Browsing by Subject "neuropsykologia"

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  • Turunen, Katri; Tuulio-Henriksson, Annamari; Poutiainen, Erja (Kela, 2019)
    Sosiaali- ja terveysturvan raportteja
    Tutkimuksessa selvitettiin Kelan myöntämän harkinnanvaraisen neuropsykologisen kuntoutuksen kohderyhmiä sekä kuntoutujien ja ammattilaisten näkemyksiä kuntoutuksen tarpeesta, tavoitteista ja vaikutuksista. Kelan harkinnanvaraista neuropsykologista kuntoutusta 1/2015–6/2016 saaneille postitettiin kysely, ja kuntoutujilta pyydettiin lisäksi lupa käyttää kuntoutusdokumentteja Kelan asiakastietojärjestelmästä. Ammattilaisten eli kuntoutussuosituksia tekevien neuropsykologien ja psykologien, kuntoutusta toteuttavien neuropsykologien sekä Kelan asiantuntijoiden kyselyt kerättiin sähköisesti. Lisäksi tutkimuksen yhteydessä järjestettiin työpaja, jossa koostettiin kysely- ja asiakirja-aineiston tuloksia. Aineisto koostuu 32 kuntoutujan kyselyvastauksista, Kelan asiakastietojärjestelmästä kerätystä kuntoutujien asiakirja-aineistosta, 34:n kuntoutusta toteuttaneen ja 69:n sitä suositelleen psykologin tai neuropsykologin ja 30 Kelan asiantuntijan vastauksista. Kuntoutujien ja kuntoutusta toteuttavien neuropsykologien mukaan Kelan harkinnanvarainen neuropsykologinen kuntoutus kohentaa kuntoutujien työ- ja opiskeluedellytyksiä. Kuntoutujat ja ammattilaiset katsoivat kuntoutuksen olevan hyödyllisintä kuntoutujien oman tilanteen ymmärtämisen ja hyväksymisen, opiskelutaitojen, arjen hallinnan sekä yleisen elämänlaadun kannalta. Ammattilaiset katsoivat kuntoutusmuodon soveltuvan erityisesti nuorille, joilla on kehityksellisiä neuropsykologisia vaikeuksia. Toisaalta erityisesti asiakirja-aineisto osoitti, että kuntoutusmuotoa käytetään osana monenlaisia kuntoutuspolkuja. Tutkimuksen perusteella kuntoutusmuodon kehittämiskohteiksi nousivat erityisesti kuntoutukseen hakeutumisen käytännöt sekä kuntoutuksen raportointikäytännöt. Lisäksi moni taho nosti esiin kuntoutusmuodon taloudellisen tuen matalan tason, jonka katsottiin heikentävän kuntoutuksen tasa-arvoista saatavuutta. Sekä kyselytutkimuksen että hankkeen yhteydessä järjestetyn työpajan myötä nousi vahvasti esiin tarve parantaa Kelan harkinnanvaraisen neuropsykologisen kuntoutuksen saatavuutta koko maassa.
  • Rautavaara, Sallamaria (Helsingfors universitet, 2015)
    Objective: Developmental dyslexia is a neurobiological learning disorder and its prevalence is approximately 3–10 %. The working memory problems associated with dyslexia are well documented. Yet there is no research on subjective memory failures of adults with developmental dyslexia. This study focuses on the relationship between subjective everyday memory failures and cognitive functioning measured by neuropsychological examination. Methods: Neuropsychologically examined 80 Finnish speaking subjects aged 18-35 filled out Everyday Memory Questionnaire (EMQ) as a part of a larger study of neuropsychological rehabilitation for developmental dyslexia. Totally 28 variables that represented all the measures included in the neuropsychological examination were analyzed in this study. EMQ contains totally 36 questions that are divided into five subscales: Speech, Reading and Writing, Actions, Faces and Places and Learning New Things. EMQ subscale scores were transformed into z-scores. Linear regression models were created to predict these z-transformed EMQ subscales and the weighted total score. The Faces and Places subscale was not included in the subscale level analyses because of its low reliability. Results and conclusions: Only one of the 28 analyzed neuropsychological measures significantly predicted the experience of memory problems in everyday life: a nonword spelling task from the Dyslexia screening test for youth and adults. The results show that very few neuropsychological measures predict subjective everyday memory failures of adults with developmental dyslexia even though the study included a wide set of cognitive functions. This result is in line with previous studies on other patient groups, where the self-reported subjective cognitive problems have only few connections with objective cognitive functioning especially in mild cognitive dysfunctions.
