reMIND

Mental neurorehabilitation research for differential diagnosis and individualised intervention in disorders of cognition, emotion, and motivation.

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Cognitive and affective neurorehabilitation

Cognitive, emotional, and motivational disorders are common and often severely disabling consequences of acquired brain injury. These disorders often remain hidden, leading to underdiagnosis and undertreatment. Consequently, they pose a risk of prolonged hospitalization and diminished outcomes upon discharge. When returning to everyday life, individuals experiencing cognitive, emotional, and motivational disorders face heightened risks of isolation and increased caregiver burden.

The lack of effective, evidence-based neurorehabilitation methods for mental disorders highlights the need for focused and strengthened research efforts. Our ultimate goal is to strengthen the functional abilities, activity levels, and social participation of patients and their caregivers, promoting independence despite the cognitive, affective and motivational challenges caused by acquired brain injury.

Research Strategy

Our mission is to engage research-minded clinicians and enhance our national and international network of fellow researchers in the field. We aim to initiate more multi-centre studies in close collaboration with our national and international networks. Our ambition is to recruit PhD students and postdoctoral researchers to further strengthen our research efforts. We are committed to bolstering our expertise in aphasia and neglect, as well as broadening our proficiency in other cognitive, affective and motivational disorders.

Aphasia and spatial neglect are common cognitive disorders following acquired brain damage, most often due to stroke. Strokes most often occur in the middle cerebral artery, a vital supplier of the perisylvian neural networks within both hemispheres of the brain. These networks are essential for linguistic and spatial cognitive functions in the left and right hemispheres, respectively. Damage to these networks can result in aphasia or spatial neglect in affected individuals. Both aphasia and spatial neglect profoundly impact patients' independence and increase caregiver burden. Thus, the reMIND research group has prioritised mitigating these adverse outcomes through targeted and specialised neurorehabilitation research efforts.

Lars Evald
PhD, Head of Neuropsychological Development and Research, Head of reMIND Research Group

Lisbeth Frølund
PhD fellow, speech and language therapist

Christian Hede Kirkedal
MD, upcoming PhD fellow

Louise Høj Jensen
MSc in psychology, upcoming PhD fellow

Projects

More than 31,000 people in Denmark live with aphasia following acquired brain injuries. Aphasia, characterized by a profound language impairment, carries extensive and devastating repercussions, severely impeding affected individuals' communication abilities. The impact extends beyond the individual, affecting their caregivers as well. Consequences include social isolation, depression, loss of friendships, decreased autonomy, altered family dynamics, and heightened reliance on rehabilitation services.

Living well with aphasia

Finalised research project (2022-2023) carried out in collaboration with Jytte Kjærgaard Isaksen, associate professor, Department of Language and Communication, University of Southern Denmark, and Leena Eklund Karlsson, associate professor, Department of Public Health, University of Southern Denmark.

To prevent some of the many negative consequences, rehabilitation after aphasia and stroke should include both the person with aphasia and significant others throughout the care pathway. However, it is unclear how current care pathways through the cross-sectorial Danish systems work and if and how much the consequences for the whole family living with aphasia are considered. Hence, the overall aim of this project was to produce a comprehensive needs assessment for developing a cross-sectoral system-oriented care pathway for people with aphasia and their significant others.

The needs assessment included

An exploration and mapping of families living with aphasia’s route through and experiences of the existing care pathway,
A catalogue of ideas and solutions created by stakeholders for further development and implementation across the care pathway from acute care to civil society. The catalogue of ideas was launched at an event in February 2024.

Aphasia is more than a language impairment – cross-sectorial and cross-disciplinary psychosocial care for people with aphasia and their families

This study (2024-2027) will, based on the ideas from “Living well with aphasia”, develop, feasibility test and implement intervention for families with aphasia that goes across the care pathway and into third sector for families living with aphasia. The main body of research will be delivered by two PhD students, one of these affiliated with Hammel Neurorehabilitation and Research Centre, Lisbeth Frølund Kristensen.

