Catherine A. Mateer

Analysis of assets for virtual reality applications in neuropsychology

Abstract Virtual reality (VR) technology offers new opportunities for the development of innovative neuropsychological assessment and rehabilitation tools. VR-based testing and training scenarios that would be difficult, if not impossible, to deliver using conventional neuropsychological methods are now being developed that take advantage of the assets available with VR technology. If empirical studies continue to demonstrate effectiveness, virtual environment applications could provide new options for targeting cognitive and functional impairments due to traumatic brain injury, neurological disorders, and learning disabilities. This article focuses on specifying the assets that are available with VR for neuropsychological applications along with discussion of current VR-based research that serves to illustrate each asset. VR allows for the precise presentation and control of dynamic multi-sensory 3D stimulus environments, as well as providing advanced methods for recording behavioural responses. This serves as the basis for a diverse set of VR assets for neuropsychological approaches that are detailed in this article. We take the position that when combining these assets within the context of functionally relevant, ecologically valid virtual environments, fundamental advancements can emerge in how human cognition and functional behaviour is assessed and rehabilitated.

Self-awareness after traumatic brain injury: A comparison of measures and their relationship to executive functions

Poor awareness of deficit is common after brain injury. Recent literature has examined various tools for measurement of this phenomenon; the most widely used being self-other rating scales. Although self-other scale measures have face validity, their criterion-related validity has not been adequately demonstrated, and there is little information as to whether and how they relate to other neuropsychological measures. The present study compared measurement of awareness by the Dysexecutive (DEX) Questionnaire self-other rating scale with the Self-Awareness of Deficits Interview (SADI), a semistructured interview measure. Evaluation of awareness by these measures was compared to tests of executive functioning and IQ. Results indicated significant, albeit marginal relationships between the two measures, and better correlation of the SADI with measures of frontal lobe functioning. The SADI also predicted injury severity.

Utilization Behavior: Clinical Manifestations and Neurological Mechanisms

This paper describes a variety of motor release phenomena, including manual grasping and groping, imitation behavior, utilization behavior, and alien hand sign, their clinical manifestations, and proposed neural mechanisms. One of these specific neurobehavioral disorders, initially described by Lhermitte (Brain [1983] 106: 237–255), and termed utilization behavior, is addressed in more detail. Patients with this disorder are described as reaching out and using objects in the environment in an automatic manner. The current paper provides a comprehensive review of studies that have documented utilization behavior in individuals with a variety of pathologies, all having a specific predilection for the frontal lobes and frontal-striatal systems. Goldbergs (Behavioral and Brain Sciences [1985] 8: 567–616) theoretical framework for understanding motor release phenomena, which conceptualizes these behaviors as resulting from an imbalance between proposed medial (voluntary, goal directed, and future directed) and lateral (automatic, stimulus bound, and visually based) motor systems, is also discussed. Utilization behavior may prove to be a common underlying cause of high levels of excessive and intrusive motor behaviors within various clinical populations. A more comprehensive understanding of the neural systems underlying utilization behavior may prove highly useful for the differential diagnosis of conditions involving the mesial frontal cortex and fronto-striatal connections. Recent studies have started to investigate utilization behavior in clinical populations with known or suspected frontal system dysfunction, including adult patients with a variety of psychiatric conditions and children with ADHD.

Management of Attention and Memory Disorders Following Traumatic Brain Injury

Disorders of attention, memory, and executive function are common sequelae in children who have sustained traumatic brain injuries. Given the persistent nature of these deficits, there is a need for efficacious remedial approaches. Typically, remediation is approached through one of three general intervention strategies: externally focused interventions aimed at changing the environment so that the effect of the dysfunction is minimized, internally focused interventions aimed at improving the underlying cognitive ability, and compensatory interventions aimed at teaching children to use alternate strategies that lessen the impact of the dysfunction. This article describes current research involving these approaches for the treatment of attention and memory disorders in children.

Improving Attention and Managing Attentional Problems

Abstract: Research and clinical experience in the field of brain injury rehabilitation have focused quite extensively on the need and potential to retrain attentional skills that are commonly affected by acquired brain injury. Four approaches to managing attention impairments that have emerged from this literature include attention process training, training use of strategies and environmental support, training use of external aids, and the provision of psychosocial support. Most often, several of these will be used in combination. For example, a therapy regimen might include attention process training emphasizing specific components of attention (e.g., sustained attention), in conjunction with training in pacing techniques, and psychosocial support, where the client keeps behavioral logs and discusses insights gained from tracking attention successes and attention lapses. Although there are as yet little data with regard to the effectiveness of these approaches in adults with developmental disorders of attention, there is a growing literature suggesting they may be effective in children and adolescents with ADHD. Further investigation of the application of such techniques in adults with a wide variety of attention disorders, including developmental disorders, would be valuable.

