Anne-Lise Christensen

Subjective experience in brain injured patients and their close relatives: A European Brain Injury Questionnaire study

Results are reported from an international project the aim of which has been to develop and validate a wide-ranging questionnaire suitable for administration to brain-injured patients and their relatives. A self-report questionnaire concerning subjective experience of cognitive, emotional and social difficulties (The European Brain Injury Questionnaire, EBIQ) was administered to a group of 905 brain-injured patients, and close relatives to these competed a parallel version of the questionnaire concerning the brain-injured person. The sample was drawn from seven European countries together with Brazil. The same questionnaire was also administered to a group of 203-non-brain-injured controls, similarly in self-report and relative-report versions. Scales relating to eight specific areas of functioning, together with a global scale, are derived from the questionnaire and their internal reliability was estimated in the present data. Analyses of the 63 items of the questionnaire showed consistently greater levels of problems for the brain-injured group, especially as indicated by relatives. This pattern was substantially replicated among the nine scales. The scales discriminated well between stroke patients and those who had suffered a traumatic brain injury. There was also a tendency for reported problems to be greater for patients who were surveyed later post-injury (> or = 19 months) rather than earlier. Comparison of sets of controls derived from two countries (France and Brazil) showed small but important differences. It is concluded that the questionnaire has an acceptable reliability and validity, but that it will be necessary to obtain culturally relevant non-brain-injured control data when employing it in different countries.

Psychosocial rehabilitation of cranial trauma and stroke patients.

This paper presents the results of a longitudinal psychosocial study of 22 cranial trauma patients and 14 stroke patients from the time preceding injury (using retrospective data), through a 4-5 month intensive rehabilitation programme, to a follow-up 1 year after completion of the programme. Although the two groups of patients differed on several demographic and medical characteristics, essentially similar patterns for psychosocial decline following injury and improvement following rehabilitation could be observed. For both groups, the proportion in marital or cohabitational relationships returned to pre-injury levels, and for both groups the proportion requiring assistance in their living situation declined following rehabilitation, as did use of the health services. Virtually all patients in both groups had been in employment or undergoing education at the time of the injury, and although this percentage declined in practice to a small minority of both groups post-injury, there was a significant increase in the proportions working or in education following the rehabilitation programme. Similarly, the pattern of leisure-time activities in both groups declined post-injury and was restored following rehabilitation. Since both groups entered the programme at over 2.5 years post-injury, these generally encouraging results seem less likely to reflect spontaneous recovery than a beneficial effect of the programme itself.

Luria's neuropsychological and neurolinguistic testing

Abstract In this paper Lurias neuropsychological and neurolinguistic theory is briefly reviewed in order to relate it to his neuropsychological testing. Lurias neuropsychological and neurolinguistic testing is based on his general theory of brain-behaviour relations, which emphasizes the overlap between different functional systems. Lurias goal was to provide a principled approach to testing and rehabilitation, based upon an understanding of the factors underlying complex psychological activities and derived from observations and studies of normal and pathological populations. A case history illustrates these principles.

Luria's neuropsychological evaluation in the nordic countries.

The publication of Lurias Neuropsychological Investigation (LNI) by Christensen in 1975 introduced Lurias evaluation procedures to worldwide neuropsychology. The LNI demonstrated the benefit of a thorough qualitative analysis of an individual patients functioning as well as the usefulness of a comprehensive theory of brain functioning. This article reviews the experiences that led to the development of the LNI, discusses its use and extension in Scandinavian countries, and presents clinical and research applications of the LNI in diagnosis and rehabilitation. A series of case examples provides justification and validity for the continued use of the LNI and related procedures. Discussion of the advantages and disadvantages of the LNI and consideration of possible modifications of the procedures and interpretative methods provide the rationale for continued development of Lurias approach.

Neuropsychological Postacute Rehabilitation

On the grounds of a lifelong experience with and research into brain injury, its sequelae, and restoration, it is the purpose of this chapter to present theoretical and practical tenets that have given evidence of the validity of neuropsychological rehabilitation.

Apolipoprotein E and subjective symptomatology following brain injury rehabilitation

The Apolipoprotein E (APOE) allele ε4 has been repeatedly demonstrated to be related to the development of Alzheimers disease. We have investigated its potential significance in stroke and traumatic brain injury as reflected in outcome following neuropsychological rehabilitation of 39 brain injured adults (mean age at injury 33.3 years, range 16–56). Outcome was evaluated by rating scales derived from a questionnaire completed by each brain injured subject and by a close relative. The questionnaire scales covered physical, cognitive, emotional, and social functioning. Ten of the subjects were found to carry the APOE-epsilon4 gene and the remaining 29 did not. There were no differences between these two groups on the questionnaire scales at the time of entry into the rehabilitation programme. At follow-up, however, on average more than 1 year after completing the rehabilitation programme, scale scores for the APOE-non epsilon4 group showed significant improvements in functioning whereas the APOE-ε4 showed deterioration, the two groups differing on a global scale by 0.87 standard deviations. A battery of attention and memory tests, administered and readministered over a shorter test-retest interval, showed no such deterioration. Within the constraints of the time interval and small sample sizes involved, these findings would suggest that the presence of the APOE-epsilon4 may be associated with poorer outcome following neuropsychological rehabilitation.

Communication in relation to self-esteem

Abstract A holistic approach is essential in the rehabilitation of brain-damaged patients. This approach should be based not only on the specific neurolinguistic impairment, but also on the spared abilities of the patient, which are necessary to allow an acceptable role in life. The case of a patient illustrating this position is shortly presented.

The CRBI at the University of Copenhagen

The Center for Rehabilitation of Brain Injury (CRBI) is a postacute, holistic rehabilitation day program, of approximately 4 months duration, where 15 patients (referred to as students) participate in a combination of individual and group activities. The program is holistic and neuropsychological in orientation, allows for individualized goal setting, uses interdisciplinary planning and treatment, and provides a therapeutic milieu that addresses cognitive, emotional, and social concerns. See Christensen and Caetano (1999), Christensen and Teasdale (1998), and Trexler and Helmke (1996), for an extensive description of these types of programs.

Outpatient/Day Patient Rehabilitation at the Centre for Rehabilitation of Brain Injury, Copenhagen Denmark

The Centre for Rehabilitation of Brain Injury, Copenhagen University, Denmark is presented as an example of how assessment is conducted at an outpatient day treatment rehabilitation programme. As the cognitive, psychosocial, and physical sequelae of acquired brain injury are diverse, individualisation of assessment is stressed within the context of a comprehensive (holistic) treatment approach. Outcome assessments are described, with measures of psychosocial functioning regarded as particularly relevant.

The European Brain Injury Questionnaire

The European Brain Injury Questionnaire (EBIQ) study reported here formed part of the 4-year BIOMED1 EU Concerted Action project entitled “European Standardized Computerized Assessment Procedure for the Evaluation and Rehabilitation of Brain-Damaged Patients.” The project included nine groups focusing on assessment and rehabilitation in the traditional cognitive areas (i.e., memory, language, attention, visual neglect, etc.). Such a reductionist approach toward cognitive functioning was adopted in order to simplify the experimental protocols and designs, but it resulted in fractionating the study of persons with brain injury. To counter this, an “integration” work group was established by Professor Christensen, whose aim was to study emotional, personality, and social aspects of patients’ daily lives, in combination with the consequences and sequelae of cognitive dysfunction. This international work group developed and researched a unified questionnaire for tapping the subjective experience of patients across these areas.