S. Rasquin

Long-term neuropsychological performance in a cohort of children and adolescents after severe paediatric traumatic brain injury

Objective: The purpose of the present study was to evaluate progress in neuropsychological performance in children and adolescents with severe paediatric traumatic brain injury (TBI), from admission to the rehabilitation centre up to 3–12 years after the trauma. Methods: Children and adolescents (n = 31, mean age at injury 11.8 years, SD = 3.8; at follow-up 18.8 years; SD = 4.5) who all had suffered a TBI participated. A comprehensive neuropsychological test battery was administered at the start of rehabilitation (T1), around discharge (T2) and in the long-term (at least 3 years after rehabilitation; T3). T1 and T2 were clinical assessments; T3 was executed as a follow-up measurement for this study. Results: At T1 and T2, most problems were in the domains of attention, memory and executive functioning. At the start of rehabilitation most deficits were with performal intelligence (61%); at discharge (mean length of stay 411 days) considerably less children had severe deficits on the intelligence domain (23%). At long-term follow-up, most problems were in the domains attention, mental speed and memory. From admission to discharge 42% of the children improved on two or more cognitive tests; from discharge to follow-up this percentage was 13%. Conclusions: In this unique study a clinical cohort of children with severe TBI was followed for many years after injury. Most cognitive deficits were found in the early phase of rehabilitation. Most children did improve on cognitive functioning (40%) during the first year after their injury, whereas at follow-up most children had not changed. At follow-up, more than half of the children (54%) attended a regular school or had a regular job, corresponding to their age and pre-morbid functioning.

Checklist for cognitive and emotional consequences following stroke (CLCE-24): Development, usability and quality of the self-report version

OBJECTIVE In this paper a new checklist (CLCE-24) for identification of cognitive and emotional problems after stroke is presented. The CLCE-24 is intended to support a clinical interview by health care professionals other than the trained (neuro)psychologist. METHODS Patients were interviewed with the CLCE-24, 6 months post stroke. Usability was determined by interviews. Quality of the self-report version was determined using reference instruments (MMSE, CAMCOG). RESULTS Sixty-nine patients participated in the study (37 men; mean age 66 years). Both patients and assessors were positive about the use of the CLCE-24. Eighty percent of the patients had cognitive and/or emotional problems (73% cognitive; 51% emotional problems). Patients with complaints on the CLCE-24 also showed problems on the MMSE and the CAMCOG (p<0.05). The CLCE-24 was a predictor of the MMSE and CAMCOG (Adj. R(2)=0.13 and 0.16, respectively) at 12 months post stroke. Internal consistency of the CLCE-24 was good (alpha of 0.81). CONCLUSIONS The CLCE-24 is a usable and valid instrument for cognitive screening by health care professionals in the stroke service in the chronic phase after stroke.

Effectiveness of a low intensity outpatient cognitive rehabilitation programme for patients in the chronic phase after acquired brain injury

The aim of this prospective cohort study was to examine the effectiveness of a low intensity outpatient cognitive rehabilitation programme for patients with acquired brain injury in the chronic phase. Twenty-seven patients with acquired brain injury (i.e., stroke, traumatic brain injury, subarachnoid haemorrhage; 52% male) with a mean age of 49.5 (SD 9.2) years and 25 relatives with a mean age of 48.8 (SD 8.8) years were recruited to the study. Mean time since injury in the patient group was 1.9 years (SD 2.0). The group programme consisted of 15 weekly sessions of 2.5 hours and included cognitive strategy training, social skills training, and psycho-education. Patients also received homework. Relatives were invited to attend twice. Repeated measurements were taken: prior to treatment (baseline, T0); directly after treatment (T1, 21 weeks); and at follow-up (T2, 45 weeks). Primary outcome measures were individualised goals (GAS), cognitive failures (CFQ), and quality of life (SA-SIP). Patients did improve significantly on individual goals (p < .05) between T0 and T1 and the level of attainment remained stable between T1 and T2. Goals were mostly set in the cognitive and behavioural domains. There were no significant differences between the measurements (T0–T1–T2) on the CFQ and the SA-SIP. The programme had a positive effect on the individual goals set by the patients. However, this did not result in a higher participation level or a better quality of life. This may be due to the low intensity and short duration of the programme.

