Role and Impact of Cognitive Rehabilitation

To explore the relationship between preoperative psychological personality traits of glioma patients and preoperative psychological distress of their primary caregivers.

A retrospective analysis was conducted on 85 glioma patients (tumor group) who were admitted to our hospital from February 2016 to December 2018 and 85 primary caregivers. Forty-one healthy volunteers were used as controls.

The scores of 9 scales of the Minnesota Multiphasic Personality Inventory (MMPI) increased significantly in the tumor group compared to the healthy controls (P < 0.05), including L (lie): [(56.0 ± 11.5 vs. 50.0 ± 10.0)], F (fake): [(53.0 ± 10.6 vs. 41.7 ± 8.8)], Hs (hypochondriasis): [(55.6 ± 11.2 vs. 44.2 ± 8.3)], D (depressive personality): [(49.2 ± 9.6 vs. 42.2 ± 10.3)], Mf (masculinity-femininity): [(49.9 ± 9.4 vs. 42.8 ± 14.0)], Pt (psychasthenia): [(51.5 ± 10.0 vs. 40.9 ± 11.5)], Sc (schizophrenia): [(51.2 ± 10.6 vs. 40.2 ± 10.6)], Ma (hypomania): [(51.8 ± 9.1 vs. 47.7 ± 9.4)] and Si (social introversion): [(46.6 ± 8.7 vs. 36.7 ± 13.0)]. However, the K (defensive responses) scale score in the tumor group decreased significantly (52.1 ± 13.9 vs. 58.8 ± 12.1, P = 0.009). The F (fake): [(r_s=0.253, P=0.019 / r_s=0.215, P=0.048)], Hs (hypochondriasis): [(r_s=0.310, P=0.004 / r_s=0.345, P=0.001)], Pt (psychasthenia): [(r_s=0.299, P=0.006 / r_s=0.258, P=0.017)], and Sc (schizophrenia): [(r_s=0.325,P=0.002/r_s=0.322, P=0.003)] of preoperative glioma patients were positively correlated with their preoperative psychological distress (depression/anxiety); the D (depressive personality): [(r_s=0.229, P=0.035)] of preoperative glioma patients was positively correlated with the preoperative depression symptoms of their primary caregivers, and the Hy (hysteria): [(r_s=0.233, P=0.002)] and Pd (psychopathic deviate): [(r_s=0.215, P=0.006)] of preoperative glioma patients were positively correlated with the preoperative anxiety symptoms of their primary caregivers.

The preoperative psychological personality traits of glioma patients were positively correlated with preoperative symptoms of depression and anxiety in primary caregivers.

Rehabilitation services are commonly utilized when patients have developed physical, functional, or cognitive deficits due to an injury, acquired brain injury, illness, surgical or other medical interventions, or a progressive neurologic or physical disorder. Rehabilitation needs after neurosurgical procedures can vary greatly depending on a number of factors including the condition leading to the need for neurosurgery; the type of neurosurgical procedure and approach used; the location of the brain involved; relative motor, sensory, cognitive, and functional deficits associated with the surgery; additional treatment contributions; comorbid medical issues; and the age and overall health of the patient. This chapter focuses on how to identify and implement appropriate rehabilitation interventions following neurosurgical procedures. This will begin with an overview of the rehabilitation process with specific rehabilitation applications for some common neurosurgical patient populations. The chapter closes with a call for postsurgical rehabilitation protocols to be included in neurosurgical planning and processes.

To determine whether the Short-Term Executive Plus (STEP) cognitive rehabilitation program improves executive dysfunction after traumatic brain injury (TBI).

Randomized, waitlist controlled trial with minimization and blinded outcome assessment.

Community.

Participants with TBI and executive dysfunction (N=98; TBI severity 50% moderate/severe; mean time since injury ± SD, 12±14y; mean age ± SD, 45±14y; 62% women; 76% white).

STEP program: 12 weeks (9h/wk) of group training in problem solving and emotional regulation and individual sessions of attention and compensatory strategies training.

Factor analysis was used to create a composite executive function measure using the Problem Solving Inventory, Frontal Systems Behavior Scale, Behavioral Assessment of the Dysexecutive Syndrome, and Self-Awareness of Deficits Interview. Emotional regulation was assessed with the Difficulties in Emotion Regulation Scale. The primary attention measure was the Attention Rating and Monitoring Scale. Secondary measures included neuropsychological measures of executive function, attention, and memory and measures of affective distress, self-efficacy, social participation, and quality of life.

Intention-to-treat mixed-effects analyses revealed significant treatment effects for the composite executive function measure (P=.008) and the Frontal Systems Behavior Scale (P=.049) and Problem Solving Inventory (P=.016). We found no between-group differences on the neuropsychological measures or on measures of attention, emotional regulation, self-awareness, affective distress, self-efficacy, participation, or quality of life.

The STEP program is efficacious in improving self-reported post-TBI executive function and problem solving. Further research is needed to identify the roles of the different components of the intervention and its effectiveness with different TBI populations.

Evidence is emerging of diverse, chronic, cumulative disabilities experienced by children in the months and years after acquired brain injury. The long-held assumption that younger children recover better from brain injury than older children or adults has been challenged by recent studies. Populations with acquired brain injury include children with traumatic brain injury and stroke, and a proportion of children with cerebral palsy. Although characteristics of brain injury in children vary, subgroups of this population offer the potential to inform our understanding of developing brain structure-function relationships in response to intervention. Limited evidence and few controlled rehabilitation trials exist regarding children with neurologic conditions. A number of rehabilitation approaches produced benefits in adult stroke, and cerebral palsy populations may be applied to children with other acquired brain injuries. Rehabilitation approaches that have been applied to children with acquired brain injuries, or hold promise for future applications, are reviewed.

Homelessness affects men, women, and children of all races and ethnicities. On any given night, more than 610,000 persons in the United States are homeless; a little more than one-third of these are families. Homeless persons are more likely to become ill, have greater hospitalization rates, and are more likely to die at a younger age than the general population. The average life span for a homeless person is between 42 and 52 years. Homeless children are much sicker and have more academic and behavioral problems. Insufficient personal income and the lack of affordable housing are the major reasons for homelessness. Complex, advanced medical problems and psychiatric illnesses, exacerbated by drug and alcohol abuse, in combination with the economic and social issues (such as the lack of housing and proper transportation) make this subset of the population a unique challenge for the health care system, local communities, and the government. An integrated, multidisciplinary health care team with an outreach focus, along with involvement of local and state agencies, seems best suited to address the components needed to ensure quality of care, to help make these patients self-sufficient, and to help them succeed. Family physicians are well suited to manage the needs of the homeless patient, provide continuity of care, and lead these multidisciplinary teams.