David Man

Management of impaired self-awareness in persons with traumatic brain injury

Aim: To develop and evaluate a systematic intervention programme for the management of impaired self-awareness (ISD) in people with traumatic brain injury. Methods: This study adopted a pre-test–post-test control group design. Twenty-one patients with traumatic brain injury were randomly assigned to an experimental group and a control group according to their admission sequence. The groups joined a newly developed Awareness Intervention Programme (AIP) and a conventional rehabilitation programme respectively for 4 weeks. Pre- and post-intervention outcome measures taken from the two groups were compared. Wilcoxon Signed-Ranks Tests were conducted to compare the within-group changes of the outcome measures of the Self-Awareness of Deficits Interview (SADI), the Functional Independence Measure (FIM) and the Lawton Instrumental Activities of Daily Living Score (Lawton IADL) in the control and experimental groups. Mann Whitney U-tests were conducted to compare the across-group differences of improvements of outcome measures between the participants in the two groups. Results: After AIP training, the participants in the experimental group demonstrated significant improvement in their level of awareness as compared to the control group. However, the functional outcomes of the participants in experimental group did not show significant differences. Conclusion: The AIP can promote improvement in the level of self-awareness of people with traumatic brain injury. This new programme can be further developed to extend a better carryover treatment effect to functional improvement in daily activities.

Computerized errorless learning-based memory rehabilitation for Chinese patients with brain injury: a preliminary quasi-experimental clinical design study.

Aim: To evaluate the effectiveness of a computerized, errorless learning-based memory rehabilitation program for Chinese patients with traumatic brain injury (TBI). Methods: This study adopted a pre- and post-test quasi-experimental design. A total of 37 patients with TBI were randomly assigned to a Computer-Assisted Memory Training Group (CAMG), a Therapist-administered Memory Training Group (TAMG) and a Control Group (CG). Except for the CG, the patients in both the CAMG and TAMG groups received, respectively, 1-month memory training programmes that were similar in content but differed in delivery mode. All patients were followed up 1 month after treatment. The outcome measures that were taken were the Neurobehavioural Cognitive Status Examination (NCSE or Cognistat), the Rivermead Behavioural Memory Test (RBMT) and The Hong Kong List Learning Test (HKLLT). Repeated measure analyses were performed to investigate differences among the three groups. Results: The patients in the Computer-assisted Memory Rehabilitation (CAMG) and Therapist-administered Memory Rehabilitation group (TAMG) were found to perform better than the CG in the NCSE and RBMT, but no significant differences were found between the CAMG and TAMG. The CAMG showed significant improvement in their HKLLT assessment as compared with the TAMG and CG. No statistically significant differences were found between the CAMG and TAMG when comparing the post-training outcome measures with the follow-up results. Conclusion: There is no difference between CAMG and TAMG, but the efficacy has been demonstrated when comparing with CG. It is suggested that the combined use of an errorless learning and a computerized approach may be an effective way of enhancing the memories of patients with TBI. This new method may smooth the progress of the whole human memory process and produce a better carryover treatment effect.

A virtual reality-based vocational training system (VRVTS) for people with schizophrenia in vocational rehabilitation.

Employment provides schizophrenic patients with a positive identity and hope. Cognitive impairments have been suggested to slow down the progress in work rehabilitation. The purpose of this study was to investigate the efficacy and effectiveness of VR as a cognitive intervention for enhancing vocational outcomes. 95 inpatients with schizophrenia were randomly assigned to a virtual reality-based vocational training group (VRG), a therapist-administered group (TAG) and a conventional group (CG). Twenty-five of them in each group had completed the study. Their performances were evaluated, before and after interventions, by Brief Neuropsychological Cognitive Examination, Digit Vigilance Test, Rivermead Behavioural Memory Test, Wisconsin Card Sorting Test (WCST) and Vocational Cognitive Rating Scale. Patients in the VRG were found to perform better than patients in the TAG and CG in cognitive functioning, as shown by the WCST-percentage of error (F (2, 72)=7.146, p<0.001) and the WCST-percentage of conceptual level response (F (2, 72)=8.722, p<0.001). The post-hoc test revealed that the VRG showed a better performance than both the TAG (p=0.03) and the CG (p<0.001) in the WCST-percentage of error. The VRG also showed a better performance than patients in both the TAG (p=0.01) and the CG (p<0.001) in the WCST-percentage of conceptual level response. The VRG also showed a better self-efficacy score than CG. Both VRG and TAG showed a better work performance as reflected by the on-site tests. Further studies on the use of VR in schizophrenia rehabilitation and for vocational success are discussed.