The research is carried out in collaboration with Jytte Kjærgaard Isaksen, associate professor, Department of Language and Communication, University of Southern Denmark, professor Charlotte Overgaard, the Research Unit for Health Promotion at Department of Public Health at University of Southern Denmark, Jens Bak Sommer, neuropsychologist and head of research and innovation at Vejlefjord Rehabiliteringscenter A/S, Dorthe Hansen, guest researcher, Department of Language and Communication, University of Southern Denmark, and Professor Madeline Cruice, City University of London.

This study has three interconnected aims:

To undertake a comprehensive overview of current cross-disciplinary services in Denmark along the care pathway and into third sector for families living with aphasia. The overview will focus on provision of information and communications partner training tailored for families.
To co-design a family-based intervention focusing on improving life with aphasia, provision of information and partner communication training for families living with aphasia
Feasibility testing and realist evaluation of the family-based intervention and assess potential for its future implementation across the care pathway and into the third sector.

This project will contribute to bridge the clear gap between the needs of persons and families affected by aphasia and the care they receive. Building on the emerging evidence from international research literature as well as the newly ended Danish project exploring the needs of families living with aphasia across sectors and the key personnel (leaders of change) that families with aphasia meet during the care pathway.

The project will focus on the parts of the family intervention that are related to provision of information (probably broadly delivered by the multidisciplinary teams and at later stages SLTs and patient organisations) and communication partner training (probably delivered by SLTs and later patient organisations).

The reMIND research group has several ongoing national and international multicentre projects concerning cognitive and affective deficits after cardiac arrest.

TTH48 long-term follow-up

Current research project in collaboration with Hans Kirkegaard, professor emeritus, Research Centre for Emergency Medicine, Aarhus University Hospital, which is a long-term follow-up 5-8 years after cardiac arrest in continuation of the randomised clinical trial: "Targeted Temperature Management for 48 vs 24 Hours and Neurologic Outcome After Out- of-Hospital Cardiac Arrest (TTH48)". The primary purpose is to investigate the self-reported cognitive and affective state and quality of life in cardiac arrest survivors and their partners. The secondary objective is to compare results between the original treatment groups in the TTH48 study.

TTM2 neuropsychological substudy

Current research project in collaboration with neuropsychologist Erik Blennow Nordström, postdoc, Division of Neurology, Department of Clinical Sciences Lund, Lund University, Sweden in continuation of the neuropsychological 7 and 24-month follow-up study of the randomised clinical trial: "Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (TTM2)". The primary aim is to obtain detailed longitudinal knowledge of cognitive impairment in cardiac arrest survivors and associated factors, such as affective functioning, fatigue and sleep. The secondary purpose is to validate cognitive screening methods that can be implemented in general clinical practice.

Danish Cognitive Screen after Cardiac Arrest (DANcSCA)

Current research project in collaboration with Anders Wieghorst, PhD student and Tonny Elmose Andersen, professor, Department of Psychology, University of Southern Denmark. The purpose of this study is threefold. First, to develop a digital test battery targeting cognitive impairment after cardiac arrest based on existing tests in the Cambridge Neuropsychological Test Automated Battery (CANTAB). Second, to validate this digital test battery as a screening tool for cognitive impairment after cardiac arrest compared to existing screening tools. Third, to assess the predictive validity of the digital test battery in relation to return to work, quality of life, psychological problems and self-reported problems.

Spatial neglect is a neurocognitive disorder characterised by deficits in spatial attention and intention, impacting spatial perception, representation, and motor action planning. Those affected show a failure or slowness to report, respond, orient, or initiate action towards stimuli in the side of space opposite to the brain injury. Spatial neglect is a prevalent impairment following stroke, affecting 30-50% of stroke survivors during hospitalisation. Spatial neglect predicts prolonged hospitalisation, poorer rehabilitation outcomes, slowed recovery and increased caregiver burden. Notably, spatial neglect is a heterogeneous disorder with diverse sub-symptoms that respond differentially to various treatment approaches.

Virtual reality whack-a-mole

Ongoing research project in collaboration with associate professor Hendrik Knoche and PhD student Bastian Ilsø Hougaard, Department of Architecture, Design and Media Technology, Aalborg University, Denmark.

