person's home television. Three participants were recruited, all of whom had survived a hemispheric stroke and presented with neurogenic dysphagia and co-occurring cognitive impairments. Two home program delivery conditions were alternately presented on randomized days in a single-case experimental alternating treatment design: TAP delivery (e.g., TV prompting with motivational videos) or typical practice (TYP) delivery (e.g., care provider prompting as needed to follow assigned written home programs). The same exercises were presented in each condition. Measures included feasibility (e.g., reliability of the TAP system), efficacy (e.g., number of exercises completed per session), and satisfaction. Results revealed that two of three participants showed dramatic benefits from the TAP system. Participant 1 was 17 times more likely to complete exercises when prompted by the TAP system; participant 2 was six times more likely. Participant 3 completed exercises with equal likelihood on TAP or TYP days. All three participants reported preference for TAP system delivery and requested to increase the frequency of TAP delivery to every day. Care providers unanimously reported preference for the TAP system to prompt patients and reduce their burden of care. The TAP system malfunctioned during 21.70% (23/106) of scheduled sessions; two participants needed clarifications, instruction to use the system, or customized modifications in order to interact independently with the device. Recommendations for system improvements and applications to the field of assistive technology are provided. / Adviser: McKay Moore Sohlberg

Made available in DSpace on 2016-08-17T18:39:52Z (GMT). No. of bitstreams: 1 6612.pdf: 4040962 bytes, checksum: d477235c184b0bdc58a0783fa553e5cc (MD5) Previous issue date: 2014-10-31 / With advancing age, there is a tendency of loss of cognitive aspects such as memory, attention, learning new technologies and motor aspects such as loss of range of motion of the upper limbs. The literature points to investments made to investigate the use of virtual reality in cognitive and motor aspects, however, due to the few researches found on the topic, is one notable gap in terms of describing the training of motor skills of the member and higher cognitive skills using virtual reality applications. This research aimed to evaluate the use of virtual reality application KapMan® for training of motor skills of upper member and cognitive in institutionalized elderly. The research was performed in a long - term institution, located in a midsize city in the state of São Paulo. The participants in this study were six seniors and we used a questionnaire about participants - to make sure about their skills and understanding about the game - measurement of range of motion, heart rate and blood pressure, the DASH questionnaire was used and Mini - mental State Examination. Furthermore, adaptations in the original game KapMan® were made. The results indicated a reduction in execution time of activity between the first and last time, and an increase of the final score (score) obtained, leading to believe that the adjustments made in the game and the training of the proposed activity resulted in better performance of the elderly. There were no observable changes in variables heart rate and blood pressure. The data shows an improvement in pain and upper limb function, and increased range of motion of the upper limb of the elderly. As the cognitive aspects, four elderly have compatibility with cognitive disabilities and two do not have this loss. Nevertheless, the elderly understood, learned and developed motor skills of the upper limb and cognitive training with the proposed activity. Thus, the premise that the deployment of virtual reality applications help the training of motor skills and cognitive upper limb was confirmed. / Com o avançar da idade, há uma tendência de perdas dos aspectos cognitivos como a memória, atenção, na aprendizagem de novas tecnologias e perdas de aspectos motores, como amplitude de movimento dos membros superiores. A revisão de literatura aponta para investimentos realizados para averiguar o uso da realidade virtual nos aspectos cognitivos e motores. No entanto, devido aos poucos trabalhos encontrados sobre a temática, é notável uma lacuna no que se refere a descrever sobre treino de habilidades motoras do membro superior e de habilidades cognitivas utilizando aplicativos de realidade virtual. O presente estudo teve por objetivo avaliar o uso do aplicativo de realidade virtual KapMan® para treino de habilidades motoras do membro superior e cognitivas em idosos institucionalizados. A pesquisa foi realizada em uma instituição de longa permanência, localizada em uma cidade de médio porte do interior do estado de São Paulo. Os participantes dessa pesquisa foram seis idosos e para a coleta de dados foi utilizado um questionário de caracterização dos participantes, das habilidades e entendimento dos participantes em relação ao jogo, mensuração da amplitude de movimento, da frequência cardíaca e da pressão arterial, questionário DASH e o Mini - exame do estado mental. Além disso, foram realizadas adaptações no jogo KapMan® original. Os resultados apontam para uma diminuição no tempo de execução da atividade entre a primeira e a última vez, e para o aumento da pontuação final (score) obtida, revelando que as adaptações realizadas no jogo e o treinamento da atividade proposta resultaram na melhor atuação dos idosos. Não houve alterações nas variáveis frequência cardíaca e pressão arterial. Os dados apontam para uma melhora na dor e na função do membro superior, além do aumento da amplitude de movimento do membro superior dos idosos. Quanto aos aspectos cognitivos, quatro idosos apresentam compatibilidade com deficiência cognitiva e dois não possuem essa perda. Apesar disso os idosos, compreenderam, aprenderam e desenvolveram habilidades motoras do membro superior e cognitivas com o treinamento da atividade proposta. Dessa forma, a premissa de que a implementação de aplicativos de realidade virtual favorecem o treino de habilidades motoras do membro superior e cognitivas foi confirmada.

