In Hungary, aphasia assessment relies primarily on impairment-based language measures. However, no aphasia-specific patient-reported outcome measure (PROM) is currently available to assess the impact of aphasia on everyday communication, participation, and psychological well-being. This study aimed to (1) adapt the Aphasia Impact Questionnaire-21 (AIQ-21) to Hungarian, (2) evaluate the content validity of the Hungarian version (AIQ-21-H), and (3) explore the impact of aphasia on communication, participation, and psychological well-being, and their associations with aphasia severity. Adaptation involved semi-structured interviews and focus groups with six people with aphasia (PWA). In the content validity phase, 13 PWA and 12 professionals rated relevance, comprehensibility, and comprehensiveness of the AIQ-21-H. Content validity indices ranged from 0.92-1.00 for PWA and 0.75-1.00 for professionals, indicating high content validity. Thirty-four PWA with chronic aphasia reported difficulties in communication (especially reading and writing), participation (everyday tasks, maintaining friendships), and emotional well-being (frustration, worry, helplessness, and anger). Communication and participation were strongly associated, psychological well-being was moderately associated with both domains, and greater aphasia severity was associated with greater difficulties across all AIQ-21-H domains. The AIQ-21-H is the first aphasia-specific, aphasia-friendly PROM in Hungarian and offers a much needed tool for clinical practice and research.
This clinical programme evaluation describes a telehealth, transdiagnostic Goal Management Training (GMT®) group adaptation delivered within RENEW (Resilience through Neurologic and Emotional Wellness), an academic outpatient neuropsychological rehabilitation programme. GMT® is an evidence-based cognitive rehabilitation intervention targeting goal neglect and goal-directed behaviour in acquired executive dysfunction. Using components of the RE-AIM framework, we characterize programme reach across 28 months (N = 371 completers), telehealth and transdiagnostic adaptations, and preliminary outcome data from a passive, platform-based monitoring system. Among survey completers (34% of programme completers), acceptability and satisfaction were high, and statistically significant pre-to-post improvements were observed across mood, anxiety, cognitive self-efficacy, quality of life, and mindful attention, with the largest effects for mood and anxiety. Implementing this monitoring infrastructure generated four lessons: (1) evaluation is limited by what is not collected at referral; (2) monitoring at the margins of clinical care is structurally unsustainable; (3) monitoring that does not return value to patients is a missed therapeutic opportunity; and (4) initiating data collection at referral enables evaluation and rigorous programme learning. These lessons help refine our monitoring design and offer a practical, generalizable account of what is required to deliver and evaluate neuropsychological rehabilitation at scale within routine clinical care.
Stroke sequelae impose heavy socioeconomic burdens. The hand mental rotation task (HMRT), imagined hand rotation training, may boost upper-limb motor and cognitive recovery yet lacks sufficient stroke rehabilitation evidence. Neuroimaging and transcranial magnetic stimulation research have verified its neural mechanisms. This study explored HMRT's effects on post-stroke motor and cognitive function. Thirty stroke survivors (18 ischemic, 12 hemorrhagic) with moderate-severe upper limb dysfunction were randomized to an intervention group (IG) or a control group (CG), with a mean Fugl-Meyer Assessment of Upper Extremity (FMA-UE) score of 29.13 and Brunnstrom stages II-V. The CG received 60-minute daily conventional rehabilitation treatment (CRT), 6 days weekly for 3 weeks; the IG received CRT combined with an extra 30 min of daily HMRT. Assessments including the FMA-UE, wrist range of motion (ROM) on pronation and supination, Modified Barthel Index (MBI), and Montreal Cognitive Assessment (MoCA) were implemented before and after the intervention. The IG displayed significant improvements in FMA-UE, MBI, and MoCA compared to the CG, providing a basis for HMRT as a potentially effective supplementary therapy for improving upper limb and cognitive function post-stroke.
