Anna Lundqvist

Computerized training of working memory in a group of patients suffering from acquired brain injury

Objective: Study short- and long-term transfer effects of a computerized working memory (WM) training programme for patients suffering from working memory deficits after acquired brain injury. Research design: A controlled experimental study with a cross-over design. Methods: A consecutive sample of 21 subjects. Mean age 43.2 years, time since injury/illness onset 37 months (median). The subjects were randomly selected into two groups where one group served as controls. All subjects trained daily for 5 weeks in a computer WM task program. They were followed-up at 4 and 20 weeks after the training. Results: A significant improvement in the trained WM tasks, significant improvements in neuropsychological WM-test results at 4 and 20 weeks after training compared to baseline. Improvement in the subjects’ rated occupational performance and satisfaction with performance in pre-defined occupational problems. Rated quality-of-life did not change. However, rated overall health increased 20 weeks after training. Conclusions: Structured and intense computerized WM training improves subjects’ cognitive functioning as measured by neuropsychological WM-demanding tests, rated occupational performance, satisfaction with performance and rated overall health. The training probably has an impact on the rehabilitation outcome, returning to work, as well as on daily activities for individuals with verified WM impairments.

Neuropsychological aspects of driving after a stroke : in the simulator and on the road

Thirty patients with stroke and 30 matched controls participated in the study (mean age 68 years, mean interval since stroke onset 8.6 months). The patients performed significantly worse on cogniti ...

Factors influencing driving 10 years after brain injury.

Objective: To study long-term consequences of brain injury on health status, driving characteristics and car accidents. To study whether driving 10 years after brain injury was retrospectively related to cognitive functioning and on-road driving performance 10 years before. Research design: A semi-structured telephone interview with 38 patients with sequelae of brain injury and 49 healthy controls was used. Results: Hypertension, heart disease and vascular disorder were the most frequently reported diseases. The patients reported fatigue, irritability, memory and initiative problems. Concentration and vision problems influenced their driving. Patients had more car accidents reported to an insurance company during the observation period than control subjects. Present driving was retrospectively significantly related to neuropsychological test results but not to on-road test outcome 10 years before. Car accidents were not related to neuropsychological test results or to on-road test outcome 10 years back. Half of the dropouts were stroke patients and they performed significantly worse on the neuropsychological tests but not on the on-road test 10 years before. Conclusion: Neuropsychological tests focusing on information processing speed and attention is a useful screening tool for predicting driving competence. Stroke patients are vulnerable if they continue to drive and need to be evaluated for their driving capacity to drive.

Driving After Brain Injury: Self-Awareness and Coping at the Tactical Level of Control

Objective: To study whether metacognition is a prerequisite for coping at the tactical level of driving. Research design: A consecutive series of 30 drivers with acquired brain injury were assessed concerning cognitive functions and driving performance. In addition the drivers assessed their driving performance through self-rating. Results: On average the drivers had cognitive impairments compared to a healthy reference group. The group that passed the driving test and the group that failed the driving test did not differ in terms of cognitive functions. Neither did they differ in their self-ratings of driving performance. However, the group that failed the driving test significantly over-estimated their performances as compared to the assessments made by the professional driving inspector, while the group that passed the test made more accurate self-ratings. Conclusions: One interpretation of these results is that the group that made a more realistic evaluation of their driving performance were more aware of their cognitive capacity compared to those who failed the driving test. They seemed to have a better ability to adjust their driving behaviour at a tactical level. Thus, the subjects metacognition, awareness of his/her own cognitive capacity, is important for coping with cognitive impairments at tactical driving.

Improved self-awareness and coping strategies for patients with acquired brain injury—A group therapy programme

Primary objective: This study evaluates the effects of a group therapy programme for anticipatory self-awareness and coping strategies. Design: The study includes methodological triangulation using three methods to gather data: an overall self-report questionnaire, Self Regulation Skills Interview (SRSI) and focus group interview. Subjects: Twenty-one individuals with acquired brain injury participated in a group therapy programme. Methods: A self-report questionnaire developed and used especially for evaluation of the described intervention was used at the end of the last session of the group therapy programme. The Self Regulation Skills Interview–SRSI, was used within 2 weeks before and after the subjects participated in one group program. Three Focus groups were used as a third method for data collection. The Focus group interviews were accomplished 1 month after each group programme. Results: The individuals increased their self-awareness and strategy behaviour significantly. Participating in the group therapy programme had had an effect on their life and work situation and on their self-confidence. Conclusions: A structured group therapy programme helps patients with acquired brain injury understand the consequences of their neuropsychological deficits, helps them improve awareness of their impairments and helps them develop coping strategies.

Driving problems and adaptive driving behaviour after brain injury: A qualitative assessment

One professional driving expert was interviewed after each of 22 on-road driving occasions with brain-injured patients. Driving problems were found in five prescribed qualitative dimensions: speed, manoeuvring, position, attention, and traffic behaviour. In addition, three non-prescribed qualitative dimensions were found: orientation, decision-making, and confidence. Also, adaptive aspects important for safe driving despite brain injury were identified: anticipatory attention, slowing down speed, interest and motivation for safe driving, and driving experience. The results are discussed in terms of a hierarchical model of driving performance. In addition, driving problems and adaptive aspects are discussed in relation to attention and information processing. Anticipatory attention is considered a working memory-based attention system, which is essential for driving quality. Practical implications are outlined, for example, educational practice for driving evaluators and adaptive driving behaviour for patients facilitating driving practice as a part of the rehabilitation programme.

