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improving the lives of people with brain injury

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2006 Publications

Dawkins, N., Cloherty, M.E., Gracey, F and Evans, J.J. (2006) The factor structure of the hospital anxiety and depression scale in acquired brain injury. Brain Injury, 20(12), pp. 1235 - 1239.

Yeates, G., Henwood, K., Gracey, F., and Evans. J. (2006) Awareness of disability after acquired brain injury: subjectivity within the psychosocial context. Neuro-Psychoanalysis, 8,2, 175-189

Keohane, C.P., and Prince, L. (2006) A case for continuing rehabilitation: Improving chronic naming abilities in a brain injured client - Brain Impairment 7(2) see abstract online at http://www.koenigundmueller.de/htm/liecht06/liecht_p16.htm

Wilson, B.A. (2006) Rehabilitation of memory for everyday life

In L-G Nilsson & N Ohta (Eds.), Memory and society: Psychological Perspectives, 269-280

Abstract: This chapter has been concerned with the rehabilitation of people with memory difficulties. Rehabilitation is taken to mean enabling people to achieve their optimum level of functioning and return to their most appropriate environment. It does not have, as a major concern, the improvement of scores on tests. If recovery is taken to include partial resolution of cognitive deficits then some recovery is to be expected after non-progressive brain injury. Most memory-impaired people show relatively little recovery once the early stages are passed, although most learn to adapt to and compensate for their problems – at least to some extent. There are some general strategies that can be taught to memory-impaired people and their families or carers. These include guidelines to enable people to encode, store and retrieve information more effectively. I addition to these general guidelines, more-specific techniques are considered, particularly environmental adaptations, ways to improve learning such as "errorless learning" and compensations for memory impairment including electronic memory aids. The final section addresses the emotional consequences of memory impairment. Anxiety, depression and social isolation are common in people with memory difficulties, they may be as handicapping as the cognitive deficits themselves and should be part of any memory rehabilitation programme. Although we probably cannot restore memory functioning to the level present before the neurological insult, we can reduce the effects of impaired memory on everyday life and can improve quality of life for clients and their families.

WILSON, B.A. (2006)

Single-case experimental designs

In Choosing Methods in Mental Health Research: Mental Health Research from Theory to Practice, 9–23

Abstract: This chapter is concerned with single-case experimental designs for the evaluation of an individual’s response to treatment. Following an account of the historical origins and development of single-case experimental designs, the chapter continues with a brief description of the methodology of such designs and assumptions about the theoretical framework involved. A comparison of single-case and group studies is outlined together with the limitations of group studies for evaluating individual patients. We then consider the nature of the evidence produced by single-case studies, the types of questions that can be answered by an N of 1 and the key strengths and weaknesses of such designs. A case study follows to illustrate the use of a single-case experimental design in rehabilitation. The chapter concludes with an overview of single-case designs in the mental health services.

WILSON, B.A. (2006)

Recent Developments in Neuropsychological Rehabilitation

In Higher Brain Function Research, 1–8

Abstract: There are six changes that I feel have been particularly influential in neuropsychological rehabilitation in the past decade: 1) Rehabilitation is now seen as a partnership between patients, families and health care staff 2) Goal setting is well established as a means of planning rehabilitation programmes 3) There is general recognition that cognition, emotion, social functioning and behaviour are interlinked and should be all be addressed in the rehabilitation process 4) Rehabilitation should begin in the first days after brain injury when people may still be in a state of reduced consciousness 5) There has been an increase in the use of technology to help people compensate for their difficulties and 6) There is a greater acknowledgement that rehabilitation requires a broad theoretical base; no one theory, model or framework is sufficient to address all the problems faced by people with neuropsychological deficits.

WILSON, B.A. (2006)

Memory problems after brain injury: third edition Nottingham: Headway, The Brain Injury Association

Abstract: This booklet has been written for primarily for families and carers of people who have memory problems following a brain injury. It describes different types of memory and memory impairment, along with some general strategies to help with everyday memory difficulties.

