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4 Initial Application of Constraint-Induced Cognitive Therapy to Long COVID Brain Fog
- Gitendra Uswatte, Edward Taub, Karlene Ball, Kristine Lokken, Shruti P Agnihotri, Victor W Mark, Amy Knight, Brandon Mitchell, Jason Blake, Staci McKay, Terika Miller, Elizabeth Pollard, Piper Hempfling, Morgan Smith, Rebekah Chatfield, Erin Stanley, Cliff Lynam, Kyli Blagburn, Brooke Carroll, Gary Cutter
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 598-599
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Objective:
Persistent brain fog is common in adults with Post-Acute Sequelae of SARS-CoV-2 infection (PASC), in whom it causes distress and in many cases interferes with performance of instrumental activities of daily living (IADL) and return-to-work. There are no interventions with rigorous evidence of efficacy for this new, often disabling condition. The purpose of this pilot is to evaluate the efficacy, on a preliminary basis, of a new intervention for this condition termed Constraint-Induced Cognitive therapy (CICT). CICT combines features of two established therapeutic approaches: cognitive speed of processing training (SOPT) developed by the laboratory of K. Ball and the Transfer Package and task-oriented training components of Constraint-Induced Movement therapy developed by the laboratory of E. Taub and G. Uswatte.
Participants and Methods:Participants were > 3 months after recovery from acute COVID symptoms and had substantial brain fog and impairment in IADL. Participants were randomized to CICT immediately or after a 3-month delay. CICT involved 36 hours of outpatient therapy distributed over 4-6 weeks. Sessions had three components: (a) videogamelike training designed to improve how quickly participants process sensory input (SOPT), (b) training on IADLs following shaping principles, and (c) a set of behavioral techniques designed to transfer gains from the treatment setting to daily life, i.e., the Transfer Package. The Transfer Package included (a) negotiating a behavioral contract with participants and one or more family members about the responsibilities of the participants, family members, and treatment team; (b) assigning homework during and after the treatment period; (c) monitoring participants’ out-of-session behavior; (d) supporting problem-solving by participants and family members about barriers to performance of IADL; and (e) making follow-up phone calls. IADL performance, brain fog severity, and cognitive impairment were assessed using validated, trans-diagnostic measures before and after treatment and three months afterwards in the immediate-CICT group and on parallel occasions in the delayed-CICT group (aka waitlist controls).
Results:To date, five were enrolled in the immediate-CICT group; four were enrolled in the wait-list group. All had mild cognitive impairment, except for one with moderate impairment in the immediate-CICT group. Immediate-CICT participants, on average, had large reductions in brain fog severity on the Mental Clutter Scale (MCS, range = 0 to 10 points, mean change = -3.7, SD = 2.0); wait-list participants had small increases (mean change = 1.0, SD = 1.4). Notably, all five in the immediate-CICT group had clinically meaningful improvements (i.e., changes > 2 points) in performance of IADL outside the treatment setting as measured by the Canadian Occupational Performance Measure (COPM) Performance scale; only one did in the wait-list group. The advantage for the immediate-CICT group was very large on both the MCS and COPM (d’s = 1.7, p’s < .05). In follow-up, immediate-CICT group gains were retained or built-upon.
Conclusions:These preliminary findings warrant confirmation by a large-scale randomized controlled trial. To date, CICT shows high promise as an efficacious therapy for brain fog due to PASC. CICT participants had large, meaningful improvements in IADL performance outside the treatment setting, in addition to large reductions in brain fog severity.
3 CI Cognitive Therapy: Initial Application in a Pilot Study to Improve Cognitive Impairment in Chronic Stroke Survivors
- Edward Taub, Gitendra Uswatte, Karlene Ball, Victor W Mark, Staci McKay, Brandon Mitchell, Jason Blake, Amy Knight, Chen Lin, Gary Cutter
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 597-598
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Objective:
CI Cognitive Therapy (CICT) is a combination of behavioral techniques derived from CI Movement Therapy (CIMT) modified to apply to the cognitive domain, and Speed of (Cognitive) Processing Training (SOPT). SOPT is effective in improving cognitive function in the treatment setting and driving ability in everyday situations. The data concerning the effect of SOPT on other cognition-based instrumental activities of daily living (IADL) in everyday situations is incomplete. The strengths of CIMT, based on its Transfer Package (TP), are to facilitate 1) transfer of improved function from the treatment setting to IADL in everyday settings, and 2) long-term retention of the improved performance of IADL. This study sought to determine in a preliminary case series whether the TP of CI Movement Therapy combined with SOPT would have the same effect on a wide range of impaired cognition-based ADL.
Participants and Methods:Participants were 6 adults with chronic stroke: mean chronicity = 36.2 months, (range, 16-56 months); mean age = 59.7 years, (range, 47-55); 1 female; 3 African American and 3 European American. Five had mild cognitive impairment, while one had moderate impairment. Participants received 35 hours of outpatient treatment in 10-15 sessions distributed over 2-6 weeks, depending on the participants’ availability. Sessions began with 1 hour of SOPT training followed by training of cognition-based ADL by the process of shaping, a common method in the behavior analysis field. Other behavior analysis methods employed in the TP of CI Movement Therapy were used, including: 1) behavior contracting, daily assignment of homework, participation of a family member in the training and monitoring process, daily administration of a structured interview assessing amount and quality of performance of 30 IADL, problem solving to overcome perceived (or real) barriers to performance of IADL. Participants were given daily homework assignments in follow-up and were contacted in periodic, pre-arranged phone calls to determine status, compliance and problem-solve.
