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Principles of Neuropsychological Rehabilitation
Rev Neurol Paris. Abstract An increasing number of studies have demonstrated the efficiency of various neuropsychological interventions on individuals with early Alzheimer's disease. Supplemental Content Full text links. In conclusion to the WM training studies, there is good quality evidence in support of computerised WM training from several different studies, from different centres, and from different populations. There is also evidence of generalisation to other tasks or everyday behaviours. The main characteristics of beneficial training procedures include the following: first, adaptation to participant performance whereby task demands increase as the participant improves, and second, the tasks are varied in terms of modality and cognitive demands.
Errorless learning EL is a teaching technique whereby people are prevented, as far as possible, from making mistakes while they are learning a new skill or acquiring new information.
This can be carried out in a number of ways, for example, through the provision of spoken or written instructions or physically guiding the trainee through a task. The principle is to avoid mistakes being made during learning and to minimise the possibility of erroneous responses. Since then, EL has been an important principle in memory rehabilitation.
Several studies have used EL to teach several everyday tasks to people from different diagnostic groups and of different ages and at different times post insult. There is convincing evidence that EL is superior to trial—error learning for people with severe memory problems Wilson, The reason it is effective for these patients is, probably, because in order to benefit from our mistakes, we need to be able to remember them. Therefore, those people whose episodic memory is severely impaired and who are dependent on implicit memory functioning cannot correct their incorrect responses, and once errors are introduced, they may, indeed, be strengthened.
Consequently, we should try to prevent any incorrect responses. What about EL for people with language impairments? In , in just one issue of the journal, Neuropsychological Rehabilitation , there were three articles comparing EL with other approaches. Two of these studies were with language-impaired patients: Raymer, Strobel, Prokup, Thomason, and Reff compared EL with errorful learning EF to train spelling for people with acquired dysgraphia.
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There was a tendency for the EF to be better, but the patients preferred the EL strategy. Jokel, Rochon, and Anderson used EL and a computer-based treatment for a patient with semantic dementia.
Principles Neuropsychological Rehabilitation by George Prigatano
The man was able to relearn words using this approach. This may be because language-impaired people do not necessarily have severe episodic memory deficits so, unlike people with severe amnesia, they can benefit from their mistakes. Lambon-Ralph personal communication, says that the general consensus from his studies, and those of many others, is that EL and EF are equally effective for name relearning but that patients especially the more severe tend to strongly prefer the EL. Evans says that problem-solving difficulties are one of the major characteristics of the dysexecutive syndrome DES , and much of the rehabilitation efforts for people with executive deficits focus on problem-solving therapy PST.
There is evidence for the efficacy of PST from earlier studies. They found the PST group showed a significant improvement on ratings of problem-solving ability and some test performance e. A later study by Rath, Simon, Langenbahn, Sherr, and Diller included 60 outpatients who had sustained a brain injury, all of whom were at least 1-year post injury. The PST group showed greater improvement on an executive test, self-appraisal, and role play.
Principles of Neuropsychological Rehabilitation
More recently, Spikman, Boelen, Lamberts, Brouwer, and Fasotti carried out a randomised control trial RCT of a multifaceted treatment programme for executive dysfunction. They included 75 patients who were randomised into a control group and a PST group in which treatment focussed on self-awareness, goal-setting, planning, self-initiation, self-monitoring, self-inhibition, flexibility, and strategic behaviour. The PST group showed greater improvements on a number of measures including role resumption, goal attainment, and performance on a specially designed executive secretarial task.
Miotto, Evans, and Souza Da Lucia carried out a carefully designed study comparing three groups of people with executive deficits: the participants comprised 15 males and 15 females with lesions in frontal lobes of whom 23 patients had undergone surgery for a tumour and 7 had sustained a TBI; 9 had lesions in the orbitofrontal cortex OFC , 8 had lesions in the dorsolateral prefontal cortex DLPFC , and 13 had combined lesions in the OFC and DLPFC. The average time since injury was 2. Patients were randomly allocated to the attention and problem-solving group APSG , an information and education group, and a treatment-as-usual group.
The APSG was then given to the other participants. Cicerone et al. Interest in this area has been encouraged by the recognition that the efficacy of currently available medications is very limited. The first RCT of individual, goal-oriented CR aimed at supporting functioning in everyday activities has been completed Clare et al.
Participants were receiving a stable dose of acetylcholinesterase-inhibiting medication.
A total of 44 family carers also contributed. Treatment took place over 8 weeks, consisting of individual sessions of CR with personalised interventions to address individually relevant goals. This was supported by the provision of information, practical aids and strategies, techniques for learning new information, practice in maintaining attention and concentration, and techniques for stress management. The primary outcomes were goal performance and satisfaction. Questionnaires assessing mood, quality of life and carer strain, and a brief neuropsychological test battery were also administered.
A subset of participants underwent fMRI. The CR produced significant improvement in ratings of goal performance and satisfaction, while scores in the other two groups did not change. The results suggest that CR in the early stages of dementia is clinically effective and helps people with dementia and their families to manage the effects of the condition. It involves many complex processes aimed at enabling people who are disabled by injury or disease to achieve their optimum level of physical, psychological, social, and vocational well-being McLellan, RCTs in rehabilitation are possible, but they are not easy to implement and they need to be thought out carefully.
RCTs, however, are not the only way to evaluate rehabilitation, and there is increasing recognition that RCTs are of limited value in determining their efficacy. He goes on to say that the RCT is excellent where 1 the design is simple, 2 marked changes are expected, 3 the factors involved are relatively specific, and 4 the number of additional variables likely to affect the outcome are few and can be balanced out.
This is quite unlike the situation in rehabilitation. They are perfectly respectable scientific methods, and they provide complementary information to group studies. Large group studies need many people to share out individual differences, but small groups and SCEDs do not have to concern themselves with this as each subject is his or her own control , and baselines are used instead of control groups.
The scale considers whether or not the SCED being examined reports or provides information on the following: 1 the history, 2 the target behaviour, 3 the design, 4 a baseline, 5 the behaviour during treatment, 6 the raw data, 7 a measure of inter-rater reliability, 8 an independent assessor, 9 statistical analysis, 10 replication, and 11 information on generalisation.
Thus, each article can be rated on its methodological quality. Of course, studies can be highly rated for methodology but still report on trivial, meaningless, or unimportant aspects and can be poor in other ways, so further information will always be needed. The value of the work of Tate, Perdices, and their Australian colleagues is likely to be of great benefit in improving research into the evaluation of the efficacy of NR. SenseCam is a small camera usually worn around the neck that takes pictures automatically. It does not have a viewfinder but is fitted with a wide-angle fish-eye lens that maximises its field of view.
A number of studies have looked at the value of SenseCam to improve autobiographical memory Berry et al. The camera has been used successfully for patients with dementia and encephalitis and other kinds of brain injury.
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SenseCam provides security, confidence, and ownership of experiences. Browne et al. I was able to go over situations in the privacy of my own home to review things which I was uncomfortable with.
https://blocinreleabikl.tk The outside world can be very frightening and fast and I felt afraid and thought I would have difficulty keeping up. I was able to review my visits into the outside world. This built my confidence.
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