This study was undertaken to establish empirically whether couples in which the husband has sustained a severe traumatic brain injury (TBI) differed significantly, with respect to perceptions of husbands' interpersonal communication skills, from control couples in which the husband had sustained a traumatic orthopaedic injury (ORTHO) without injury to the brain. Fifty married couples (25 TBI dyads and 25 ORTHO dyads) were interviewed and completed a questionnaire for the study. Analysis of variance and planned comparisons were used to examine between- and within-group differences. TBI dyads were significantly different to control dyads with respect to perceptions of husbands' communication abilities. Both husbands and wives in long-term TBI dyads reported husbands to experience continuing interpersonal communication difficulties. As a group, TBI husbands self-reported significantly more communication difficulties than did ORTHO husbands. TBI wives and ORTHO wives also produced significantly different perceptions of their husbands' communication abilities. TBI wives perceived their husbands to have a number of interpersonal communication difficulties, while control group wives reported their husbands to be competent communicators.

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.

Background: Findings from prognostic studies of functional and psychosocial recovery after traumatic brain injury (TBI) reported to date have been limited by the restricted timeframe for prediction, generally within the first 5 years post-trauma. This investigation examined prediction of functional and psychosocial recovery in the medium-term (6 years post-trauma; Time 1) and long-term (23 years post-trauma; Time 2). Methods: The participants comprised a consecutive series of the first 100 patients with severe TBI receiving their primary rehabilitation at a regionally based unit. At the 23-year follow-up, 91% of the sample was traced: 17 had died, 5 declined participation, and 69 were interviewed, with 68 participating at both Time 1 and Time 2. Five outcome domains were examined: mobility, self-care, employability, relationships and living skills. Results: Very few of seven pre-injury variables were significantly correlated with any of the outcome variables. A series of logistic regression analyses successfully predicted levels of recovery in all domains using four predictor variables: pre-injury occupational status, duration of post-traumatic amnesia, and physical and neuropsychological disability at rehabilitation discharge. At Time 1, 60% or more of the variance was accounted for in four of the five domains, and at Time 2, more than 40% of the variance was accounted for in all domains. Sensitivity ranged from 62% (self-care) to 90% (mobility). With a single exception (employability at Time 2), specificity was also high, ranging from 80% (relationships) to 98% (mobility). Comparable accuracy rates were also found for positive and negative predictive power. Conclusions: These results demonstrate impressive predictive capacity of early post-trauma variables for the very long-term levels of recovery. They provide guidance for the tailoring of individual rehabilitation programs and the identification of people who may require special supports after rehabilitation discharge.

People with severe traumatic brain injury (TBI) often have poor psychosocial outcomes. Poor memory may contribute to this because it impedes the ability to share experiences and reminisce about past experiences. This study was designed to determine whether photographic partial reminders would improve recall of incidentally learned complex events in people with severe TBI. Two groups of 10 people with severe TBI viewed videotapes of everyday events. One group was shown photographic reminders of half the events shown two days later on 3 occasions separated by 10 minutes. Twenty minutes after the last review (or control activity) both groups were tested for free recall and recognition of the videotape events. The reminder group recalled a greater percentage of reviewed events and objects per events recalled, but a similar number of actions per event recalled, compared to the control group. Photographic review did not decrease recall of nonreviewed events or affect recognition of reviewed or nonreviewed events.

Although the n-back task has been widely applied to neuroimagery investigations of working memory (WM), the role of practice effects on behavioural performance of this task has not yet been investigated. The current study aimed to investigate the effects of task complexity and familiarity on the n-back task. Seventy-seven participants (39 male, 38 female) completed a visuospatial n-back task four times, twice in two testing sessions separated by a week. Participants were required to remember either the first, second or third (n-back) most recent letter positions in a continuous sequence and to indicate whether the current item matched or did not match the remembered position. A control task, with no working memory requirements required participants to match to a predetermined stimulus position. In both testing sessions, reaction time (RT) and error rate increased with increasing WM load. An exponential slope for RTs in the first session indicated dual-task interference at the 3-back level. However, a linear slope in the second session indicated a reduction of dual-task interference. Attenuation of interference in the second session suggested a reduction in executive demands of the task with practice. This suggested that practice effects occur within the n-back task and need to be controlled for in future neuroimagery research using the task.

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.

This study assesses whether the Starship Post-Traumatic Amnesia scale, developed for children aged 3 to 7 years, can predict neuropsychological impairment and behavioural outcome following mild to moderate traumatic brain injury. Participants are 19 children aged from 3 to 7 years with a GCS score of >13, and a PTA of 0–3 days. Neuropsychological outcome is measured by the NEPSY, and behavioural outcome by the Child Behaviour Checklist (CBCL) two months after the TBI. The duration of PTA contributed to the prediction of scores on the NEPSY memory and learning domain. In all cases the longer the duration of PTA, the poorer the memory scores were. The duration of PTA did not contribute to the prediction of NEPSY visuospatial processing or attention and executive functions domain scores, or to any of the CBCL scores. This preliminary study suggests that the Starship PTA scale has good sensitivity for this very young age group, even when the TBI is mild.

