Nigel V. Marsh

Neuropsychological aspects of multiple sclerosis.

Since S. Raos [“Neuropsychology of Multiple Sclerosis: A Critical Review,” A Journal of Clinical and Experimental Neuropsychology, Vol. 85, pp. 503–542] (1986) seminal review, considerable research has been undertaken on the neuropsychological consequences of multiple sclerosis. This review incorporates the research literature of the last decade in presenting an overview of the current state of our knowledge concerning the etiology, course, symptoms, assessment, consequences, and treatment of multiple sclerosis (MS). The concept of subcortical dementia is revisited in light of the most recent literature documenting the neuropsychological deficits in patients with MS. The view that cognitively heterogeneous patient groups may disguise more specific patterns of focal neuropsychological impairment is considered. A critical review of the recent literature is also presented, detailing the degree to which recent research has addressed the areas of research need identified by Rao in 1986. Given recent advances in our knowledge, the need for more attention to be directed toward the evaluation of rehabilitation and psychological intervention is highlighted.

Psychosocial functioning during the year following severe traumatic brain injury

The psychosocial functioning of a group of 65 adults with severe traumatic brain injury was assessed at 6 months and 1 year post-injury. Aspects of emotional, behavioural, and social functioning were investigated. The prevalence of depression remained constant (24%) over time, although there was some individual variation in the reporting of symptoms. Impatience was the most frequently reported behavioural problem at both assessments. Whilst there was a slight increase in the number of behavioural problems and level of distress reported over time, the most obvious change was in the type of behavioural problems that caused distress. At 1 year post-injury, problems with emotional control were found to be most distressing for the patients. A comparison with pre-morbid social functioning showed the loss of employment to be 70%, 30% returned to live with their parents, and relationship breakdown occurred for 38%. There was also a significant and ongoing decrease in all five aspects of social and leisure activities.

Caregiver burden at 6 months following severe traumatic brain injury

Sixty-nine primary caregivers of people with a severe traumatic brain injury (TBI) were assessed at 6 months post injury. Caregivers completed questionnaires on the physical, cognitive, emotional, behavioural, and social functioning of the persons with the TBI. Caregiver psychosocial functioning and levels of subjective and objective burden were also assessed. Clinically significant levels of anxiety, depression, and impairment in social adjustment were evident in over a third of the caregivers. The frequency with which various changes in the person with the TBI and types of objective burden were reported had little relationship to the degree of distress caused by these changes. The person with TBIs social isolation and negative emotional behaviours caused the greatest degree of stress for caregivers. Caregivers were also most distressed by the impact that caregiving had on their personal health and free time. The results from a multiple regression analysis suggest that it is the presence of behavioural problems in the person with the TBI that has the most severe and pervasive impact on all aspects of caregiver functioning. It is suggested that these findings be taken into account when providing rehabilitation services to people with TBI and their families.

Caregiver burden during the year following severe traumatic brain injury.

Fifty-two primary caregivers of people with a severe traumatic brain injury (TBI) were assessed at 6-months and 1-year postinjury. Caregiver appraisal of the person with TBIs physical, cognitive, emotional, behavioural, and social functioning was assessed. Caregiver psychosocial functioning and levels of subjective and objective burden were also assessed. Some aspects of the difficulties reported for the people with TBI remained stable, while others increased in frequency, over time. At 6-months postinjury, approximately one third of caregivers reported clinically significant symptoms of anxiety and depression, and poor social adjustment. By 1-year postinjury, the prevalence of anxiety and depression remained the same, although only one-quarter continued to report poor social adjustment. There was some evidence of adaptation by care-givers, as the frequency with which various types of objective burden were reported remained stable, while the distress caused by these decreased in the first year postinjury. It appears that the impact on caregivers of physical impairment is comparatively short-lived and that caregivers learn some practical ways to manage the behavioural problems of the people with TBI. Despite this, over time the person with TBIs behavioural and cognitive problems begins to play a larger role in the level of distress experienced by the caregiver. However, it is the person with TBIs social isolation that has a stable and consistent role in the experience of subjective burden for primary caregivers in the first year postinjury.

Understanding Workaholism: Data Synthesis, Theoretical Critique, and Future Design Strategies

Workaholism involves a personal reluctance to disengage from work, which is evidenced by the tendency to work irrespective of external demands. While the term workaholism has been widely used by the public for over 30 years, scientists are only beginning to explore the behavior in depth. To date, most research has occurred on an ad hoc basis, emerging from a wide variety of paradigms without being explicitly linked to theory. The current article presents three methods for defining workaholism and a précis of relevant measures, then provides an integrated overview of research relating workaholism to individual well-being. Three models implicit in existing workaholism research (addiction, learning, and trait theory) are expounded and critiqued, and four new procedures for researching workaholism are suggested. Finally, an integrated, multidisciplinary approach is proposed as an essential element in encouraging rigorous debate and continued development of workaholism theory.

Screening tests for visual neglect following stroke

Abstract This study examined the incidence and implications of visual neglect in a group of elderly stroke patients. A consecutive series of 27 patients were assessed for visual neglect using four commonly administered tests at 15–20 days poststroke. Those who continued to show neglect were reassessed at 30, 60, and 90 days. Incidence of visual neglect at 15–20 days poststroke was found to be 48%. A decrease in the number of patients with neglect occurred up to 90 days poststroke. Significant correlations between performance on the tests provided evidence for their construct validity. There was no significant evidence for laterality of neglect. The most sensitive measure for detecting visual neglect was found to be the Star Cancellation test, which was the best predictor of functional outcome as assessed by an Activities of Daily Living scale. Overall, the results indicated that the Star Cancellation test was the most effective and functionally useful measure of visual neglect. It is also suggested that r...

Neuropsychiatric functioning after traumatic brain injury

This review highlights recent developments in five areas relevant to neuropsychiatric functioning after traumatic brain injury. The increasing use of brain imaging techniques and the evaluation of the relationship between their results and traditional forms of assessment demonstrate the complementary, rather than competing, value of both procedures. Guidelines for the evaluation and management of mild traumatic brain injury in infants have been published. Despite evidence of inconsistency in the management of mild traumatic brain injury in adults, progress is evident in developing a theoretical basis for understanding the wide variety of symptoms that are apparent in this population, and in developing a biochemical marker for quantifying the degree of organic damage. An increased understanding of neuropsychiatric functioning after severe traumatic brain injury is now possible as a result of the availability of comprehensive, longitudinal studies and large sample, very long-term follow-up studies. Finally, evidence continues to accumulate that demonstrates the benefits of rehabilitation after traumatic brain injury, and improvements in procedures for the training of direct-care staff are apparent.

Neuropsychosocial Functioning of Children with Hydrocephalus

Recent studies on the rehabilitation of children with hydrocephalus have demonstrated the need for those planning such rehabilitation programmes to have a clear understanding of the neuropsychological and psychosocial aspects of this disorder. In an attempt to provide such information, the neuropsychological and psychosocial functioning of a group of 17 children with hydrocephalus between the ages of eight and fourteen years old was investigated. Performance by the sample with hydrocephalus was compared to that of a ‘normal’ control sample. Participants with hydrocephalus and control participants were matched on the variables of sex, age, years of education, and socio-economic status. Relative to control participants, the participants with hydrocephalus were impaired on measures of intellectual, attention, verbal and visual memory, and visuo-spatial abilities. Language alone was relatively preserved. The children with hydrocephalus also exhibited poorer self-esteem, fewer adaptive competencies, and more problem behaviours than the ‘normal’ controls. For the children with hydrocephalus, the relationship between their impaired intellectual abilities and their psychosocial functioning was investigated.