Neuropsychological aspects of driving characteristics

Brain injury often causes impairments of cognitive functions, which may affect driving performance. The question of whether the brain-injured patient can resume car driving or not generally comes up during rehabilitation. The medical clinical examination, covering neurological status, screening of cognitive functions, and affective state, is insufficient in assessing relevant functions required for driving performance. A neuropsychological assessment and a driving test are additional parts of the driving assessment besides the medical examination. In this paper, neuropsychological test results and driving test results from four patients with brain injury are presented. The paper demonstrates the complementary value of neuropsychological assessment and a driving test: the relevance of cognitive factors for interpretation of driving problems, but also the relevance of a driving test to show compensatory capacity in some drivers with brain injury. Thus, collaboration between medical, neuropsychological and driving expertise can promote and deepen the total assessment of driving performance after brain injury.

Behavioural ratings of self-regulatory mechanisms and driving behaviour after an acquired brain injury

Abstract Objective: To explore whether measurements of self-regulatory mechanisms and cognition predict driving behaviour after an acquired brain injury (ABI). Design: Consecutive follow-up study. Participants: At baseline participants included 77 persons with stroke and 32 persons with a traumatic brain injury (TBI), all of whom completed a multidisciplinary driving assessment (MDA). A follow-up cohort of 34 persons that succeeded the MDA was included. Baseline measurements: Neuropsychological tests and measurements of self-regulatory mechanisms (BRIEF-A and UPPS Impulsive Behaviour Scale), driving behaviour (DBQ) and pre-injury driving characteristics (mileage, compensatory driving strategies and accident rates). Follow-up measurements: Post-injury driving characteristics were collected by mailed questionnaires from the participants who succeeded the MDA. Methods: A MDA, which included a medical examination, neuropsychological testing and an on-road driving test, was considered in the decision for or against granting a driver’s license. Self-regulatory mechanisms and driving behaviour were examined for research purposes only. Results: At baseline, self-regulatory mechanisms were significantly associated to aberrant driving behaviour, but not with neuropsychological data or with the outcome of the on-road driving test. Aspects of self-regulation were associated to driving behaviour at follow-up. Conclusion: It is recommended that self-regulatory measurements should regularly be considered in the driving assessments after ABI.

Return to work after acquired brain injury: A patient perspective

Primary objective: To study significant factors supporting vocational rehabilitation after acquired brain injury from a patient perspective. Methods: Two focus group interviews were accomplished with former patients. One focus group interview with professional rehabilitation personnel was performed to review the correspondence between patients’ and professionals’ opinion. Subjects: Fourteen informants with acquired brain injury (ABI) were interviewed. All were working at the time of the focus group interviews. Three occupational therapists and two psychologists participated in the professional group. Results: Two themes were identified as significant for returning to work: Personal and Society factors. Identified meaningful units could be categorized into sub-categories, which were grouped into six main- and 14 sub-categories. The main categories were: Self-continuity, Coping, Social factors, Rehabilitation intervention, Professionalism and Health insurance. Length of treatment time was described as crucial for the rehabilitation process and for utilizing individual resources. Conclusions: The effects of various synergies and processes form the basis for a successful return to work, which are dependent on, influence and reinforce each other. Society factors support personal factors to be used for returning to work after acquired brain injury. The impact of individual resources and rehabilitation highlights that vocational rehabilitation is inseparable from the individuals capacity, society and the context in which the individual lives.

Self-ratings of everyday memory problems in patients with acquired brain injury : a tool for rehabilitation

Introduction: Memory problems are common in everyday life of patients with acquired brain injury (ABI). Some patients with ABI also have problems with self-monitoring/awareness. The ecological validity of neuropsychological tests for everyday life memory problems is questionable. Can self-report instruments supply complementary information? Aims: 1) To document the frequency/impact of self-reported memory problems in a sample of consecutive referrals of ABI patients using PEEM and REEM. 2) To characterize the instruments with respect to psychometrics and internal consistency. 3) To document differences in memory problem patterns for various kinds/localization of brain lesions, and associated anxiety/ depression symptoms. Methods: A descriptive retrospective study of consecutive referrals of ABI patients was performed. Ratings from the Evaluation of Everyday Memory (EEM), in a patient version (PEEM) and a version for relatives/proxies (REEM) were analysed as well as self-ratings of anxiety and depression. Results: The EEM instruments displayed good psychometric characteristics. The mean PEEM score were close to the tenth percentile of healthy controls. PEEM and REEM versions were strongly inter-correlated. Sex, age, and lesion characteristics did not matter much with one exception. Right-hemisphere lesion patients rated their memory problems significantly lower than the proxy, for all other lesions it was vice versa. Anxiety and depression symptoms were associated with memory problems.