Efficacy of memory aids after traumatic brain injury: A single case series

BACKGROUND

Individuals living with traumatic brain injury commonly have difficulties with prospective memory-the ability to remember a planned action at the intended time. Traditionally a memory notebook has been recommended as a compensatory memory aid. Electronic devices have the advantage of providing a cue at the appropriate time to remind participants to refer to the memory aid and complete tasks. Research suggests these have potential benefit in neurorehabilitation.

OBJECTIVE

This study aimed to investigate the efficacy of a memory notebook and specifically a smartphone as a compensatory memory aid.

METHODS

A single case series design was used to assess seven participants. A no-intervention baseline was followed by training and intervention with either the smartphone alone, or a memory notebook and later the smartphone. Memory was assessed with weekly assigned memory tasks.

RESULTS

Participants using a smartphone showed improvements in their ability to complete assigned memory tasks accurately and within the assigned time periods. Use of a smartphone provided additional benefits over and above those already seen for those who received a memory notebook first.

CONCLUSIONS

Smartphones have the potential to be a useful and cost effective tool in neurorehabilitation practice.

Peritraumatic distress: its relationship to posttraumatic stress and complicated grief symptoms in sudden death survivors

Although sudden death has been linked to posttraumatic stress disorder (PTSD), its role in complicated grief (CG) and sudden death survivors is unknown. This questionnaire study investigated the role of peritraumatic distress in PTSD and CG symptoms in adults (n = 125) an average of 28.37 months (SD = 3.12) after a loved one's sudden death. The Peritraumatic Distress Inventory, Impact of Event Scale-Revised, and Inventory of Complicated Grief were administered to assess symptoms of peritraumatic distress, PTSD, and CG, respectively. Peritraumatic distress was the strongest correlate of both PTSD (β = .42, p < .001) and CG (β = .39, p < .001) symptoms, in a model containing current distress (Hopkins Symptom Checklist-21). Peritraumatic distress may be a key mechanism in the development of both PTSD and CG, therefore suddenly bereaved individuals reporting higher peritraumatic distress may be at risk of both adverse trauma and grief reactions.

Assessing executive performance during cognitive rehabilitation

Executive functioning influences a host of other cognitive processes and people who attend neuropsychological services are more likely to display executive dysfunction than any other cognitive deficit (Stuss & Levine, 2002). Impairment in executive functioning disrupts a person's ability to effectively employ their intact areas of functioning, and undermines effective self-management of other areas of dysfunction, hampering attempts to employ compensatory strategies. Therefore, assessment of a person's executive functioning is a high priority as part of a comprehensive neurorehabilitation plan. Guided by the International Classification of Functioning, Disability, and Health model (ICF model; Peterson, 2005), we suggest that an important development in the field is moving to formal assessment of executive performance in functional contexts, in addition to more traditional assessment of executive impairment. We outline a number of existing studies in this area, review current measures that can provide clinicians with useful information on these issues, and discuss how this research could be further advanced.

A study investigating the effects of Tai Chi Chuan: Individuals with traumatic brain injury compared to controls

OBJECTIVE

To explore the effects of a 6-week course in Tai Chi associated with traumatic brain injury (TBI) symptoms.

METHOD

Eighteen participants, with TBI assigned to a control (waiting list) group (n = 9) or Tai Chi group (n = 9) completed the Medical Outcome Scale Short Form 36 (SF-36) and Rosenberg Self-Esteem Scale (RSES) before, during, immediately after and 3 weeks after completion of the Tai Chi course. The Tai Chi group completed the Visual Analogue Mood Scales (VAMS) before and after each class.

RESULTS

Tai Chi was associated with significant improvement on all VAMS scores (except fatigue) with decreases in sadness, confusion, anger, tension, fear and increases in energy and happiness. There were no significant between-group differences on the SF-36 or RSES.

