Jessica Fish

Compensatory strategies for acquired disorders of memory and planning: differential effects of a paging system for patients with brain injury of traumatic versus cerebrovascular aetiology

Background: Previous studies have demonstrated the effectiveness of paging systems in compensating for everyday memory and planning problems after brain injury, including in individuals with traumatic brain injury (TBI). Methods: Here, in addition to further analyses of the TBI data from a previous randomised control crossover trial, results are reported from a sub-group of 36 participants with brain injury from cerebrovascular accident (CVA). Results: Results indicate that, as with the TBI group, the pager was effective. However, the pattern of results following cessation of treatment differed. At a group level, TBI participants demonstrated maintenance of pager-related benefits, whereas CVA participants’ performance returned to baseline levels. Comparisons of demographic and neuropsychological characteristics of the groups showed that the CVA group was older, had a shorter interval post-injury, and had poorer executive function than the TBI group. Furthermore, within the TBI group, maintenance was associated with executive functioning, such that executive dysfunction impeded maintenance. This correlation remained after controlling for demographic differences between groups. Conclusions: Together, these findings suggest that executive dysfunction may affect treatment—for example, whether or not temporary use of the pager is sufficient to establish a subsequently self-sustaining routine.

The assessment and rehabilitation of prospective memory problems in people with neurological disorders: A review

People with neurological disorders often report difficulty with prospective memory (PM), that is, remembering to do things they had intended to do. This paper briefly reviews the literature regarding the neuropsychology of PM function, concluding that from the clinical perspective, PM is best considered in terms of its separable but interacting mnemonic and executive components. Next, the strengths and limitations in the current clinical assessment of PM, including the assessment of component processes, desktop analogues of PM tasks, and naturalistic PM tasks, are outlined. The evidence base for the rehabilitation of PM is then considered, focusing on retraining PM, using retrospective memory strategies, problem-solving training, and finally, electronic memory aids. It is proposed that further research should focus on establishing the predictive validity of PM assessment, and refining promising rehabilitation techniques.

Assessment of Unilateral Spatial Neglect: Scoring Star Cancellation Performance From Video Recordings―Method, Reliability, Benefits, and Normative Data

Unilateral spatial neglect, a debilitating condition affecting awareness of one side of space, is commonly assessed using cancellation tasks in which patients cross out targets distributed over a sheet. Standard scores emphasize the left-right distribution of omissions. Here, the additional value of extracting temporal as well as spatial aspects of performance from video recordings was examined. Videos from 18 patients with left neglect and 19 healthy age-matched control participants were obtained. Interrater reliability of the video analysis was high. In addition to overall differences in target detection and bias, patients significantly differed from the control group in terms of the location of first cancellation, overall slowness, greater variability in speed, systematic slowing with time on task and as a function of target location, less coherent search organization, and a sharply increased tendency to recancel targets. Considering a subset of patients whose scores, by standard criteria, were at or near the normal range indicated that these additional variables indeed increased the sensitivity of the task as well as allowed the simultaneous assessment of spatial and nonspatial aspects of the disorder.

Alleviation of carer strain during the use of the NeuroPage device by people with acquired brain injury

Background: Previous studies have demonstrated the efficacy of a paging system, NeuroPage (Cambridgeshire Primary Care Trust Corporation, Fulbourn, Cambridgeshire, UK), in compensating for memory and planning dysfunctions in people with acquired brain injury (ABI; mainly stroke or traumatic brain injury). In this study, the degree to which this efficacy is accompanied by a reduced experience of strain among carers of patients with ABI was investigated. Methods: Carers of 99 people with ABI completed a questionnaire concerning strain resulting from caring for the injured individual. The questionnaire was completed at the following three time points: before the use of NeuroPage, at the end of a 7-week period of use, and, for one subgroup, a further 7 weeks after withdrawal of NeuroPage. Results: There were significant reductions in strain reported by carers following the 7-week period of NeuroPage use (Cohen’s d = 0.3–0.4). This finding persisted when the carer was a spouse or a parent. The reduced strain among carers continued even after withdrawal of NeuroPage. Conclusion: The efficacy of the NeuroPage paging system for people with ABI appears to result in reduced strain for their carers.

The NeuroPage system for children and adolescents with neurological deficits

Objective: Several studies have demonstrated the effectiveness of a paging system, NeuroPage, in helping survivors of brain injury compensate for everyday memory and planning problems. This study examines the effectiveness of the paging system in the sub-group of 12 children and adolescents with neurological deficits who took part in a larger study. Methods: Twelve participants aged 8–17 years took part in a randomized controlled crossover trial in which their completion of everyday goals was monitored prior to and during use of the NeuroPage system, where participants were sent reminder messages regarding tasks they should complete. Results: All 12 young people showed significant improvements in carrying out everyday tasks between the baseline and treatment phases. Conclusions: The NeuroPage system can be successfully used by children and adolescents with neurological deficits and can alleviate some of the everyday difficulties caused by their memory and planning difficulties.

Long-term compensatory treatment of organizational deficits in a patient with bilateral frontal lobe damage.

Evans et al. (1998) described compensatory strategy use in R.P., a patient with executive dysfunction following bilateral frontal lobe damage who had difficulty acting upon her intentions. A pager was used to remind R.P. of regularly scheduled activities, along with a checklist that aimed to moderate a perseverative routine. Although successful, 10 years after the original intervention, the strategies were no longer used, and considerable everyday problems were evident. In the current study, we conducted a follow-up assessment to examine potential reasons for this deterioration. No change in neuropsychological functioning was evident. Whereas the previous study introduced the two strategies together, and examined effects upon separate goals, in the current study we reintroduced the two strategies separately, and examined effects on three common goals. In addition to prompting specific activities, we aimed to support completion of more general goals (those that could be enacted within a wider window of time). The paging intervention had a dramatic effect on all three measured behaviors, at a much more consistent level than the checklist. We suggest that, in addition to direct reminders, the pager can cue a process of goal monitoring that bridges the gap between intention and action.

