Betto G. Deelman

Long-term effects of memory rehabilitation: A controlled study

Abstract Severely closed-head-injured patients (n = 39) received either memory strategy training or drill and repetitive practice on memory tasks; a control group received no treatment. The treatment procedures were evaluated by subjective ratings, by memory tasks on which an effect of the use of strategies was expected and by reaction time tasks to control for spontaneous recovery or motivational factors. Tests were administered before and after two 3-week periods of training and at follow-up 4 months after the end of therapy. Neither treatment procedure showed significant effects on reaction time measures. Both groups of trainees subjectively rated the effects of therapy on their everyday memory functioning as highly positive, although significant effects on objective memory performance scores could only be demonstrated in the strategy training group. These results appeared most clearly at the 4-month follow-up.

Efficacy of strategy training in left hemisphere stroke patients with apraxia: A randomised clinical trial

The objective of the present study was to determine in a controlled study the efficacy of strategy training in left hemisphere stroke patients with apraxia. A total of 113 left hemisphere stroke patients with apraxia were randomly assigned to two treatment groups; (1) strategy training integrated into usual occupational therapy and (2) usual occupational therapy only. Assessments took place at baseline, after an 8 week treatment period and 5 months after baseline (follow-up). Patients were assessed on apraxia, motor functioning and activities of daily living (ADL). The primary outcome measure was a standardised ADL observation by a blinded research assistant. Additional ADL measures were used as secondary outcome measures (Barthel ADL index, ADL judgement by occupational therapist and by patient). After 8 weeks of treatment, patients who received strategy training (n = 43) improved significantly more than patients in the usual treatment group (n = 39) on the ADL observations (mean change .24; 90% CI, .15–.34 vs. .12, .03–.21). This reflects a small to medium effect (effect size .37) of strategy training on ADL functioning. With respect to the secondary outcome measures a medium effect (effect size .47) was found on the Barthel ADL index. No beneficial effects of strategy training were found after 5 months (at follow-up). In this trial evidence was found for the short-term effectiveness of strategy training in left hemisphere stroke patients with apraxia.

Outcome of strategy training in stroke patients with apraxia: a phase II study

Objective: Evaluation of a therapy programme for stroke patients with apraxia. The programme is based on teaching patients strategies to compensate for the presence of apraxia. This programme was designed for assessment and treatment by occupational therapists. Design: The outcome was studied in a pre–post test design. Measurements were conducted at baseline and 12 weeks later. Subjects: Thirty-three stroke patients with apraxia were treated at occupational therapy departments in general hospitals, rehabilitation centres and nursing homes. Main outcome measures: The following measurements were conducted: an apraxia test, a motor functioning test, observation of activities of daily living (ADL), Barthel Index, and an ADL questionnaire for the therapist and the patient. Results: The patients showed large improvements in ADL functioning on all measures and small improvements on the apraxia test and the motor functioning test. The effect sizes for the disabilities, ranging from 0.92 to 1.06, were large compared to the effect sizes for apraxia (0.34) and motor functioning (0.19). The significant effect of treatment is also seen when individual improvement and subjective improvement are considered. Measured with the Barthel Index for instance, 71% of the patients improved. Conclusions: These results suggest that the programme seems to be successful in teaching patients compensatory strategies that enable them to function more independently, despite the lasting presence of apraxia.

Speed of information processing after unilateral stroke

Speed of information processing in the subacute stage after stroke was studied in 88 first ever, unilateral, ischemic stroke patients. The patient group included 42 right and 46 left hemisphere patients. Seventy-one control subjects were also examined. Four reaction time tasks with different levels of complexity were used: two visuomotor, and two semantic categorisation tasks. The results showed that stroke causes a decrease in decision making speed, but that the effect is different for right and left hemisphere patients. The right hemisphere group were slower than the control group on all reaction time tasks, and slower than the left hemisphere patients on the visuomotor tasks. The left hemisphere patients were slower than the healthy controls, only on the most complex tasks, the categorisation tasks.

Suboptimal performance on neuropsychological tests in patients with suspected chronic toxic encephalopathy.

Suboptimal performance during neuropsychological testing can seriously complicate assessment in behavioral neurotoxicology. We present data on the prevalence of suboptimal performance in a group of Dutch patients with suspected chronic toxic encephalopathy (CTE) after long-term occupational exposure to solvents. One hundred and forty-five subjects referred to one of two Dutch national assessment centers for CTE were administered the Amsterdam Short-Term Memory Test (ASTM) and the Test of Memory Malingering (TOMM), two tests specifically developed for the detection of suboptimal performance. For both tests, very cautious cut-off scores were chosen with a specificity of 99%. Results indicated that suboptimal performance appears to be a substantial problem in this group of patients with suspected CTE after long-term exposure to organic solvents. Only 54% of our subjects obtained normal scores on both tests of malingering, i.e. at or above cut-off score. The two tests seemed to measure the same concept in that nearly all the subjects with low TOMM scores also had low ASTM scores. However, a higher proportion of subjects scored below the cut-off on the ASTM than on the TOMM.

Relations between subjective evaluations of memory and objective memory performance.