Yes / Preliminary evidence suggests that goal-oriented cognitive rehabilitation (CR) may be a clinically effective intervention for people with early-stage Alzheimer's disease, vascular or mixed dementia and their carers. This study aims to establish whether CR is a clinically effective and cost-effective intervention for people with early-stage dementia and their carers. Methods/design: In this multi-centre, single-blind randomised controlled trial, 480 people with early-stage dementia, each with a carer, will be randomised to receive either treatment as usual or cognitive rehabilitation (10 therapy sessions over 3 months, followed by 4 maintenance sessions over 6 months). We will compare the effectiveness of cognitive rehabilitation with that of treatment as usual with regard to improving self-reported and carer-rated goal performance in areas identified as causing concern by people with early-stage dementia; improving quality of life, self-efficacy, mood and cognition of people with early-stage dementia; and reducing stress levels and ameliorating quality of life for carers of participants with early-stage dementia. The incremental cost-effectiveness of goal-oriented cognitive rehabilitation compared to treatment as usual will also be examined. Discussion: If the study confirms the benefits and cost-effectiveness of cognitive rehabilitation, it will be important to examine how the goal-oriented cognitive rehabilitation approach can most effectively be integrated into routine health-care provision. Our aim is to provide training and develop materials to support the implementation of this approach following trial completion. Trial registration: Current Controlled Trials ISRCTN21027481

No / Improving cognition is service users' top research priority for life after stroke, and future research should include outcomes that they deem important. Patient perspectives on outcomes are collected using patient-reported outcome measures (PROMs). There is currently no patient-centred PROM specific for cognitive rehabilitation trials. Objective Inform PROM development by exploring stroke survivor perspectives on the important, measurable impacts of persisting post-stroke cognitive problems. Design Qualitative semi-structured interviews in participants' homes. Participants Purposive sample of 16 cognitively impaired stroke survivors at least six months post-stroke. Methods Interviews used a schedule and communication aids developed through patient consultation. Interviews were transcribed verbatim with non-verbal communication recorded using field notes. Data were analysed using a framework approach to find commonalities to shape the focus and content of an outcome measure. Results Participants identified important impacts of their ‘invisible’ cognitive problems, outside of other stroke-related impairments. Cognitive problems exacerbated emotional issues and vice versa. Changes in self-identity and social participation were prominent. Impact was not spoken about in terms of frequency but rather in terms of the negative affect associated with problems; terms like ‘bothered’ and ‘frustration’ were often used. Conclusions The results support the development of a PROM specifically designed to address the impact of cognitive problems. It should: include items addressing a comprehensive range of cognitive skills; ask questions about mood, self-identity and social participation; use accessible wording that respondents understand and endorse; measure impact rather than frequency; and explore perceived impact on carers.

The prevalence and sequelae of moderate-to-severe (M/S) traumatic brain injury (TBI) are significant and pervasive problems, and effective rehabilitation techniques are key. Errorless learning is regarded as a useful tool for memory impairments; however, the efficacy of errorless learning in a M/S TBI population is unclear. The primary goal (aim 1) of this study was to evaluate the efficacy of a single session of errorless vs. errorful learning in a group of M/S TBI survivors and matched controls. A secondary goal (aim 2) was to investigate the neural time course of errorless learning in participants with M/S TBI by analyzing the error-related negativity (ERN) component of the scalp-recorded event-related potential (ERP). The ERN is an electrophysiological measure of error processing that is disrupted in M/S TBI survivors. Measures of neuropsychological performance, self- and informant-report of executive functioning, and affect further informed both study aims. Data from 28 M/S TBI survivors (9 female) and 28 controls (9 female) were analyzed for aim 1, with data from 19 M/S TBI survivors (6 female) and 20 controls (8 female) analyzed for aim 2. There were significant differences between the TBI and control groups with regard to executive, mood, and neuropsychological functioning. Results from aim 1 indicated that TBI participants were slower across learning conditions, while both groups had significantly faster reaction times in the errorless condition. Regarding accuracy, there was not a statistically significant main effect of learning condition (p = .07), group (p = .06), or Group x Condition x Accuracy interaction (p = .33). Indices of memory and executive functioning, and group (TBI, Control) used in regressions predicted accuracy in both learning conditions (ps < .01). The memory composite was a significant independent predictor of errorless accuracy. Results from aim 2 indicated a reliable ERN was present across conditions, although there were no main effects of Condition, Group, or Group x Condition interactions on ERN amplitude or latency (ps > .22). ERN latency was not predictive of accuracy for either condition (ps > .08). Group was a significant independent predictor of accuracy in the errorless condition (p = .05), but not the errorful condition (p = .45). Findings indicate that memory functioning was a better predictor of accuracy than executive functioning or group membership. This suggests that the errorless learning benefit may be specific to memory functioning, rather than other cognitive variables. This conclusion aligns with research reporting that benefits of errorless learning depend upon the severity of memory impairments. Results from ERN analyses are only partially supported by previous research, and further work is needed to clarify the role of neural representations of errorless learning in M/S TBI.