Virtual reality (VR)-based community living skills training for people with acquired brain injury: A pilot study

Primary objective: The purpose of the present study was to test the usability and effectiveness of a newly-developed virtual reality (VR)-based community living skills training program for people with acquired brain injury (ABI). Method: A small-sample, pre- and post-quasi experimental design was adopted to initially study the efficacy of the VR-based training program. Its usability was also investigated through interviewing subjects. Outcomes were documented in terms of subjects’ skills acquisition, self-efficacy in applying the learnt skills and the transfer ratio of the learnt skills to the real environment. Global cognitive ability and the functional independence level were also assessed. Results: Four subjects with ABI (one traumatic brain injury and three stroke subjects) were successfully recruited and received 10 sessions of VR-based community living skills training. All four subjects showed improvement in skills acquisition and memory performance, while three out of four also showed improvement in self-efficacy and demonstrated transfer of skills to the real environment. Usability was initially supported. Conclusions: Preliminary results suggested positive changes in ABI subjects. The proposed virtual reality (VR) community living skills training software will be further investigated in a randomized controlled trial.

Evaluation of a computer-assisted errorless learning-based memory training program for patients with early Alzheimer’s disease in Hong Kong: a pilot study

Background Improving the situation in older adults with cognitive decline and evidence of cognitive rehabilitation is considered crucial in long-term care of the elderly. The objective of this study was to implement a computerized errorless learning-based memory training program (CELP) for persons with early Alzheimer’s disease, and to compare the training outcomes of a CELP group with those of a therapist-led errorless learning program (TELP) group and a waiting-list control group. Methods A randomized controlled trial with a single-blind research design was used in the study. Chinese patients with early Alzheimer’s disease screened by the Clinical Dementia Rating (score of 1) were recruited. The subjects were randomly assigned to CELP (n = 6), TELP (n = 6), and waiting-list control (n = 7) groups. Evaluation of subjects before and after testing, and at three-month follow-up was achieved using primary outcomes on the Chinese Mini-Mental State Examination, Chinese Dementia Rating Scale, Hong Kong List Learning Test, and the Brief Assessment of Prospective Memory-Short Form. Secondary outcomes were the Modified Barthel Index, Hong Kong Lawton Instrumental Activities of Daily Living Scale, and Geriatric Depression Scale-Short Form. The data were analyzed using Friedman’s test for time effect and the Kruskal-Wallis test for treatment effect. Results Positive treatment effects on cognition were found in two errorless learning-based memory groups (ie, computer-assisted and therapist-led). Remarkable changes were shown in cognitive function for subjects receiving CELP and emotional/daily functions in those receiving TELP. Conclusion Positive changes in the cognitive function of Chinese patients with early Alzheimer’s disease were initially found after errorless training through CELP. Further enhancement of the training program is recommended.