CONCLUSIONS

Tai Chi provides short-term benefits after TBI, with rigorous outcome measurement needed to examine long-term benefits.

Neuropsychological Assessment of Individuals with Expressive Disabilities in Addition to Traumatic Brain Injuries

Little empirical research has examined guidelines for neuropsychological assessment of people with severe physical and sensory disabilities. This study focused on people with expressive disabilities--people unable to speak, write, draw, or manipulate test materials. Measures were selected and adapted to be suitable for the assessment of cognitive functioning for such people. Responses were selected from multiple choice answers or were spelled out on an alphabet board. Individuals with expressive disabilities in addition to traumatic brain injuiry (TBI) were compared to individuals with TBI alone and a normative group. The measures were generally found to be reliable and valid assessment instruments. Individuals with expressive disabilities were able to manage the task requirements of the adapted tests. The results provided support for the adaptations trialed.

Neuropsychological assessment difficulties associated with "hard-to-assess" individuals: a retrospective review

This paper presents the first phase of a wider research programme examining neuropsychological assessment as it applies to individuals with physical and sensory disabilities to such a degree as to make them "hard-to-assess" (HTA). The aim of this paper was to investigate the extent to which physical and sensory disabilities interfered with the neuropsychological assessments of individuals referred following traumatic brain injury. A retrospective review of 288 individuals with brain injury revealed 22 who met the criteria for being HTA on the basis of physical or sensory disabilities. The modifications necessary to standard techniques for assessment of these individuals, and the domains in which assessment was difficult or impossible are discussed. Most HTA were individuals who had impairment in two or three of the visual, motor and speech domains.

Sports-related brain injury research: methodological difficulties associated with ambiguous terminology

A basic premise underlying sound methodological research is that it is based on constructs that have a sound operational definition. Failure to do so impedes comparison with other relevant literature. In sports-related brain injury research, the varied criteria and inconsistent use of the term 'concussion' and its interchangeability with other generic terms such as mild/minor head injury, and mild brain injury exemplifies such a situation. This paper will background the issues involved and provide rationale to support a call for tightening the use of terminology in the area.

Cognitive deficits due to asymmetrical bilateral thalamic lesions

The cognitive deficits are described in a 20-year-old right-handed man with asymmetrical bilateral thalamic lesions and a lesion resulting in the 'locked-in' syndrome. Memory and intellectual assessment, modified due to the physical and communication difficulties, suggested that the patient had little impairment of verbal intelligence and performed normally on memory test involving immediate recall of new material. There was, however, considerable impairment of organization, planning and in the recall of visual and especially verbal memory, over longer periods. Remote memory was relatively intact, except for chronological errors in time-tagged material, and he was disoriented for year, month and day.

Affective disorders after traumatic brain injury: cautions in the use of the Symptom Checklist-90-R

DESIGN

The current study compared the Symptom Checklist 90-Revised (SCL-90-R) results from a population of 88 individuals with traumatic brain injury (TBI) to those of a normative group.

SETTING

Individuals with traumatic brain injury referred to a university-based psychology clinic.

RESULTS

Results corroborated those from a smaller study,(1) where a considerable proportion of the elevations found on the subscales was attributed to endorsement of items identified as having a neurological basis.

CONCLUSION

This reinforces the view that the results of neurological groups on clinical measures of emotional distress that have been standardized on physically healthy populations can be distorted because many of the items can be answered from physical and emotional perspectives.

Neuropsychological outcomes of traumatic brain injury and substance abuse in a New Zealand prison population

Fifty subjects with a history of traumatic brain injury (TBI) and/or substance use, completed neuropsychological measures of short and long term verbal and visual memory, information processing, motor speed and co-ordination, executive functioning, and malingering. All subjects performed below norms on tests of verbal memory and verbal abstract thinking, but overall no differences were found due to either severity of TBI or level of substance use. Maori subjects obtained the lowest scores on tests of verbal ability, but also reported higher rates of TBI and substance use, which is presumed to account for this result. In conclusion, prison populations seem to have disproportionately high rates of TBI, recurrent TBI, and substance use, compared to the general population. Further, there are a group of individuals who have experienced both TBI and substance abuse, with associated impairments in verbal memory and learning, abstract thinking, and who report problems with general memory and socialization. These difficulties may affect functioning both in prison and following release.