Close others (COs) of individuals with acquired brain injury (ABI) report negative psychological wellbeing associated with caregiving. The transition period from hospital discharge to home is a known vulnerable time. An ABI transitional rehabilitation service (ABI TRS) was piloted, utilizing a family-focused care model and aiming to support COs' needs. This study assessed the impact of ABI TRS on CO psychological well-being and caregiver strain compared to a "treatment as usual" (TAU) approach. Data from 70 individuals with ABI and 77 COs involved in ABI TRS were analysed alongside data from 82 individuals and COs in the TAU group. Measures included gender and age; injury type, length of stay, and Functional Independence Measure (FIM) scores (person with ABI); Depression, Anxiety and Stress Scale (DASS-21) and Caregiver Strain Index (CSI) (CO); and Mayo-Portland Adaptability Inventory (MPAI-4) (CO proxy-rated). Analyses indicated both treatment groups had higher stress, depression, and anxiety symptoms at discharge compared to three months post-discharge. However, ABI TRS COs exhibited significantly lower caregiver strain after three months compared to the TAU group. Additionally, females reported higher strain than males. Predictors of caregiver strain were also identified. The findings support benefits of the ABI TRS model in reducing caregiver strain.
The aim of this review was to examine if Brain-Derived Neurotrophic Factor (BDNF) could be a predictor for post-stroke depression (PSD). We searched Web of Science, Embase, PubMed, and Scopus databases for all relevant studies, with no language restrictions from inception of databases to 1st September 2025. We analyzed average BDNF levels in PSD versus non-PSD groups to estimate the Mean Difference (MD) with 95% confidence intervals (CI). Additionally, pooled odds ratios (OR) with 95% CI were determined to assess the link between reduced BDNF levels and PSD risk. Ten studies were included. In the meta-analysis of nine studies, patients with PSD had significantly lower circulating BDNF levels compared with non-PSD patients (MD: -4.21, 95% CI -6.65 to -1.77; I2 = 97%). Six studies reporting OR showed that low BDNF was associated with an increased risk of PSD (OR 0.84: 95% CI 0.76-0.92; I2 = 77%). Publication bias was noted in the later analysis. Sensitivity analyses confirmed the stability of results, and subgroup analyses demonstrated consistent associations across study location, stroke type, follow-up duration, and diagnostic method. BDNF may be a potential biomarker for PSD. Lower levels of BDNF are noted in PSD as compared to non-PSD patients. Lower levels of BDNF seem to be significantly associated with higher risk of PSD. Evidence must be interpreted with caution given the presence of publication bias. Further studies are needed to increase the validity of these conclusions.
This study examined the effects of Verb-Semantic Feature Analysis (Verb-SFA) on verb naming, noun retrieval, sentence comprehension, and discourse production in individuals with Dementia of the Alzheimer's Type (DAT). Given the lexical-semantic degradation characteristic of DAT and the central role of verbs in Korean, a verb-final language, this study evaluated whether Verb-SFA facilitates treatment, near-transfer, and far-transfer effects. Three male participants, aged 60 or older with 16 years of education, completed 17 sessions: pre-treatment (4 sessions), treatment (10 sessions), and post-treatment (3 sessions). Treatment effects were assessed using 45-item probe sets derived from the Korean Item Selection Naming Test. Results showed significant improvement in naming accuracy for treated verbs, with a robust interaction between treatment sessions and treated items. No significant near-transfer effects were found for untreated verbs in the probe set or on the Action Naming Test. However, significant near-transfer effects were observed for noun retrieval on the Korean-Boston Naming Test, although verbal fluency tasks showed no improvement. Far-transfer effects emerged in sentence comprehension, suggesting strengthened verb-semantic processing supports higher-level linguistic abilities. No measurable gains were observed in discourse production. Overall, Verb-SFA treatment enhanced verb naming and sentence comprehension in individuals with DAT.
Acalculia, an acquired deficit in numerical skills, affects between 30%-60% of brain-injury survivors and impacts independence and wellbeing. Four previous reviews covered interventions for acalculia, but all missed some studies. The current review updates previous work, identifies gaps, and informs future interventions. Web of Science and ProQuest Dissertation databases were systematically searched to identify studies describing interventions for acalculia published before June 2025. To be included, studies had to be written in English, involve an intervention for post-stroke/brain-injury acalculia, directly address numerical skills, and report intervention outcomes. Studies' quality was assessed using the Quality Assessment with Diverse Studies (QuADS) tool. Only 16 publications involving N = 31 participants were identified, alongside one unpublished app-based intervention (N = 18). Most interventions (10) targeted relearning of multiplication tables, followed by interventions for transcoding (4). All interventions were delivered individually (no group interventions) and mostly tailored to individual patients. The most common delivery method was intense repetition ("drill"), and most interventions were conducted in French or German, with only one delivered in non-European language (Japanese), despite evidence for linguistic and cultural effects on numerical skills. Findings highlight the scarcity of evidence for acalculia interventions, and the discussion explores suggestions for future interventions. Urgent work is required to improve provisions for patients.