Self-Appraised, Informant-Reported, and Objective Memory and Cognitive Function in Mild Cognitive Impairment

Background/Aim: The current knowledge of how self-appraised memory and cognitive function relates to informant reports and neuropsychological performances in mild cognitive impairment (MCI) is limited. Methods: Sixty-nine older community-dwelling subjects with MCI and 86 adults with normal cognition (NC) were evaluated on self-appraised (Multifactorial Memory Questionnaire) and objective performance of memory and cognitive function (Mini-Mental State Examination, Fuld Object Memory Evaluation, Digit Span tests, Rivermead Behavioral Memory Test). Informant ratings on the subjects’ cognitive and memory functioning (Informant Questionnaire on Cognitive Decline in the Elderly) were also obtained. The two groups (MCI, NC) did not significantly differ in mean age (79 ± 5.29 vs. 77 ± 5.33) and mean years of education (2.8 ± 3.03 vs. 3.7 ± 4.18). Results: Self-appraised satisfaction and ability of memory and cognitive functions did not correlate with informant reports and neuropsychological performances, but self-reported strategy use correlated with list recall and everyday memory tests in MCI. Conclusion: Persons with MCI may show signs of diminished awareness towards their subtle impairments of memory and cognitive function, as indicated by informant reports and neuropsychological tests.

Evaluation of a virtual reality-based memory training programme for Hong Kong Chinese older adults with questionable dementia: a pilot study

Older adults with questionable dementia are at risk of progressing to dementia, and early intervention is considered important. The present study investigated the effectiveness of a virtual reality (VR)‐based memory training for older adults with questionable dementia.

Virtual reality-based prospective memory training program for people with acquired brain injury

Acquired brain injuries (ABI) may display cognitive impairments and lead to long-term disabilities including prospective memory (PM) failure. Prospective memory serves to remember to execute an intended action in the future. PM problems would be a challenge to an ABI patients successful community reintegration. While retrospective memory (RM) has been extensively studied, treatment programs for prospective memory are rarely reported. The development of a treatment program for PM, which is considered timely, can be cost-effective and appropriate to the patients environment. A 12-session virtual reality (VR)-based cognitive rehabilitation program was developed using everyday PM activities as training content. 37 subjects were recruited to participate in a pretest-posttest control experimental study to evaluate its treatment effectiveness. Results suggest that significantly better changes were seen in both VR-based and real-life PM outcome measures, related cognitive attributes such as frontal lobe functions and semantic fluency. VR-based training may be well accepted by ABI patients as encouraging improvement has been shown. Large-scale studies of a virtual reality-based prospective memory (VRPM) training program are indicated.

The empowering of Hong Kong Chinese families with a brain damaged member: its investigation and measurement

This is an increasing recognition of the influential roles played by the families of brain damaged persons in rehabilitation. Although these families are expected to take up the burden of care, they are usually ill-prepared to face this long-term process. This preliminary study of empowerment is aimed at helping Hong Kong Chinese families with a brain damaged member to regain a sense of mastery over the brain damage, their environment and their lives. The impact of brain damage on families was explored in order to propose a model to guide the development of assessment and intervention, as well as for the justification of practice by health care professionals. A 52-item instrument, the empowerment questionnaire, was developed through explorative factor analysis of responses of 211 families that included a brain damaged member. This analysis yielded four interpretable factors: efficacy: knowledge: support and aspiration and they demonstrated high validity reliability.

Self-efficacy outcomes of people with brain injury in cognitive skill training using different types of trainer-trainee interaction.

Primary objective: To evaluate the effects of different trainer–trainee interaction patterns on the self-efficacy outcomes of trainees with brain injury. Research design: A pre-test and post-test randomized clinical trial design. Methods and procedures: One hundred and three subjects with brain injury were recruited and 83 subjects participated in analogical problem-solving training that was delivered in three respective interaction modes: (a) direct trainer–trainee interaction, (b) self-paced computer-assisted and (c) on-line training with real-time audio-visual interaction. Quizzes on daily behavioural problem- solving and a problem-solving self-efficacy rating scale were adopted as outcome measures. The trainees in the trainer-administered group that received instructions in person with a continuous ‘human touch’ showed more significant improvement in their problem-solving self-efficacy than the two other groups. Conclusions: Interactive modes of cognitive skill training can be flexible enough to match the needs of individual trainees. However, human interaction is considered important in promoting self-efficacy in trainees with brain injury.