Roderick Ashton

Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationship to outcome

The purpose of this study was to investigate the relationship between self-awareness, emotional distress, motivation, and outcome in adults with severe traumatic brain injury. A sample of 55 patients were selected from 120 consecutive patients with severe traumatic brain injury admitted to the rehabilitation unit of a large metropolitan public hospital. Subjects received multi disciplinary inpatient rehabilitation and different types of outpatient rehabilitation and community-based services according to availability and need. Measures used In the cluster analysis were the Patient Competency Rating Scale, Self-Awareness of Deficits Interview, Head Injury Behavior Scale, Change Assessment Questionnaire, the Beck Depression Inventory, and Beck Anxiety Inventory; outcome measures were the Disability Rating Scale, Community Integration Questionnaire, and Sickness Impact Profile. A three-cluster solution was selected, with groups labeled as high self-awareness (n=23), low self-awareness (n=23), and good recovery (n=8). The high self-awareness cluster had significantly higher levels of self-awareness, motivation, and emotional distress than the low self-awareness cluster but did not differ significantly in outcome. Self-awareness after brain injury is associated with greater motivation to change behavior and higher levels of depression and anxiety; however, it was not clear that this heightened motivation actually led to any improvement in outcome. Rehabilitation timing and approach may need to be tailored to match the Individuals level of self-awareness, motivation, and emotional distress

Action word meaning representations in cytoarchitectonically defined primary and premotor cortices

Recent models of language comprehension have assumed a tight coupling between the semantic representations of action words and cortical motor areas. We combined functional MRI with cytoarchitectonically defined probabilistic maps of left hemisphere primary and premotor cortices to analyse responses of functionally delineated execution- and observation-related regions during comprehension of action word meanings associated with specific effectors (e.g., punch, bite or stomp) and processing of items with various levels of lexical information (non body part-related meanings, nonwords, and visual character strings). The comprehension of effector specific action word meanings did not elicit preferential activity corresponding to the somatotopic organisation of effectors in either primary or premotor cortex. However, generic action word meanings did show increased BOLD signal responses compared to all other classes of lexical stimuli in the pre-SMA. As expected, the majority of the BOLD responses elicited by the lexical stimuli were in association cortex adjacent to the motor areas. We contrast our results with those of previous studies reporting significant effects for only 1 or 2 effectors outside cytoarchitectonically defined motor regions and discuss the importance of controlling for potentially confounding lexical variables such as imageability. We conclude that there is no strong evidence for a somatotopic organisation of action word meaning representations and argue the pre-SMA might have a role in maintaining abstract representations of action words as instructional cues.

Handedness assessment inventory.

A modified form of Oldfields Edinburgh Handedness Inventory was given to 406 students. The results obtained were subjected to factor analysis. This analysis revealed the presence of two factors; one which could be labelled handedness and a smaller one which was dependent upon the wording of items. It was speculated that the latter factor may be associated with the respondents ability to manipulate mental images.

The measurement of attitudes towards and beliefs about pain

&NA; This study compared the psychometric properties of two scales designed to measure attitudes towards and beliefs about pain. The Survey of Pain Attitudes (Revised) SOPA(R) (Jensen and Karoly 1987) and the Pain Beliefs and Perceptions Inventory (PBPI) (Williams and Thorn 1989) were examined in terms of internal consistency, discriminant validity, factor structure, construct validity and sensitivity to age and gender effects. Results provided strong support for the SOPA(R) as a useful measurement tool for use with patients with chronic low back pain. Further work is suggested for the PBPI, as the reported factor structure was not replicated. Discussion centred around the possible reasons for this finding, with issues such as the possible orientation of different treatment facilities, the possible differences in attitudes between patients with different types of pain, and the possible influence of length of years in pain or the receipt of workers compensation payments being considered.