Virtual reality (VR) offers unparalleled control over both input and output parameters, and the capability to capture data in high temporal and spatial resolution, making it an optimal tool for exploring spatial cognition. Consequently, spatial neglect can be examined within a four-dimensional multi-modal space to accurately diagnose its various sub-symptoms. Leveraging this assessment, personalised VR-based treatments can be tailored to address each patient’s specific sub-symptoms. Moreover, training difficulty can be automatically and dynamically be adjusted based on the patient’s performance, thereby optimising the treatment effect.

Our objective is to develop and evaluate a VR system designed for both assessment and treatment of spatial neglect, with the goal of enhancing training specificity and intensity via precision medicine and gamification techniques. Additionally, we aim to bolster treatment intensity and efficiency by promoting self-training and tele-rehabilitation, facilitated by readily available, cost-effective, off-the-shelf technology.

We have developed a VR whack-a-mole (WAM) game integrated with eye-tracking capabilities, serving as a dual-purpose tool for assessment and treatment of spatial neglect and related disorders. Our procedures encompass diagnostic protocols for neglect subtypes diagnostic and for assessment of motor range. Within the VR system, we have integrated three conventional neglect training methods: prism adaptation training, mirror therapy and half-field eye-patching. We are planning pilot studies on diagnostic accuracy and treatment efficacy.

International multidisciplinary network on VR neurorehabilitation

In collaboration with international partners in more than 20 countries, we have fostered a multidisciplinary network of clinicians and researchers working with VR and spatial neglect. The network has obtained a so-called COST Action from the European Cooperation in Science and Technology (COST) Association. The network offers an open collaboration between researchers across Europe (and beyond) and thereby give impetus to innovation and research progress.

There are several research groups in Europe working on the development of assessment and treatment of spatial neglect in VR, but only a few projects achieve commercialisation or implementation in practice. There is great potential for increasing the intensity and effectiveness of neurorehabilitation of spatial neglect using VR, but this requires international cooperation in development and research.

The aim is to improve diagnostic precision of spatial neglect subtypes to increase the intensity and effectiveness of the training through personalisation (precision medicine), motivation (gamification), self- and home training (tele-rehabilitation). The ultimate goal is to increase patients’ independence in everyday activities and reduce the caregiver burden.

The COST Action will establish network meetings, workshops, conferences, short scientific missions and training schools to form a theoretical and empirical basis (white papers) for the implementation of assessment and treatment of spatial neglect in VR. Thus, creating the foundation for future funding proposals to initiate multicentre studies of diagnostic accuracy and treatment efficacy.

The reMIND research group also has research activities within other cognitive disorders and diagnosis groups. The group has a long-lasting research collaboration with the Centre for Functionally Integrative Neuroscience (CFIN) concerning cognitive and affective consequences of other somatic diseases (e.g. congenital heart decease and hypoparathyroidism).

Posttraumatic amnesia (PTA) duration prognostication

Ongoing research project in collaboration with Anne Norup and Maria Elizabeth Anna Assenholt, Department of Brain and Spinal Cord Injuries, Rigshospitalet, Glostrup. Based on the Danish Head Trauma Database, the aim is to develop prognosis models that can predict the functional ability of the individual patient in the short term and in the long term. Based on data during the early hospitalization, a model is developed to predict the duration of post-traumatic amnesia (PTA) for the individual patient. This knowledge can be of decisive importance for treatment planning and cooperation with relatives during hospitalization. Based on analyses of the factual PTA duration, when this is known, as well as other demographic and clinical factors at the time of discharge, a prognosis model is developed to predict the individual patient's functional capacity one year after the injury. This can be of great importance in addressing the patient's needs after discharge to the municipality.

Post-stroke apathy: Detection and alleviation of a silent disability
Upcoming PhD project by Christian Hede Kirkedal, MD,

Hypnosis for headache: A meta-analysis and a randomised controlled trial
Upcoming PhD project by Louise Høj Jensen, MSc in psychology,

Contact

+45 78 41 90 07

neurorehab.forskning@midt.rm.dk

Hammel Neurorehabilitation Centre and University Research Clinic
Voldbyvej 15
8450 Hammel
Denmark