CLARE, L. & WILSON, B.A. (2006)

Longitudinal assessment of awareness in early-stage Alzheimer's disease using comparable questionnaire-based and performance-based measures: A prospective one-year follow-up study

In Aging and Mental Health, 10(2): 156-165

Abstract: Few studies of awareness in dementia have taken a longitudinal perspective, yet exploring the ways in which awareness changes over time may offer important information about the processes involved and the relationship between awareness and other variables. The present study explored in detail the patters of change in awareness scores over time for a group of 12 participants with early-stage Alzheimer’s disease using a multi-dimensional measure giving comparable participant-carer and postdiction-performance discrepancy scores. There were small, non-significant increases in mean discrepancy scores for each of these components of the assessment, with similar patterns for questionnaire-based and performance-based ratings. The small changes that were observed reflected both participant and informant factors. The majority of participants showed only very minor changes; others showed changes in the direction of either reduced or increased awareness. There was no significant association between change in mean discrepancy score and change in MMSE score over time, although there was a significant decline in MMSE scores at follow-up. The observation of different longitudinal trajectories for awareness scores, reflecting increased or decreased awareness or no change, may indicate the operation of different processes affecting the expression of explicit awareness that can be understood within a biopsychosocial formulation of this complex construct.

PAGE, M., WILSON, B.A., SHIEL, A., CARTER, G., NORRIS, D. (2006)

What is the locus of the errorless-learning advantage?

In Neuropsychologia 44(1), 90-100

Abstract: In two experiments involving word-stem completion, an advantage was found for errorless over errorful-learning conditions, for both severely and moderately memory-impaired participants. This advantage did not depend on the implicit/ explicit nature of the question asked. Additional tests showed that subsequent recognition of target items was good for both groups, but only in the absence of lures derived from participants’ prior errors. Source-memory was shown to be virtually absent in the severely impaired group and only weakly present in the moderately impaired group. This combination of results suggests that preserved implicit memory, in the absence of explicit memory, is sufficient for an errorless-learning advantage to accrue.

MIOTTO, E., SAVAGE C., EVANS, J., WILSON, B.A., MARTINS, M.G.M., IAKI, S., AMARO, E. (2006)

Bilateral Activation of the Prefrontal Cortex after Strategic Semantic Cognitive Training

In Human Brain Mapping 27(4), 288-295

Abstract: The prefrontal cortex (PFC) has been implicated in the ability to apply semantic organizational strategies during verbal encoding and episodic learning. However, there has been no direct evidence demonstrating which specific areas in the PFC are engaged after cognitive training using semantic organizational strategies in healthy adult human subjects. In this study, we investigated the effects of semantic strategic training on brain activity and changes in behavioural performance, after cognitive training, using functional MRI (fMRI). There was a significant activation in bilateral dorsolateral prefrontal (DLPF) and orbitofrontal (OFC) areas after cognitive training. These results demonstrate the engagement of bilateral DLPF and OFC cortex during strategic memory processes, particularly when mobilization and effort of effective use of strategies are required. The functional adaptations observed here may also shed light on some of the processes underlying recovery with cognitive rehabilitation in patient populations with brain injury. Hum Brain Mapp 27:288-295, 2006.

WILSON, B.A. (2006)

Current Challenges for Neuropsychological Rehabilitation

In Brain Impairment 7(2) 151-165

Abstract: Although we have come a long way in improving services for people with brain injury since modern rehabilitation began in World War I, there are still a number of challenges facing us at the beginning of the 21st century. This paper addresses six of them. First, we need to strengthen the link between basic cognitive neurosciences and rehabilitation as results from the former remain of limited use to those of us dealing with the practical problems faced by survivors of brain injury. Second, we need to ensure that findings from neuroimaging really benefit rehabilitation in more than just name. Third, we should collaborate more with the pharmaceutical industry in the expectation that a combination of drug and neuropsychological treatments will lead to better results than either treatment used alone. Fourth, we need to improve ways of evaluating rehabilitation, which will mean relinquishing dependence on traditional outcome measures that frequently fail to apprehend the real needs of patients and families. Fifth, we must learn to make more informed decisions when selecting treatments so that our choice of whether to attempt restoration of lost function or to teach compensatory strategies or to rely on environmental modifications is based on more than just intuition. Finally, we need to know how best to persuade health care purchasers to fund rehabilitation: how do we convince them that while rehabilitation is likely to be expensive initially, it will be cost effective in the long term?

