Ken McFarland

Construct validity of eight tests of attention: Comparison of normal and closed head injured samples

Abstract Attentional problems are common symptoms of brain impairment and are generally assessed by a number of psychological tests. However, clinicians do not always agree on the processes measured by these tests and validation of the tests is often inadequate. The present study used factor-analytic techniques to examine the construct validity of eight attention tests (Letter Cancellation, Serial Subtraction, Digit Span, Digit Symbol, Stroop Colour-Word, Trail Making, Symbol Digit Modality, and Knox Cube). These tests were administered to 125 university controls, 45 normal controls from the community, and 37 closed-head-injured patients. Each of the 13 measures from the eight tests were found to load on one of three components/factors (identified as visuo-motor scanning, sustained selective processing, and visual/auditory spanning) for the normal as well as the patient group. Comparison of the mean performances of the patients and their matched controls suggested that: (a) severe short-term patients were...

Self-awareness and psychosocial functioning following acquired brain injury: An evaluation of a group support programme

This study investigated a group support programme designed to improve selfawareness deficits and psychosocial functioning in a group of chronic patients (N = 21) with acquired brain injury (ABI). The participants were on average 8.6 years (range: 1-36 years) post-injury and were seen at the Brain Injury Association of Queensland, Australia. The assessment of participants involved two standardised measures of intellectual self-awareness with collateral reports from relatives. The present study introduced a new measure called the Self-Regulation Skills Interview (SRSI) which assessed higher levels of self awareness and self-regulation skills. Psychosocial functioning was assessed using a standardised self-report measure. At baseline the group had a relatively high level of intellectual self-awareness regarding their deficits, a low to moderate level of self-regulation skills, and significant psychosocial impairment. The participants were involved in a 16-week group programme which involved components of cognitive rehabilitation, cognitive-behavioural therapy, and social skills training. A post-intervention assessment indicated that participants had significantly improved levels of self-regulation skills and psychosocial functioning. A 6-month follow-up assessment indicated that overall, participants had maintained the gains made during the programme. The important role of self-regulation skills is emphasised as the principle factor contributing to the maintenance of the gains observed.

The investigation of factors underlying deficits in self-awareness and self-regulation

Primary objective : To examine a theoretical model which suggests that a contribution of both psychological and neuropsychological factors underlie deficits in self-awareness and self-regulation. Research design : Multivariate design including correlations and analysis of variance (ANOVA). Methods : Sixty-one subjects with acquired brain injury (ABI) were administered standardized measures of self-awareness and self-regulation. Psychological factors included measures of coping-related denial, personality-related denial and personality change. Neuropsychological factors included an estimate of IQ and two measures of executive functioning that assess capacity for volition and purposive behaviour. Main outcomes and results : The findings indicated that the relative contribution of neuropsychological factors to an outcome of deficits in self-awareness and self-regulation had a more direct effect than psychological factors. In general, measures of executive functioning had a direct relationship, while measures of coping-related and personality-related denial had an indirect relationship with measures of self-awareness and self-regulation. Conclusion : The findings highlighted the importance of measuring both neuropsychological and psychological factors and demonstrated that the relative contribution of these variables varies according to different levels of self-awareness and self-regulation.

Cisplatin-based therapy: A neurological and neuropsychological review

The present paper reviews research in the area of the broad‐spectrum chemotherapeutic agent cisplatin (cis‐diamminedichloro‐platinum II) and examines the implications for clinical neuropsychology arising from the neurological disruption associated with cisplatin‐based therapy. The paper begins with a brief review of cisplatin treatment in terms other than survival alone, and examines the side‐effects and the potential central nervous system (CNS) dysfunction in terms of neurological symptoms and concomitant implications for neuropsychology. Two main implications for clinical neuropsychology arising from cisplatin therapy are identified. First, cisplatin therapy impacts upon the psychological well‐being of the patient, particularly during and in the months following treatment. It is suggested that during this time, a primary role for neuropsychology is to focus upon the monitoring and the active enhancement of the patients social, psychological and spiritual resources. Second, with regard to neurocognitive changes, the review suggests that (1) neurocognitive assessment may not yield stable results within 8 months following treatment and (2) while perceptual, memory, attentional and executive dysfunction may be predicted following cisplatin treatment, little systematic research has been carried out to investigate such a possibility. Future research might profitably address this issue and also specifically examine the effects of low dosage cisplatin‐based therapy and the effects of recently developed neuroprotective agents. Finally, there is some evidence to suggest that women may be more susceptible to neurotoxicity during cisplatin therapy, but no gender‐related cognitive effects are reported in the cisplatin literature. Future research could usefully investigate gender differences in association with cisplatin chemotherapy. Copyright

Stigma, seizure frequency and quality of life : The impact of epilepsy in late adulthood

Epilepsy is one of the most common neurological disorders of late adulthood, yet little research has examined the impact of epilepsy on the quality of life of older people. Current measures of health-related quality of life (HRQOL) have been developed and used almost exclusively in adults under the age of 65. The issues, which affect HRQOL in younger adults, may differ from those which affect older adults who may have age-related physical limitations and multiple co-morbidities. This study sought to explore the HRQOL and psychosocial function of a community dwelling sample of 64 older adults with epilepsy compared with a similar, age-matched control group. An additional objective of the study was to examine the impact of perceived stigma and seizure frequency on HRQOL and psychosocial well-being. Results indicated that HRQOL and psychosocial functioning in the epilepsy group was significantly impaired relative to normal controls. A greater perception of stigma and more frequent seizures was also strongly related to poor quality of life and reduced psychosocial function. Although more than two thirds of the sample had seizure frequency of less than one per year, it was apparent that even infrequent seizures had the facility to impair HRQOL, suggesting that in older adults, the apprehension induced by even the possibility of a seizure may be sufficient to reduce HRQOL. The results have implications for the clinical management of epilepsy and suggest the need for further research in older populations.