  • Kantele, Oona (Helsingin yliopisto, 2020)
    Epilepsy surgery is an effective treatment in drug-resistant epilepsy and in addition to seizure reduction, surgery also seems to improve employment among epilepsy patients. While seizures and many psychosocial factors predict the employment outcome after epilepsy surgery, not all changes in employment observed over time can be attributed to these factors. This study investigated whether the level of cognitive functions or changes in cognitive functions predicted employment two years after the surgery. Furthermore, the study investigated whether changes in epileptic seizures, employment and cognitive functions could be observed after the surgery in comparison to pre-surgery level. For this registry study, data of 46 epilepsy surgery patients was acquired from medical reports and neuropsychological test records of HUS Neurocenter Neuropsychology unit. Predictors of postoperative employment were analyzed with univariate and multivariate logistic regression analysis. In this study 83% of the patients were seizure-free two years after the surgery. Employment status improved statistically significantly and 13 % of the patients not working preoperatively were employed or studying after the surgery. No change or only small changes were observed in cognitive functions after the surgery when compared to preoperative level. None of the changes in cognitive functions predicted employment after the surgery, but of the postoperative cognitive functions verbal reasoning (Similarities) and verbal fluency were significant predictors of postoperative employment, even though only verbal reasoning remained statistically significant in multivariate analysis. Seizure frequency was not associated with employment two years after the surgery. Of psychosocial factors employment pre-surgery and the number of antiepileptic drugs used were the strongest predictors of employment after the surgery. This study supports the earlier observations that good seizure outcome is not alone sufficient to explain the employment outcome after the surgery, but other predictors are likely to have an influence on employment as well. However, cognitive functions do not appear to have a significant effect on postoperative employment two years after the surgery, instead postoperative employment is best explained by preoperative employment and the number of antiepileptic drugs used.
  • Alenius, Minna (Helsingfors universitet, 2017)
    Objectives – Ageing is progressing worldwide. Cognitive decline and dementia are highly associated with age and have significant economic impacts. Alzheimer's disease (AD) is the major cause of dementia. In Finland the 'baby boomer' generation (born 1945-1949) shall already during the 2020s increase the amount of the very old substantially. The CERAD (The Consortium to Establish a Registry for Alzheimer's Disease) neuropsychological battery (nb) is used as an evaluation tool for dementia. In Finland, CERAD-nb was introduced in 1999 and has been used in primary health care as a screening instrument to detect memory deficits. The continuum would benefit of updated clinical dementia/MCI assessment tools, norms and methodologies for the larger scale cognitive screening as the amount of the very old is soon growing remarkably. The main focus of this study is the overall performance of general population on selected CERAD-nb variables and how it fits to previously established Finnish cut-off scores. Materials and Methods – The study data is derived from the Finnish nationwide Health 2011 health examination survey (Health 2011), which was carried out in 2011. The study population consisted of a sample (n=4544) of Finnish subjects aged from 30 to 100 years belonging to either the lowest, middle or highest education class. Because of health-related factors possibly affecting cognitive performance, medical exclusion criteria were used and due to the high prevalence of dementia at older age, a cognitive status-screening test was used for subjects aged 55 and over. The final sample size was 4174 subjects. A weighted variable was used and thus the statistical analyses (weighted n=3389) prepared are estimations of population quantities. The sample underwent a CERAD-nb investigation for variables Verbal Fluency Animal Category (VFA), Word List Memory (WLM), Word List Recall (WLR) and Word List Savings (WLS) as a part of a wider Health 2011 examination procedure. Results – The total effect size of demographic variables was largest and clearest in WLM (30%) and WLR (27%) and the independent effect size of age (11% in both) was noticeable, as well. The results showed a continuous downward slope by advancing age steps: in the age groups 30-54 years, 55-64 years, 65-74 years and ≥75 years in WLM, in age groups 30-49, 50-54 years, 55-64 years, 65-74 years and ≥75 years in WLR, in age groups 30-49 years, 50-69 years, 70-74 years and ≥75 years in VFA, and finally the mildest effect in WLS in the group ≥55 with only age groups of 55-74 years and ≥75 years showing a decline. Education had the largest independent effect (5%) in VFA and WLM. The highest education class differed (p < .001) from other education classes for all variables. Gender had only a mild effect, largest in WLM (3%) and women mainly performing better. In total 25% (854 subjects) fell below the previously established cut-off scores. To the group <55 years belonged 26% (221 subjects) of those and 74% (633 subjects) to the group ≥75, of which 59% were in the lowest education class, 52% men and 32% were 75 years and over. Conclusions – Significant differences in performance between the age and education groups and minor differences between genders are found. Proposals for new normative scores for VFA, WLM, WLR and WLS are presented in Appendices. Indications of differences in the education-age-gender synergetic effect are found in affected variables for performance falling below the previously established cut-off scores. Most importantly, a clear indication for need of an update of the national normative and cut-off scores of the whole CERAD-nb for the age 55 is found.