GREENFIELD, E., EVANS, J., EMSLIE, H. AND WILSON, B.A. (2006)

The Pint Test

In Brain Impairment 7(2) 155

Abstract: After a brain injury (BI) many people have a problem with dual tasking (DT), which has serious repercussions on many aspects of their life, affecting activities of daily living, returning to work and leisure. There are few tools available to enable clinicians to assess DT performance. As part of the development of a new battery of tests of divided attention and DT (The DivA), we designed a test that has a high ecological validity and is sensitive to difficulties in combining cognitive and motor tasks. The Pint Test involves a primary condition walking 5-metre lengths for 2 minutes carrying a full glass of water (inside a larger glass), the aim being to spill the minimum whilst walking as many lengths as possible. In a second condition, the added demand of conversing is included. The two conditions are compared in terms of the volume of water spilt per length walked in order to derive an index of cognitive-motor DT performance. We will present performance data for 200 controls and 100 people with BI. Some BI people, under DT conditions, tend to be more stimulus driven, sacrificing the more automatic, learned motor action of walking in favour of the more attentionally demanding tasks, whilst others perform surprisingly well in a demanding task. Possible reasons will be discussed.

JANSARI, A.S., GARDNER, C., WILSON, B.A. (2006)

Is memory rehabilitation possible in older densely amnesic adults? A detailed case study of a post-encephalitic patient using errorless learning and a personal digital computer

In Brain Impairment 7(2) 157

Abstract: Neuropsychological research has shown that both procedural (Corkin, 1968) and implicit memory remain intact in patients with amnesia (e.g., Schacter, 1987; Graf et al., 1984). Research has capitalised on this to develop rehabilitation paradigms for patients using a range of methods and devices such as NeuroPage (NP; e.g., Wilson et al. 2001). In a single case study, Wilson et al. (1997) suggested that a younger age at the time of amnesic insult was one strong predictor of successful rehabilitation. We report the case of a 62-year-old densely amnesic postencephalitic patient, NP using an errorless learning method (Baddeley & Wilson, 1994) in conjunction with an electronic personal digital computer (PalmTop) to remember to perform a series of activities of daily living. Despite NP’s age, the regime proved to be very successful with significant gains following training. The bearings that this finding has on rehabilitation attempts with other groups of patients are discussed.

EMSLIE, H., WILSON, B.A. (2006)

Using a paging system in the rehabilitation of four encephalitic patients

In Brain Impairment 7(2) 158

Abstract: Memory and executive problems following encephalitis are common yet there are few published papers on the successful rehabilitation of such patients. We recently demonstrated (Wilson, Emslie, Quirk, & Evans, 2001; Wilson, Emslie, Quirk, Evans, & Watson, 2005) that a paging system could reduce everyday memory and planning problems for people with nonprogressive brain injury. Among the 143 patients who participated in the 2001 study were 4 people who had survived encephalitis. Their results are reported here. During a 2-week baseline, the successful task achievement of our four clients ranged from 2% to 81%. Each then received a pager for 7 weeks and task achievement was documented in weeks 6 and 7. All were significantly more successful with the pager than they had been at baseline with success rates ranging from 45% to 96%. Five weeks after returning their pagers they were monitored once more. One of the encephalitic patients failed to achieve any of his target tasks, returning to baseline level, the other three dropped back a little but were still much more successful than at baseline. It is concluded that the paging system significantly reduces everyday memory and planning problems of patients with encephalitis.

