The short- and long-term effectiveness of the LSVT for dysarthria following TBI and stroke

Objectives: To examine the effectiveness of Lee Silverman Voice Treatment (LSVT®) for the treatment of 10 individuals with dysarthria following TBI and stroke.

Research design: ABAA experimental research design.

Methods: Participants received 4 weeks of the standard LSVT® programme. To measure the effects of intervention, participants were assessed using perceptual and acoustic speech measures and everyday communication outcome measures prior to, immediately post and 6 months post-treatment.

Results: Following treatment, participants demonstrated statistically and clinically significant improvements to several acoustic and perceptual parameters. This included increased vocal loudness in sustained phonation and connected speech, increased vocal frequency range and improved word and sentence intelligibility. Improved ratings of communication initiation and participation and well-being were also found on the AusTOMs and items on participant questionnaires post-LSVT®. The majority of treatment effects were maintained 6 months following treatment.

Conclusions: LSVT® has the potential to be a viable treatment option for individuals with dysarthria featuring respiratory-phonatory impairments following TBI and stroke.     

The factor structure of the Hospital Anxiety and Depression Scale in acquired brain injury

Primary objective: To evaluate the factor structure of the Hospital Anxiety and Depression Scale (HADS) as a mood assessment in a sample of individuals with acquired brain injury (ABI).

Research design: Cohort study.

Methods and procedures: HADS data from 140 people with ABI was subjected to principle components analysis (PCA).

Experimental interventions: None.

Main outcomes and results: A three-factor solution emerged. Items loading on the first two factors map on to the anxiety and depression scales. However, two items from the depression sub-scale did not load significantly on either of these two main factors. Possible reasons are discussed.

Conclusions: This study suggests that the HADS is a useful tool for examining depression and anxiety in a brain injured population, but interpretation of responses to some items should be cautious.     

Feedback of brain-imaging findings: effect on impaired awareness and mood in acquired brain injury

Primary objective: To investigate the utility of feedback of brain-imaging findings as an intervention for improving impaired awareness, depression and anxiety levels.

Research design and methods: A prospective within-subjects repeated measures design was used with an intervention sample of 17 adults with acquired brain injury. Baseline and post-intervention measures included self-report and questionnaire-based self-awareness instruments and self-report questionnaires for depression and anxiety. Participants also completed a range of neuropsychological tests.

Intervention: The intervention consisted of a session where a Consultant Neurologist explained the findings of brain scans in terms of pathological findings and possible neurobehavioural outcome.

Results: Scores on measures of unawareness and two of three mood measures decreased significantly following the intervention. This improvement was maintained at 2-week follow-up.

Conclusion: Individuals with an acquired brain injury may benefit from a feedback procedure where the findings of brain scans are presented.     

Comparison of the Sydney Psychosocial Reintegration Scale (SPRS) with the Community Integration Questionnaire (CIQ): psychometric properties

Primary objective: This study compared the psychometric properties of two community integration measures used with people with acquired brain injury (ABI) in the community.

Research design: Questionnaires were mailed-out to people with ABI and nominated proxies.

Methods and procedures: Responses were obtained from 96 people with ABI and 121 proxies on the Community Integration Questionnaire (CIQ) and the Sydney Psychosocial Reintegration Scale (SPRS).

Main outcomes and results: Matched client-proxy scores were not significantly different. The SPRS had greater internal consistency and more normal distributions than the CIQ. Correlations between the three pairs of theoretically parallel sub-scales were modest (0.41-0.60). Multi-dimensional scaling did not support the theoretical structure of the sub-scales, but found two dimensions underpinning the measurement of community integration.

Conclusions: Mail-out administration is associated with poor completion rates. The SPRS has sound psychometric properties when compared to the CIQ. Further research investigating the theoretical structure of community integration in ABI is recommended.     

Recovery from brain injury: finding the missing bits of the puzzle

Background: One basic problem found during rehabilitation is that people with brain injuries lack awareness of their difficulties. Research into this phenomenon has often disregarded the voices of those affected by the trauma and do not give an insider's perspective on the process through which a person with a brain injury develops awareness of their difficulties.

Objective: To explore how people construct their experiences of brain injury and the challenges they face afterwards.

Setting: Two day care centres.

Method: In-depth interviews were conducted with 24 individuals with brain injuries. Data were analysed using the interpretative phenomenological approach (IPA).

Results: Three themes were found to be relevant for understanding how participants construct their experiences of brain injury: finding the bits of the puzzle, filling the holes of memory and redefining the self. The evidence suggests that they construct knowledge of their difficulties in a manner resembling the sorting of a puzzle.

Conclusion: Qualitative enquiries into awareness of difficulties provide clinical and rehabilitation settings with new insights and alternative strategies for interventions.     

Positive mood and sleep disturbance in acquired mania following temporal lobe damage

Primary objective: To determine the mood profile and sleep functioning of a patient with left anterior temporal region damage characterized by post-operative symptoms of mania.

Methods and procedures: In a structured clinical assessment, the patient's mood status, psychiatric diagnosis and sleep functioning—sleep onset latency, total sleep time, wake after sleep onset—were assessed. The sleep-wake cycle and daily mood was measured for 11 consecutive days.

