This article represents a summary of the George Burniston Oration of the Australian Faculty of Rehabilitation Medicine, which was given as a keynote address at the 6th World Congress on Brain Injury, Melbourne, May 2005. The paper concerns evaluation of the evidence for effectiveness of rehabilitation following acquired brain injury (ABI). It explores the current evidence available, and discusses a number of different review strategies which may be used to overcome the challenges of assimilating research evidence in this context.

Despite the prevalence of psychiatric illness in people with acquired brain injury (ABI), there are very few empirically validated studies examining the efficacy of treatments targeting commonly occurring disorders such as depression and anxiety. Using a randomised controlled trial, this study evaluated the efficacy of a cognitive behavioural intervention specifically designed for managing social anxiety following ABI. Twelve brain-injured participants were screened, randomly allocated to either treatment group (TG) or a wait list group (WLG), and proceeded through to the final stages of therapy. The TG received between 9 and 14 hourly, individual sessions of cognitive behavioural therapy. Repeated measures analyses revealed significant improvements in general anxiety, depression and a transient mood measure, tension-anxiety, for the TG when compared to the WLG at posttreatment. These treatment gains were maintained at one-month follow-up. Although in the predicted direction, postintervention improvements in social anxiety and self-esteem for the TG were not significant in comparison with the WLG. This study lends support to the small body of literature highlighting the potential of cognitive behavioural interventions for managing the psychological problems that serve as a barrier to rehabilitation following ABI.

Neuropsychiatric symptoms are common features in patients with neurodegenerative diseases, and have important clinical implications for both patients and caregivers. This study used the Neuropsychiatric Inventory (NPI) to measure symptomatology in 120 patients drawn from five disease groups: Parkinson's disease (PD), Alzheimer's disease (AD), dementia associated with Lewy bodies (DLB), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). Ninety per cent of the patient group reported experiencing at least one symptom, with the most prevalent symptoms being depression and apathy. However, a differential pattern of symptomatology was reported across the disease groups, a finding which has diagnostic and treatment implications. Furthermore, this provides additional evidence that a broad cortical–subcortical distinction cannot be supported.

Parkinson's disease (PD) has long been associated with dementia. This has been found to correlate with participant age, age at onset of PD and severity of PD. In addition, a large corpus of research points to the fact that participants with, as well as without, dementia can be impaired in a variety of cognitive tasks. Among these, set-shifting and dual-tasking skills have received particular focus. Most studies report that a reduction in attentional resources can lead to problems with these tasks. However, none have been able to determine exactly which systems are involved in these skills and which neurological impairments underlie the observed cognitive deficits. The current study set out to investigate how performance on tasks requiring set-shifting and dual tasking related to each other, as well as overall measures of cognition gained across a variety of tasks. Fifteen participants with PD and 12 control participants underwent screening tests for dementia, as well as specific tests to assess attention, set-shifting and dual tasking. The results indicate that set-shifting ability correlated well with other measures of cognitive performance, whereas dualtasking skills did not. This could suggest that set-shifting and dual tasking are not necessarily controlled by the same process, or that a particular process is involved to different degrees. In addition, many participants showed individual performance variations and dissociations between tasks that were not necessarily evident from the statistical analysis. This indicates that it can be difficult to make assumptions on overall cognitive performance from specific tasks and vice versa. This observation has implications for clinical practice as well as research methodology.

The study aimed to identify themes in songs written by clients with traumatic brain injury (TBI). Lyrics (1834) from 82 songs written by 11 female and 21 male clients aged between 5 and 60 years were categorised into 8 main themes and 24 subcategories. Incidence of subcategories and themes were calculated. Self-reflections and messages were the most frequent themes portrayed within songs. Memories and reflections about significant others were also frequently communicated. It was noticeable that clients felt safer to communicate thoughts and feelings about the past and present but were less inclined to confront the future.

Neuropsychological assessment plays a prominent role in the diagnosis of Alzheimer's disease (AD) and other cognitive impairments. Increasingly, neuropsychological test results are also used to guide clinicians in the prescription of anti-dementia medication. There is evidence to suggest that the cognitive ability of an individual with AD may vary over the course of a day. If time of day can influence an individual's performance on cognitive tests, then it could potentially affect his or her diagnosis and eligibility for treatment. This study set out to explore the effect of time of day on Mini-Mental State Examination (MMSE) performance in individuals with AD and Age-Associated Cognitive Decline (AACD). No significant effect of time of day (TOD) on Folstein MMSE performance was found. However, some interesting results were highlighted and future research suggested. Overall, the study does not provide evidence that time of day needs to be considered when interpreting the result of a short cognitive screening test.

It is important to know when improvement or deterioration in cognitive function occurs. Until fairly recently neuropsychologists have made these judgments clinically, with little resort to empirical methods. In addition to the issue of whether a change in performance is reliable, there is also the consideration of whether it is clinically significant. This article briefly discusses these concepts, reviews the most common methods for determining reliability in change in test scores, considers their use in the broader clinical context, and illustrates their application with reference to an actual database.