BERRY, E., WILLIAMS, L., WOOD, K., KAPUR, N., WILSON, B.A. (2006)

The use of SenseCam as a pictorial aid to improve autobiographical memory in a limbic encephalitis patient with amnesia: a preliminary report

In Brain Impairment 7(2) 159

Abstract: This case study describes the use of a wearable camera, SenseCam, which automatically captures several hundred images per day, to aid autobiographical memory in a patient, Mrs B, with marked amnesia following limbic encephalitis. Mrs B’s severe memory impairments led to anxiety and a loss of confidence in social situations. By using SenseCam to record personally experienced events, we hoped that the SenseCam pictures could be used as a pictorial diary to consolidate and cue her autobiographical memories. After a period of time wearing SenseCam, she plugged the camera into a standard PC which downloaded the recorded images and allowed them to be viewed at speed, like watching a movie. In the control condition a written diary was used to verbally record and remind her of autobiographical events. After viewing SenseCam images, Mrs B was, in the majority of cases, able to recall approximately 90% of the event. Retention of events was maintained in the longer term, many months after the event, and without looking at the SenseCam images for 2 months. As a result, Mrs B’s subjective levels of anxiety reduced, and her confidence increased. By contrast, after using the written diary, Mrs B was able to remember on average 40% of an event 2 weeks after it occurred. A range of factors may have enabled Mrs B to recall her memories so effectively using SenseCam, and various hypotheses are discussed. The benefits and drawbacks of using SenseCam with brain-injured patients are also considered, as are SenseCam’s potential further applications in aiding therapy and rehabilitation.

DEWAR, B-K., WILSON, B.A. (2006)

Training face identification in prosopagnosia.

In Brain Impairment 7(2) 160

Abstract: Prosopagnosia is the inability to recognise people from face alone, although recognition from other modalities remains intact (Francis, Riddoch, & Humphreys, 2004). It has proved notoriously difficult to treat. We describe the case of VO who presented with impaired face recognition of familiar people following herpes simplex encephalitis. Photographs and semantic information were collected of family and friends that VO had difficulty recognising. Following multiple baseline assessment, eight faces were selected for training. Face identification was trained with the use of a mnemonic and the errorless learning paradigm of expanded rehearsal. Two faces were trained at weekly sessions, in addition to home practise. Recall of all faces was tested at the beginning of each session. Maintenance and generalisation of learning were also assessed. VO was able to correctly name the faces following training. There was evidence of generalisation of learning to different (profile) photographs and learning was maintained in the absence of practise. Results are discussed with respect to semantic relearning and generalisation. Methodological issues of treatment of face and person identification impairments are also discussed.

FISH, J., EVANS, J.J., NIMMO, M., MARTIN, E., BATEMAN, A., WILSON, B.A., MANLY, T. (2006)

External alerting strategies for the rehabilitation of executive dysfunction in Acquired Brain Injury

In Brain Impairment 7(2): 158

Abstract: Prospective memory (PM) is often claimed to rely upon executive as well as mnemonic resources. Here, we examined the contribution of executive functions towards PM by providing intermittent support for monitoring processes using "content-free" cues, which carried no direct information regarding the PM task itself. Twenty participants with non-progressive brain injury and PM difficulties received brief training in linking a cue phrase "STOP!" with pausing current activity and reviewing stored goals. The efficacy of this strategy was examined with a PM task requiring participants to make telephone calls to a voicemail service at four set times each day for ten days. Task content was encoded using errorless learning to minimise retrospective memory-based failures. On five randomly selected days, eight text messages reading simply "STOP!" were sent to participants’ mobile telephones, but crucially not within an hour of a target time. Striking improvements in performance were observed on cued days, thus demonstrating a within-subjects experimental modulation of PM performance using cues that carry no information other than by association with participants’ stored memory of their intentions. In addition to the theoretical insights, the time course over which the effect was observed constitutes encouraging evidence that such strategies are useful in helping to remediate some negative consequences of executive dysfunction. It is proposed that this benefit results from enhanced efficiency of goal management via increased monitoring of current and future goals, and the steps necessary to achieve them, perhaps compensating for under-functioning fronto-parietal attention systems.