Characteristics of the Frequent Nightmare Sufferer

Previous research has found that persons who experience frequent nightmares score highly on scales that measure psychotic symptomatology. Neurotic symptoms have also been implicated as correlates of nightmare frequency. In this study, 30 adult lifelong nightmare sufferers were compared with 30 control subjects, matched for age, sex, and socioeconomic status. Subjects were asked to record all dreams for 1 month and to complete the Minnesota Multiphasic Personality Inventory (MMPI) and the Eysenck Personality Questionnaire (EPQ). Nightmare subjects scored significantly higher on the EPQ Neuroticism scale and on 8 MMPI clinical scales than did the control group. These scales also best discriminated between the groups in a direct discriminant analysis. The results are interpreted as a reflection of global maladjustment rather than of specific psychotic symptomatology.

Nelson's (1976) modified card sorting test: A review

We review studies of Nelsons (1976) Modified Card Sorting Test (MCST) that have examined the performance of subjects with frontal lobe dysfunction. Six studies investigated the performance of normal controls and patients with frontal lobe dysfunction, whereas four studies compared the performance of frontal and nonfrontal patients. One further study compared the performance of amnesic patients both on the MCST and on the original Wisconsin Card Sorting Test (WCST). Evidence regarding the MCSTs differential sensitivity to frontal lobe dysfunction is weak, as is the evidence regarding the equivalence of the MCST and WCST. It is likely that the MCST is an altogether different test from the standard version. In the absence of proper normative data for the MCST, we provide a table of scores derived from the control groups of various studies. Given the paucity of evidence, further research is required before the MCST can be recommended for use as a marker of frontal lobe dysfunction.

Pain intensity measurement in chronic low back pain

This study investigated the psychometric properties of eight pain intensity measures used with chronic low back pain patients. All measures were similar in terms of scale distribution and rates of incorrect responses, with all scales apart from the Pain Rating Index significantly correlated. Principal axis factoring of data from 92 patients indicated the presence of one general factor on which all pain intensity measures except the Pain Rating Index loaded. The 101-point Numeric Rating Scale and the Box Scale had the strongest relationship, with loadings of 0.90. The Numeric Rating Scale and the Box Scale appear to be the scales of choice for the measurement of pain intensity in the low back pain patient.

Function and the patient with chronic low back pain.

OBJECTIVE To undertake a comparative examination of the reliability and validity of two frequently used self-report measures of functional disability, the Pain Disability Index (PDI) and the Oswestry Low Back Pain Disability Questionnaire (OLBPDQ). DESIGN A descriptive ex-post facto design was used in the study. SETTING Pain clinics and neurosurgical units at three metropolitan hospitals. SUBJECTS One hundred patients with chronic low back pain of noncancer origin were administered the two questionnaires as part of a larger questionnaire battery. RESULTS Acceptable internal consistency values of 0.76 for the PDI and 0.71 for the OLBPDQ were obtained. A correlation of r = 0.63 was found between the PDI and the OLBPDQ, supporting the concurrent validity of the two scales. Both the scales were found to be correlated to the Beck Depression Inventory scores (PDI, r = 0.42; OLBPDQ, r = 0.39), with higher disability associated with greater depression. Only the total PDI score was found to be sensitive to functional status differences within the patient sample. CONCLUSIONS These findings support other recent work in favor of the PDI. The PDI had a slightly higher internal consistency and was more sensitive than the OLBPDQ.

The influence of concurrent task difficulty on manual performance

Subjects successively pressed two switches while performing a running-memory-span task of either words or random shapes. In short-span conditions manual performance was differentially affected by the nature of the memory task material. In longer-span conditions no differential effects were found over the right- and left-hands. These results were accounted for by an attentional model of cerebral lateralization that incorporated consideration of the neural mechanisms subserving cerebral motor functions.

Agenesis of the corpus callosum: Report of two pre-school children and review of the literature

The results of neuropsychological examinations of two patients with agenesis of the corpus callosum showed low intelligence‐test performance, impared visuo‐motor co‐ordination and impaired bimanual co‐ordination. The most striking deficits were observed in Case A, particularly in her inability to identify objects verbally when placed in the non‐dominant hand, and in her ability to complete a task with the non‐dominant hand without vision, when she was unable to complete the same task with vision. This patient is unusual insofar as she manifests deficits noted in acallosal patients, as well as some noted in split‐brain patients but not previously ascribed to acallosal patients.