Aquired brain injury is still a current topic and a serious problem nowadays. After a treatment, a lot of consequences appear which cause a long-term inability to work and invalidation of many people. One of the serious problems is a disorder of cognitive functions which disables people to get back to a normal life. One of the options how to affect the cognitive functions impairment is a system called CogniPlus. Theoretical part of this work presents aquired brain injury, its dividing, basic classification and the consequences. Furthermore, this work dedicates to rehabilitation of cognitive functions using both computers and conventional methods. It also shows the work of the occupational therapist and the possibility of cognitive function testing. The aim of the research is to find out if CogniPlus cognitive function training is more effective than the conventional pencil-paper method. 20 people were tested in this study. Unfortunately, one of them had to quit due to health problems. The experimental and the control group had a therapy once or twice a week. All the participants went through Addenbrooke cognitive test and through a questionnaire of cognitive mistakes at the beginning and at the end of the testing. The experimental group showed a significant improvement in the global score ACE and in the...

L'être humain doit, au cours de sa vie, faire face à des évènements pouvant être douloureux, traumatisants et handicapants. Face à ces accidents de vie, il doit s'adapter afin de retrouver un équilibre et une qualité de vie satisfaisante. Ce travail de thèse permet d'étudier, dans le domaine de la santé, les facteurs impliqués dans la créativité adaptative et la résilience afin d'identifier des leviers susceptibles de favoriser l'adaptation et la réadaptation. Un entraînement cognitif informatisé testé auprès d’une population de traumatisés crâniens, a un effet favorable sur les fonctions cognitives entraînées mais un effet plus limité sur la vie quotidienne et la réinsertion sociale. Ce constat nous a conduit à proposer un nouveau concept de réadaptation associant résilience et créativité. Nous avons ainsi vérifié que la résilience peut être considérée comme une forme de créativité adaptative s'appliquant aux aléas de notre vie quotidienne. Une tâche utilisable comme outil de stimulation cognitive a plus précisément été étudiée: la tâche du Tangram. Cette tâche entraîne certains processus impliqués lors de l'élaboration des représentations mentales qui ont un rôle majeur dans la résolution de problème. A l'issue de ce travail, quatre grandes orientations sont proposées en vue de la création d'un programme de rééducation cognitive destiné à favoriser l'adaptabilité des patients en s'appuyant sur leurs réserves psycho-cognitives. Elles concernent: la redéfinition d'un problème en challenge, la stimulation mnésique et attentionnelle, l'entraînement au Mindfulness et la prise en compte des processus impliqués dans la résolution créative de problème. / Throughout their lives, humans have to deal with various events, which can sometimes be painful, traumatic and disabling. Facing these accidents of life, they must adapt in order to find a balance and a satisfactory quality of life. This thesis allows the study, in the field of health, of the factors involved in the adaptive creativity and the resilience, in order to identify levers likely to promote adaptation and rehabilitation.The starting point is the observation of the favorable effect of a cognitive training conducted by means of a digital device on stimulated functions but a more limited impact on daily life and social reintegration. This observation, made on a population of TBI, leads us to propose a new concept of rehabilitation based on the resilience and the creativity. We check that resilience can be considered as a form of adaptive creativity used to respond to the vagaries of everyday life. The task of Tangram is more precisely studied since it appears to be usable as a tool of cognitive stimulation. This task entails some processes involved in the development of mental representations, which have a major role in problem solving.At the end of this work, four orientations are proposed for the creation of a cognitive rehabilitation program designed to promote the adaptability of patients by relying on their psychological and cognitive reserve. They consist in the redefinition of a problem into a challenge, the mnesic and attentional stimulation, the training in Mindfulness and the consideration of the processes involved in creative problem solving.

Aquired brain injury is still a current topic and a serious problem nowadays. After a treatment, a lot of consequences appear which cause a long-term inability to work and invalidation of many people. One of the serious problems is a disorder of cognitive functions which disables people to get back to a normal life. One of the options how to affect the cognitive functions impairment is a system called CogniPlus. Theoretical part of this work presents aquired brain injury, its dividing, basic classification and the consequences. Furthermore, this work dedicates to rehabilitation of cognitive functions using both computers and conventional methods. It also shows the work of the occupational therapist and the possibility of cognitive function testing. The aim of the research is to find out if CogniPlus cognitive function training is more effective than the conventional pencil-paper method. 20 people were tested in this study. Unfortunately, one of them had to quit due to health problems. The experimental and the control group had a therapy once or twice a week. All the participants went through Addenbrooke cognitive test and through a questionnaire of cognitive mistakes at the beginning and at the end of the testing. The experimental group showed a significant improvement in the global score ACE and...

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