Ca Honan

Cognitive Factors Underpinning Poor Expressive Communication Skills After Traumatic Brain Injury: Theory of Mind or Executive Function?

OBJECTIVE The ability to see things from anothers perspective, that is, have a theory of mind (ToM), is essential to effective communication. So too is the ability to regulate verbal output, that is, to exercise executive control. People with traumatic brain injuries (TBIs) have impaired communication abilities, but the extent to which this reflects ToM versus executive dysfunction is unclear. This study explored the relative contributions of executive abilities, specifically flexibility and inhibition and ToM abilities in language production post-TBI. METHOD Twenty-five adults (18 males: mean age of 48.2 years, SD = 12.0 years) with moderate to severe TBI (posttraumatic amnesia = 69.2, SD = 54.6 days) and 28 noninjured adults (19 males: mean age 49.0, SD = 12.2 years) completed three sets of communication tasks with low executive demands, high flexibility, and high inhibition demands. Within each, parallel versions had low or high ToM requirements. RESULTS For low executive and high flexibility tasks, scores on the high ToM versions were predicted by scores on the low ToM versions, suggesting that poor performance was explained by the executive demands the parallel tasks had in common. The exception was the high inhibition task. In this case, speakers with TBI had differential difficulty with the high ToM version, that is, they had specific difficulty inhibiting self-referential thoughts in order to cater for anothers perspective. CONCLUSION We found problems with inhibiting the self-perspective accords with descriptive accounts of the egocentric nature of some communication patterns following TBI, which points to potential targets for remediation.

The Multiple Sclerosis Work Difficulties Questionnaire

Background: A better understanding of the workplace difficulties experienced by people with multiple sclerosis (PwMS) may be critical to developing appropriate vocational and rehabilitative programs. Objective: We aimed to assess the factor structure, internal consistency and validity of the new Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ). Methods: Work difficulty items were developed and reviewed by a panel of experts. Using the MSWDQ, cross-sectional self-report data of work difficulties were obtained in addition to employment status and MS disease information, in a community-based sample of 189 PwMS. Results: Exploratory Maximum Likelihood Factor Analysis on the draft questionnaire yielded 50 items measuring 12 factors. Subscale internal consistencies ranged from 0.74 to 0.92, indicating adequate to excellent internal consistency reliability. The MSWDQ explained 40% of the variance in reduced work hours since diagnosis, 40% of the variance in expectations about withdrawing from work, 34% of the variance in expectations about reducing work hours, and 39% of the variance in expectations about changing type of work due to MS. Conclusion: The MSWDQ is a valid and internally reliable measure of workplace difficulties in PwMS. Physical difficulties, as well as cognitive and psychological difficulties were important predictors of workplace outcomes and expectations about future employment.

Development and validation of the smoking expectancy scale for adolescents

This study assessed the factor structure, internal consistency, and concurrent validity of the Smoking Expectancies Scale for Adolescents (SESA) using 717 Australian adolescents (87% nonsmokers, 11% current smokers, and 2% ex-smokers). Exploratory factor analysis of SESA yielded 8 factors. Confirmatory factor analysis indicated that the 8-factor model, and also a 2nd-order cost-benefit model, fit the data significantly better than 4 alternatives. Validation analyses revealed the 8-factor model explained 26% to 32% of the variance in adolescent cigarette use, smoking intentions, smoking subjective norms, and peer smoking. The 2nd-order model explained 12% to 17% of the variance in these same variables.

Perceived cognitive difficulties and cognitive test performance as predictors of employment outcomes in people with multiple sclerosis

Perceived cognitive difficulties and cognitive impairment are important determinants of employment in people with multiple sclerosis (pwMS). However, it is not clear how they are related to adverse work outcomes and whether the relationship is influenced by depressive symptoms. Thus, this study examined perceived and actual general cognitive and prospective memory function, and cognitive appraisal accuracy, in relation to adverse work outcomes. The possible mediating and/or moderating role of depression was also examined. A cross-sectional community-based sample of 111 participants (33 males, 78 females) completed the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ), Beck Depression Inventory - Fast Screen (BDI-FS), and questions related to their current or past employment. They then underwent cognitive testing using the Screening Examination for Cognitive Impairment, Auditory Consonant Trigrams test, Zoo Map Test, and Cambridge Prospective Memory Test. Perceived general cognitive and prospective memory difficulties in the workplace and performance on the respective cognitive tests were found to predict unemployment and reduced work hours since MS diagnosis due to MS. Depression was also related to reduced work hours, but it did not explain the relationship between perceived cognitive difficulties and the work outcomes. Nor was it related to cognitive test performance. The results highlight a need to address the perceptions of cognitive difficulties together with cognitive impairment and levels of depression in vocational rehabilitation programs in pwMS.