FISH, J., EVANS, J.J., NIMMO, M., MARTIN, E., KERSEL, D., BATEMAN, A., WILSON, B.A., MANLY, T. (2006)

Rehabilitation of executive dysfunction following brain injury: "Content-free cueing" improves everyday prospective memory performance.

In Neuropsychologia 45(6): 1318-1330

Abstract:Prospective memory (PM) is often claimed to rely upon executive as well as mnemonic resources. Here, we examined the contribution of executive functions towards PM by providing intermittent support for monitoring processes using "content-free" cues, which carried no direct information regarding the PM task itself. Twenty participants with non-progressive brain injury and PM difficulties received brief training in linking a cue phrase "STOP!" with pausing current activity and reviewing stored goals. The efficacy of this strategy was examined with a PM task requiring participants to make telephone calls to a voicemail service at four set times each day for 10 days. Task content was encoded using errorless learning to minimise retrospective memory-based failures. On five randomly selected days, eight text messages reading simply "STOP!" were sent to participants’ mobile telephones, but crucially not within an hour of a target time. Striking improvements in performance were observed on cued days, thus demonstrating a within-subjects experimental modulation of PM performance using cues that carry no information other than by association with participants’ stored memory of their intentions. In addition to the theoretical insights, the time course over which the effect was observed constitutes encouraging evidence that such strategies are useful in helping to remediate some negative consequences of executive dysfunction. It is proposed that this benefit results from enhanced efficiency of goal management via increased monitoring of current and future goals, and the steps necessary to achieve them, perhaps compensating for under-functioning fronto-parietal attention systems.

FISH, J., MANLY, T., EVANS, J.J., EMSLIE, H., WILSON, B.A. (2006)

Further investigation into the NeuroPage system for memory and planning disorders

In Journal of the International Neuropsychological Society 12(S2): 11-12.

Abstract: Previous studies have demonstrated the effectiveness of a paging system in the amelioration of problems associated with memory impairment and executive dysfunction (Wilson et al 1997, 2001, 2005). In these studies, people with memory or planning problems were randomly assigned to pager-first (group A) or waitlist-first (group B) conditions. Completion of target behaviours was monitored over a two-week baseline period (Time 1), followed by either introduction of the pager for group A, or further baseline period for group B (Time 2), followed by either removal of the pager for group A, or introduction of the pager for group B (Time 3). Here, we examine patterns of response to the paging system according to aetiology, and the moderation of these effects by factors such as age and cognitive functioning. Though all groups show benefits following the introduction of the pager, there are differences in maintenance of said benefits, with larger decreases in completion of target behaviours following removal of the pager for the CVA group than for the TBI group, who overall show maintenance of the pager-related gains. We also examined relationships between baseline performance and neuropsychological test scores, and found that measures of everyday memory and executive functioning had a significant relationship to the real-life measure, demonstrating the validity of the measures used in predicting problems with everyday functioning.

FISH, J., MANLY, T., WILSON, B.A. (2006)

Modulation of executive function in acquired brain injury

In Journal of the International Neuropsychological Society 12(S2):42

Abstract: A principal aim in the assessment of executive functioning is the prediction of problems in everyday life. The assumption that tests predict everyday performance is by no means unequivocally supported by research findings (Burgess et al, 1998), though the development of ecologically valid tests is helping to improve the situation. Most assessment procedures share one major drawback: they tell us very little about variability in performance. We have used methods that attempt to gauge this variability, with reference to prospective memory rehabilitation. We used a naturalistic task, in which patients are asked to make four daily telephone calls to a voicemail service, and found significant facilitation of performance when a text-message based alerting strategy was used. A second study investigated how different aspects of executive functioning are influenced by motivational salience, employing traditional experimental research methodology. We would argue that measuring variability in, rather than absolute level of, performance, provides a better reflection of everyday function than standard "snapshot" assessment procedures, as well as providing theoretical insight into the cognitive processes involved in these complex behaviours, and clinical insight regarding the implementation of rehabilitation strategies.