Several explanations for the weak relations between subjective memory judgments and objective memory performance were investigated in two groups of normal older adults. Group 1 sampled a general population (mean age 61.6 yr., range 46–89), while Group 2 sampled subjects who were on a waiting list for memory training (mean age 63.0 yr., range 45–85 years). In both groups, subjective memory judgments were assessed with global ratings of memory capacity and with ratings of frequency of forgetting in specific memory situations. Memory performance was assessed with several well-known tests and with recently developed tests for domain-specific aspects of memory. Most tests concerned episodic memory. Study 1 also included measures of semantic, incidental, and working memory. Study 2 further examined the influence of the domain-specificity of objective and subjective measures for remembering names, intentions, and texts. Relations between memory self-reports and performance were weak in both groups and for all kinds of tests. Against expectations, the low correlations could not be explained by differences between ecological and laboratory tests or incidentally and intentionally remembered information, or by differences between specific failures compared to global, stereotyped judgments. Surprisingly, correlations did not increase when subjective and objective measures assessed the same ability, like remembering names. Also noncognitive variables (mood and lifestyle) did not influence the relations. The (weak) relations between subjective and objective memory measures were comparable for subjects over and under 65 years of age. Furthermore, relations were comparable for the general population sample and the memory compliant group.

Subjective changes in emotion, cognition and behaviour after stroke: Factors affecting the perception of patients and partners

The presence and severity of changes in emotion and cognition experienced by left- and right-sided stroke patients and observed by their partners were compared at 3 months poststroke. The results showed that, regardless of the side of stroke, several changes were reported by half of the stroke patients and their partners. It appeared that while left hemisphere stroke patients agreed with their partners on the number and severity of most changes, partners of right hemisphere patients reported more frequent and more severe changes than the patients themselves. The level of observability of the altered behaviour, distress of the partner, distress of left-sided stroke patients and hemispatial neglect of right-sided stroke patients emerged as factors related to disagreement between stroke patient and partner.

Rehabilitation of stroke patients with apraxia: the role of additional cognitive and motor impairments.

Purpose : The present study investigated which additional cognitive and motor impairments were present in stroke patients with apraxia and which of these factors influenced the effects of treatment. Method : A group of 33 patients with apraxia were treated according to the guidelines of a therapy programme based on teaching patients strategies to compensate for the presence of apraxia. Patients were treated at occupational therapy departments in general hospitals, rehabilitation centres and nursing homes. The outcome of the strategy training was studied in a pre-post test design; measurements were conducted at baseline and after 12 weeks of therapy. The pretreatment scores of the patients with apraxia were compared to normscores and scores of a control group of patients without apraxia ( n = 36) to investigate which impairments are present. The following variables were analysed in order to determine which factors influence outcome: additional neuropsychological deficits (comprehension of language, cognitive impairments due to dementia, neglect and short term memory), level of motor functioning, severity of apraxia and performance on activities of daily living (ADL), and some relevant patient characteristics (gender, age, type of stroke, time since stroke, and location of treatment). Results : The results showed that the presence of apraxia is associated with the presence of additional cognitive and motor impairments. The successful outcome of strategy training was not negatively influenced by cognitive comorbidity. The outcome seemed to be more prominent in patients who were more severely impaired at the start of rehabilitation in terms of the degree of motor impairments, the severity of apraxia and the initial ADL dependence. The ADL observations, however, displayed a ceiling effect, which was taken into account in discussing the results. Demographic variables, especially age, did not predict the outcome of treatment. Conclusions : We suggest that the effect of this training is stronger in more severely disabled patients. However, neither the presence of additional cognitive impairments nor the severity of motor problems nor old age should be an indication for refraining from treating apraxia.

Rehabilitation of memory for people's names

In a training study, memory-impaired patients were taught strategies to improve the learning of new names and the retrieval of familiar peoples names. To improve new name learning, the patients were encouraged to give more meaning to a persons name, without requiring an explicit association between the face and the name. Strategies to improve retrieval of familiar names mainly concerned ways to resolve tip-of-the-tongue states. Learning names to faces improved following training on one of the two target tests and this improvement was maintained six months following training. Retrieval of familiar peoples names also improved immediately following the training, although the improvement disappeared at the six-month follow-up. Two control memory tests and a group of normal subjects, who received no training, were used to discriminate an effect of training from the effects of repeated testing and the extensive attention received by the trained group.

PROSPECTIVE MEMORY TRAINING IN OLDER ADULTS

This study evaluates the results of a training program for prospective remembering. The goal of the training was to improve prospective memory by associating cues from the retrieval situation with the to be remembered information. The training group consisted of 20 participants, aged between 45 and 81 years. The effects of strategy training were compared with those of an educational training group (N = 23 , age range 45-84) directed at reducing worries about forgetfulness, and a retest control group (N = 22 , age range 46-74). The educational training and retest control groups did not differ in demographic characteristics and test performance and were combined into one control group. Subjective evaluations revealed that subjects were very satisfied with the effects of training. This also was true for subjects in the educational training condition. The objective effects of training were evaluated with a telephone task which had to be performed in the daily life situation, and a prospective categorization task performed in the laboratory. Despite the low reliabilities of the prospective tasks, a significant but small effect of training compared to the combined control group was found on the sum score of prospective tests. The training effect was not related to age or pretraining performance level. At the three months follow-up, however, performance of the control group had increased to the level of the trained group. As expected, training effects did not generalize to other memory measures (assessed with tests for remembering names) or control measures (assessed with visuo-motor reaction time tests).This study evaluates the results of a training program for prospective remembering. The goal of the training was to improve prospective memory by associating cues from the retrieval situation with the to be remembered information. The training group consisted of 20 participants, aged between 45 and 81 years. The effects of strategy training were compared with those of an educational training group (N = 23 , age range 45-84) directed at reducing worries about forgetfulness, and a retest control group (N = 22 , age range 46-74). The educational training and retest control groups did not differ in demographic characteristics and test performance and were combined into one control group. Subjective evaluations revealed that subjects were very satisfied with the effects of training. This also was true for subjects in the educational training condition. The objective effects of training were evaluated with a telephone task which had to be performed in the daily life situation, and a prospective categorization t...