Self- and informant-ratings on the patient competency rating scale in patients with traumatic brain injury

The Patient Competency Rating Scale (PCRS) provides self- and informant-ratings of everyday memory and gives a guide to patients' awareness of their difficulties. Research using the PCRS has focussed on groups with severe TBI and little is known about ratings of functioning in other severity groups or in a non-TBI population. In the current study the TBI group (n = 53) overrated their pre-accident competency compared to controls (n = 131). Patients with severe TBI (n = 25) underestimated their difficulties, while ratings of those with moderate (n = 14) and mild (n = 14) TBI were consistent with their informants, that is, in areas of cognition and emotion. Controls reported difficulty in interpersonal functioning and emotional control that their informants were unaware of.

Order of item difficulty on the WAIS-R picture arrangement subtest: data from a traumatically brain-injured sample

Although the items within the WAIS-R subtests are presumed to be in ascending order of difficulty, several studies have indicated that the Picture Arrangement subtest items are out of order for clinical groups. The present study retrospectively examined item difficulty and discrimination in the test data of 74 individuals who had been referred for neuropsychological assessment following a traumatic brain injury. While results were not statistically significant, qualitative analysis of partial credit scoring for four of the items indicated some inconsistencies in the scoring rationale. Caution is recommended in the use and interpretation of the Picture Arrangement tests scores in the assessment of individuals with traumatic brain injury.

Incidence and outcomes of traumatic brain injury and substance abuse in a New Zealand prison population

The present study investigated the rates and perceived effects of past traumatic brain injury (TBI) and substance use in a prison population. Responses to a questionnaire indicated that 86.4% of the 118 respondents had sustained a TBI, with 56.7% reporting more than one, and rates of illicit substance use were higher than the general population. Maori reported 12% more TBI and more substance use than non-Maori. All those with TBI reported difficulties with general memory and socialization on a problem rating scale, but there was no relationship between level of difficulty and severity of TBI, problems with interpersonal relationships, family, and finances were associated with greater substance use.

Adolescents' understanding of the causes and consequences of traumatic brain injury

A class of 135 students ages 14 to 15 years (67 mate and 68 female) were given 2 examples of head injury (HI) and asked what they thought would be the resulting outcomes. Most commonly reported were migraines/headaches, memory difficulties, dizziness and coma or brain damage. Although awareness of the causes and outcomes of HI was limited, those who had experienced HI appeared to be more aware of the causes and outcomes than did those who had not. This is contrary to the Gouvier, Prestholdt, and Warner (1988) and O'Jile et al. (1994) findings for adults and is probably due to a combination of differences in data collection methods and a heightened awareness in adolescents due to the recent introduction of compulsory helmets for cyclists in New Zealand.

Neuropsychological sequelae of head injury in a New Zealand adolescent sample

The purpose of this study was to determine the nature and extent of any difficulties experienced by students after head injury, and the degree to which these were recognized by their parents and teachers. All year 10 students at a co-educational high school in New Zealand were surveyed for information regarding incidence, aetiology and severity of head injury-related symptomatology and general everyday competency. A proportion of students reporting injury (mostly mild) and a matched control group were studied in more detail. Information was obtained through a self-report questionnaire, neuropsychological measures, and teacher and parent rating forms. Apart from trials 5 and 6 of the AVLT, in which the head-injury group scored significantly lower than the control group, there were no other significant differences between the two groups on neuropsychological measures. There was a low level of agreement between students, teachers and parents with regard to behavioural and cognitive difficulties that the students were experiencing.