Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014.

The brain’s life-long capacity for experience-dependent plasticity allows adaptation to new environments or to changes in the environment, and to changes in internal brain states such as occurs in brain damage. Since the initial discovery by Hebb (1947) that environmental enrichment (EE) was able to confer improvements in cognitive behaviour, EE has been investigated as a powerful form of experience-dependent plasticity. Animal studies have shown that exposure to EE results in a number of molecular and morphological alterations, which are thought to underpin changes in neuronal function and ultimately, behaviour. These consequences of EE make it ideally suited for investigation into its use as a potential therapy after neurological disorders, such as traumatic brain injury (TBI). In this review, we aim to first briefly discuss the effects of EE on behaviour and neuronal function, followed by a review of the underlying molecular and structural changes that account for EE-dependent plasticity in the normal (uninjured) adult brain. We then extend this review to specifically address the role of EE in the treatment of experimental TBI, where we will discuss the demonstrated sensorimotor and cognitive benefits associated with exposure to EE, and their possible mechanisms. Finally, we will explore the use of EE-based rehabilitation in the treatment of human TBI patients, highlighting the remaining questions regarding the effects of EE.

/pdf/environmental-enrichment-and-the-sensory-brain-the-role-of-3so0d48kn2.pdf

Environmental enrichment and the sensory brain: the role of enrichment in remediating brain injury.

An orbitomedial frontal syndrome is proposed, characterized by anosmia, amnesia with confabulation, Go-NoGo deficits, personality change, and hypersensitivity to pain. The orbitomedial frontal syndrome is distinct from the clinical picture that results from dorsolateral frontal damage. Aspects of orbitomedial damage have been discussed previously in isolation, but we argue that recognition of this syndrome in toto is clinically important. It appears to be associated with poor social and vocational adjustment after brain injury, and the co-occurrence of features of the syndrome provides clues to underlying mechanisms for disinhibition and confabulation in frontal lobe patients.

The orbitomedial frontal syndrome

Functional near-infrared spectroscopy (fNIRS), a growing neuroimaging modality, has been utilized over the past few decades to understand the neuronal behavior in the brain. The technique has been ...

https://www.worldscientific.com/doi/pdf/10.1142/S179354581930012X

Application of functional near-infrared spectroscopy in the healthcare industry: A review

Objectives. While a number of studies provide evidence of neural and cognitive decline in traumatic brain injury (TBI) survivors during the post-acute stages of injury, there is a dearth of research on the possible mechanisms underlying this decline. The purposes of this paper, therefore, are to (1) examine evidence that environmental enrichment (EE) can influence long-term outcome following TBI, and (2) examine the nature of post-acute environments, whether they vary in degree of EE, and what impact these variations have on outcomes. Methods. We conducted a scoping review to identify studies on EE in animals and humans, and post-discharge experiences that relate to barriers to recovery. Results. Ninety-six articles that met inclusion criteria demonstrated the benefits of EE on brain and behaviour in healthy and brain-injured animals and humans. Nineteen papers on post-discharge experiences provided evidence that variables such as insurance coverage, financial and social support, home therapy, and transition from hospital to home, also play a vital role in regaining independence. Conclusion. There is evidence to suggest that lack of EE, whether from lack of resources or limited ability to engage in such environments, may play a role in post-recovery cognitive and neural decline. Maximizing EE in the post-acute stages of TBI may improve long-term outcomes for the individual, their family and society.

/pdf/traumatic-brain-injury-and-post-acute-decline-what-role-does-10d0zuxk8z.pdf

Traumatic brain injury and post-acute decline: what role does environmental enrichment play? A scoping review