Results:All six participants showed marked improvement on the SOPT test similar to that in the Ball et al studies. However, here transfer to IADL outside the treatment setting was substantial. On the main real-world outcome, the Canadian Occupational Performance Measure (COPM), there were increases of 2.7±1.3 and 2.1±1.6 on the two scales (d’s = 1.9 & 1.3, respectively). (Changes on the COPM > 2 points are considered clinically meaningful and changes in d’ >.8 are considered large). On two other real-word measures, the Cognitive Task Activity Log (CTAL) and inventory of Improved and New Cognitive Activities (INCA), there was a marked increase during the acquisition phase of training. There was no loss in retention over the 6-16 months (mean = 12.2) of follow-up to date. Instead, the INCA showed strong further improvement after the end of treatment-setting training, especially in the New Activities Not Performed Since Before Stroke Onset category, going from a mean of 8.2 after training to 14.6 at the end of follow-up.
Conclusions:These very preliminary results suggest that CICT may be an efficacious therapy for mild to moderate cognitive impairment in chronic stroke and possibly other disorders.
4 - You can teach an old dog new tricks:
- Edited by Prem S. Fry, Trinity Western University, British Columbia, Corey L. M. Keyes, Emory University, Atlanta
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- Book:
- New Frontiers in Resilient Aging
- Published online:
- 06 December 2010
- Print publication:
- 29 July 2010, pp 104-129
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Summary
Abstract
Animal and human research has shown that the brain can reorganize and even remodel itself to restore function in response to central nervous system (CNS) injuries, such as stroke, traumatic brain injury, and spinal cord injury. This chapter will discuss the phenomenon of neuroplasticity after damage to the CNS demonstrated in animal and human experiments. Research on Constraint-Induced Movement therapy or CI therapy, which is a behaviorally based approach to physical rehabilitation, will be a major focus. This body of work, among other contributions, overthrew the reigning clinical wisdom that stroke survivors more than 1-year post-event can not benefit from additional physical rehabilitation. It also provided the first evidence that physical rehabilitation can produce large improvements in real-world arm function and change CNS organization and structure. This evidence provides a neurophysiological basis for continued plasticity in behavior among older adults.
Introduction
Clinical wisdom, and even the scientific view, until relatively recently was that older adults who suffered damage to their brain had little hope that this vital organ could repair itself or adapt how it functioned to overcome the injury. The scientific view was based on the long-held tenet that the mature central nervous system (CNS) had little capacity to repair or reorganize itself. Though contrary views were expressed (e.g., Flourens, 1842; Fritsch and Hitzig, 1870; Lashley, 1938; Munk, 1881), the mature CNS was generally believed (Kaas, 1995, p. 735) to exhibit little or no plasticity (e.g., Hubel and Wiesel, 1970; Ruch, 1960, p. 274).
Contributors
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- By Claude Alain, Amy F. T. Arnsten, Lars Bäckman, Malcolm A. Binns, Sandra E. Black, S. Thomas Carmichael, Keith D. Cicerone, Maurizio Corbetta, Bruce Crosson, Jeffrey L. Cummings, Deirdre R. Dawson, Michael deRiesthal, Roger A. Dixon, Laura Eggermont, Kirk I. Erickson, Anthony Feinstein, Susan M. Fitzpatrick, Fu Qiang Gao, Douglas D. Garrett, Omar Ghaffar, Robbin Gibb, Elizabeth L. Glisky, Martha L. Glisky, Leslie J. Gonzalez Rothi, Cheryl L. Grady, Carol Greenwood, Gerri Hanten, Richard G. Hunter, Masud Husain, Narinder Kapur, Bryan Kolb, Arthur F. Kramer, Susan A. Leon, Harvey S. Levin, Brian Levine, Nadina Lincoln, Thomas W. McAllister, Edward McAuley, Bruce S. McEwen, David M. Morris, Stephen E. Nadeau, Roshan das Nair, Matthew Parrott, Jennie Ponsford, George P. Prigatano, Joel Ramirez, John M. Ringman, Ian H. Robertson, Amy D. Rodriguez, John C. Rosenbek, Bernhard Ross, Erik Scherder, Victoria Singh-Curry, Trudi Stickland, Donald T. Stuss, Edward Taub, Gary R. Turner, Harry V. Vinters, Samuel Weiss, John Whyte, Barbara A. Wilson, Gordon Winocur, J. Martin Wojtowicz
- Edited by Donald T. Stuss, University of Toronto, Gordon Winocur, University of Toronto, Ian H. Robertson, Trinity College, Dublin
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- Book:
- Cognitive Neurorehabilitation
- Published online:
- 05 September 2015
- Print publication:
- 11 September 2008, pp ix-xiv
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23 - The use ofconstraint-induced movement therapy (CI therapy) to promote motor recovery following stroke
- from Section 5 - Behavioral/ neuropsychological approaches
- Edited by Donald T. Stuss, University of Toronto, Gordon Winocur, University of Toronto, Ian H. Robertson, Trinity College, Dublin
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- Book:
- Cognitive Neurorehabilitation
- Published online:
- 05 September 2015
- Print publication:
- 11 September 2008, pp 401-416
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