Deficits in comprehension of speech acts after TBI: The role of theory of mind and executive function

Theory of mind (ToM) is critical to effective communication following traumatic brain injury (TBI) however, whether impairments are specific to social cognition, or reflective of executive demands is unclear. This study examined whether ToM impairments are predicted by executive function difficulties using everyday conversation tasks. Twenty-five individuals with severe-TBI were compared to 25 healthy controls on low- and high-ToM tasks across four conditions: (1) low cognitive load, (2) high flexibility, (3) high working memory (WM) and (4) high inhibition. TBI individuals were impaired on high-ToM tasks in the WM condition. When the WM demands of the task were controlled, the impairments were no longer apparent. TBI individuals were not impaired on high-ToM tasks in the inhibition and flexibility conditions, suggesting these tasks may not have been sufficiently demanding of ToM abilities. The results suggest that ToM impairments in everyday communication may arise due to WM demands, in individuals with TBI.

Diagnostic Efficiency of ImPACT and CogSport in Concussed Rugby Union Players Who Have Not Undergone Baseline Neurocognitive Testing

The current study endeavored to replicate the approach to sports-related concussion management adopted by some community-based sporting organizations by examining the diagnostic efficiency of CogSport and ImPACT in athletes without baseline test data and assessed only once postinjury. Recently concussed nonelite-level rugby union players (N = 51) were tested within 72 hours of sustaining a concussion and were compared to nonconcussed matched controls (N = 41). Demographic information and history of recent concussion were also collected. Logistic regression analysis and receiver-operating characteristic curve analysis were conducted to evaluate the most accurate scores at identifying group membership. Overall, the classification accuracy of CogSport and ImPACT represented only very minimal improvements over a demographic-only (age, estimated premorbid Full-Scale IQ, and number of previous concussions) model. Positive predictive power and negative predictive power of composite scores were modest. The ImPACT postconcussion symptoms total (severity) score was most accurate at classifying concussed athletes. Where neuropsychological tests are utilized on a single occasion postconcussion and in the absence of baseline testing, postinjury testing does not improve diagnostic utility beyond the demographic model. These results do not validate this approach as a useful method of managing sports-related concussion.

The awareness of social inference test: development of a shortened version for use in adults with acquired brain injury

Abstract Objective: The Awareness of Social Inference Test (TASIT) is an ecologically valid test of complex social perception. Despite its utility for detecting social perception deficits in clinical groups, its lengthy administration time has limited its routine use in clinical practice. This paper describes the development and validation of a shortened version of the TASIT (TASIT-S) in 160 individuals (males = 129) with moderate to severe acquired brain injury (ABI). Method: Both Rasch and confirmatory factor analysis modeling were used to create the TASIT-S, which, consistent with the original test, included the following subtests: (1) Emotion Evaluation Test (10 items), assessing basic emotion recognition; (2) Social Inference (Minimal) Test (9 items), assessing understanding of sincere and sarcastic exchanges; and (3) Social Inference (Enriched) Test (9 items), assessing comprehension of lies and sarcasm. Results: The TASIT-S demonstrated excellent construct validity as evidenced by its high correlations with the original TASIT and correlations with social cognition and cognitive neuropsychological measures. Importantly, the TASIT-S also successfully differentiated between ABI participants and healthy controls (n = 43). Conclusions: The new shortened version of the TASIT is a promising new tool with excellent psychometric properties that can assist clinicians with the detection of complex social perception deficits in ABI.