  • Salo, Micaela (Helsingfors universitet, 2015)
    Subjective memory complaints (SMC) are common among the elderly. People experiencing SMC have been shown to be at a greater risk of suffering cognitive decline and potentially developing dementia. Studies have shown that SMC is associated with poorer performance in e.g. perceptual reasoning -tasks and tasks of delayed memory. This Masters' thesis aims to study the prevalence of SMC in a sample of healthy Finnish adults aged 50 to 80 years, and the association between SMC and other than directly memory related cognitive performance on the WAIS-IV -test. Based on earlier research, we hypothesized that individuals who reported SMC would perform worse on WAIS-IV perceptual reasoning subtests and verbal comprehension subtest related to memory retrieval. The data consisted of a subsample of healthy 50-80 year old adults in the Finnish WAIS-IV standardization sample. Twenty-five adults reported SMC (10.2 %). The control group consisted of 220 persons from the same sample without memory complaints. We used regression analysis to study the association between SMC and WAIS-IV indexes and profile analysis to study the association between SMC and individual subtests. The results did not support the hypothesis. People reporting SMC performed significantly better at Matrix Reasoning, a subtest belonging to the Perceptual Reasoning Index (PRI). No differences in performance were found between the SMC-group and the control group in any of the verbal comprehension subtests or any other WAIS-IV subtests. This is the first study in Finland that examines SMC by using the WAIS-test. Not even in the English literature has the SMC previously been reportedly studied in such a comprehensive manner regarding other than directly memory related cognitive performance. The results indicate, that SMC reported in this study corresponds to the current definition of SMC: people experienced a decline in memory, but the study did not reveal objective cognitive impairment. The challenge for future research is further detailing the SMC neuropsychological profile regarding other than memory related cognitive performance, as well as recognising the need for longitudinal research of the middle-aged and older Finnish population.
  • Kullberg-Turtiainen, Marjo; Forsbom, Maj-Britt; Säynevirta, Kirsi; Molander, Kiki (Kela, 2021)
    Kuntoutusta kehittämässä
    Tämän julkaisun tavoite on kuvata tanssikuntoutusmenetelmän kehittämistä, siitä saatuja kokemuksia ja koota ehdotuksia sen edelleen kehittämiseksi. Tanssin merkitystä neurologisessa kuntoutuksessa on tutkittu hyvin vähän. Helsingin yliopiston psykologian ja logopedian osaston ja Validia Kuntoutus Helsingin kehittämis- ja tutkimushankkeen tavoitteena oli kehittää moniammatillinen, tanssinopettajan ja fysioterapeutin yhdessä ohjaama yksilöllinen tanssikuntoutusmenetelmä aivovammakuntoutujille. Kehityshankkeessa ja siihen liittyneessä pilottitutkimuksessa (Särkämö ym. 2021) osallistujina oli 11 vaikean traumaattisen aivovamman saanutta, aivovamman kroonisessa vaiheessa ollutta henkilöä. Tanssikuntoutus on neurologinen kuntoutusmuoto, joka tarkoittaa tässä tanssinopettajan ja fysioterapeutin yhdessä ohjaamaa yksilöllistä terapiaa vaikean/erittäin vaikean aivovamman saaneelle henkilölle, jolla on rajoitteita liikkumis- ja toimintakyvyssä, mutta tarpeeksi motorista toimintaa pystyäkseen osallistumaan tähän kuntoutusmuotoon. Tanssinopettaja ohjaa kuntoutujaa tanssimaan koreografiaan ja fysioterapeutti ohjaa tarvittaessa kuntoutujaa manuaalisesti. Fysioterapeutin ohjauksen tavoitteena on auttaa kuntoutujaa suorittamaan tanssiliikkeen mahdollisimman oikein ja toteuttamaan tanssisarjan mahdollisimman oikeassa rytmissä, jolloin kuntoutuja voi saada kokemuksen siitä, kuinka koko keho osallistuu tanssiin, vaikka omatoiminen liikkeiden suorittaminen ei onnistuisikaan. Tanssiasento (esimerkiksi istuen tai seisten), koreografia, fysioterapeutin ohjaus ja kuntoutujan valitsema tanssittava lempimusiikki sovitetaan yksilöllisesti ottaen huomioon kunkin kuntoutujan fyysiset ja kognitiiviset rajoitteet ja kyvyt. Tavoitteena on motorinen, kognitiivinen ja emotionaalinen kuntoutuminen. Tanssi-liiketerapiasta (TLT) tanssikuntoutus eroaa monella tavalla. TLT on psykoterapian soveltava muoto, tanssikuntoutus on neurologista terapiaa. Nyt käsillä olevassa julkaisussa kerromme, kuinka tanssikuntoutus sai alkunsa, kuinka tätä terapiamuotoa vietiin eteenpäin hankkeen aikana ja miten sitä suunnitellaan kehitettävän edelleen. Kuvaamme sitä, kuinka tanssinopettaja, fysioterapeutti ja kuntoutuja toimivat yhteistyössä. Kerromme kuntoutuksen toteuttamisesta ja hankkeen aikana saaduista havainnoista ja kokemuksista. Pohdimme, mihin tanssikuntoutus voi vaikuttaa ja kuinka sitä kannattaisi kehittää edelleen.