WILSON, B.A., MOSCOVITCH, M., KOPELMAN, M., BIGLER, E. (2006)

Living With Amnesia: The Story Of Clive Wearing.

In Journal of the International Neuropsychological Society 12(S1): 83

Abstract: Clive Wearing was a world class musician and musical scholar. He played at the wedding of Prince Charles and Diana Spencer. In 1986 he contracted herpes simplex encephalitis which left him densely amnesic but with his musical skills intact. His wife has written a book about the personal side of living with amnesia entitled "Forever Today" reflecting the fact that Clive constantly believes he has just woken up. In this symposium we describe Clive, the nature of his memory functioning including both strengths and weaknesses, the anatomical structures affected by the virus, his contribution to our understanding of memory and his place in memory research. We also look at changes over the twenty year period since he first became ill and his response to rehabilitation.

WILSON, B.A. (2006)

The Man Who Has Just Woken Up: A Twenty Year Follow Up Study.

In Journal of the International Neuropsychological Society 12(S1): 83

Abstract: CW survived Herpes Simplex Viral Encephalitis in 1985. He was left with extremely severe amnesia. For the past twenty years he thinks he has just woken up and this is one of the major themes in his conversation. He also records this moment of just awakening in his diary and has done so many times each day over the years. Although his scores on standardised memory tests have changed little since he was first assessed and he has failed to learn new linguistic terms such as ‘e-mails’ and ‘mad cow disease’ that have entered the English language since the onset of his amnesia, there have been improvements in his behaviour and his mood. This paper addresses four issues. First we establish the stability of CW’s episodic memory impairments since he was assessed in 1985 a few months after his illness. Second, we consider the almost total lack of new semantic learning when this is assessed in a standardised way (his wife, however, can elicit some new semantic knowledge when she asks leading questions). Third, we look at his implicit memory which appears to be relatively intact given that he can benefit from an errorless learning procedure. The fourth and final issue addresses CW’s response to rehabilitation. Given the severity of his amnesia and the fact that he has additional cognitive difficulties, the most effective rehabilitation approach is that which involves modifications to CW’s physical and verbal environment. These are described and considered within a recent model of rehabilitation.

EMSLIE, H., WILSON, B.A., QUIRK, K., WATSON, P. (2006)

Can School Age Children Use a Paging System to Reduce Everyday Memory and Planning Problems?

In Journal of the International Neuropsychological Society 12(S2): 20

Abstract: Memory and organisational problems are frequently reported in children who have sustained a traumatic brain injury or who have a developmental disorder such as dyspraxia or dyslexia. We recently demonstrated (Wilson, Emslie, Quirk, & Evans, 2001; Wilson, Emslie, Quirk, Evans, & Watson, 2005) that a paging system could reduce everyday memory and planning problems for people with non-progressive brain injury. Among the 143 patients in the 2001 study were 12 school-aged children (age range 8-16 years). Their results are reported here. In a randomised control crossover design 4 children were randomly allocated to group A and 8 to group B. Children chose their own tasks for which they needed reminders. These ranged from prompts to go to the toilet to remembering to take lunchbox or PE kit. During the 2-week baseline group A achieved 69.75% of tasks and group B 43.37%. Group A then received a pager for 7 weeks. During the last two weeks of this period group A now achieved 92.5% of tasks and group B (on the waiting list) 39.25%. Group A then returned their pagers and group B received pagers. During the last two weeks of this stage children in group A dropped back slightly but were still significantly better than during baseline (81.5%). Group B, meanwhile, were now achieving 80.12% of tasks, significantly better than during baseline. We discuss how this paging system can be used to reduce everyday memory and organisational problems of schoolaged children.

