An evaluation of perceptual retraining. A comparison of two approaches in the treatment of perceptual problems after stroke. One-year outcome of auditory-tactile-visual-vestibular intervention in the neonatal intensive care unit: effects of severe prematurity and central nervous system injury. Neuropsychological rehabilitation for traumatic brain injury: do carers benefit? Traumatic brain injury: efficacy of multidisciplinary rehabilitation. A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury. Management of impaired self-awareness in persons with traumatic brain injury. Viewing less to see better. Rehabilitation of postural disturbances of hemiplegic patients by using trunk control retraining during exploratory exercises.
A group of head injury and stroke patients with impairment of visual perception were randomly allocated to receive either perceptual retraining or conventional occupational therapy. No significant differences were found between the groups, either before or after 4 weeks of treatment, on measures of visual perception or on activities of daily living scale. To compare the effectiveness of the transfer of training and functional approaches in improving perceptual and functional abilities after stroke.
                Patients identified as having perceptual problems were randomly allocated to either the transfer of training approach or the functional approach for perceptual treatment. On completion of six weeks of treatment, each patient was reassessed for perceptual and functional abilities.
                Eighty inpatients on the Nottingham Stroke Unit.
                Perceptual treatment was given for 2.5 hours per week for six weeks.
                Rivermead Perceptual Assessment Battery, Barthel ADL Index and Edmans ADL index.
                There was no significant difference between the treatment groups on patient characteristics or impairments. The results also showed no significant difference between the treatment groups before and after treatment on perceptual ability total scores, individual perceptual subtest scores, or functional ability total scores (Mann-Whitney U 642.5-798.0, p > 0.05). Wilcoxon matched pairs signed ranks tests showed a significant improvement in both groups after treatment on perceptual and functional abilities (perceptual z = 6.02, p < 0.001, functional z = 6.72, p < 0.001).
                These results indicated that the improvement in perceptual abilities was equivalent using either of the two approaches. This could be due to spontaneous recovery or the effects of the Stroke Unit. Thirty-seven infants with severe central nervous system injury or extreme prematurity were randomly assigned to a multisensory (auditory-tactile-visual-vestibular) intervention or control group. Intervention began in the hospital at 33 weeks' postconceptional age and continued twice daily in the home until 2 months' corrected age. Mother-infant interactions during feedings were videotaped, and the Bayley Scales of Infant Development were administered. Control mothers stimulated their infants more during feeding, but these significant differences dissipated by 4 months. The presence of periventricular leukomalacia was associated with significantly poorer mental development, regardless of group assignment. Experimental infants tended to exhibit better motor and mental performance and had 23% fewer cerebral palsy diagnoses at 1 year, but these trends were not statistically significant. The type of brain injury was more important in determining 1-year developmental outcome than type of postnatal experience, suggesting that periventricular leukomalacia presents a major challenge for infant development. This study evaluated the effectiveness of a new rehabilitation service, compared with existing services, for carers of people with traumatic brain injury (TBI). Subjects were 96 adult carers of people consecutively admitted to two local hospitals. They were assigned to one of three groups: Early new service (pre-discharge); Late new service (post-discharge); or a Control condition (existing services only). Individual randomization was not possible and randomization by hospital site was rejected because of demographic and clinical differences between sites. Group assignment was determined by a pre-specified timetable which alternated between hospitals. Two outcomes were compared at 6 months post-injury: carers' emotional distress and how well-informed they felt about TBI and available resources. Analyses adjusting for potential confounding factors confirmed a clinically plausible superior outcome for both intervention groups compared to the control group. However, these differences did not obtain statistical significance (p > or = 0.01). Several reasons for these findings are discussed, including the novelty of the new service and methodological issues such as statistical power. Longer term follow-up studies are required as psychological sequelae and, therefore, the need for intervention is known to increase with time and may not be most apparent during the first 6 months. To establish efficacy of a coordinated multidisciplinary rehabilitation service for severe head injury, provided at Hunters Moor Regional Rehabilitation Centre.
                A quasi-experimental design to compare treatment effects between two groups. The first group received a coordinated, multidisciplinary regional rehabilitation service; the other, a single discipline approach provided by local, district hospitals. Follow-up was for 2 years postinjury.
                Fifty-six consecutive severe head injury admissions, with an identified main caregiver, referred for rehabilitation within 4 weeks of their injury.
                The Barthel index, the Functional Independence Measure (FIM), and the Newcastle Independence Assessment Form (NIAF), a newly developed, real-life, comprehensive measure. In addition, caregivers completed the General Health Questionnaire.
                The group that received coordinated multidisciplinary rehabilitation not only demonstrated significant gains throughout the study period but also maintained treatment effect after input ended. Furthermore, caregivers of this group had significantly reduced levels of distress. The comparison group, despite initial lower injury severity and shorter hospital stay, did not demonstrate equivalent gains or any posttreatment effect.
