Adam McKay

Semantic involvement in reading aloud: evidence from a nonword training study.

The current research uses a novel methodology to examine the role of semantics in reading aloud. Participants were trained to read aloud 2 sets of novel words (i.e., nonwords such as bink): some with meanings (semantic) and some without (nonsemantic). A comparison of reading aloud performance between these 2 sets of novel words was used to provide an indicator of the importance of semantic information in reading aloud. In Experiment 1, in contrast to expectations, reading aloud performance was not better for novel words in the semantic condition. In Experiment 2, the training of novel words was modified to reflect more realistic steps of lexical acquisition: Reading aloud performance became faster and more accurate for novel words in the semantic condition, but only for novel words with inconsistent pronunciations. This semantic advantage for inconsistent novel words was again observed when a subset of participants from Experiment 2 was retested 6-12 months later (in Experiment 3). These findings provide support for a limited but significant role for semantics in the reading aloud process.

The impact of progressive semantic loss on reading aloud

The role of semantics in reading aloud remains controversial. To explore this issue, the current study examined the impact of semantic loss on reading-aloud performance in 7 patients with semantic dementia. The results revealed a heterogenous pattern of reading difficulties. Of the patients, 2 selectively made errors on inconsistent words (i.e., surface dyslexia), 4 had a generalized reading deficit with increased errors on consistent words, inconsistent words, and nonwords, while the remaining patient had relatively intact reading-aloud accuracy. All patients had longer reading latencies on real words than controls. The relationship between the reading and semantic deficits in the patients was examined at the item-specific level. This suggested that reading-aloud errors were related to the semantic impairment for inconsistent words but not consistent words. In contrast, semantic loss was related to longer latencies for both consistent and inconsistent words. These findings support models of reading that include a role for semantics in the reading-aloud process.

Efficacy of motivational interviewing and cognitive behavioral therapy for anxiety and depression symptoms following traumatic brain injury.

BACKGROUND Anxiety and depression are common following traumatic brain injury (TBI), often co-occurring. This study evaluated the efficacy of a 9-week cognitive behavioral therapy (CBT) program in reducing anxiety and depression and whether a three-session motivational interviewing (MI) preparatory intervention increased treatment response. METHOD A randomized parallel three-group design was employed. Following diagnosis of anxiety and/or depression using the Structured Clinical Interview for DSM-IV, 75 participants with mild-severe TBI (mean age 42.2 years, mean post-traumatic amnesia 22 days) were randomly assigned to an Adapted CBT group: (1) MI + CBT (n = 26), or (2) non-directive counseling (NDC) + CBT (n = 26); or a (3) waitlist control (WC, n = 23) group. Groups did not differ in baseline demographics, injury severity, anxiety or depression. MI and CBT interventions were guided by manuals adapted for individuals with TBI. Three CBT booster sessions were provided at week 21 to intervention groups. RESULTS Using intention-to-treat analyses, random-effects regressions controlling for baseline scores revealed that Adapted CBT groups (MI + CBT and NDC + CBT) showed significantly greater reduction in anxiety on the Hospital Anxiety and Depression Scale [95% confidence interval (CI) -2.07 to -0.06] and depression on the Depression Anxiety and Stress Scale (95% CI -5.61 to -0.12) (primary outcomes), and greater gains in psychosocial functioning on Sydney Psychosocial Reintegration Scale (95% CI 0.04-3.69) (secondary outcome) over 30 weeks post-baseline relative to WC. The group receiving MI + CBT did not show greater gains than the group receiving NDC + CBT. CONCLUSIONS Findings suggest that modified CBT with booster sessions over extended periods may alleviate anxiety and depression following TBI.

