Marina Zettin

Rehabilitation Treatments for Adults with Behavioral and Psychosocial Disorders Following Acquired Brain Injury: A Systematic Review

This review was aimed at systematically investigating the treatment efficacy and clinical effectiveness of neurobehavioral rehabilitation programs for adults with acquired brain injury and making evidence-based recommendations for the adoption of these rehabilitation trainings. Using a variety of search procedures, 63 studies were identified and reviewed using a set of questions about research methods, treatments, results and outcomes for the 1,094 participants. The 63 studies included treatments falling into three general categories: approaches based on applied behavior analysis, interventions based on cognitive-behavior therapy (CBT), and comprehensive-holistic rehabilitation programs (CHRPs). Considerable heterogeneity exists in the reviewed literature among treatment methods and within reported sample subjects. Despite the variety of methodological concerns, results indicate that the greatest overall improvement in psychosocial functioning is achieved by CHRP that can be considered a treatment standard for adults with behavioral and psychosocial disorders following acquired brain injury. Both approaches based on applied behavior analysis and CBT can be said to be evidence-based treatment options. However, findings raise questions about the role of uncontrolled factors in determining treatment effects and suggest the need for rigorous inclusion/exclusion criteria, with greater specification of theoretical basis, design, and contents of treatments for both interdisciplinary-comprehensive approaches and single-case methodologies.

Communicative Impairment in Traumatic Brain Injury: A Complete Pragmatic Assessment.

The aim of the present study was to examine the communicative abilities of traumatic brain injury patients (TBI). We wish to provide a complete assessment of their communicative ability/disability using a new experimental protocol, the Assessment Battery of Communication, (ABaCo) comprising five scales--linguistic, extralinguistic, paralinguistic, context and conversational--which investigate all the main pragmatic elements involved in a communicative exchange. The ABaCo was administered to 21 TBI subjects and to a control group. The results showed that performance by TBI patients was worse than that of controls on all scales; moreover they showed a trend of increasing difficulty in understanding and producing different pragmatic phenomena, i.e., standard communication acts, deceits and ironies, whether such phenomena are expressed through the linguistic or extralinguistic modality.

Narrative Language in Traumatic Brain Injury.

Persons with traumatic brain injury (TBI) often show impaired linguistic and/or narrative abilities. The present study aimed to document the features of narrative discourse impairment in a group of adults with TBI. 14 severe TBI non-aphasic speakers (GCS<8) in the phase of neurological stability and 14 neurologically intact participants were recruited for the experiment. Their cognitive, linguistic and narrative skills were thoroughly assessed. The group of non-aphasic individuals with TBI had normal lexical and grammatical skills. However, they produced narratives with increased errors of cohesion and coherence due to the frequent interruption of ongoing utterances, derailments and extraneous utterances that made their discourse vague and ambiguous. They produced a normal amount of thematic units (i.e. concepts) in their narratives. However, this information was not correctly organized at micro- and macrolinguistic levels of processing. A Principal Component Analysis showed that a single factor accounted for the production of global coherence errors, and the reduction of both propositional density at the utterance level and proportion of words that conveyed information. It is hypothesized that the linguistic deficits observed in the participants with TBI may reflect a deficit at the interface between cognitive and linguistic processing rather than a specific linguistic disturbance.

Agrammatic speech production after a right cerebellar haemorrhage

Abstract We report the case of a patient who developed a severe expressive agrammatic disorder, mainly characterized by the omission of function words, after a haemorrhagic stroke involving the right cerebellar hemisphere. A detailed analysis of syntactic and morphological abilities confirmed that the disorder was limited to spontaneous production, and was much less evident in recitation of well known dramatic pieces (the patient was a professional actor). The speech disorder recovered in about 2 months. The presence of crossed frontal diaschisis on a SPECT scan performed in the acute stage and its regression after recovery suggest that interference within a complex cerebellar basal ganglia-frontal cortex loop may be responsible for this unusual speech disorder.

The anatomical basis of proper name processing. A critical review

Abstract A specific role has recently been proposed in proper name processing for, respectively, the right hemisphere, the anterior temporal lobe and the thalamus. None of these claims seems to be fully justified with regard to a review of known relevant single case reports.

Effects of emotional face cueing on line bisection in neglect: A single case study

One patient with left neglect (FM) and four right brain-damaged controls were tested on a line bisection task with pictures of neutral and emotional faces as unilateral cues. We thus manipulated the attentional salience of the cues (higher for emotional and lower for neutral faces) while keeping constant their physical dimensions. Our findings showed that left emotional faces were more effective than left neutral faces in reducing bisection errors only in FM. These data indicate that in the neglected hemispace cues bias attention rather than simply altering the perceptual point of balance of the line in the horizontal plane.

Cognitive correlates of narrative impairment in moderate traumatic brain injury.

