Leonard Diller

Group treatment of problem‐solving deficits in outpatients with traumatic brain injury: A randomised outcome study

Sixty higher‐level outpatients with traumatic brain injury (TBI), all at least 1 year post‐injury, were randomly assigned to either conventional group neuropsychological rehabilitation or an innovative group treatment focused on the treatment of problem‐solving deficits. Incorporating strategies for addressing underlying emotional self‐regulation and logical thinking/reasoning deficits, the innovative treatment is unique in its attention to both motivational, attitudinal, and affective processes and problem‐solving skills in persons with TBI. Participants in the innovative group improved in problem solving as assessed using a variety of measures, including (1) executive function, (2) problem‐solving self‐appraisal, (3) self‐appraised emotional self‐regulation and clear thinking, and (4) objective observer ratings of roleplayed scenarios. These improvements were maintained at follow‐up. Baseline performance on timed attention tasks was related to improvement; individuals who processed the most slowly benefited the most. These participants did not show improvements on timed attention tasks, but did improve on problem‐solving measures. Such findings are consistent with successful compensatory strategy use—the person may still have deficits and symptoms, but now has effective strategies for reducing their impact on daily functioning.

Parameters of emotional processing in neuropsychiatric disorders: conceptual issues and a battery of tests.

Components of emotional processing were examined in psychiatric and neurological populations: communication channel (face/voice), processing mode (expression/perception), and emotional valence (positive/negative). These were assessed with an experimental affect battery which was administered to schizophrenic, unipolar depressive, right-brain-damaged, Parkinsons disease, and normal control right-handed adults. For expression, subjects were taped while producing facial and vocal emotional expressions. Judges rated the expressions for accuracy and intensity. For perception, subjects were asked to identify and discriminate facial and vocal emotions. Using correlational techniques, relationships between facial and vocal channels and between expressive and perceptual modes were explored. The test battery has good psychometric properties and discriminates among diagnostic groups.

A preliminary comparison of flat affect schizophrenics and brain-damaged patients on meausres of affective processing☆

Flat affect is a major component of schizophrenia and is often also seen in neurological disorders. A preliminary set of comparisons were conducted to delineate neuropsychological mechanisms underlying flat affect in schizophrenia, and new measures are described for the assessment of affective deficits in clinical populations. Subjects were schizophrenic with flat affect (SZs), right brain-damaged (RBD), Parkinsons Disease (PDs), and normal control (NC) right-handed adults. Subjects were administered affective measures of expression and perception in both facial and vocal channels. For both perceptual and expressive tasks the SZs performed significantly less accurately than the NCs and the PDs but did not differ from the RBDs. This was the case for both face and voice. This finding lends support to the speculation that right hemisphere mechanisms, especially cortical ones, may be compromised among schizophrenics with flat affect.

Traumatic brain injury: A hidden consequence for battered women

The inability of substantial numbers of battered women to terminate or extricate themselves from violent relationships is of grave concern to clinical practitioners. Despite professional intervention, many victims of domestic violence return to the batterer and to repetitive battering, demonstrating that, for these women, traditional psychosocial interventions are ineffective. In a sample of 53 battered women, 92% reported having received blows to the head in the course of their battering; 40% reported loss of consciousness. Correlations between frequency of being hit in the head and severity of cognitive symptoms were significant, strongly suggesting that battered women should be routinely screened for traumatic brain injury and postconcussive syndrome. Development of treatment strategies to address the potentially damaging sequelae of head trauma in this population is essential. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Psychosocial aspects of living with cancer: a review of the literature.

Up until several years ago, little systematic effort was directed at developing an empirically based understanding of issues pertinent to psychosocial aspects of living with cancer. Recently, however, increased interest has been focused on this topic. This manuscript reviews over 100 articles, papers, and books written between 1960 and 1980 on the psychosocial impact of cancer on the adult patient and on methods of psychosocial treatment providing a “state of the art” appraisal of the area. A methodological critique of the research studies is provided as well.

Exploratory eye movements and visual Hemi-Neglect

The severity of visual hemineglect (VHN), as defined by a VHN Index from scores obtained on letter cancellation and visual matching tests, was compared to eye movement behavior during a visual searching task in a group of right-hemisphere stroke patients and a group of age-matched normal controls. A strong negative correlation was obtained between the VHN Index and eye movement Exploration Time of the left visuospatial field for the stroke patients, but not for the control subjects. Further analyses failed to discriminate Exploration Time performance of stroke patients with mild VHN from the performance of control subjects, but did discriminate stroke patients with marked VHN from each of these two groups. Covarying for the presence of a left-visual-field sensory defect slightly reduced the significance level of this finding. The results and questions raised by this study are discussed in the context of developing an operational definition for VHN using the method of directly monitoring eye movement.