DEWAR, B-K., WILSON, B.A., PATTERSON, K., GRAHAM, K.S. (2006)

Can People with Semantic Memory Deficits Re-learn Information?

In Journal of the International Neuropsychological Society 12(S2): 21

Abstract: There have only been a few systematic studies into the acquisition of semantic material in people with semantic memory problems. As part of a larger project to investigate reacquisition of semantic material in cases of impaired semantic memory due to both progressive (semantic dementia) and non progressive (encephalitis) aetiologies, here we report the training of two patients post encephalitis. Selecting the semantic category of famous people, we trained each subject on ten items each consisting of a photograph (e.g. of Tony Blair), the corresponding name and a semantic fact (e.g. Longest serving UK Labour Prime Minister). Semantic material was trained with a mnemonic, using errorless learning paradigms of vanishing cues and expanded rehearsal. The participants also engaged in home practice. Recall of all items was tested at the beginning of each session. Maintenance and generalisation were assessed at the end of training. Both subjects improved relative to baseline in naming of the photographs but recall of the semantic fact was less robust. There was some evidence of subsequent maintenance of learning following cessation of practice and one but not the other participant demonstrated some generalisation to new photographs of the famous target people. Results are discussed with respect to (a) the characteristics of semantic re-learning and (b) methodological issues of treatment for person identification impairments.

GREENFIELD, E., EVANS, J.J., EMSLIE, H., MANLY, T., WILSON, B.A. (2006)

Cognitive-Motor Dual Tasking in Alzheimer’s Disease.

In Journal of the International Neuropsychological Society 12(S2): 49

Abstract: Previous studies have suggested that walking may be disproportionately affected by concurrent cognitive demands (e.g. conversing) in patients with Alzheimer’s disease. Cognitive-motor dual task difficulties may increase the risk of falls or could contribute to poor attention to important environmental stimuli (e.g. traffic) when motor demands are increased (e.g. negotiating pavements). We present results of a study of the performance of a group of patients with Alzheimer’s disease on a battery of cognitive-motor dual tasking tests. Twenty patients with a diagnosis of Alzheimer’s disease were compared with 20 matched healthy controls. Groups were compared on a single motor condition (walking), dual motor condition (walking when clicking a counter), two dual cognitive-motor conditions (walking and sentence verification; walking and tone counting) and a dual cognitive condition (sentence verification and tone counting). AD patients were poorer in the single task conditions, but also showed a disproportionate decrement (difference between dual task and single task) on walking when combined with another motor task (clicking), walking when combined with one of the cognitive tasks (tone counting), but not when combined with the other cognitive task (sentence verification). In the dual cognitive condition, performance on the sentence verification task showed a disproportionate decrement. Consistent with previous findings, it appears that there is a tendency for the cognitive/ more demanding task to be preserved at the expense of the motor/ easier task. Our findings support the argument that this is an important area of clinical assessment with potentially significant functional implications.

GRACEY, F., HENWOOD, K., EVANS, J., MALLEY, D., PSAILA, K., BATEMAN, A., WILSON, B.A. (2006)

"There was a Big Meeting … and then Everybody Seemed to Pull Together": Clinical Difficulty, Team Functioning and the Role of Interdisciplinary Formulation.