Results: The patient met diagnostic criteria for bipolar disorder (excluding the requirement that the disturbance must not be due to a medical disorder) and delayed sleep-phase syndrome. Across 11 days, the patient exhibited elevated positive, but not negative, mood. Correlational analyses indicated a possible association between mood and sleep disturbance.

Conclusions: This pattern of findings implicates the temporal lobe in positive mood regulation and sleep-related impairments.     

The ineffectiveness of the Hospital Anxiety and Depression Scale for diagnosis in an Omani traumatic brain injured population

Background: The rehabilitation of the traumatic brain injury (TBI) patient is especially challenging in non-western populations as the phenotypic indicators as well as the neurobehavioral assessments for the survivors of brain injury are limited.

Objective: The study screened for the prevalence of anxiety and depressive states among patients with TBI and examined the validity of the Hospital Anxiety and Depression Scale (HADS) to identify TBI patients with comorbid affective dysfunctions, specifically anxiety and depressive disorders, in an Omani population.

Methods: Sixty-eight survivors of TBI were screened with the semi-structured, Composite International Diagnostic Interview (CIDI) and the HADS. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the HADS for every possible threshold score.

Results: The semi-structured interview revealed the prevalence rate of 57.4% for depressive disorder and 50% for anxiety disorder. The sensitivity (53.8%) and specificity 75.9%, gave the best compromise using the cut-off score of 4, suggesting HADS is not a useful screening tool for this particular population.

Conclusions: Phenotypic indicators as detected by CIDI revealed that prevalence of affective dysfunctionality is common among this TBI population. Although the HADS is the most widely used screening instrument in other clinical populations, it does not appear to be a reliable resource in identifying depression and anxiety in people with traumatic brain injury in Oman.     

The effects of cognitive teletherapy on reported everyday memory behaviours of persons with chronic traumatic brain injury

Primary objective: The purpose of this study was to evaluate the effects of an errorless training approach, Spaced Retrieval (SR) training delivered over the telephone, on the reported everyday memory problems of adults with chronic traumatic brain injury (TBI).

Research design: The study was a randomized controlled clinical trial.

Methods: Thirty-eight participants received either SR training or didactic strategy instruction (SI). Participants in both groups identified three memory-related goals and were paired to receive the same total telephone contact time. The main outcome measures were frequency of reported memory problems and perceived quality of life.

Results: Participants in the SR group reported significantly more treatment goal mastery/strategy use than those in the SI group, immediately and at 1-month post-training. Caregivers reported similarly significant between-groups differences in everyday use of treatment behaviours at 1 month. Both groups reported some generalized strategy use to other non-targeted behaviours and decreased frequency of reported memory problems, but there were no significant between-groups differences in participant or caregiver reports of generalized strategy use or reported memory problems at either time-point. There was no change in perceived quality of life in either group.

Conclusions: SR treatment delivered by phone produced significantly more treatment goal mastery/strategy use and maintenance than SI; however, both treatments improved reported everyday memory functioning for persons with TBI, without significant group differences on measures of generalized strategy use or perceived quality of life.     

Context-sensitive cognitive-behavioural supports for young children with TBI: a replication study

Objective: To replicate an investigation of the effects of a multi-component cognitive-behavioural intervention on the challenging behaviour of two young children with growing behavioural concerns after TBI.

Experimental design: Single-subject reversal designs used to document the effects of the combined behavioural, cognitive and executive function intervention on the following dependent variables: frequency and intensity of aggressive behaviours, amount of work accomplished.

Participants: Two young children with escalating behaviour problems after TBI.

Intervention: Integrated components of positive behaviour supports, cognitive supports (e.g. graphic organizers) and an executive function routine (goal-plan-do-review).

Results: Reduced frequency and intensity of challenging behaviours; increased quantity of work completed.

Conclusions: Positive replication of previous single-subject experiments demonstrating the potential for successfully treating behaviour disorders in young children with TBI using a support-oriented intervention that combines behavioural, cognitive and executive function components.     

The effects of Donepezil on traumatic brain injury acute rehabilitation outcomes

Primary objective: To evaluate the effects of administering Donepezil during inpatient rehabilitation for individuals with TBI.

Research design: Retrospective, age and injury severity matched, mixed between-within subjects analysis.

Methods and procedures: Thirty-six patients with moderate-to-severe TBI admitted to acute rehabilitation within 90 days of injury. Main outcome measures included FIM cognitive total scores and rehabilitation lengths of stay.

Intervention: Initiation of Donepezil administration beginning at 5 mg daily. Dose titration and continuation based on perceived clinical response.

Main outcomes and results: No differences in cognitive improvement were observed between the Donepezil treatment group and the matched control group. Sub-set analyses suggested that administration of Donepezil early in the rehabilitation stay was significantly related to higher rates of cognitive improvement.

Conclusions: Preliminary evidence suggests that Donepezil administration early in the rehabilitation stay may have advantageous treatment effects. A prospective, randomized, placebo-controlled clinical trial with standard timing, dosage and treatment duration is recommended to further evaluate treatment efficacy.