Course of cognitive functioning during stroke rehabilitation

The aim of the study was to determine the course of cognitive functioning within the subacute phase (< 4 months) after stroke during rehabilitation. Stroke patients admitted to a rehabilitation centre were submitted to a neuropsychological examination on admission (1 month post-stroke) and upon discharge (4 months post-stroke). Cognitive domains studied were attention, executive functioning, memory, and visual attention. Forty-two patients (mean age = 57.1 years; SD = 7.7) participated. At admission more than half of the patients showed deficits in attention and memory. Patients improved significantly on these domains; the largest improvement was seen in the domain of visual attention, while executive functioning did not improve significantly. A differential course of cognitive functioning was found in the subacute phase after stroke. The prognosis of visual attention is the most prominent.

Development and validity of the Brain Injury Alert (BI Alert) screening tool for cognitive, emotional and social problems after paediatric acquired brain injury

Purpose: Validation of a new screening tool, viz., the Brain Injury Alert (BI Alert) for identification of cognitive and emotional problems after traumatic brain injury (TBI) in children. Methods: Parents and teachers of children with TBI as well as controls were interviewed using the BI Alert. Validity was determined using reference instruments (CBCL and TRF; neuropsychological functioning). Results: The BI Alert was feasible; Required assessment time: 15 minutes. Parents and teachers of children with TBI (n = 42) reported significantly more problems compared to controls (n = 29). Internal consistency (α = 0.68 for parents and 0.82 for teachers) and inter-rater reliability (r > 0.66) were good. Test–re-test reliability was reasonable (r > 0.46). Correlations with CBCL were statistically significant for the parents (r range from 0.36–0.66) and TRF emotion for the teachers (r = 0.62). The correlations with the TRF cognition and school were statistically significant for the teachers (r range from 0.43–0.63). There were only low correlations with the neuropsychological tests. Conclusions: The BI Alert is a useful, feasible and valid instrument for the cognitive screening of children with TBI by health professionals in primary care.

CheckLijst voor het opsporen van cognitieve en emotionele gevolgen na een beroerte (CLCE-24)

SummaryBackground and purpose. Cognitive and emotional problems are common after stroke and screening is essential. In this paper a new screening instrument is presented and its usability is investigated.Methods. A group of stroke patients (N = 69) were interviewed using the new instrument, the CLCE-24, six months post stroke. Moreover extensive neuropsychological testing was conducted (including MMSE/CAMCOG).Results. Patients, relatives and assessors (a psychologist) were positive about its use. The interview with the CLCE-24 took 11.1 minutes on average (5-35 minutes). Eighty percent of the patients had complaints; 73% had cognitive problems, while 51% had emotional problems. Patients with at least one complaint on the CLCE-24 scored lower on the MMSE (t=2.5; p = 0.01) and the CAMCOG (t= 2.5; p= 0.02) compared to patients without complaints.Conclusions. The CLCE-24 can be applied by professionals in primary care for identification of cognitive and emotional complaints after stroke. Further research and implementation in clinical practice and the stroke service is recommended.SamenvattingAchtergrond en doel: Eerstelijns zorgverleners geven aan dat ondersteuning nodig is voor het onderkennen en signaleren van cognitieve en emotionele stoornissen na een beroerte. Deze studie beschrijft een nieuw signaleringsinstrument, de CheckLijst voor Cognitieve en Emotionele problemen na een beroerte (CLCE-24).Methode: Bij een groep patiënten (N = 69) werd 6 maanden na de beroerte voorafgaand aan het uitgebreid neuropsychologisch onderzoek (waaronder de MMSE en CAMCOG) de CLCE-24 afgenomen.Resultaten: De CLCE-24 werd positief ontvangen door zowel de patiënt, de naaste als de interviewer (psycholoog). De gemiddelde afnameduur was 11.1 minuten (5-35 minuten). Tachtig procent van de patiënten rapporteerde klachten; 73% cognitieve klachten en 51% emotionele klachten. Patiënten met ten minste één cognitieve klacht scoorden lager op de MMSE (t = 2.52; p=0.01) en de CAMCOG (t = 2.45; p= 0.02) dan patiënten zonder klachten.Conclusie: De CLCE-24 is een bruikbaar instrument om cognitieve en emotionele klachten na een beroerte op te sporen, waarna verwijzing naar bijvoorbeeld een neuropsycholoog en/of revalidatiearts kan plaatsvinden. Verder onderzoek moet o.a. gericht zijn op betrouwbaarheid tussen beoordelaars en op implementatie in de zorgketen.