                The results show the efficacy of a comprehensive, specialist multidisciplinary regional service. There are significant implications for service provision for people with severe traumatic head injury. To evaluate the effectiveness of comprehensive, holistic neuropsychologic (NP) rehabilitation compared with standard, multidisciplinary rehabilitation for people with traumatic brain injury (TBI).
                Randomized practical controlled trial.
                Postacute brain injury rehabilitation center within a suburban rehabilitation hospital.
                Participants with TBI were recruited from clinical referrals and referrals from the community. Sixty-eight participants who met inclusion criteria were randomly allocated to treatment conditions. Most participants (88%) had sustained moderate or severe TBI, and greater than half (57%) were more than 1 year postinjury at the beginning of treatment.
                Treatment was conducted 15 hours per week for 16 weeks. Standard neurorehabilitation consisted primarily of individual, discipline specific therapies (n=34). Intensive cognitive rehabilitation emphasized the integration of cognitive, interpersonal, and functional interventions within a therapeutic environment (n=34).
                Primary outcomes were the Community Integration Questionnaire (CIQ) and Perceived Quality of Life scale (PQOL). Secondary outcomes included NP functioning, perceived self-efficacy, and community-based employment.
                NP functioning improved in both conditions. Intensive cognitive rehabilitation participants showed greater improvements on the CIQ (effect size [ES]=0.59) and PQOL (ES=0.30) as well as improved self-efficacy for the management of symptoms (ES=0.26) compared with standard neurorehabilitation treatment. These gains were maintained at the 6-month follow-up. Standard neurorehabilitation participants showed improved productivity at the 6-month follow-up associated with the need for continued rehabilitation.
                Improvements seen after intensive cognitive rehabilitation may be related to interventions directed at the self-regulation of cognitive and emotional processes and the integrated treatment of cognitive, interpersonal, and functional skills. The results show the effectiveness of comprehensive holistic NP rehabilitation for improving community functioning and quality of life after TBI compared with standard rehabilitation. To develop and evaluate a systematic intervention programme for the management of impaired self-awareness (ISD) in people with traumatic brain injury.
                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.
                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.
                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. To assess the efficacy, as well as the long term duration, of a new procedure for the rehabilitation of visuospatial neglect in patients with right hemisphere stroke.
                Patients with right unilateral hemispheric damage identified with neglect were assigned to a treatment (T+) or a control (T-) group. The treatment consisted in abolishing all visual inputs from the right hemispace for one week by means of specially devised hemiblinding goggles. Patients' visuospatial abilities were tested and compared between groups immediately after the week of treatment. Both groups were further assessed one week after treatment suspension for evaluation of long term beneficial effects.
                Following the treatment, a substantial amelioration of visuospatial neglect symptoms was selectively observed in the T+ group. In contrast, untreated patients showed only weak signs of recovery. Most important, the amelioration obtained in the T+ group of patients was not ephemeral, being significantly maintained after a further period of one week, even after suspension of the treatment.
                The protracted efficacy of the proposed "hemiblinding technique" may have important implications for the recovery of visuospatial neglect and may be a very promising tool for investigating both the cognitive and the neural basis of neglect rehabilitation. To assess use of the Bon Saint Côme device for axial postural rehabilitation in hemiplegic patients, a technique based on voluntary trunk control during exploratory retraining.
                A 3-month randomized controlled trial.
                A public neurorehabilitation center.
                Twenty consecutive hemiplegic patients with axial postural disturbance resulting from recent stroke were randomly assigned to a device group (DG) or control group (CG). The 2 groups of 10 patients were similar.
                For 1 month, the DG patients followed an experimental program for 1 hour daily and conventional neurorehabilitation for 1 hour daily, whereas CG patients had conventional neurorehabilitation for 2 hours daily. For the next 2 months, all 20 patients had conventional neurorehabilitation for 2 hours daily.
                Patients were assessed on days 0, 30, and 90 by using a battery of postural tests, gait evaluation, the Bells neglect test, and the FIM instrument.
                On day 30, postural and neglect tests improved significantly more in DG than in CG. The benefit remained at day 90. Gait improved earlier in DG than in CG. FIM scores improved equally.
                Voluntary trunk control retraining during spatial exploration with the Bon Saint Côme device appears to be a useful approach for rehabilitation of postural disorders in hemiplegic patients. Treatments designed to improve spatial cognition deficits probably enhance postural disorder recovery in hemiplegia.
There is insufficient evidence to support or refute the view that perceptual interventions are effective. Future studies should be sufficiently large, include a standard care comparison and measure longer term functional outcomes. People with impaired perception problems should continue to receive neurorehabilitation according to clinical guidelines.