In Journal of the International Neuropsychological Society 12(S2): 53

Abstract: Objectives: To report the findings of a qualitative research approach to the study of psychiatric rehabilitation team functioning when faced with clinical ‘difficulty’. To describe the relevance of these findings to practice development in a holistic neuropsychological rehabilitation service. Methods: A social constructionist grounded theory analysis of a psychiatric rehabilitation team’s discussions about ‘difficult patients’ was carried out to develop a theoretical account of team functioning. A case report of service application of this model to facilitate effective teamwork and collaboration with service users in neuropsychological rehabilitation is described. Results: The analysis identified 5 core categories regarding the sharing and shifting of responsibility, client characteristics, and service resources. When discussing ‘difficult patients’ team members provided accounts of staff, team and organisational difficulty. The grounded theory account highlighted how the team engaged in systemic shifting of responsibility that served to maintain poor team functioning and compromise client rehabilitation. In contrast, when discussing clients described as ‘not so difficult’ the team described a ‘fit’ or ‘match’ between client and service, and within the team. The use of interdisciplinary formulation within a neuropsychological rehabilitation service appears to facilitate collaboration between different disciplines and with the service users. Conclusion: This study models team functioning in response to client ‘difficulty’. It is concluded that development of shared understanding is a feature of good teamwork. A formulation-based approach to facilitating shared understanding in neuropsychological rehabilitation is advocated, along with the need for further organisational research within neuropsychological rehabilitation.

S Palmer 2006 Understanding and coping: Family members' experience of rehabilitation services http://www.koenigundmueller.de/htm/liecht06/liecht_p21.htm

The crucial role families play in rehabilitation is increasingly acknowledged in clinical practice and Government targets. Although desirable, it is not always possible for professionals to work collaboratively with family members. This project explored how collaboration might be improved. Questions addressed whether understanding of brain injury (UBI) or individual coping style related to use of rehabilitation strategies. Family members' experiences of helpful and unhelpful aspects of professionals were also explored. A mixed-methods design was incorporated. Thirty-two participants completed measures of: UBI, mood, strategy use and coping style. Data were analysed using correlations. Semi-structured interviews explored experiences of collaboration. All transcripts were analysed using top-down theme analysis for specific questions. Four were further analysed using Interpretative Phenomenological Analysis to identify emergent themes. Results revealed no statistical relationships between UBI and use of strategies, or coping style. However, qualitative analyses revealed a complex relationship where UBI is crucial to collaboration, and to use of strategies. A theme about expectations of services emerged, which linked with dissatisfaction. Essential characteristics of professionals were identified as empathy, honesty and competence. This project offers insight into perspectives of 32 family members. Suggestions for managing expectations, such as increasing information and opportunities to ask questions, are discussed.

A Bateman and M Horton (2006) Assessing construct validity of the European Brain Injury Questionnaire (EBIQ) using Rasch analysis http://www.koenigundmueller.de/htm/liecht06/liecht_p2.htm

Background: Studies of effectiveness of rehabilitation require measurement tools that have established measurement properties that are appropriate for the patient group. Rasch analysis is an interesting method for examining rating scale validity. Methods: Responses to the EBIQ from 226 people were entered into the analysis. The sample (72% male, median age 34) with acquired brain injury (1-10 years prior to assessment) represented consecutive referrals to Oliver Zangwill Centre. The EBIQ consists of 63 items requiring a rating of frequency of symptoms (cognitive, physical, motivational impairments). There are three response categories for each item (not at all, a little, a lot). Results: Seventeen items were excluded: 14 because ChiSq P values <0.05 and three further items were removed as they displayed significant uniform DIF by gender (crying easily, irritability, finding your way). After exclusion of these, the remaining 49 items yielded an overall fit to the Rasch model (Total item ?2=159.6, P=0.10). Principal Components analysis was used to examine local independence. No significant differences were found between person estimates given by the subsets when compared to person estimates given by the full 47-item scale. This supports the assumption of unidimensionality of the scale. Visual inspection of a plot of targeting revealed a good spread of items across the full range of respondents' scores indicating that the items provide a good operational measurement range for difficulties experienced by people with brain injury. Conclusion: This analysis demonstrated the scale does not work as a 63 item scale. Further work on proposed subscales is underway. The analysis provides a platform for further parametric analysis of impact of rehabilitation. A score based on 46 EBIQ items meets the expectations of Rasch model and can be considered a valid unidimensional scale for assessing personal experience of brain injury.

 

 

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