Traumatic brain injuries (TBIs) are often associated with communicative deficits. The incoherent and impoverished language observed in non-aphasic individuals with severe TBI has been linked to a problem in the global organization of information at the text level. The present study aimed to analyze the features of narrative discourse impairment in a group of adults with moderate TBI (modTBI). 10 non-aphasic speakers with modTBI and 20 neurologically intact participants were recruited for the experiment. Their cognitive, linguistic and narrative skills were thoroughly assessed. The persons with modTBI exhibited normal phonological, lexical and grammatical skills. However, their narratives were characterized by lower levels of Lexical Informativeness and more errors of both Local and Global Coherence that, at times, made their narratives vague and ambiguous. Significant correlations were found between these narrative difficulties and the production of both perseverative and non-perseverative errors on the WCST. These disturbances confirm previous findings which suggest a deficit at the interface between cognitive and linguistic processing rather than a specific linguistic disturbance in these patients.

A combined robotic and cognitive training for locomotor rehabilitation: evidences of cerebral functional reorganization in two chronic traumatic brain injured patients

It has been demonstrated that automated locomotor training can improve walking capabilities in spinal cord-injured subjects but its effectiveness on brain damaged patients has not been well established. A possible explanation of the discordant results on the efficacy of robotic training in patients with cerebral lesions could be that these patients, besides stimulation of physiological motor patterns through passive leg movements, also need to train the cognitive aspects of motor control. Indeed, another way to stimulate cerebral motor areas in paretic patients is to use the cognitive function of motor imagery. A promising possibility is thus to combine sensorimotor training with the use of motor imagery. The aim of this paper is to assess changes in brain activations after a combined sensorimotor and cognitive training for gait rehabilitation. The protocol consisted of the integrated use of a robotic gait orthosis prototype with locomotor imagery tasks. Assessment was conducted on two patients with chronic traumatic brain injury and major gait impairments, using functional magnetic resonance imaging. Physiatric functional scales were used to assess clinical outcomes. Results showed greater activation post-training in the sensorimotor and supplementary motor cortices, as well as enhanced functional connectivity within the motor network. Improvements in balance and, to a lesser extent, in gait outcomes were also found.

Video game play changes spatial and verbal memory: rehabilitation of a single case with traumatic brain injury

IntroductionTraumatic brain injury (TBI) occurs when mechanicalforce causes damage to brain tissue resulting in the dis-ruption of brain functioning. Cognition is frequentlydamaged after TBI; although the effects of TBI can bevariable, the domains of memory, attention, and executivefunctioning are consistently impaired. Memory deficit isone of the most (if not the most) common and disablingimpairments caused by TBI (Vakil 2005).Theuseof3D video games inbraindamagerehabilitationis a very little explored resource at the present time. 3Dvideo games are based on virtual reality technology. Theadvantage of using VR in cognitive rehabilitation is tosimulate many real life situations, thereby providing theopportunity for more ecologically valid and dynamicassessment and training (Rose et al. 2005). The utility of thismethod has been established through some spatial memorystudies (see Rose et al. 2005). It has been shown that navi-gation ofavirtualenvironmentallowsparticipantstoencodethe spatial layout of the virtual environment and activate anetwork of areas as the Hippocampus involved in memoryprocessing(Maguireetal.1998).Someauthorsassumedthathippocampal activations are more likely to be observedwhen the knowledge acquired concerns a complex anddetailed large-scale spatial layout (Woollett et al. 2008).The aim of this exploratory study was to assess themodifications occurring in cognitive functions, in particularspatial and verbal memory, and a potential fMRI increaseof signal in hippocampal and extrahippocampal brainregions in a TBI patient after a 3D video game rehabili-tation training.MethodsThe present study describes the rehabilitation of a 24-year-old, right-handed man, with 8 years of education. Hismedical history was unremarkable till when he wasinvolved in a motor vehicle crash and sustained a TBI ofmoderate severity. His Glasgow Coma Scale score was 5.He was diagnosed with trauma cranial injury. The patientwas tested 7 months after the event and was not in the post-traumatic amnesia (PTA) stage.Neuropsychological assessment indicated the presenceof a severe anterograde (recall and recognition) and retro-grade amnesia and deficits in spatial learning (supra-spanon Corsi’s test).Thetraining consistedofaseries of1.5 hsessions thriceaweek(totallengthofintervention:5 weeks).Thevideogamewas a driving simulator. During the training the participantwas requested to explore a complex virtual town from aground-levelperspective.Ineachtrainingsessionthesubjectinterchanged 20 min of navigation with 7 min of break.The patient was evaluated before and after training bymeans of a fMRI and a standardized neuropsychologicalassessment. He was then re-tested 1 and 2 months after thelast memory training session for two follow-up testingsessions.

Virtual navigation for memory rehabilitation in a traumatic brain injured patient

The use of 3D video games in memory rehabilitation has been explored very little. A virtual navigation task allows participants to encode the spatial layout of the virtual environment and activate areas involved in memory processing. We describe the rehabilitation of a 24-year-old man with traumatic brain injury presenting memory deficits, and evaluate the efficacy of a navigational training program measuring neuropsychological changes and fMRI modification cerebral activations. Memory improvement appears to be present both after navigational training and in follow-up testing. Furthermore, fMRI data suggest that this training may increase activation of the hippocampal and parahippocampal brain regions. The results suggest that intensive training in virtual navigational tasks may result in an enhancement of memory function in brain-damaged adults.