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Purpose:The study explored the direction of change (decline vs. improvement) after diffuse axonal injury (DAI) in the domains of the ICF: body structure, body function, and activity.Methods: Thirteen patients with DAI were assessed by using diffusion tensor imaging (DTI) to measure body structure, the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) to measure body function, and the Assessment of Motor and Process Skills (AMPS) to measure activity. The DTI, BNIS, and AMPS were applied at the acute phase (A1), and at 6 and 12 months post-injury (A2 and A3). Visual and statistical analyses were conducted to explore time-dependent changes in the ICF domains.Results:Improvements were observed for most patients in all ICF domains from injury until six months. Thereafter, the results diverged, with half of the subjects showing a decline in DTI and BNIS scores between A2–A3, and all but one of the patients exhibiting identical or better A2–A3 AMPS process skill scores.Conclusions:From 6 to 12 months post-injury, some patients underwent an ongoing degenerative process, causing a decline in cognitive function. The same decline was not observed in the activity measure, which might be explained by the use of compensatory strategies.Implications for rehabilitationIn rehabilitation it is essential to be aware that in some cases with TBI, an ongoing degenerative process in the white matter can be expected, causing an adverse late effect on cognitive function.The cognitive decline, caused by DAI, does not necessarily mean a concurrent decrease in activity performance, possibly explained by the use of compensatory strategies. This suggests that, after the post-acute phase, rehabilitation offering strategy training may be beneficial to enhance every-day functioning.Strategy use requires awareness, which imply the need to assess level of awareness in order to guide rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Working memory (WM) problems influence most activities of daily living. The aim was to evaluate if computerized working memory training after brain injury has a significant effect on functioning in daily life. Method: Outpatients with WM deficits, aged 22-63 years, were randomized to either intervention group (IG, n = 20) or control group (CG, n = 18) and received 5 weeks standard rehabilitation. The IG also received WM training with the Cogmed QM training program. Assessments were made before (A1), immediately (A2) and 3 months (A3) after intervention. After follow-up, the CG was offered the computerized training and assessed after this (A4; n = 8). Assessments included the WAIS-III Digit span reversed, Fatigue Impact Scale (FIS), Assessment of Motor and Process Skills (AMPS), Rivermead Behavioural Memory Test-II (RBMT-II) and a WM questionnaire. Results: The IG improved on digit span and FIS, A1-A2, and significantly more than the CG on the WM questionnaire, A1-A3. Both groups improved in AMPS motor skill and the AMPS process skill score tended towards significant improvement in the IG, from A1-A3. After training (A3-A4), the CG improved in digit span and RBMT-II. Conclusion: The WM training seems to have a generalized effect on functional activity and lessens fatigue. [ABSTRACT FROM AUTHOR]

Objective: To study if computerized working memory (WM) training, in the sub-acute phase after acquired brain injury, in patients with impaired WM, improves WM, cognition and psychological health. Research design: A randomized study ( n = 47) with an intervention group (IG) and a control group (CG), mean age 47.7 years. The WAIS-III NI, Digit span, Arithmetic, Letter-Number Sequences (Working Memory sub-scale), Spatial span, the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and the self-rating scales DEX and HADS were administered at baseline and at follow-ups at 6 and 18 weeks. Both groups underwent integrated rehabilitation. The IG also trained with the computerized WM training program, Cogmed QM, which was offered to the CG and followed up after the study completion. Results: Both groups improved after their WM training in Working Memory, BNIS and in Digit span, particularly the reversed section. Both the BNIS and the Digit span differed significantly between the IG and CG due to the greater improvement in the IG after their WM training. Psychological health improved as both groups reported less depressive symptoms and the CG also less anxiety, after the training. Conclusion: Results indicated that computerized WM training can improve working memory, cognition and psychological health. [ABSTRACT FROM AUTHOR]

Introduction: Several factors influence the return to work (RTW) after brain injury (BI). The aims of the study were to follow-up the RTW after a vocational neuropsychological programme for individuals with a brain injury and to explore factors predicting RTW. The hypothesis was that as self-awareness was already addressed in the programme, severity of injury would have a greater impact on RTW. Method: Sixty-five of 72 persons (median age 27) who had attended the programme 1998–2003 were interviewed about their occupation at 1, 2, 3 and 5 years after the programme. A logistic regression was made with the variables concerning process skill, somatic problems and irritability, the digit symbol coding and pre-morbid occupation to explore predictors of RTW. Results: The main cause was TBI (44.6%). Before injury 77% were employed or studied and after the injury 80% did not have any occupation. After 5 years 40% had returned to work. The only significant variable in the regression was the pre-morbid occupation. Discussion: The study stresses the difficulty to know the key elements involved in RTW which confirms the need for rehabilitation to focus on several factors in different contexts in order to affect the outcome. [ABSTRACT FROM AUTHOR]