This cross-sectional study: (1) investigated the presentation (frequency and severity) of fatigue and apathy after stroke; (2) identified predictors of post-stroke fatigue and apathy; and (3) explored the association between the presentation of fatigue and apathy and personal characteristics and QoL. Physical and mental health assessments utilized validated instruments: Multi-dimensional Fatigue Inventory; Apathy Evaluation Scale Short Form 10; PROMIS-10 Global Health and overall QoL. Univariate and multivariate (logistic regression) data analyses were performed. Overall, 112 stroke survivors (mean age 62y) participated; 62.1% reported fatigue (38.3% severe) and 44.9% apathy. Regarding QoL: two-thirds (63.4%) reported Good (37.5%) or Very Good (25.9%) physical health; half (50.3%) had Good (26.1%) or Very Good (24.2%) mental health. Those with poorer physical health were 18-fold more likely to have severe fatigue (OR = 17.93; 95%CI: 1.75-183.65; p<.01). On univariate analyses, those with ≥ moderately severe disability were 6.28-fold more likely to have apathy (OR = 6.28; 95%CI: 2.18-18.05; p<.01); on multivariate analysis, only fatigue severity and poorer mental health predicted apathy. Unemployed participants had significantly higher fatigue scores alongside poorer physical and mental health. Two-thirds of participating stroke survivors experienced fatigue and half reported apathy, with QoL measures of global physical and mental health predicting each, respectively. To optimize the care and recovery of stroke survivors, there is a need to first identify those "at-risk" of post-stroke fatigue and apathy so that these can be managed. Routine screening in practice may assist in identifying at-risk stroke survivors.
Alcohol use disorder (AUD) is associated with deficits in various cognitive functions which can impair conventional treatment and increase relapse risk. This longitudinal quasi-randomized controlled study investigated chess-based cognitive remediation training (CB-CRT) as add-on therapy to improve cognitive control and psychosocial outcomes compared to standard rehabilitation. Patients in the EG attended 90-minute CB-CRT group sessions twice weekly for six weeks. Assessments were conducted at baseline (T1, day 1), post-intervention (T2, day 42), and on day 126 (T3). Cognitive measures, abstinence, craving, subjective well-being, and liking of the intervention were assessed. Fifty-one participants completed two timepoints (T2 six weeks after T1): n = 32 allocated to the EG and n = 19 to the CG (no chess intervention). The CB-CRT group showed modest improvement in sustained attention at T2. No significant effects were found for short-term abstinence, craving, or mood at T3. General life satisfaction increased in the CB-CRT group at T2, but this effect was not maintained at follow-up. The intervention was well accepted, with recommendation ratings increasing over time, suggesting CB-CRT is a feasible, low-cost add-on option for AUD rehabilitation.
Fatigue is a frequent complaint after traumatic brain injury (TBI), irrespective of severity. We aimed to identify factors contributing to mental fatigue in various severities of TBI. This retrospective study examined fatigue, information processing speed, coping, and emotional distress in individuals with mild TBI (n = 56), moderate-severe TBI (n = 25), and healthy controls (n = 30). The aim was to assess differences in information processing speed between patients and controls and, within the patient groups, to explore how information processing speed, coping, and emotional distress relate to mental and physical fatigue. Slower information processing was correlated with higher mental fatigue (.40 to .50) in the moderate-severe TBI group. For moderate-severe TBI, depression and passive coping positively correlated with mental fatigue (.42 and .51). For mild TBI, depression, passive coping and anxiety positively correlated with mental and physical fatigue (.38 to .53). To conclude, slower information processing in moderate-severe TBI is likely to pose a higher cognitive load in demanding (task) situations, which in turn relates to higher levels of mental fatigue. In contrast, mental fatigue after mild TBI seems mainly associated with mental distress and passive coping. The results underscore the importance of considering injury severity when evaluating fatigue and tailoring clinical interventions.