Effects of closed-head injury on attentional processes: An information-processing stage analysis

The present study, based on Sternbergs (1969) additive-factor method, examined attentional processes in terms of four information-processing stages (feature extraction, identification, response selection, and motor adjustment). Four task variables were used to operationally define the stages (signal quality, signal similarity, signal-response compatibility, and foreperiod uncertainty). In two studies, a visuo-spatial reaction-time task was undertaken by a group of university subjects (Experiment 1) and by three groups of closed-head-injured patients (severe short-term, severe long-term, and mild short-term) and their corresponding matched controls (Experiment 2). The results indicated that both patients and normals exhibited a similar mode of linear information processing. In addition, it was found that the severe short-term group was impaired on the response-selection stage and response selection stage; the severe long-term group was impaired only on the response-selection; and no evidence of impairment was found for the mild short-term patients. The implications of these findings with reference to the study of attentional processes in closed-head injured patients and to neuropsychological assessment and rehabilitation are discussed.

Attentional deficits in head-injured children: An information processing analysis ☆

Attentional problems of closed head-injured (CHI) children were examined using an information processing (IP) approach. Based on Sternbergs (1969) additive factor method (AFM), the study examined attentional processes in terms of four stages and their corresponding task variables. A visual-spatial choice reaction-time task was undertaken with two groups of CHI children (severe and mild to moderate) and corresponding matched control groups. Results indicated that for this task both the CHI and the normal children exhibited a similar mode of linear, sequential information processing. It was found that the severe group was impaired not only in terms of slowed motor execution but also in terms of response selection. This group showed no impairment on the feature extraction, stimulus identification, and motor adjustment stages of processing. No evidence of impairment on any of the stages was found for the mild group. The utility of the AFM and implications of these findings are discussed with reference to CHI children and to neuropsychological assessment and rehabilitation.

Development and Standardization of the Self-Regulation Skills Interview (SRSI): A New Clinical Assessment Tool for Acquired Brain Injury*

The Self-regulation Skills Interview (SRSI) is a clinical tool designed to measure a range of metacognitive skills essential for rehabilitation planning, monitoring an individuals progress, and evaluating the outcome of treatment interventions. The results of the present study indicated that the SRSI has sound interrater reliability and test–retest reliability. A principle components analysis revealed three SRSI factors: Awareness, Readiness to Change, and Strategy Behavior. A comparison between a group of 61 participants with acquired brain injury (ABI) and a group of 43 non-brain-injured participants indicated that the participants with ABI had significantly lower levels of Awareness and Strategy Behavior, but that level of Readiness to Change was not significantly different between the two groups. The significant relationship observed between the SRSI factors and measures of neuropsychological functioning confirmed the concurrent validity of the scale and supports the value of the SRSI for post-acute assessment.

Imagery ability and the identification of hands: A chronometric analysis

In a replication of Cooper and Shepards (1975) study of hand recognition, it was found that individual differences in imagery ability had a significant influence on reaction times to such stimuli (Experiment 1). However, it was found (Experiment 2) that individual difference effects were only seen if prior instructions to use imagery were given to the subjects.

Cisplatin-based therapy: A neurological and neurophysical review

The present paper reviews research in the area of the broad-spectrum chemotherapeutic agent cisplatin (cis-diamminedichloro-platinum II) and examines the implications for clinical neuropsychology arising from the neurological disruption associated with cisplatin-based therapy. The paper begins with a brief review of cisplatin treatment in terms other than survival alone, and examines the side-effects and the potential central nervous system (CNS) dysfunction in terms of neurological symptoms and concomitant implications for neuropsychology. Two main implications for clinical neuropsychology arising from cisplatin therapy are identified. First, cisplatin therapy impacts upon the psychological well-being of the patient, particularly during and in the months following treatment. It is suggested that during this time, a primary role for neuropsychology is to focus upon the monitoring and the active enhancement of the patients social, psychological and spiritual resources. Second, with regard to neurocognitive changes, the review suggests that (1) neurocognitive assessment may not yield stable results within 8 months following treatment and (2) while perceptual, memory, attentional and executive dysfunction may be predicted following cisplatin treatment, little systematic research has been carried out to investigate such a possibility. Future research might profitably address this issue and also specifically examine the effects of low dosage cisplatin-based therapy and the effects of recently developed neuroprotective agents. Finally, there is some evidence to suggest that women may be more susceptible to neurotoxicity during cisplatin therapy, but no gender-related cognitive effects are reported in the cisplatin literature. Future research could usefully investigate gender differences in association with cisplatin chemotherapy.