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Seton C, Coutrot A, Hornberger M, Spiers HJ, Knight R, Whyatt C. Wayfinding and path integration deficits detected using a virtual reality mobile app in patients with traumatic brain injury. PLoS One 2023; 18:e0282255. [PMID: 36893089 PMCID: PMC9997943 DOI: 10.1371/journal.pone.0282255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/11/2023] [Indexed: 03/10/2023] Open
Abstract
The ability to navigate is supported by a wide network of brain areas which are particularly vulnerable to disruption brain injury, including traumatic brain injury (TBI). Wayfinding and the ability to orient back to the direction you have recently come (path integration) may likely be impacted in daily life but have so far not been tested with patients with TBI. Here, we assessed spatial navigation in thirty-eight participants, fifteen of whom had a history of TBI, and twenty-three control participants. Self-estimated spatial navigation ability was assessed using the Santa Barbara Sense of Direction (SBSOD) scale. No significant difference between TBI patients and a control group was identified. Rather, results indicated that both participant groups demonstrated 'good' self-inferred spatial navigational ability on the SBSOD scale. Objective navigation ability was tested via the virtual mobile app test Sea Hero Quest (SHQ), which has been shown to predict real-world navigation difficulties and assesses (a) wayfinding across several environments and (b) path integration. Compared to a sub-sample of 13 control participants, a matched subsample of 10 TBI patients demonstrated generally poorer performance on all wayfinding environments tested. Further analysis revealed that TBI participants consistently spent a shorter duration viewing a map prior to navigating to goals. Patients showed mixed performance on the path integration task, with poor performance evident when proximal cues were absent. Our results provide preliminary evidence that TBI impacts both wayfinding and, to some extent, path integration. The findings suggest long-lasting clinical difficulties experienced in TBI patients affect both wayfinding and to some degree path integration ability.
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Affiliation(s)
- Caroline Seton
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom
| | - Antoine Coutrot
- Laboratoire d’InfoRmatique en Image et Systèmes d’information, French Centre National de la Recherche Scientifique, University of Lyon, Lyon, France
| | - Michael Hornberger
- Applied Dementia Research, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Hugo J. Spiers
- Division of Psychology and Language Sciences, Department of Experimental Psychology, University College London, London, United Kingdom
| | - Rebecca Knight
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom
- * E-mail:
| | - Caroline Whyatt
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom
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Jaywant A, Arora C, Toglia J. Online awareness of performance on a functional cognitive assessment in individuals with stroke: A case-control study. Neuropsychol Rehabil 2022; 32:1970-1988. [PMID: 35293836 DOI: 10.1080/09602011.2022.2050409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Unawareness is a significant barrier to cognitive rehabilitation following acquired brain injury. Little is known about online awareness of cognitively-based instrumental activities of daily living (C-IADL) after stroke, particularly C-IADLs that emphasize executive functions. Our goal was to evaluate in stroke patients (1) online awareness during and immediately after a C-IADL task that emphasizes executive functions and (2) the association between awareness and performance on the C-IADL task. Seventy-seven stroke patients on an acute inpatient rehabilitation unit and 77 control participants completed the 10-item Weekly Calendar Planning Activity (WCPA-10), a standardized C-IADL task that requires working memory, planning, shifting, and inhibition. Trained examiners observed the use of a self-checking strategy and self-recognition of errors during the task. Immediately after the task, participants estimated their accuracy, and rated their own performance, which was compared with objective accuracy. Relative to the control group, stroke patients overestimated their accuracy, less often recognized errors, and less frequently used a self-checking strategy. Overestimation was associated with worse overall performance on the WCPA-10. Findings suggest that poor online awareness of C-IADL performance is common in stroke patients undergoing acute inpatient rehabilitation. Increasing awareness through metacognitive interventions should be a core focus of early post-stroke cognitive rehabilitation.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Catherine Arora
- School of Health and Natural Science, Mercy College, Dobbs Ferry, NY, USA
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.,School of Health and Natural Science, Mercy College, Dobbs Ferry, NY, USA
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Wheeler M, Williams OA, Johns L, Chiu EG, Slavkova ED, Demeyere N. Unravelling the complex interactions between self-awareness, cognitive change, and mood at 6-months post-stroke using the Y-shaped model. Neuropsychol Rehabil 2022; 33:680-702. [PMID: 35257640 DOI: 10.1080/09602011.2022.2042329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We investigated the relationships between cognitive change following stroke, awareness of cognitive impairments, and mood to further understanding of change processes influencing psychological outcomes post-stroke in line with the "Y-shaped" process model. Patients (n = 143; Mage = 73 years, SD = 13.73; 74 males) were assessed at 3-weeks (T1) and 6-months (T2) post-stroke and had completed the Oxford Cognitive Screen (T1 and T2), the Cognitive Failures Questionnaire (CFQ; T2), and the Hospital Anxiety and Depression Scale (HADS; T2). An ANCOVA controlling for disability relating to activities of daily living (ADL) revealed that awareness of cognitive impairment was significantly lower in participants with moderate-severe cognitive impairment. Regression analysis indicated that greater awareness of cognitive impairment and reduced independence in ADL were associated with greater emotional distress at T2. Cognitive improvement was associated with lower emotional distressat T2. Contrary to the awareness hypothesis, moderation analyses suggest that this effect was largest for those most cognitively impaired at T1. Findings emphasize the importance of monitoring stroke patients' capacity to be self-aware when assessing and formulating long-term post-stroke distress and have potential implications for improving long-term emotional status in those most cognitively impaired post-stroke, e.g., through psychoeducation, cognitive rehabilitation, and emotional support.