To evaluate neural changes during a Stroop task among individuals with TBI using functional near-infrared spectroscopy (fNIRS). Thirteen healthy controls and 14 patients with moderate to severe TBI were included in this study. Oxygenated hemoglobin (HbO) was recorded every tenth of a second using a 52-channel fNIRS unit. Data were acquired using a block design during a Stroop task (i.e., Condition A = Dot Color Naming, Condition B = Incongruent Condition). Visual stimuli were presented on a computer monitor. Behaviorally, response accuracy was similar between groups for condition A, but the TBI group made more errors than the control group during condition B. During condition A, the patient group demonstrated significant increases in HbO within bilateral frontal regions compared to controls (p < 0.01). When examining the Stroop interference effect (B-A), controls showed increased HbO in bilateral frontal lobes and left inferior parietal region suggesting increased neural response to increased cognitive demand, whereas no differences were detected among the TBI group (p < 0.05). No between group differences in latency of HbO response was observed during either condition. While the TBI group performed as accurately as controls on the simpler dot color naming condition of the Stroop task, neural activity was greater within the frontal lobes during this relatively simple task among the TBI group suggesting neural inefficiency. Furthermore, the spatial distribution of neural activity related to the interference effect was not different among patients, suggesting the neural demand for the simpler task was comparable to that of the more cognitive demanding task among the TBI sample. The results suggest that fNIRS can identify frontal lobe inefficiency in TBI commonly observed with fMRI.

fNIRS-based investigation of the Stroop task after TBI

Objective To evaluate functional improvement following a traumatic brain injury (TBI) after admission to a postacute treatment facility, focusing on the time since injury and analysis of recovery by degree of impairment at admission. Design A retrospective study of patients who received treatment at a postacute rehabilitation facility. Setting Postacute rehabilitation for persons with acquired brain injury that involved transdisciplinary teams. Patients Patients (n = 1274) were admitted for treatment less than 5 years after TBI and were assessed on our outcome measures at least 3 times. The patients were then grouped by the time since injury and the severity of impairment at admission. Methods Patients received comprehensive multidisciplinary treatment 5 days per week, 6 hours per day. Main Outcome Measurements Function was assessed by using the Pate Environmentally Relevant Program Outcome System (PERPOS) scale at admission, discharge, and approximately every 2 weeks during treatment. By using these assessment scores, the rate and degree of improvement were monitored. Results Postacute rehabilitation yielded significant gains in functioning, with 69% of all patients who demonstrated clinically meaningful gains. The time since injury had a significant impact on gains made in rehabilitation (F time × time-since-treatment group interaction = 17.75; P P P 314 = 9.05) and moderate-to-severe (F 425 = 7.32) than for the mild-to-moderate (F 533 = 2.95) severity-at-intake groups. Conclusions Postacute rehabilitation is associated with functional gains for individuals with TBI beyond what can be explained by undirected recovery. These findings provide evidence for postacute rehabilitation as effective care after TBI.

https://www.pmrjournal.org/article/S1934-1482(12)01774-1/pdf

Treatment Effect Versus Pretreatment Recovery in Persons With Traumatic Brain Injury: A Study Regarding the Effectiveness of Postacute Rehabilitation

Background Transfer of skills learned within the clinic environment to patients' home or community is important in post-inpatient brain injury rehabilitation (PBIR). Outcome measures used in PBIR assess level of independence during functional tasks; however, available functional instruments do not quantitate the environment in which the behaviors occur. Objective To examine the reliability and validity of an instrument used to assess patients' functional abilities while quantifying the amount of structure and distractions in the environment. Methods 2501 patients who sustained a traumatic brain injury (TBI) or cerebrovascular accident (CVA) and participated in a multidisciplinary PBIR program between 2006 and 2014 were identified retrospectively for this study. The PERPOS and MPAI-4 were used to assess functional abilities at admission and at discharge. Construct validity was assessed using a bivariate Spearman rho analysis A subsample of 56 consecutive admissions during 2014 were examined to determine inter-rater reliability. Intra-class correlation coefficient (ICC) and Kappa coefficients assessed inter-rater agreement of the total PERPOS and PERPOS subscales respectively. Results The PERPOS and MPAI-4 demonstrated a strong negative association among both TBI and CVA patients. Kappa scores for the three PERPOS scales each demonstrated good to excellent inter-rater agreement. The ICC for overall PERPOS scores fell in the good agreement range. Conclusion The PERPOS can be used reliably in PBIR to quantify patients' functional abilities within the context of environmental demands.

Ecologically relevant outcome measure for post-inpatient rehabilitation.

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fNIRS-based investigation of the Stroop task after TBI

Treatment Effect Versus Pretreatment Recovery in Persons With Traumatic Brain Injury: A Study Regarding the Effectiveness of Postacute Rehabilitation

Ecologically relevant outcome measure for post-inpatient rehabilitation.