A review of the stereotype threat literature and its application in a neurological population

Stereotype threat is a situational phenomenon, leading to test performance decrements, in which a member of a stigmatized group feels pressured by the possibility of confirming or being judged by a negative stereotype. This review article highlights the progression of research in the stereotype threat field, and its relevance to neurological populations. Early studies focused on demonstrating this effect in African American, women, and elderly populations. Since this time, research has continued to focus on these populations but has moved to elucidating stereotype threat’s mediating psychological factors, studying the impact of individual differences in response to stereotype threat, and attempting to reduce its overall effect. A proposal for further study in neurological populations, under the framework of stereotype threat, comprises the last portion of the paper. It is argued that this social psychological phenomenon may, at least in part, account for poor neuropsychological test performance for neurologically compromised individuals.

The effectiveness of constraint induced movement therapy in two young children with hemiplegia

Constraint induced movement therapy (CIMT) for hemiplegia involves constraining use of the unaffected limb while providing intensive shaping and practice of movements in the hemiplegic limb. The technique had been shown to be highly effective in improving upper limb function in adults following stroke, but there is only a limited literature on the use of this intervention in children. This paper provides a brief overview of the theory and background of this procedure, and reviews the literature on use of the technique in children. It then provides detailed case reports for two hemiplegic children, ages 19 and 38 months, each of whom underwent a trial of CIMT. Both children made significant gains in upper arm function that were reflected in a variety of domains, including aspects of everyday functional limb use. Gains persisted to variable degrees and some unexpected new gains were noted following cessation of CIMT. Practical challenges for the children, parents, and therapists in implementing this intensive but promising intervention are also discussed.

Sexually intrusive behaviour following brain injury: approaches to assessment and rehabilitation.

Sexually intrusive behaviour, which may range from inappropriate commentary to rape, is often observed following a traumatic brain injury. It may represent novel behaviour patterns or an exacerbation of pre-injury personality traits, attitudes, and tendencies. Sexually intrusive behaviour poses a risk to staff and residents of residential facilities and to the community at large, and the development of a sound assessment and treatment plan for sexually intrusive behaviour is therefore very important. A comprehensive evaluation is best served by drawing on the fields of neuropsychology, forensic psychology, and cognitive rehabilitation. The paper discusses the types of brain damage that commonly lead to sexually intrusive behaviour, provides guidance for its assessment, and presents a three-stage treatment model. The importance of a multidisciplinary approach to both assessment and treatment is emphasized. Finally, a case example is provided to illustrate the problem and the possibilities for successful management.

Victoria Symptom Validity Test Scores of Patients with Profound Memory Impairment: NonLitigant Case Studies

Victoria Symptom Validity Test (VSVT) scores from six nonlitigants with neurological illness accompanied by dense anterograde amnesia or severe memory impairment are presented. All of these patients obtained perfect or near perfect scores on the VSVT. These data add to the literature suggesting that the VSVT is insensitive to genuine neurologically-based memory impairment and provide an additional floor-level clinical benchmark against which to compare the performance of litigants.

The Effect of Reinforcement Variables on Inhibition in Children with ADHD

Behavioral inhibition, often cited as a central deficit in children with ADHD, has been shown to change in response to reinforcement. In this preliminary investigation, children with ADHD (n= 20) and matched controls (ages 7 to 12) completed a new version of the stop signal paradigm, the Fire Fighter Game, a measure of inhibition of a prepotent motor response, under three conditions: (1) no reinforcement; (2) immediate reinforcement; and (3) delayed reinforcement. In all conditions, the stop signal reaction time (SSRT) of children with ADHD was consistently longer than controls. Both groups improved significantly with reinforcement, and there was no strong evidence that immediate reinforcement was more effective than delayed reinforcement. However, it appeared that the reason for the changes in SSRT in response to reinforcement differed between the groups. Children in the control group responded faster on go trials, whereas children with ADHD improved their ability to inhibit responding with shorter stop delays. The relevance of these findings is discussed in terms of current theories of ADHD.