Music-based interventions have been employed in aphasia rehabilitation, modulating components such as rhythm, melody, and prosody to promote language recovery through the engagement of neuroplastic mechanisms. To address the lack of integrative reviews encompassing the full range of clinical applications, we conducted a systematic review of 33 peer-reviewed studies - including randomized controlled trials, pre-post designs, and single-case reports - that quantitatively assessed expressive oral language in patients with aphasia within the context of structured music-based protocols. Specifically, we aimed to comprehensively examine the clinical use of music-based interventions for aphasia, with a focus on the therapeutic role of specific musical components (e.g., melody, rhythm) and their neurofunctional implications for language recovery. Results revealed a range of beneficial interventions, showing improvements both in linguistic behaviour and underlying neural function. This review provides a comprehensive overview of music-based approaches addressed to patients with aphasia, offering a valuable insight into their clinical diversity and therapeutic potential.
Neglect after stroke is a common cognitive deficit and an important predictor of poor functional recovery. Video-oculography during Free Visual Exploration (FVE) has emerged as a sensitive and reliable method for detecting neglect and assessing overt visuo-spatial attention. However, broader clinical application remains limited by the absence of clinically usable reference standards and uncertainty regarding age effects. To address this gap, we established the reference framework required for clinically interpretable use of FVE across adulthood and clarified which FVE measures can be interpreted independently of age and which require age-aware interpretation. Data from 84 neurotypical participants aged 20-89 years were analysed using two FVE versions. Mean gaze position, the primary neglect marker, was not affected by age. Fixation duration and cumulative fixation duration likewise showed no age effect. Predefined neglect cut-offs retained high specificity (>95%). Older participants showed reduced mean number of fixations, as well as a reduced peripheral exploration, reflected by smaller exploration range and exploration area, indicating that these variables require age-aware interpretation. Test-retest reliability was good across variables, supporting repeated use over time. These findings support broader clinical implementation of FVE as a brief, efficient, and ecologically relevant tool for neglect assessment in clinical practice and research.
Semantic memory is affected early on in Alzheimer's disease (AD), leading to language difficulties such as anomia. Defined as the inability to find words during speech, anomia constitutes a real obstacle to the quality of life of AD patients. The aim of this research is to study the benefits of two treatment methods: the ESFA (Elaborated Semantic Feature Analysis) method, based on abstractive network models of semantic memory, and the TERM (Treatment by Embodied Reactivation of Memory) method, a new sensorimotor stimulations therapy based on the theory of embodied cognition. 19 patients with early-stage AD (MMSE ≥20/30) were distributed into two groups: ESFA group (N = 10, 7 women and 3 men; mean age = 82.7, SD = 4.52) and TERM group (N = 9, 8 women and 1 man; mean age = 81.78, SD = 7.26). Groups were equal, and comparisons were possible. While the ESFA method allows a broad improvement in both trained (W = -2.809; p = .005) and untrained (W = -2.194; p = .028) items, the TERM method seems to lead to an item-centered effect (W = -2.668; p = .008). Moreover, only with the TERM method, the benefits seem to be maintained (W = -1.715; p = .086). Further studies are still needed to further investigate the benefits of these two interesting methods.
Diaries written for patients in the intensive care unit (ICU) are widely used to promote psychological recovery. By providing a structured account, diaries may help patients reconstruct their experiences and make sense of a period marked by memory loss or confusion. Many traumatic brain injury (TBI) survivors experience impaired memory, influencing both themselves and their family caregivers (FCs). The aim of this study was to gain a deeper understanding of the impact of a nurse-written ICU diary on TBI-survivors and their FCs. Nine TBI-survivors and ten FCs were interviewed as dyads in this exploratory qualitative study. Data were analyzed inductively using the interpretive description methodology. The overarching theme "Creating a shared narrative," encompassed four themes: "Piecing the parts together," describing strategies to gather information, "Negotiating the severity of the trauma," reflecting how the diary supported mutual understanding of illness severity, "Navigating an emotional terrain," capturing the emotional complexity involved, and "Humanizing the ICU experience," highlighting how the diary acknowledged the patient as a person. For TBI-survivors, the diary helped fill memory gaps and supported understanding of illness severity. For FCs, it facilitated communication and alignment of recovery expectations. Despite emotional complexity, receiving a diary was overall a positive experience.