Errorless learning of prospective memory tasks: An experimental investigation in people with memory disorders

The term prospective memory (PM) refers to memory for future intentions. PM problems are frequent in people with cognitive impairment and, because they are central to the realisation of many everyday goals, are important in rehabilitation. Event-based PM tasks (EBPM) are environmentally-cued and have primarily mnemonic demands, whereas time-based PM tasks (TBPM) require self-initiated retrieval, and have greater executive demands. Errorless learning (EL) is an encoding method that results in superior retrospective memory compared with “errorful” learning (EF). As this EL advantage (ELA) likely stems from its reduced explicit memory demands, and there is no such advantage for executive tasks, a greater ELA for EBPM than TBPM was predicted. Fourteen adults with neurological memory impairment completed PM tasks under four counterbalanced conditions: EL of EBPM, EL of TBPM, EF of EBPM, and EF of TBPM. A significant ELA was observed for EBPM (d = .63), but not TBPM (d = –.01). These results extend the evidence for EL within cognitive rehabilitation, by showing for the first time that the method can benefit future action in addition to retrospective memory. The clinical implications are also clear: errorless learning techniques may be usefully employed to support completion of day-to-day EBPM tasks.

A case study of Locked-In-Syndrome: Psychological and personal perspectives

Objectives: Although patients with Locked-In-Syndrome (LIS) are often stated to have normal cognitive functioning, the few reports of neuropsychological assessment in these cases suggest this is not always true. This paper (a) reviews published reports of neuropsychological assessments of LIS patients, (b) presents a detailed neuropsychological assessment of a patient to determine if she has normal cognitive functioning and (c) presents the views of the patient on what has happened to her. Methods and procedures: An in-depth single case report assessing the cognitive and emotional functioning of a young woman with LIS plus a personal account from the patient. Detailed assessments were carried out using standardized neuropsychological tests and questionnaires measuring emotional functioning, pain and quality-of-life. The patient also states her views of what happened and how she feels. Results: On most tests, cognitive functioning was average or above, but some impairments were found (consistent with published literature). No emotional problems were detected. Quality of life was satisfactory. Pain perception was normal. Conclusions: Although LIS patients have no severe cognitive deficits, some cognitive difficulties are common. Despite severe physical and communication problems and some mild cognitive deficits on visual reasoning tasks, this patient feels she has a reasonable quality-of-life.

Unconscious priming of task-switching generalizes to an untrained task.

Evidence suggests that subliminal stimuli can influence ostensibly volitional, executive processes but it is unclear whether this is highly task-specific. To address this we used a set-switching task. Volunteers saw a word pair and reported either if both words had the same number of syllables or if both were concrete. Task selection was random and instructed by a hexagon/triangle preceding the words. A subliminally-presented square or diamond reliably preceded each of these consciously perceived instruction-shapes. Significant congruency effects were observed in a subsequent Test Phase in which primes no longer reliably predicted the task (and in which high/low tones now served as conscious instructions). The Generalization Phase required novel phonological (rhyme) or semantic (category) judgments. Remarkably, unconscious priming congruency effects carried over in those participants who had shown priming in the Test Phase, the degree correlating across the two conditions. In a final phase of the study, participants were asked to discriminate between the two originally presented prime shapes. Those participants whose discriminations were more accurate showed reduced priming relative to participants with less accurate discriminations. The results suggest that, rather than being highly task specific, priming can operate at the level of a generalizable process and that greater awareness of primes may lessen their impact on behavior.

The Cognitive Remediation in Bipolar (CRiB) pilot study: study protocol for a randomised controlled trial

BackgroundPeople with bipolar disorder often show difficulties with cognitive functioning, and though these difficulties are identified as important targets for intervention, few treatment options are available. Preliminary evidence suggests that cognitive remediation therapy (a psychological treatment proven beneficial for people diagnosed as having schizophrenia) is helpful for people with bipolar disorders. We are conducting a pilot trial to determine whether individual, computerised, cognitive remediation therapy (CRT) for people with bipolar disorder 1) increases cognitive function; 2) improves global functioning, goal attainment and mood symptoms; 3) is acceptable and feasible for participants; and 4) can be addressed in a comprehensive, larger, randomised, controlled trial.Methods/designThe study is designed as a two-arm, randomised, controlled trial comparing cognitive remediation therapy with treatment-as-usual (TAU) for euthymic bipolar patients. Participants are eligible to take part if aged between 18 and 65 with a diagnosis of bipolar disorder (type I) and currently in euthymic state, and no neurological, substance or personality disorder diagnoses. Sixty participants will be recruited (mainly through secondary and tertiary care) and will be block-randomised to receive either treatment-as-usual alone or in addition to a 12-week course of cognitive remediation therapy totalling 20–40 therapy hours. The intervention will comprise regular sessions with a therapist and computer-based training. Research assessments will take place before and after the intervention period and at a 12-week follow-up, and will include evaluation of neuropsychological, symptom-related, demographic and social factors, as well as collecting qualitative data regarding CRT expectations and satisfaction. Intention-to-treat analyses will examine the efficacy of cognitive remediation therapy primarily on cognition and additionally on functioning, quality of life and mood symptoms. Furthermore, we will examine the acceptability of CRT and undertake a preliminary health economics analysis to ascertain the cost of delivering the intervention.DiscussionThe results of this trial will provide valuable information about whether cognitive remediation therapy may be beneficial for people diagnosed with bipolar disorder in a euthymic state.Trial RegistrationISRCTN registry, ISRCTN32290525. Registered on 2 March 2016