A cognitive behaviour therapy (CBT) programme for anxiety following moderate–severe traumatic brain injury (TBI): Two case studies

Background: CBT is a potentially effective treatment for anxiety disorders following TBI; however, empirical evidence has mainly come from clients with mild TBI. This paper describes a CBT-based anxiety treatment programme adapted for clients with more severe injuries. Two case studies are provided to illustrate the implementation of the programme, as a step toward larger scale testing of the programmes feasibility. Methods and procedures: A manualised adapted CBT treatment manual was used to deliver CBT in a standardised manner to two clients, one with severe and one with moderate TBI. Outcome was evaluated using a single-subject design with repeated measures of anxiety, mood and coping style at pre- and post-CBT. Results: The two clients demonstrated positive treatment response on either a measure of anxiety or a continuous measure of distress. Although neither demonstrated a clinically significant change according to the primary outcome measure (Hospital Anxiety and Depression Scale), they showed significant change in at least one corroborated measure of anxiety. Conclusions: This study suggests the potential utility of the adapted CBT programme for clients with moderate–severe TBI. Limitations of the single case studies were discussed, while noting how they would be addressed in a follow-up randomised controlled trial.

The experience of challenging behaviours following severe TBI: a family perspective

Abstract Primary objective: Family caregivers play an important role in managing challenging behaviours after TBI. The aims of this study were to understand how family caregivers of individuals with TBI perceive challenging behaviours and their impact on the TBI individual’s community integration and family functioning. Research design: A qualitative research design was employed to capture the lived experience of family caregivers of individuals with TBI. Methods and procedures: Face-to-face interviews were conducted on six female family caregivers of individuals with severe TBI (sustained an average of 17 years earlier) and long-standing challenging behaviours. Main outcomes and results: The results revealed that family caregivers adopted a broader definition of challenging behaviour than that used by professionals and these behaviours impacted on the community integration of the individual with TBI, most notably leading to poor social relationships. Challenging behaviours were viewed as a key source of distress and burden for family caregivers and they used many different strategies to manage the behaviours. Conclusion: Greater understanding of challenging behaviours from the perspectives of family caregivers may help provide more effective support and interventions to improve quality-of-life for individuals with challenging behaviours after TBI and their families.

Exploring variables associated with change in cognitive behaviour therapy (CBT) for anxiety following traumatic brain injury

Purpose: In a pilot randomized controlled trial, we investigated the effectiveness of a 12-weekly anxiety treatment programme adapted for individuals with moderate-severe TBI, based on cognitive behaviour therapy (CBT) and Motivational Interviewing (MI). The current study explored the variables associated with treatment response and group differences in change expectancy and working alliance. Methods: Twenty-seven participants recruited from a brain injury rehabilitation hospital were randomly assigned to MI + CBT, non-directive counselling (NDC) + CBT and treatment-as-usual and assessors were blinded to treatment conditions. Correlation and multiple regression were used to examine the association between reduction in anxiety ratings and a number of clinical, injury and cognitive variables. Random effects regression was used to examine group difference in changes in working alliance and expectancy. Results: There was a trend suggesting that greater injury severity may be predictive of poorer response to CBT and injury severity was significantly related to memory functioning. Participants receiving MI pre-treatment showed a greater increase in change expectancy at the end of CBT and at follow-up, but not at the end of MI. Conclusions: There is a need to further investigate the effectiveness of treatment for individuals with different injury severity and to explore the relationship between change expectancy and treatment outcome. Implications for Rehabilitation Whilst cognitive behaviour therapy (CBT) has demonstrated effectiveness in treating anxiety, individuals with traumatic brain injury (TBI) may have difficulty benefiting from such therapy due to injury-related cognitive limitations. Individuals with greater injury severity and/or poor memory functioning are likely to have greatest difficulty in benefiting from CBT. For these individuals it is important to monitor their use of CBT skills, adapt therapy to meet their limitations (e.g. increased repetition, intensity or treatment dosage), provide follow-up booster sessions, and assist clients to develop realistic therapy goals.