Outcome instruments in moderate-to-severe adult traumatic brain injury: recommendations for use in psychosocial research

ABSTRACT Background: Traumatic brain injury (TBI) can reduce psychosocial functioning, causing relationship, family, and employment difficulties. The present study by Moving Ahead: Centre for Research Excellence (CRE) in Brain Recovery aimed to identify a set of adult outcome instruments for moderate-to-severe TBI psychosocial research. Procedure: A review of 115 instruments (identified through nomination, literature search, and international expert opinion) was conducted over a 15-month period. Eleven psychosocial areas were examined: Global Outcome, Communication, Social Cognition, Behavioural and Executive Function, Other Neuropsychological Functioning, Psychological Status, TBI-related Symptoms, Activities and Participation, Support and Relationships, Sense of Self, and Health-related Quality of Life. Individual instruments were considered against selection guidelines, and specific measures that best met the guidelines were identified as core (common across all studies), supplemental (dependent on study type) or emerging. Results: The final recommendations, organised in accordance with the World Health Organisation’s International Classification of Functioning taxonomy, comprised 56 instruments for use in early recovery, outcome, and intervention studies. Conclusion: These recommendations provide a coherent framework along with identified outcome instruments to guide psychosocial research in moderate-to-severe TBI. Adherence to the recommendations will enable data-pooling and comparison across studies and research settings facilitating consistent measurement across the lifespan.

The Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ): development of a shortened scale

Abstract Background: The Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ) is a recently developed, internally consistent and valid 50-item measure of self-reported workplace difficulties in pwMS. Objective: In this study, the second-order factor structure of the MSWDQ was assessed, with the aim of developing a short version of the scale. Methods: Cross-sectional MSWDQ data were obtained along with employment and MS disease information, in a community-based sample of 189 pwMS. Final items for the shortened version were selected to ensure both item breadth and adequacy of psychometric properties. Results: Confirmatory Factor Analysis on the 12 MSWDQ factors yielded a model comprised of three second-order factors termed physical barriers, psychological/cognitive barriers and external barriers, which formed the basis of the shorter 23-item scale, the MSWDQ-23. The MSWDQ-23 showed excellent subscale internal consistencies. It explained 29% of the variance in reduced work hours since diagnosis, 22% of the variance in expectations of withdrawing from work, 24% of the variance in expectations of reduced work hours and 32% of the variance in expectations of changing type of work due to MS. Conclusion: The MSWDQ-23 is a brief valid and internally consistent measure of workplace difficulties that can predict both employment outcomes and expectations in pwMS. It is an especially useful tool for clinicians who wish to quickly obtain an indication of the extent of psychological/cognitive, physical and/or external difficulties experienced by individual pwMS in the workplace. Implications for Rehabilitation The MSWDQ-23 is a shortened self-report survey that examines work difficulties in people with MS across three broad domains: psychological/cognitive barriers, physical barriers and external barriers. The MSWDQ-23 is a valid and reliable measure that is capable of predicting various employment outcomes and expectations.

Spanish validation of a specific measure to assess work-related problems in people with multiple sclerosis: The Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ-23)

INTRODUCTION Unemployment is a significant problem for people with multiple sclerosis (MS). The MS Work Difficulties Questionnaire (MSWDQ-23) is a self-report tool to assess work-related problems in people with MS across three domains: physical, psychological/cognitive, and external barriers. The aim of this study was to assess the psychometric properties of the Spanish version of the MSWDQ-23. METHODS A multicentre, non-interventional, cross-sectional study in adult patients with relapsing-remitting multiple sclerosis (RRMS) or primary progressive (PPMS) multiple sclerosis (McDonald 2010 criteria) was conducted. Socio-demographic and clinical characteristics as well as health-related quality of life using the 29-item Multiple Sclerosis Impact Scale (MSIS-29) were collected. RESULTS A total of 201 subjects were studied (mean age: 43.9 years, 60% female, 86% with RRMS). Median Expanded Disability Status Scale (EDSS) (score: 2.0 [IQR: 1.0-3.5]). The employment rate was 47.3% (n = 95). The MSWDQ-23 was feasible (90% response rate), with high internal consistency and test-retest reliability (Cronbachs alpha = 0.94 and intraclass correlation coefficient-ICC > 0.87). MSWDQ-23 scores significantly and positively correlated with EDSS and both MSIS-29 physical and psychological subscales scores, showing an adequate convergent validity. Regarding construct validity, scores of patients with PPMS were higher than those of patients with RRMS, reaching statistically significance in MSWDQ-23 physical barriers domain and total scores. CONCLUSION The Spanish version of the MSWDQ-23 shows appropriate feasibility, reliability, and discriminative performance as a patient-reported outcome. MSWDQ-23 may be a valuable addition to measure the impact of a comprehensive spectrum of difficulties experienced by people with MS in the workplace.