Neuropsychological Assessments of Patients With Acquired Brain Injury: A Cluster Analysis Approach to Address Heterogeneity in Web-Based Cognitive Rehabilitation
We aimed to (1) apply cluster analysis techniques to mixed-type data (numerical and categorical) from baseline neuropsychological standard and widely used assessments of patients with acquired brain injury (ABI) (2) apply state-of-the-art cluster validity indexes (CVI) to assess their internal valid...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-08-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.701946/full |
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| author | Alejandro García-Rudolph Alejandro García-Rudolph Alejandro García-Rudolph Alberto García-Molina Alberto García-Molina Alberto García-Molina Eloy Opisso Eloy Opisso Eloy Opisso Josep María Tormos Josep María Tormos Josep María Tormos Vince I. Madai Vince I. Madai Vince I. Madai Dietmar Frey Montserrat Bernabeu Montserrat Bernabeu Montserrat Bernabeu |
| author_facet | Alejandro García-Rudolph Alejandro García-Rudolph Alejandro García-Rudolph Alberto García-Molina Alberto García-Molina Alberto García-Molina Eloy Opisso Eloy Opisso Eloy Opisso Josep María Tormos Josep María Tormos Josep María Tormos Vince I. Madai Vince I. Madai Vince I. Madai Dietmar Frey Montserrat Bernabeu Montserrat Bernabeu Montserrat Bernabeu |
| author_sort | Alejandro García-Rudolph |
| collection | DOAJ |
| description | We aimed to (1) apply cluster analysis techniques to mixed-type data (numerical and categorical) from baseline neuropsychological standard and widely used assessments of patients with acquired brain injury (ABI) (2) apply state-of-the-art cluster validity indexes (CVI) to assess their internal validity (3) study their external validity considering relevant aspects of ABI rehabilitation such as functional independence measure (FIM) in activities of daily life assessment (4) characterize the identified profiles by using demographic and clinically relevant variables and (5) extend the external validation of the obtained clusters to all cognitive rehabilitation tasks executed by the participants in a web-based cognitive rehabilitation platform (GNPT). We analyzed 1,107 patients with ABI, 58.1% traumatic brain injury (TBI), 21.8% stroke and 20.1% other ABIs (e.g., brain tumors, anoxia, infections) that have undergone inpatient GNPT cognitive rehabilitation from September 2008 to January 2021. We applied the k-prototypes algorithm from the clustMixType R package. We optimized seven CVIs and applied bootstrap resampling to assess clusters stability (fpc R package). Clusters' post hoc comparisons were performed using the Wilcoxon ranked test, paired t-test or Chi-square test when appropriate. We identified a three-clusters optimal solution, with strong stability (>0.85) and structure (e.g., Silhouette > 0.60, Gamma > 0.83), characterized by distinctive level of performance in all neuropsychological tests, demographics, FIM, response to GNPT tasks and tests normative data (e.g., the 3 min cut-off in Trail Making Test-B). Cluster 1 was characterized by severe cognitive impairment (N = 254, 22.9%) the mean age was 47 years, 68.5% patients with TBI and 22% with stroke. Cluster 2 was characterized by mild cognitive impairment (N = 376, 33.9%) mean age 54 years, 53.5% patients with stroke and 27% other ABI. Cluster 3, moderate cognitive impairment (N = 477, 43.2%) mean age 33 years, 83% patients with TBI and 14% other ABI. Post hoc analysis on cognitive FIM supported a significant higher performance of Cluster 2 vs. Cluster 3 (p < 0.001), Cluster 2 vs. Cluster 1 (p < 0.001) and Cluster 3 vs. Cluster 1 (p < 0.001). All patients executed 286,798 GNPT tasks, with performance significantly higher in Cluster 2 and 3 vs. Cluster 1 (p < 0.001). |
| first_indexed | 2024-12-21T19:58:52Z |
| format | Article |
| id | doaj.art-303a254bee7f4cbd9e96fd444fd059f6 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-21T19:58:52Z |
| publishDate | 2021-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-303a254bee7f4cbd9e96fd444fd059f62022-12-21T18:52:01ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-08-011210.3389/fneur.2021.701946701946Neuropsychological Assessments of Patients With Acquired Brain Injury: A Cluster Analysis Approach to Address Heterogeneity in Web-Based Cognitive RehabilitationAlejandro García-Rudolph0Alejandro García-Rudolph1Alejandro García-Rudolph2Alberto García-Molina3Alberto García-Molina4Alberto García-Molina5Eloy Opisso6Eloy Opisso7Eloy Opisso8Josep María Tormos9Josep María Tormos10Josep María Tormos11Vince I. Madai12Vince I. Madai13Vince I. Madai14Dietmar Frey15Montserrat Bernabeu16Montserrat Bernabeu17Montserrat Bernabeu18Universitat Autònoma de Barcelona, Cerdanyola del Vallès, SpainFundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, SpainInstitut Guttmann Hospital de Neurorehabilitacio, Badalona, SpainUniversitat Autònoma de Barcelona, Cerdanyola del Vallès, SpainFundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, SpainInstitut Guttmann Hospital de Neurorehabilitacio, Badalona, SpainUniversitat Autònoma de Barcelona, Cerdanyola del Vallès, SpainFundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, SpainInstitut Guttmann Hospital de Neurorehabilitacio, Badalona, SpainUniversitat