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.

This study aimed to investigate the effects of methylphenidate on children with Attention Deficit Hyperactivity Disorder (ADHD). The study employed a conceptual framework of attention, consistent with contemporary theory, and including the following components: sustained attention, selective attention, divided attention, shifting attention, and speed of information processing. Fifteen children (12 boys and 3 girls) of normal intelligence, with a diagnosis of ADHD according to the DSM-IV criteria, and ranging in age from 8 to 11 years participated in the study. Children's attentional abilities were evaluated using the Test of Everyday Attention for Children (TEA-Ch: Manly, Roberston, Anderson, & Nimmo-Smith, 1999). A double-blind counterbalanced repeated-measures design approach was employed to tap on–off medication effects, and deviations from normal. Results showed that comparisons between on–off medication conditions generally detected few differences with respect to sustained and selective attention measures and simple processing speed. In contrast, for higher-level attention domains, including shifting and divided attention, children on medication demonstrated a speed–accuracy trade-off, exhibiting greater accuracy, but slower completion times. When data from the ADHD group were compared to controls a consistent pattern emerged, with children with ADHD in the medication condition being more accurate across all attention domains on all measures. While these children also tended to record slower completion times, group differences and effect sizes were of smaller magnitude. The findings of this study suggest a possible speed–accuracy trade-off effect for children with ADHD on medication.

The aims were to investigate the general and specific effects of mild traumatic brain injury (mTBI), and if people with orthopaedic injuries who had sustained their injuries through exposure to acceleration/deceleration force could have sustained a brain injury. The Rapid Screen of Concussion and Digit Symbol Substitution Test were given to patients with mTBI (89 male, 23 female), and patients with orthopaedic injuries that did (27 male, 5 female) or did not (27 male, 15 female) involve deceleration forces within 24 hours of injury. A group of uninjured people (31 male, 12 female) were also tested. Compared to all other groups, patients with mTBI recalled fewer words and correctly answered fewer orientation questions. Patients with either mTBI or deceleration orthopaedic injuries showed slower speed of information processing than patients with nondeceleration orthopaedic injuries or participants without injury. Nondeceleration patients and uninjured participants did not differ. These results suggest that there are both general injury effects and specific mTBI effects on efficiency of cognitive functioning. The results also highlight the probability that patients with a diagnosis of orthopaedic injury who were exposed to acceleration/deceleration forces may have suffered a mild brain injury as well.

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 Resiliency Model of Family Stress, Adjustment and Adaptation is a theoretical framework used in this article to understand how families adapt when their child has had a traumatic injury. This article describes the Resiliency Model in relation to the findings of studies on families where a child has sustained a brain injury. Identifying the factors impacting on the family and the adaptation process they experience provides valuable insight and information for the provision of family-centred services.

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.

For the families of children with traumatic brain injury (TBI) the transition from hospital to home, school and community can be a very stressful time for everyone involved. The present phenomenological study explored the experiences and perceptions of parents of children with TBI during this important transition time with the aim to better inform health-workers involved in discharge management and rehabilitation. Six family representatives were interviewed, with the format of interviews being semistructured. An interview guide was used that outlined key issues to be explored with each participant. The primary analytical approach was inductive and thematic content analysis was used. The themes which emerged related to the emotional journey experienced by the family, the impact of significant relationships in the process of adjustment, along with service provision and coping strategies. These themes are highlighted with respect to how they can influence intervention strategies. Implications for service referral and the communication style of health professionals are also addressed.

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.

To date there has been little research concerning the neuropsychological mechanisms of emotion perception deficits following traumatic brain injury (TBI), although such deficits are well documented. This paper considers two major issues. First, are emotion-processing deficits found regardless of the media of presentation? In a recent study examining this issue, adults with severe TBI were found to have particular problems identifying emotions from conversational tone, as well as difficulties when presented with still photographs and audiovisual dynamic displays (videoed vignettes). They were relatively normal when asked to classify emotions on the basis of moving visual displays without sound. This may reflect the fact that the parietal cortices, important for processing movement, are relatively unscathed in TBI. The second issue concerns whether emotion recognition is facilitated by empathic emotional responses and whether these are diminished in people with TBI. Evidence is presented for a relation between subjective reports of diminished emotional experience and emotion recognition accuracy. Finally, preliminary data suggests that people with TBI may fail to have empathic reactions when asked to passively view emotional expressions.

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.