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Affiliation(s)
- Miranda Wheeler
- The Oxford Institute of Clinical Psychology Training and Research, The Oxford Centre for Psychological Health, University of Oxford, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Owen A Williams
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Louise Johns
- The Oxford Institute of Clinical Psychology Training and Research, The Oxford Centre for Psychological Health, University of Oxford, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Evangeline G Chiu
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Elitsa D Slavkova
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Cameron KV, Ponsford JL, Stolwyk RJ. Do stroke survivors agree with their clinicians on the extent of their post-stroke activity limitation and participation restriction? Neuropsychol Rehabil 2019; 30:1430-1448. [PMID: 30874467 DOI: 10.1080/09602011.2019.1586734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aimed to examine discrepancies in the reporting of post-stroke functioning between stroke survivors and their clinicians across various disability domains and across current and predicted functioning. Fifty sub-acute stroke survivors (Age M = 70.30 SD = 15.80, 56% female) and their occupational therapist independently completed three measures assessing activity limitations (cognitive, physical, instrumental) and participation restrictions. Assessments were made of current functioning and predicted functioning at three months' post-discharge. Compared to physical functioning, appraisal discrepancies were more pronounced for cognitive functioning, instrumental activity limitation, and participation restriction. Discrepancies were more pronounced for current, as opposed to predicted, cognitive functioning (Z = -4.21, p < .001) and instrumental activity limitation (Z = -4.00, p < .001). Conversely, discrepancies in participation restriction were greatest for predicted functioning (Z = -4.03, p < .001). Follow-up (n = 39) showed that, compared to survivors' predictions, clinicians' predictions were more closely aligned with actual stroke survivor functioning at three months' post-discharge (as rated by a close other). These findings suggest appraisal discrepancy varies across disability domains and time reference points, with cognitive and complex functional activities being particularly discrepant between stroke survivors and clinicians. Furthermore, clinicians may hold more realistic expectations of short-term functional recovery.
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Affiliation(s)
- Kate V Cameron
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Jennie L Ponsford
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Renerus J Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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de Rooij NK, Claessen MHG, van der Ham IJM, Post MWM, Visser-Meily JMA. The Wayfinding Questionnaire: A clinically useful self-report instrument to identify navigation complaints in stroke patients. Neuropsychol Rehabil 2017; 29:1042-1061. [DOI: 10.1080/09602011.2017.1347098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- N. K. de Rooij
- Centre of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - M. H. G. Claessen
- Centre of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
| | - I. J. M. van der Ham
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
| | - M. W. M. Post
- Centre of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - J. M. A. Visser-Meily
- Centre of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
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Abstract
Management of cognitive difficulties is a significant unmet need for individuals with stroke. Incorporating multiple functions, including memory aids and communication tools, smartphones have potential to improve everyday cognitive function and independence in daily activities post-stroke. We aimed to investigate patterns of smartphone use, facilitators and barriers to use, and relationships between smartphone use and daily functioning. Twenty-nine participants with stroke and 29 comparison participants with no history of neurological conditions completed measures of smartphone use, objective and subjective cognitive function, mood and community integration. The majority of participants used smartphones, though the proportion of users was lower in the stroke group (62%) than the comparison group (86%). Older participants were less likely to use smartphones. Using apps that support memory was a main benefit of smartphone use post-stroke. In the stroke group, frequent users of memory apps had significantly fewer motor symptoms (d = 1.20), and higher productivity (d = 0.84). Stroke survivors identified difficulty learning how to use smartphones, but only one participant had assistance with this from a clinician. These results suggest that smartphones have potential as assistive technology post-stroke, however, support in using them is essential, particularly for older individuals with motor dysfunction.
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Al Banna M, Redha NA, Abdulla F, Nair B, Donnellan C. Metacognitive function poststroke: a review of definition and assessment. J Neurol Neurosurg Psychiatry 2016; 87:161-6. [PMID: 25995488 DOI: 10.1136/jnnp-2015-310305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/26/2015] [Indexed: 11/03/2022]
Abstract
Metacognition is the conscious knowledge individuals have about their own cognitive capacities and the regulation of these activities through self-monitoring. The aim of this review was to identify the definitions and assessment tools used to examine metacognition in relation to stroke studies. A computer database search was conducted using MEDLINE, CINAHL, PsycINFO, Cochrane Reviews, Scopus and Web of Science. A total of 1412 publications were retrieved from the initial database search. Following the removal of unrelated articles, 34 articles remained eligible. 5 studies examined metacognition in relation to cognitive and/or emotional functioning, 4 examined the concept in relation to memory, while others investigated its relationship to driving, employment or restrictions in daily living. 12 studies examined metacognitive function exclusively in stroke. Only 1 study examined metacognition in the acute phase of stroke. 7 studies adhered to the standard definition of metacognition in line with the neuropsychological literature. The main assessment tools utilised included the Self-Regulation and Skills Interview (SRSI), the Self-Awareness of Deficits Interview (SADI), the Awareness Questionnaire (AQ) and the Patient Competency Rating Scale (PCRS). Assessment of metacognition has tended to focus on traumatic and other acquired brain injury in comparison to stroke. The majority of the studies that examined metacognition in stroke did not assess patients in the acute phase. The heterogeneity of assessment tools was in keeping with the variation in the definition of metacognition. The emergence of a standard metacognitive assessment tool may have important implications for future rehabilitative programmes.
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Affiliation(s)
- Mona Al Banna
- School of Postgraduate Studies and Research, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain
| | - Noor Abdulla Redha
- School of Postgraduate Studies and Research, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain
| | - Fatema Abdulla
- Department of Clinical Neurosciences, Salmaniya Medical Complex, Manama, Bahrain
| | - Bindhu Nair
- School of Postgraduate Studies and Research, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain
| | - Claire Donnellan
- School of Postgraduate Studies and Research, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Bahrain School of Nursing and Midwifery, Trinity College Dublin, Ireland
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