Treating perceptual organization deficits in nonneglecting RBD stroke patients

Thirty-five right brain-damaged (RBD) stroke patients, enrolled in active rehabilitation programs, participated in this study. Patients were selected on the basis of their evidenced deficits in performing complex visuo-cognitive tasks and the absence of overt evidence of unilateral visual-spatial neglect. Seventeen of the 35 patients were randomly chosen to receive a training program (lasting approximately 1 month) designed to establish a systematic strategy of organizing complex visual material. The remaining 18 patients were re-examined after 1 month, and served as controls. The design of the treatment program was based on the hypothesis that nonneglected RBD patients fail to appreciate and synthesize elements of complex visual material due to a breakdown in compensation for a persistent lateral bias in visual-spatial attention. Upon posttesting, it was found that those patients who received training exhibited significantly improved performance, as compared to controls, on a subgroup of visuo-cognitive tasks. These results are discussed in terms of: (1) offering indirect support for the argument that pathological asymmetries in attention play a significant role in the failure of RBD patients on many visuo-cognitive tasks; and, (2) offering a basis for extending the treatment of perceptual problems in RBD patients.

The relationship between, impersistence, intellectual function and outcome of rehabilitation in patients with left hemiplegia

MOTOR IMPERSISTENCE has received some attention in recent years by Fisher,’ who coined the term, and Berlin,2 who described it in detail. It has been demonstrated that failure in motor persistence is characteristic of many patients with brain damage but occurs with only rare frequency in normal children3 and adult^.^ Recent studies”7 showing the physiological and psychological consequences of enriched oxygenation in left hemiplegia have stimulated further interest in the phenomenon if impersistence. Ben-Yishay and associates8 have shown that the inhalation of supplemental oxygen has reduced motor impersistence in 95% of a sample of patients with left hemiplegia. Because motor impersistence appears to have important clinical and theoretical implications for neuropsychology, a number of issues merit further exploration. Chief among these are the following problems: [ 13 Do the various tests for impersistence tap the same underlying disabilities, that is, does failure to sustain some voluntary motor acts constitute a syndrome? 1.21 Is impersistence a reflection of intellectual or sensory motor dysfunction or both commonly observed in individuals with brain damage, or does it exist also as an independent entity? [3] What is the relationship between impersistence and attainment of functional competence in rehabilitation parameters such as ambulation, self-care, or length of stay in the rehabilitation center? While most of the earlier investigators im-

Clinical applications of problem-solving research in neuropsychological rehabilitation: addressing the subjective experience of cognitive deficits in outpatients with acquired brain injury.

OBJECTIVE The goal of this paper is to illustrate how the lessons learned in over 20 years of randomized clinical trials have advanced cognitive rehabilitation beyond traditional approaches to problem solving by more explicitly integrating subjective self-appraisal factors in routine clinical practice. RESULTS The concept of problem orientation, as proposed by cognitive-behavioral psychologists, provides a much-needed framework for conceptualizing interventions to address the impact of subjective experience on cognitive functioning, within the context of cognitive remediation. By explicitly focusing on the beliefs, assumptions, and expectations that individuals with acquired brain injury have about their own cognitive functioning, the concept of problem orientation allows rehabilitation psychologists to add an element to interventions, not systematically addressed in standard approaches to cognitive remediation. Targeting objective deficits in cognitive remediation is necessary, but not sufficient: For optimal benefit, remedial interventions must address objective cognitive deficits and the patients subjective experience of such deficits in tandem. CONCLUSION Contemporary evidence-based treatment recommendations now typically include incorporating interventions to address motivational, attitudinal, and affective factors in cognitive remediation. Further research is needed to directly compare the effectiveness of cognitive rehabilitative interventions that systematically address subjective factors with those that do not.

Measurement of problem-solving deficits in adults with acquired brain damage.

Objective: To compare the relative utility of conventional neuropsychological and social problem-solving approaches to measuring functional problem solving deficits in individuals with acquired brain damage (ABD). Design: In Study I, scores for individuals with ABD were compared to scores for control and normative samples. In Study II, pre- and posttest scores were compared for individuals with ABD who completed a program of outpatient cognitive rehabilitation. Participants: In Study I, individuals with ABD were compared to healthy controls. In Study II, pre- and posttreatment assessments were obtained for 34 individuals with ABD. Main Outcome Measures: Two approaches were used, conventional neuropsychological (WAIS-R/II Comprehension subtest and Wisconsin Card Sorting Test) and social problem solving (Problem Solving Inventory and Rusk Problem Solving Role Play Test). Results: In Study I, the ABD group demonstrated significant deficits on both social problem solving measures; however, neither conventional neuropsychological measure detected significant deficits in the ABD group, relative to control and normative groups. In Study II, significant treatment gains were demonstrated on both social problem-solving measures, however neither conventional neuropsychological measure was sensitive to improvements in functional problem-solving ability. Conclusions: In higher-level cognitive rehabilitation settings, the evaluation of functional problem-solving deficits in individuals with ABD can be facilitated by augmenting neuropsychological test data with results from social problem-solving measures.