Development of a motivational interviewing programme as a prelude to CBT for anxiety following traumatic brain injury

A brief preparatory programme, based on the principles of motivational interviewing (MI), was developed as a way of engaging clients with traumatic brain injury (TBI) and preparing them for a cognitive behaviour therapy (CBT) programme for anxiety. The MI + CBT programme was delivered to a male client in his early 40s with severe TBI at four months post-injury, using a single-subject design with repeated measures pre- and post-treatment. The client received three sessions of manualised MI, followed by nine sessions of CBT. The MI sessions focused on helping the client to develop more realistic goals and supporting his self-efficacy about his ability to cope with anxiety. Specific strategies were used to accommodate the clients cognitive limitations, such as the use of personally meaningful metaphors and role plays. Re-assessments were conducted at the end of MI, CBT and nine weeks post-treatment, using a semi-structured clinical interview and self-report measures of anxiety, mood and change expectancy. The client showed significant improvement in anxiety following treatment and a significant reduction in subjective units of distress (SUDS) between the MI and CBT phases. The results suggest the potential utility of MI in people with TBI, and the need to evaluate treatment protocols in a controlled trial.

FACTORS ASSOCIATED WITH POSTTRAUMATIC STRESS DISORDER FOLLOWING MODERATE TO SEVERE TRAUMATIC BRAIN INJURY: A PROSPECTIVE STUDY

This study prospectively examined the relationship between preinjury, injury‐related, and postinjury factors and posttraumatic stress disorder (PTSD) following moderate to severe traumatic brain injury (TBI).

A Test of the magnocellular deficit theory of dyslexia in an adult sample

An influential theory of dyslexia is based on the premise that individuals with the disorder have impaired sensitivity to rapidly changing stimuli in the visual and auditory modalities, due to a dysfunction in the magnocellular channel of the visual system and its analogue in the auditory pathway. The deficit in the auditory system is thought to cause difficulties in the segmentation of speech and the formation of accurate phonological representations, leading to problems in making the grapheme–phoneme correspondences necessary for reading. In a sample of 13 adults with a history of severe reading difficulty and 18 controls, visual contrast thresholds were measured in response to an 8-Hz flickering Gaussian blob as well as a slowly modulated 8 cycles/deg Gaussian windowed grating. Auditory thresholds were measured in response to a 4-s burst of white noise, the 2nd or 3rd second of which was amplitude modulated at 100 Hz or 1 Hz. The adult reading difficulty group exhibited normal thresholds to rapidly changing stimuli in both modalities and to the slowly modulated visual stimulus, but some showed reduced sensitivity to the 1-Hz amplitude-modulated auditory stimulus. Sensitivity to amplitude modulation at slower rates has been shown to be important for segmentation of the speech stream and so may be implicated in the reading difficulty of the affected individuals. A magnocellular deficit cannot explain this impaired sensitivity, which may be the result of a reduced echoic memory span.

Factors influencing self-awareness following traumatic brain injury

Objective:To examine self-awareness and injury-related, emotional and demographic factors across acute/subacute (3-12 months), medium-term (24–60 months), and long-term (120-240 months) time periods after traumatic brain injury (TBI), because unawareness of injury-related changes can affect engagement in rehabilitation and functional outcomes. Participants:A total of 168 individuals with mild to severe TBI and 105 of their close others. Main Outcomes Measures:Awareness Questionnaire (AQ) and Hospital Anxiety and Depression Scale. Design:Cross-sectional study. Results:There were no significant differences in awareness as a function of time postinjury, except for the AQ motor/sensory domain wherein individuals with TBI at longer time periods displayed increased awareness of deficits than those at earlier time periods. Greater patient-other AQ discrepancy scores (interpreted as lower patient awareness) were associated with longer posttraumatic amnesia duration in the individual with TBI and also with increased self-reported depressive symptoms in the close others. Conversely, smaller AQ discrepancy scores (interpreted as better awareness) were associated with increased self-reported depressive symptoms by the individuals with TBI. Conclusion:This study highlights the limitations of using discrepancy scores to measure awareness, as ratings of injury-related changes are influenced by the mood of the individual with TBI and the close other, as well as by injury severity.