Autònoma de Barcelona, Cerdanyola del Vallès, SpainFundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, SpainInstitut Guttmann Hospital de Neurorehabilitacio, Badalona, SpainCLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, GermanyQUEST Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Berlin, GermanyFaculty of Computing, Engineering and the Built Environment, School of Computing and Digital Technology, Birmingham City University, Birmingham, United KingdomCLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, GermanyUniversitat Autònoma de Barcelona, Cerdanyola del Vallès, SpainFundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, SpainInstitut Guttmann Hospital de Neurorehabilitacio, Badalona, SpainWe aimed to (1) apply cluster analysis techniques to mixed-type data (numerical and categorical) from baseline neuropsychological standard and widely used assessments of patients with acquired brain injury (ABI) (2) apply state-of-the-art cluster validity indexes (CVI) to assess their internal validity (3) study their external validity considering relevant aspects of ABI rehabilitation such as functional independence measure (FIM) in activities of daily life assessment (4) characterize the identified profiles by using demographic and clinically relevant variables and (5) extend the external validation of the obtained clusters to all cognitive rehabilitation tasks executed by the participants in a web-based cognitive rehabilitation platform (GNPT). We analyzed 1,107 patients with ABI, 58.1% traumatic brain injury (TBI), 21.8% stroke and 20.1% other ABIs (e.g., brain tumors, anoxia, infections) that have undergone inpatient GNPT cognitive rehabilitation from September 2008 to January 2021. We applied the k-prototypes algorithm from the clustMixType R package. We optimized seven CVIs and applied bootstrap resampling to assess clusters stability (fpc R package). Clusters' post hoc comparisons were performed using the Wilcoxon ranked test, paired t-test or Chi-square test when appropriate. We identified a three-clusters optimal solution, with strong stability (>0.85) and structure (e.g., Silhouette > 0.60, Gamma > 0.83), characterized by distinctive level of performance in all neuropsychological tests, demographics, FIM, response to GNPT tasks and tests normative data (e.g., the 3 min cut-off in Trail Making Test-B). Cluster 1 was characterized by severe cognitive impairment (N = 254, 22.9%) the mean age was 47 years, 68.5% patients with TBI and 22% with stroke. Cluster 2 was characterized by mild cognitive impairment (N = 376, 33.9%) mean age 54 years, 53.5% patients with stroke and 27% other ABI. Cluster 3, moderate cognitive impairment (N = 477, 43.2%) mean age 33 years, 83% patients with TBI and 14% other ABI. Post hoc analysis on cognitive FIM supported a significant higher performance of Cluster 2 vs. Cluster 3 (p < 0.001), Cluster 2 vs. Cluster 1 (p < 0.001) and Cluster 3 vs. Cluster 1 (p < 0.001). All patients executed 286,798 GNPT tasks, with performance significantly higher in Cluster 2 and 3 vs. Cluster 1 (p < 0.001).https://www.frontiersin.org/articles/10.3389/fneur.2021.701946/fullacquired brain injurycluster analysiscognitive rehabilitationweb-based platformneuropsychological assessmentmixed-type data |
| spellingShingle | Alejandro García-Rudolph Alejandro García-Rudolph Alejandro García-Rudolph Alberto García-Molina Alberto García-Molina Alberto García-Molina Eloy Opisso Eloy Opisso Eloy Opisso Josep María Tormos Josep María Tormos Josep María Tormos Vince I. Madai Vince I. Madai Vince I. Madai Dietmar Frey Montserrat Bernabeu Montserrat Bernabeu Montserrat Bernabeu Neuropsychological Assessments of Patients With Acquired Brain Injury: A Cluster Analysis Approach to Address Heterogeneity in Web-Based Cognitive Rehabilitation Frontiers in Neurology acquired brain injury cluster analysis cognitive rehabilitation web-based platform neuropsychological assessment mixed-type data |
| title | Neuropsychological Assessments of Patients With Acquired Brain Injury: A Cluster Analysis Approach to Address Heterogeneity in Web-Based Cognitive Rehabilitation |
| title_full | Neuropsychological Assessments of Patients With Acquired Brain Injury: A Cluster Analysis Approach to Address Heterogeneity in Web-Based Cognitive Rehabilitation |
| title_fullStr | Neuropsychological Assessments of Patients With Acquired Brain Injury: A Cluster Analysis Approach to Address Heterogeneity in Web-Based Cognitive Rehabilitation |
| title_full_unstemmed | Neuropsychological Assessments of Patients With Acquired Brain Injury: A Cluster Analysis Approach to Address Heterogeneity in Web-Based Cognitive Rehabilitation |
| title_short | Neuropsychological Assessments of Patients With Acquired Brain Injury: A Cluster Analysis Approach to Address Heterogeneity in Web-Based Cognitive Rehabilitation |
| title_sort | neuropsychological assessments of patients with acquired brain injury a cluster analysis approach to address heterogeneity in web based cognitive rehabilitation |
| topic | acquired brain injury cluster analysis cognitive rehabilitation web-based platform neuropsychological assessment mixed-type data |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.701946/full |
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