Despite widespread use of the Functional Independence Measure (FIM) in clinical and research settings, the applicability of the Cognitive scale to the traumatic brain injury (TBI) group remains problematic. This study evaluated the clinical utility of the FIM-Cognitive scale. We examined the sensitivity, specificity, and positive and negative predictive values of the five items of the FIM-Cognitive scale, by comparing them with reference standards provided by performance on 14 specific cognitive and behavioural variables that mapped to individual FIM-Cognitive items. A total of 67 participants with severe TBI comprised an Inpatient sample (n = 35), assessed at 2- and 6-months post-trauma, and a Community sample (n = 32) at 3-years post-trauma. Ceiling effects were common and high (>20% on 14/15 FIM-Cognitive items from Inpatient and Community samples), which impacted responsiveness. Sensitivity, specificity, positive and negative predictive values were highly variable in all samples, but few reached an 80% threshold on any index. The clinical utility of the FIM-Cognitive scale thus has significant limitations when used with the severe TBI group, both in the post-acute stages and longer-term. These results suggest that the FIM-Cognitive scale should not be used in isolation for clinical decision-making purposes or benchmarking and service delivery.
Dual-task training helps improve balance and cognitive function in people with Parkinson's disease, but existing clinician-led, clinic-based programmes lack standardization. This qualitative study aimed to inform new programme designs by exploring the experiences and needs of individuals with Parkinson's disease, their supporters, and physiotherapists. Semi-structured interviews were conducted with ten participants - six with mild-to-moderate Parkinson's disease, two supporters, and two physiotherapists. Interviews were recorded, transcribed, and independently analysed by two researchers using framework analysis. Three main themes emerged: what comprises "An Engaging Dual-task Training," emphasizing enjoyment, daily life integration, and the need for a balance between challenge and reward as well as the effectiveness of the task to be known; the impact of "Home-Based Dual-task Training," discussing the pros and cons of home-based training and technology use, and the opportunity to engage supporters as training buddies; the need for "Acceptable Assessment Options," exploring hybridization of the use of remote and clinic-based assessment methods. Participants valued traditional, clinic-based, clinician-supervised rehabilitation, while also supporting home-based adjunctive programmes for their potential to offer greater autonomy, flexibility, cognitive engagement, and inclusive integration into daily life.
Capacity tasks are often used to assess working memory after stroke. However, in daily activities, patients may rely on the outside world by (re)inspecting information as needed (i.e., offloading), a strategy that is also advocated in memory rehabilitation. While individuals may use offloading in everyday life to support memory, and choose to memorize only to a low or medium extent, capacity tasks do not allow for nor reflect this. To understand how stroke patients use their working memory when less-than-full-loading is allowed, we recorded eye-movements of patients (n = 15) and controls (n = 38) as an index of offloading. Both patients and controls avoided working memory loading and relied heavily on offloading. Strategies varied at the individual level, with a subset of patients showing excessive offloading. Interestingly, these patients were also those who showed abnormal capacity scores, but the reverse was not necessarily true. We conclude that low memory capacity is related to, but does not automatically lead to, offloading behaviour. Even when offloading was hampered, maintaining offloading was still more beneficial than switching to a memory-based strategy, supporting the adoption of external strategies in memory rehabilitation. The free-choice paradigm brings us a step closer to estimating working memory use in everyday life.
Stroke is often a life-altering event for families. Guided by interpretative phenomenological analysis (IPA), this qualitative study aimed to understand the self-perceived impact of caregiver stroke on the lives, wellbeing, and relationships of their children. Ten participants took part; aged 8-18 years when a substantial caregiver (nine fathers, one grandmother) had a stroke. Semi-structured interviews were audio-recorded and transcribed. Using IPA, individual-level analysis preceded the development of four group-level themes: facing the unexpected; the need for family-centred information; redefined roles and relationships; and changed perspectives. The suddenness of caregiver stroke was an overwhelming emotional experience for children. They faced adjustments across several life domains including family relationships. Limited understanding of the impact of stroke on their caregiver and family life contributed to distress and, in some cases, relational tension. Children saw increased vulnerability in caregivers and took on additional responsibilities. Some described long-term shifts in their own personalities. This study recommends providing well-timed, family-specific and age-appropriate information to support children after caregiver stroke. Information sharing may support children's adaptation to changes in caregiver's behaviour post-stroke, which may reduce the likelihood of relational tension. As most participants in this study had experienced paternal stroke, future research should explore maternal stroke.
