Soule Alexa Caitlin, Fish Taryn Jane, Winegardner Jill, Schrieff-Brown Leigh
ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa.
Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
Front Rehabil Sci. 2024 Jun 12;5:1393302. doi: 10.3389/fresc.2024.1393302. eCollection 2024.
TBI incidence and distribution are largely overrepresented in low- to middle-income countries (LMICs), such as South Africa (SA), with substantial associated human and financial costs. However, access to rehabilitation for the public is severely limited and not standard practice in SA. Given this background, studies demonstrating the successful implementation of neuropsychological rehabilitation in a LMIC setting are important. Published studies of this nature are generally lacking in this context. Further, there is a need to evaluate interventions that can be implemented at a low cost. To this end, we report on a neuropsychological rehabilitation program for an individual with severe TBI in a LMIC context, aimed at improving his capacity for activities of daily living.
A 33-year-old, South African male who sustained a severe traumatic brain injury (TBI) partook in a neuropsychological intervention aimed at remediating functional deficits and enhancing independent functioning. The intervention utilised principles of Goal Management Training and external memory aids, with reliance on procedural memory and errorless learning, to target the participant's impairments in executive functioning and memory through the use of assistive technology-namely smart device applications.
Data collected pre- and post-intervention on formal neuropsychological measures demonstrated no significant change in cognition. However, observational data and qualitative feedback from the participant's family indicated notable improvement in performance on everyday tasks with reduced number of errors and reduced need for external prompting whilst completing intervention tasks across sessions.
In the context of severe TBI, neuropsychological rehabilitation can facilitate gains in independent functioning. This study provides support for the value of neurorehabilitation especially for interventions that can be rolled out at low cost and should serve as impetus for further such research in South Africa, where neuropsychological rehabilitation infrastructure and services are lacking.
在低收入和中等收入国家（LMICs），如南非（SA），创伤性脑损伤（TBI）的发病率和分布情况在很大程度上被高估，且伴有巨大的人力和财务成本。然而，南非公众获得康复治疗的机会极为有限，且并非标准做法。鉴于此背景，证明在低收入和中等收入国家环境中成功实施神经心理康复的研究很重要。在这种情况下，此类已发表的研究普遍缺乏。此外，有必要评估可以低成本实施的干预措施。为此，我们报告了在低收入和中等收入国家背景下为一名重度创伤性脑损伤患者开展的神经心理康复项目，旨在提高他的日常生活活动能力。
一名33岁的南非男性遭受了重度创伤性脑损伤，参与了旨在纠正功能缺陷和增强独立功能的神经心理干预。该干预采用目标管理训练原则和外部记忆辅助工具，依靠程序记忆和无错误学习，通过使用辅助技术——即智能设备应用程序，来针对参与者执行功能和记忆方面的损伤。
干预前后收集的正式神经心理测量数据显示认知方面无显著变化。然而，观察数据以及参与者家属的定性反馈表明，日常任务表现有显著改善，错误数量减少，且在完成各阶段干预任务时对外部提示的需求减少。
在重度创伤性脑损伤的背景下，神经心理康复可以促进独立功能的提升。本研究为神经康复的价值提供了支持，特别是对于可以低成本推广的干预措施，并且应该为南非进一步开展此类研究提供动力，因为南非缺乏神经心理康复基础设施和服务。
